Gentle Wiping of Face, Nose and Mouth Appears as Effective as Suction for Clearance of Secretions at Birth of Term Neonates

EBM Focus - Volume 8, Issue 31

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Reference: Lancet 2013 Jul 27;382(9889):326, (level 3 [lacking direct] evidence)

Oronasopharyngeal suction is frequently used immediately following routine delivery to clear the airway secretions of neonates both to prevent aspiration and to provide stimulation to start spontaneous respiration. However, due to an increase in the risk of bradycardia and apnea, guidelines from the American Heart Association recommend suction for babies born through clear amniotic fluid only in cases of obvious obstruction or need for mechanical ventilation (Circulation 2010 Nov 2;122(18 Suppl 3):S909). A recent randomized trial assessed the efficacy of simply wiping the mouth and nose at birth in 506 term neonates.

Infants born at ≥ 35 weeks gestational age (median 39 weeks) at a single hospital were randomized to gentle wiping of the face, mouth, and nose with a towel vs. suction of mouth and nostrils with a bulb syringe immediately after cutting of umbilical cord and were followed for 24 hours. After randomization, 15 nonvigorous neonates with meconium-stained amniotic fluid were intubated and excluded from analysis. The primary outcome to assess successful clearance of secretions was mean 24-hour respiratory rate.

The rates of crossover to the alternate treatment were high in both groups: 26% in the wiping group received suction, and 14% in the suction group received wiping. The mean 24-hour respiratory rates were 51 breaths/minute with wiping vs. 50 breaths/minute with suction in the intention-to-treat analysis (not significant). Respiratory rates also showed no significant differences in per-treatment and per-protocol analyses. There were also no significant differences in incidence of tachypnea (respiratory rate > 60 breaths/minute) (46% vs. 46%), need for advanced resuscitation at birth (10% vs. 7%), or 5-minute Apgar scores (9 vs. 9). Wiping was associated with a nonsignificant increase in need for admission to neonatal intensive care (18% vs. 12%, p = 0.07).

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