Time of Positive Pressure Ventilation in Non-vigorous Infants Born Through Meconium-stained Amniotic Fluid
Time of Positive Pressure Ventilation in Non-vigorous Infants Born Through Meconium-stained Amniotic Fluid
Background: Meconium stained amniotic fluid (MSAF) complicates 3 to 14% of pregnancies,
 causing meconium aspiration syndrome (MAS) in 5-10% of neonates born. Due to lack of evidence
 of benefits of endotracheal suctioning at birth in non-vigorous infants, recent neonatal
 resuscitation guidelines do not recommend it as a routine and they suggest to start
 ventilation within the first minute of life, which may be critical to reverse asphyxia and
 stabilize the neonate. There are concerns regarding the safety and efficacy of this change in
 practice because it is not based on large randomized controlled trials. Besides that, the
 delay in the beginning of the PPV in these babies has not been previously explored.

 Objective: to compare the time of PPV initiation between performing immediate laryngoscopy
 with intubation and suctioning and performing immediate PPV without intubation in a manikin.

 Methods: Level III NICU consultants, residents, and fellows trained in advanced airway
 management will be randomly assigned to AB arm (endotracheal suction, followed by the
 procedure without endotracheal suction) and to BA arm (reverse sequence), with a washout
 period of 6 hour. During each simulation, an external observer will record the time of PPV
 initiation. The primary outcome measure will be the time of PPV initiation in the
 endotracheal suction arm compared to the control arm.
Background: Meconium stained amniotic fluid (MSAF) complicates 3 to 14% of pregnancies,
 causing meconium aspiration syndrome (MAS) in 5-10% of neonates born. Due to lack of evidence
 of benefits of endotracheal suctioning at birth in non-vigorous infants, recent neonatal
 resuscitation guidelines do not recommend it as a routine and they suggest to start
 ventilation within the first minute of life, which may be critical to reverse asphyxia and
 stabilize the neonate. There are concerns regarding the safety and efficacy of this change in
 practice because it is not based on large randomized controlled trials. Besides that, the
 delay in the beginning of the PPV in these babies has not been previously explored.

 Objective: to compare the time of PPV initiation between performing immediate laryngoscopy
 with intubation and suctioning and performing immediate PPV without intubation in a manikin.

 Methods: Level III NICU consultants, residents, and fellows trained in advanced airway
 management will be randomly assigned to AB arm (endotracheal suction, followed by the
 procedure without endotracheal suction) and to BA arm (reverse sequence), with a washout
 period of 6 hour. During each simulation, an external observer will record the time of PPV
 initiation. The primary outcome measure will be the time of PPV initiation in the
 endotracheal suction arm compared to the control arm.
Inclusion Criteria:

 -  Level III NICU consultants, residents, and fellows trained in advanced airway
 management will be eligible to participate in the study

 Exclusion Criteria:

 -  No exclusion criteria