title: Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT.
abstract: OBJECTIVE
  Evidence about IP-OP suction and selective tracheal intubation in meconium stained neonates is from developed countries. Little information is available about their role in developing countries with high incidence of meconium staining and MAS. This randomized trial was planned to evaluate the effectiveness of IP-OP suction in meconium stained term neonates on prevention of MAS and reduction of its severity.
  
  
  METHODS
  Out of 540 meconium stained full term, cephalic presentation, singleton neonates without major congenital malformations born from June'08 to January'09, 31 were excluded and 509 randomized. In the intervention group IP-OP suction was done at the time of delivery of head using a 10 Fr suction catheter with a negative pressure of 100 mmHg. No IP-OP suction was performed in control group. All neonates with MSAF were assessed as vigorous or non-vigorous after birth and provided care as per NRP guidelines 2005.
  
  
  RESULTS
  Two hundred and fifty three neonates were randomized to IP-OP suction and 256 to no IP-OP suction. Eighty-two neonates (16%) developed MAS, the primary outcome parameter, with 40 infants in the intervention group (15.8%) and 42 (16.4%) in the non-intervention group (RR 0.86, 95% CI 0.60-1.54). Incidence of severe MAS was comparable (3.55% vs. 2.34%) (P value=0.40). Other variables like requirement of oxygen >48 h (9.8% vs. 10.5%) and mortality (2.7% vs. 1.7%) were also comparable.
  
  
  CONCLUSIONS
  IP-OP suctioning did not reduce the incidence or severity of MAS even in a setting of high incidence of MAS in a developing country. The mortality in two groups was comparable.
authors.affiliation: Department of Pediatrics, Kalawati Saran Children Hospital & Lady Hardinge Medical College, New Delhi, India. Electronic address: drsnangia@gmail.com.
authors.forename: Sushma
authors.initials: S
authors.lastname: Nangia
authors.affiliation: Department of Pediatrics, Kalawati Saran Children Hospital & Lady Hardinge Medical College, New Delhi, India.
authors.forename: Mansi M
authors.initials: MM
authors.lastname: Pal
authors.affiliation: Department of Pediatrics, Kalawati Saran Children Hospital & Lady Hardinge Medical College, New Delhi, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Saili
authors.affiliation: Department of Obstetrics & Gynecology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Gupta
mesh_terms: D036861:Delivery, Obstetric; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control*; D009960:Oropharynx; D013396:Suction / Q000379:methods
keywords: Intra-partum oro-pharyngeal suctioning; Meconium aspiration syndrome; Meconium stained amniotic fluid