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Endotracheal Intubation Not Needed in the Vigorous Infant Delivered Through Meconium-Stained Amniotic Fluide


  • In vigorous infants born through a thin meconium-stained amniotic fluid (MSAF), does endotracheal intubation decrease risk of developing respiratory disorders and meconium aspiration syndrome?

Clinical Bottom Lines

  1. Approximately 10% to 15% of all infants are born through MSAF. These infants are 100 fold more likely to develop respiratory distress than infant born through clear fluid.
  2. 4% to 6% of infants born through MSAF will go on to develop Meconium Apriation Syndrome (MAS).
  3. There is no increased risk of MAS in vigorous infants where endotracheal intubation and suctioning are not performed.
  4. The complication rate of intubation is low and complications are minor and transient.
  5. Endotracheal intubation should be performed in infants born through MSAF if they are not vigorous, need bag-mask ventilation (BMV), or develop respiratory symptoms after initial assessment.

Summary of Key Evidence

  1. 708 infants were delivered through MSAF at Health Park Medical Center 5/94 to 6/97.1
  2. 365 were delivered through thin meconium. 24 were excluded for medical reasons.  169 excluded for non medical reasons.
  3. The infants were randomized to group I (77)-the intubation group or group II (92)-no intubation.
  4. An additional subset of patients where informed consent was not obtained were included in the results. These were group IB and group IIB.
  5. There was no statistical difference in respiratory symptoms or need for supplemental oxygen.

Additional Comments

  • Liu et al had to discontinue their study due to difficulty obtaining informed consent.
  • Wiswell et al. did not obtain consent and were able to achieve a larger population of 2094.  They looked at incidence of MAS in infant delivered through all consistencies of meconium.


  • Liu William, Harrington T.  The need for delivery room intubation of thin meconium in the low-risk newborn: A clinical trial. American Journal of Perinatology, 1998; 15:674-682.
  • Wiswell TE, Gannon CM, et al.  Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collabrative trial.  Pediatrics, 2000; 105:1-7.
  • Wiswell TE, Fuloria M.  Management of meconium-stained amniotic fluid. Clinics of Perinatology, 1999; 26:659-668.

CAT Author: Karl F. Nicles, MD

CAT Appraisers: John Frohna, MD

Date appraised: January 24, 2000

Last updated June 15, 2003
Department of Pediatrics and Communicable Diseases
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