Have the 2015 Neonatal Resuscitation Program Guidelines changed the management and outcome of infants born through meconium-stained amniotic fluid?

BACKGROUND: In 2015, the Neonatal Resuscitation Program (NRP) guidelines were updated to recommend that nonvigorous infants delivered through meconium-stained amniotic fluid (MSAF) do not require routine intubation and tracheal suction. OBJECTIVE: Explore the implications of 2015 NRP guidelines on delivery room management and outcome of infants born through MSAF. DESIGN: Retrospective cohort study. SETTINGS: King Abdul-Aziz University Hospital (KAUH). PATIENTS AND METHODS: All term (≥37 weeks) infants born in KAUH through MSAF between January 1, 2016, and December 31, 2017, were included. Patients were divided into two groups according to the date of birth: period 1 (January 1, 2016, to December 31, 2016), before the implementation of the new NRP guidelines; period 2 (January 1, 2017, to December 31, 2017), after the implementation. MAIN OUTCOME MEASURES: Outcomes of infants born through MSAF. SAMPLE SIZE: 420 infants. RESULTS: A majority of infants (n=261) were born in period 1 and 159 after in period 2. No differences were found in the booking status of mothers, cesarean section rate, and number of deliveries attended by physicians between the 2 cohorts. Infants in both cohorts were of similar gestational age, birth weight, and gender. A nonsignificant lower rate of intubation at birth (2.3% vs 0.6%), admission to neonatal intensive care unit (3.8% vs 3.1%), and meconium aspiration syndrome (1.5% vs 0.6%) were found in period 2 compared with period 1. Only 1 infant died in period 1. CONCLUSION: After the implementation of 2015 NRP guidelines, fewer infants were intubated at birth for MSAF. No difference was observed in the rate of associated morbidities and mortality. LIMITATIONS: A single-center retrospective study of misclassification bias because some of the medical staff started practicing the new guidelines before the official implementation.