Baby airway suction little value

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Baby

airway suction little value

Sucking

clear a baby's airways to prevent a potentially fatal respiratory disease is

probably ineffective, say researchers.

Around 10% of babies are at risk of inhaling their own faeces

during labour, which may put them at risk of respiratory problems.

However, doctors have found the widely practice procedure of 'suctioning'

the airways does little to cut the risk.

The University

of Buenos Aires research

is published in The Lancet.

 

 

 

 

 

 

The

value of suctioning at the time of delivery has been questioned for some

time.

Professor Stephen Robson

 

 

 

 

The researchers say

that although suctioning has been widely practised since the 1970s, there has

been little hard evidence of its usefulness.

Doctors tend to use it as a precaution when there are signs that

the amniotic fluid surrounding a baby has been stained with the baby's faeces -

known technically as meconium.

If meconium, which is very sticky, gets down into a baby's lungs,

it can lead to tissue damage and a serious respiratory problem known as

meconium aspiration syndrome.

Doctors hope that by making sure the airways are clear after birth

the risk of this happening will be minimised. However, the procedure itself is

not without risk.

It is usually carried out when only the baby's head has been

delivered, as the infant does not take its first breath until its body has been

delivered as well.

The Buenos Aires

team, lead by Dr Nestor Vain,

carried out a trial on 2,500 babies. Some received suctioning at the mouth and

nose, and others no suctioning at all during delivery.

The researchers found around 4% of babies in each group developed

symptoms of meconium aspiration syndrome.

Around 1%-2% of babies in each group required mechanical

ventilation.

Dr Vain said: " We conclude that routine intrapartum oropharyngeal

(mouth) and nasopharyngeal (nose) suctioning of term-gestation,

meconium-stained infants does not prevent MAS or its complications.

" There are many ongoing malpractice lawsuits based on the

mistaken belief that if a baby develops respiratory distress associated with meconium

aspiration the responsibilities belong to the obstetrician and neonatologist

who failed to appropriately clear the airway.

" We hope that our study will bring light to this erroneous

belief. "

Deeper problems

Dr Vain told BBC News Online that respiratory disorders were more likely

to be linked to longer term problems involving constriction of the vessels

taking blood to the lungs to pick up oxygen, and not to airway obstructions

caused by taking in meconium.

Ms Maggie Blott, an obstetrician at King's College Hospital,

agreed that suctioning the airways probably did not prevent meconium aspiration

syndrome.

However, she it was common practice to carry out the procedure on

babies who had inhaled meconium simply to ensure there was no obstruction in their

airways, and that they were breathing easily.

Dr Peter Bowen-Simpkins, of the Royal College of Obstetricians and Gynecologists, told

BBC News Online that suctioning tended to be carried out as a matter of course

by midwives, but paediatricians were more aware of its limited value.

He said: " We have accepted a huge amount of unproven

therapies over the years, and as time goes on we are finding more and more of

them turn out not to be of proven value. "

Professor Stephen Robson, an expert in obstetrics and gynaecology at Newcastle Royal

Infirmary, said he was not surprised by the findings.

He said: " The value of suctioning at the time of delivery has

been questioned for some time.

" This reflects the fact some aspiration occurs before birth

of head, and the inefficiency of oropharyngeal and nasopharyngeal

suction. "

But Dr Andrew Lyon, a consultant neonatologist at the Simpson

Centre for Reproductive Health, Edinburgh, said: " This is a well run study

that tells us that an accepted practice may well not be as necessary we might

have thought. "

However, Dr

Lyon said the risk associated with

the procedure may have been over-stated.

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/3556562.stm

 

Published: 2004/08/13 14:54:32 GMT

 

© BBC MMIV

 

 

 

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