CHAPTER 178 DeLee Suctioning
Suctioning with a DeLee suction device may clear the upper airway of the neonate. Meconium is present in the amniotic fluid in 9% to 20% of deliveries. For many years, it was thought that DeLee suctioning of the oropharynx and stomach carried out before delivery of the neonate’s chest would prevent meconium aspiration syndrome, and there were studies to support this practice. It is now known that some infants aspirate before delivery and therefore no intrapartum intervention can prevent all meconium aspiration. Although DeLee suctioning after delivery of the anterior shoulder and before delivery of the chest (i.e., intrapartum suctioning, before the neonate’s first breath) may prevent further meconium aspiration with the first breath, it is no longer part of neonatal resuscitation guidelines (published in 2005; see Chapter 180, Neonatal Resuscitation). This change is because one large, randomized multicenter trial (Vain and colleagues, 2004) found no benefit to performing such an intrapartum procedure. That said, many experts in both obstetrics and pediatrics still recommend suctioning the oropharynx or nasopharynx if the amniotic fluid or infant is meconium stained. Most agree that nothing more needs to be done if the infant is vigorous (defined by strong respiratory efforts, a heart rate >100 beats per minute, and good muscle tone), and this is supported by randomized, controlled trials. Most also agree that further intervention, such as endotracheal intubation and direct suctioning of the trachea (usually with a meconium aspirator applied to the endotracheal tube as the endotracheal tube is withdrawn) is indicated in those infants who are not vigorous, especially premature infants. (This assumes that the equipment and expertise are available and that, if so, and if at all possible, endotracheal suctioning should occur before stimulating these infants.)
