Special resuscitation is required if there is meconium in
the amniotic fluid. The infant is to be suctioned intrapartum,
presumably by the obstetrician. Suctioning should occur
once the head is delivered but before delivery of the
shoulders and chest. Once the infant is completely delivered,
the infant will breathe spontaneously unless depressed. The
goal of suctioning the nasal and oropharynx intrapartum is to
remove any meconium that may be present in the
oropharynx which could be aspirated with the first breath.
Recommendations regarding suctioning of the infant with
meconium staining changed with the review of the NRP
guidelines in 2000. Prior to that publication, it was
recommended to suction only infants with thick or
particulate meconium in the amniotic fluid (AHA/AAP,
1994). A multi-center, international collaborative trial
demonstrated that the intervention that proves the most
effective is suctioning before the baby can take the first
breath, thus intrapartum before delivery of the shoulders
(Wiswell, Gannon, & Jacob, 2000).