Meconium staining of the liquor:
Passing meconium before delivery may be a sign of fetal hypoxia. There is no role for suctioning of the baby’s airways at the perineum to prevent meconium aspiration syndrome as this is usually an antenatal event. If the baby is breathing and pink at birth, nothing more needs to be done.
If the baby is born with thick meconium, floppy and with no respiratory effort, postpone drying the baby while the oropharynx is visualized with a laryngoscope and any visible meconium removed. If there is meconium below the cords and a skilled intubator present, the trachea should then be intubated with a suction tube and the lower airway suctioned. This may need to repeated until the airway is clear or if the HR falls below 60/min when oxygenating the baby takes priority. The resuscitation is then continued as detailed above.
Following resuscitation, pass a nasogastric tube into the stomach and aspirate the stomach to remove any swallowed meconium. If this is not done the baby may vomit later and re-aspirate. If there is meconium below the cords this indicates that the baby had passed through primary apnoea to the gasping stage and should be admitted to NICU. In practice, it is usually the pulmonary hypertension that causes the ventilatory problem rather than meconium per se. These babies can be extremely difficult to manage and may have multi-organ failure. If a baby has aspirated meconium it should be admitted to the neonatal unit, even if it appears to pick up quickly.