European Journal of Pediatrics

, Volume 178, Issue 12, pp 1825–1832 | Cite as

Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial

  • Ashok KumarEmail author
  • Preetam Kumar
  • Sriparna Basu
Original Article


The current version of Neonatal Resuscitation Program no longer favors routine endotracheal suctioning (ETS) in non-vigorous newborns with meconium-stained amniotic fluid (MSAF) due to possibility of procedure-related harms and questionable benefits. However, it calls for additional research on this procedure to provide a definitive answer. The present study was conducted to evaluate the role of ETS in non-vigorous neonates of ≥ 34 weeks’ gestation born through MSAF on the incidence of meconium aspiration syndrome (MAS). In this open-label randomized controlled trial, 132 non-vigorous neonates with MSAF were randomized to receive ETS (n = 66) or no-ETS (n = 66) during delivery room resuscitation (DRR). Primary outcome variable was incidence of MAS. Secondary outcome variables were requirement of DRR, need of respiratory support, development of complications, duration of hospitalization, and mortality. Both the groups were comparable with respect to maternal and neonatal characteristics. Incidence of MAS was 21 (31.8%) and 15 (22.7%) cases in ETS and no-ETS groups, respectively (relative risk (RR), 1.400, 95% confidence interval (CI), 0.793–2.470). The two groups did not differ with regard to DRR, need for respiratory support, and development of complications. Nine (13.6%) neonates in ETS group, and 5 (7.5%) in no-ETS group died (p > 0.05). Median (interquartile range) duration of hospital stay was 54 (31–141) h and 44 (26–102) h in ETS and no-ETS groups, respectively (p > 0.05).

Conclusions: Routine ETS at birth is not useful in preventing MAS in non-vigorous neonates of ≥ 34 weeks’ gestation born through MSAF.

Trial registration: Clinical Trials Registry of India (CTRI/2015/04/008819).

What is Known:

Routine endotracheal suctioning is of questionable benefit in non-vigorous newborns with meconium stained amniotic fluid and may have a possibility of procedure-related harms.

What is New:

Routine endotracheal suctioning at birth is not useful in preventing meconium aspiration syndrome in non-vigorous newborns of ≥ 34 weeks’ gestation born through meconium stained amniotic fluid.


Delivery room resuscitation Endotracheal suctioning Meconium aspiration syndrome Meconium-stained amniotic fluid 



Confidence interval


Delivery room resuscitation


Endotracheal suctioning


Meconium aspiration syndrome


Meconium-stained amniotic fluid


Neonatal resuscitation program


Persistent pulmonary hypertension of newborn


Relative risk


Standard deviation


Transient tachypnea of newborn


Authors’ contributions

Prof Ashok Kumar and Prof Sriparna Basu conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Preetam Kumar designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The trial was ethically approved by the Institute Ethics Committee of Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Clinical trial registration

The trial was registered under Clinical Trials Registry of India (CTRI/2015/04/008819).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neonatal Unit, Department of Pediatrics, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  2. 2.Department of Neonatology, All India Institute of Medical SciencesRishikeshIndia

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