Clinical Question: Does Medical Evidence Support Routine Oronasopharyngeal Suction at Delivery?

Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has essentially become habitual for most obstetricians, its theorized usefulness to help promote expeditious lung aeration after delivery by removal of amniotic fluid, meconium, mucus and blood that may otherwise be aspirated by the newborn, is currently not recommended. ONPS can cause vagal stimulation-induced bradycardia and thus hypercapnea, iatrogenic infection due to mucous membrane injury, and development of subsequent neonatal brain injury due to changes in cerebral blood flow regulation, particularly in premature infants. Multiple studies that have been performed comparing routine use of ONPS to no intervention controls indicate that newborns receiving ONPS took a longer time to achieve normal oxygen saturations, caused apneic episodes, and caused disturbances in heart rate (mainly bradycardia) compared to the control groups. Although the ONPS groups revealed no significantly different APGAR scores at 1 and 5 minutes, the ONPS groups took longer than the control group to reach an arterial oxygen saturation greater than or equal to 92% in the first minutes of life. Currently, Neonatal Resuscitation Program guidelines discourage the use of or meconium-stained amniotic fluid and in the absence of obvious obstruction. Furthermore, this manuscript highlights various literature sources revealing that the routine use of ONPS at the time of delivery can cause more harm than good, if any good at all.