Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term

Meconium is the first stool of a newborn baby, greenish-black in colour and rather sticky in consistency.  If a baby is distressed before birth meconium may be passed into the amniotic fluid and if the baby then gasps the meconium-stained fluid may pass into the lungs.  Once in the lungs the meconium can make the baby ill by obstructing the airways and causing inflammation this is called meconium aspiration syndrome.  It is possible to reduce the amount of meconium getting into the lungs by sucking it from the baby’s throat and windpipe (trachea) soon after birth but it is not certain if this leads to overall benefit for the vigorous term newborn baby.  Furthermore, placing a tube in the windpipe (endotracheal intubation) of a vigorous term baby is not always easy and could cause harm.  Four studies enrolled 2844 term infants and randomly allocated them to intubation to clear the airways or routine resuscitation without intubation.  No benefit was found from routine intubation compared to routine resuscitation for vigorous term babies.  The outcomes reported included: meconium aspiration syndrome, lung air leaks, need for oxygen, noisy breathing (stridor) and fits but there were no significant differences between the two groups.  Routine endotracheal intubation of vigorous term babies born through meconium-stained amniotic fluid cannot be recommended.  For non-vigorous babies endotracheal intubation is probably indicated until more information becomes available.