Primary prevention

Preventive measures include early identification of high-risk pregnancies that predispose to fetal distress and fetal hypoxia. Obstetric management includes avoiding postmaturity and timely delivery at an appropriate level of care.[8] High-risk mothers with a potential risk for delivering a depressed infant should be transferred to a tertiary center with a level III or higher neonatal intensive care unit (NICU) as defined by the American Academy of Pediatrics.[31] Meta-analysis has shown that labor induction for term or post-term pregnancies results in fewer cases of MAS and reduced perinatal mortality compared with expectant management.[14][15]​​ [ Cochrane Clinical Answers logo ] ​

Bacterial growth may be enhanced with the presence of meconium in the amniotic fluid. Intrapartum antibiotics have been found to prevent chorioamnionitis, but not postpartum endometritis, neonatal sepsis, or NICU admission, although the sample size was small.[32]

Preventive measures for babies born through meconium-stained amniotic fluid (MSAF) have been investigated. Such interventions include amnioinfusion, oropharyngeal suctioning of the baby at the perineum, tracheal suction, and gastric aspiration. None of these interventions has been shown to reduce the risk of MAS, and their routine use is not recommended.[29][33][34][35][36][37][38][39][40][41] [ Cochrane Clinical Answers logo ]

Amnioinfusion may be helpful in reducing cord compression in oligohydramnios.[42] It may also be helpful when there is heavy meconium in the amniotic fluid in settings with limited facilities for fetal surveillance.[43] [ Cochrane Clinical Answers logo ]

Larger trials are needed to investigate the effect of tracheal suctioning on nonvigorous neonates born through MSAF. Meta-analysis has shown no significant difference in risk of MAS, incidence of hypoxic ischemic encephalopathy, need for mechanical ventilation, or risk of all-cause neonatal mortality with tracheal suction compared with no tracheal suction.[44][45][46] However, the authors of one meta-analysis rated the certainty of the evidence as very low, due to small study sizes, infrequent outcomes, and the inability to blind clinicians to the treatment administered.[45]

The 2020 Neonatal Resuscitation Program guidelines recommend that nonvigorous newborns with MSAF do not require routine intubation and tracheal suction.[47]​ However, tracheal suctioning may be considered when airway obstruction is suspected. The emphasis is on establishing ventilation without delay.

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