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the posterior pharynx, larynx, and trachea to facilitate air entry. This maneuver
may also be accomplished by placing a towel or blanket beneath the upper back
of the supine infant. Avoid flexion or hyperextension of the newborn’s neck,
which is likely to exacerbate airway obstruction.
Suctioning
If needed, clear secretions with a bulb syringe or suction catheter. Many
newborns have excessive secretions related to amniotic fluid, cervical mucus, or
meconium. Suctioning may cause bradycardia or apnea; additionally, excessive
suctioning may contribute to atelectasis. Therefore, suctioning is reserved for the
newly born infant whose airway appears obstructed or if PPV is required.
Meconium-Stained Fluid
Management of meconium-stained amniotic fluid has changed substantially over
the last two decades. Approximately 2% to 5% of infants born with meconium in
the amniotic fluid will experience some degree of aspiration syndrome, ranging
from mild tachypnea to very severe pneumonitis with persistent pulmonary
hypertension ( Fig. 9.18 ).
Vigorous infants with good spontaneous respiratory effort and muscle tone who
are born through meconium-stained amniotic fluid may receive routine postnatal
care with the parents. Gentle clearing of meconium from the mouth and nose may
be accomplished with a bulb syringe. Infants with inadequate respiratory effort
and poor muscle tone should be moved to a radiant warmer bed and initial
resuscitation steps initiated. Begin PPV for apnea or HR less than 100/min
following initial steps. Routine intubation for tracheal suction in the setting of
meconium-stained amniotic fluid is not recommended. Appropriate intervention
to support oxygenation and ventilation of these infants should be initiated as
clinically indicated, and may include intubation and suction if the airway is
obstructed.