Launceston General Hospital Clinical Guideline SDMS ID: P2010/0487-001 2.

4/09WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Meconium Stained Liquor Meconium Stained Liquor WACSClinProc2.4/06 Management of the neonate born with meconium stained liquor Midwifery and Medical Staff, Queen Victoria Maternity Unit Meconium, suction P2010/0486-001Intrapartum Fetal Monitoring P2010/0380-001 Newborn Resuscitation Purpose: Meconium stained liquor occurs in 10 -15% of labours. Meconium aspiration syndrome only occurs in 1 5% of neonates. Routine suctioning of the neonates mouth and nose on the perineum is no longer recommended for neonates born with meconium stained liquor (ILCOR 2006, ARC 2006). Neonates who are vigorous at birth do not require any suctioning for meconium (ILCOR 2006, ARC 2006). Neonates who have absent or depressed respirations and decreased muscle tone should have suctioning of the mouth and pharynx under direct vision by a skilled operator (ILCOR 2006, ARC 2006). Definitions: A vigorous neonate has: good muscle tone active breathing efforts HR > 100 bpm. Meconium within the maternity unit is describes as Thin meconium (previously grade 1) Thick meconium (previously grade 2 or 3) Management in Labour Notify in charge midwife and obstetric registrar or consultant of presence of meconium liquor. Initiate continuous electronic fetal monitoring. Plan for birth obstetric registrar should inform the paediatric registrar or consultant if thick meconium is present during labour. Usually the Paediatric registrar or consultant should be present at the time of birth or a medical practitioner competent at intubation of the newborn.

If vigorous provide standard care (as per P2010/0380-001 Newborn Resuscitation)

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If not vigorous and an operator skilled in intubation is present Place the neonate under radiant warmer avoiding stimulation Insert laryngoscope Suction (100mmHg) the mouth and pharynx with a 10 to 12 Fr catheter Insert either a 3.0 or 3.5 endotracheal tube (ET) into the trachea, attach a meconium aspirator, applying suction while withdrawing the ET Intubation and suctioning must be brief and should not compromise the neonate If not vigorous and the operator present is unable to perform intubation Place the neonate under the radiant warmer avoiding stimulation Suction the mouth and nose using a large bore catheter (size 10 to 12 FG). Suctioning should be limited to 5 seconds and the catheter should be inserted no further than 5 cm from the lips of a term neonate. Negative pressure should not exceed 100mmHg. Establish effective ventilation. Post Birth Neonatal Observations Admission to 4N for observation is required when there is: Meconium below the cords Ongoing respiratory distress or oxygen requirement Need for active resuscitation involving CPR or prolonged IPPV. All other neonates require: Routine hourly observations for the first four hours followed by AC observations for 48 hours. Notify RMO/paediatrician of any deviations from normal.

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Attachments
Attachment 1 References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Date: 10 September 2009

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APPENDIX 1 REFERENCES American Academy of Pediatrics 2006, Neonatal Resuscitation Textbook, 5th Edn, AAP/AHA Australian Resuscitation Council 2006 Guideline 13.4 Airway management and mask ventilation of the newborn born neonate. Online: www.resus.org.au NETS Victoria Neonatal Handbook Meconium stained liquor, delivery room management. Online: http://www.netsvic.org.au/nets/handbook/index.cfm?doc_id=459 Pairman S, Pincombe J, Thorogood C, Tracy S, Midwifery preparation for practice 2006 Elsevier Australia The International Liaison Committee on Resuscitation (ILCOR) 2006 Consensus on science with treatment recommendations for pediatric and neonatal patients: Neonatal Resuscitation. Online: http://www.pediatrics.org/cgi/content/full/117/5/e978.

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