At first glance at this title, I thought the article would be about our profession
no longer performing interventions, such as suctioning at perineum or intubating to
suction meconium for nonvigorous infants.
But that is not what the article is about. Rather, I think Dr. Arora is saying, “There’s
already been enough about the delivery room and meconium – let’s talk about management
outside the delivery room!”
For those clinicians who began practice in labor and delivery and the NICU in recent
years, perhaps this latter message is worth emphasizing. With the latest ILCOR guidelines, there might be a perception that meconium is not worth worrying about since we no
longer are suggesting routine intubation for suctioning of meconium. Of course, that
is not quite right.
Meconium at birth is still obviously a risk factor (a necessary risk factor, perhaps
sufficient, although not absolute) for meconium aspiration syndrome. Also, given the
trend toward fewer post-term deliveries over the past two decades, our workload in
taking care of these patients has decreased as well and perhaps has created an impression
among our trainees and younger colleagues that meconium is not that big of a big deal.
Therefore, as we know that meconium—and its aspiration—still happen from time to time,
I appreciate the review by Dr. Arora introducing trainees to this serious disease, as well as helping us
to review current strategies in the management of these patients outside of the delivery