Failure to prevent meconium aspiration syndrome.

To determine the impact of routine naso-oropharyngeal DeLee and tracheal suction on the prevention of meconium aspiration syndrome, we compared 755 infants with meconium-stained fluid, born during a 12-month period (1983), with a similar group of 742 infants born in a previous year (1975) when these suctioning techniques were not routinely used. Morbidity and mortality data from meconium aspiration syndrome in 103 infants, using combined DeLee and tracheal suction during a five-year period (1979-1983), were also analyzed retrospectively. In spite of a combined DeLee and tracheal approach toward the prevention of meconium aspiration, the rate of meconium aspiration syndrome (2%) was not different in 1975 and 1983. Timing of obstetric DeLee suction (whether before or after delivery of the chest) did not influence the presence of meconium below the vocal cords (37 versus 36%, respectively). Even though significant morbidity remained associated with meconium aspiration in both periods studied, a drastic reduction occurred in neonatal mortality, from 46%, in 1975 to 12.5% in 1983, which was probably aided by major advances in perinatal care and supports routine prophylactic suctioning of meconium at birth. From these findings, we suggest that meconium aspiration syndrome is predominantly an intrauterine event secondary to fetal distress, and that DeLee and tracheal suctioning reduce only its severity.