A baby is born with meconium stained liquor which of the following is taken account of in terming a baby vigorous except- (AIIMS Nov 2014)
Resuscitation of neonate born through meconium-stained liquer MSL)
a. When baby passes meconium in utero, there is a chance that the mecomium will be aspirated into intant's month and potentially into the trachea and lungs
b. Appropriate steps must be taken irimectiately after delivery to reduce the risk of serious consequences resulting from as Piration of meconium'
c. Intrapartum nasopharyngeal suctioning iust after the deliveU of head is no longer recommended as it does not reducethe risk of meconium aspiration syndrome and, on rore occssiorts, may cause nasopharyngeal trauma or a cardiac arrhythmia.
The first step after delivery is to identify whether the newborn is r.igrous or 'rLrrl-\ lgrous :
a. Vigrous newborn
i. A newborn is classified as vigrous, if he has all the three signs are present: -
• Strong respiratory effort
• Good muscle tone
• Heart rate greater than 100
ii. The vigrous child does not require any tracheal suctioning and the usual initial steps of resuscitation are provided, provide warmth. Positioning, suctioning of mouth and nose (not tracheal suctioning) Dry, stimulate and 02 if necessary'
i. If any of the above three signs is present, the newborn is classifieu as
ii. For non-vigrous child, the initial steps are modified: -
• Place the baby under radiant warmer and postpone suctioning to prevent stimulation of posterior pharyngeal wall that can cause bradycardia'
• Residuil meconium in the mouth and posterior pharynx should be removed by suctioning under direct vision using a laryngoscope.
• The trachea should-then be intubated and mechonium suctioned from the lower airway' Tracheal suctioning is best done by applying suction directly to the endotracheal tube'
iii. After provicling initial steps, the further management is same as with resucitation for other conditions.