Impact of Change in Neonatal Resuscitation Program Guidelines for Infants Born Through Meconium-Stained Amniotic Fluid

Background: In 2016, the neonatal resuscitation program (NRP) withdrew its recommendation to perform endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF). The objective of this study is to compare outcomes in non-vigorous neonates born through MSAF before and after the change in NRP’s recommendations. Methods: This is a retrospective cohort study in a single center assessing all neonates ≥34 weeks of gestation with MSAF in 2010-2015 (pre-implementation of new guidelines) and 2017-2022 (post-implementation of new guidelines). Results: Neonates receiving tracheal suctioning were more likely to be diagnosed with MAS (29.3% vs. 19.7%; P=0.03) and PPHN (8.9% vs. 2.5%; P=0.003), and more likely to receive surfactant (7.6% vs. 3.2%; P=0.03). Conclusion: In our institution, non-vigorous neonates born via MSAF after the change in NRP guidelines were less likely to be diagnosed with MAS and PPHN and were less likely to receive surfactant. Our study supports current NRP guidelines.