• Fahad Muqdhib Aldhafeeri, Fawaz Mayouf Aldhafiri, Maha Bamehriz, and Heidi Al-Wassia.
• Dr. Fahad Muqdhib Aldhafeeri, Faculty of Medicine,, King Abdulaziz University,, Jeddah 21441,, Saudi Arabia, T: +966 595506503, dr.fahadaldh@ gmail.com, ORCID: https://orcid. org/0000-0002-9855-2166.
• Ann Saudi Med. 2019 Mar 1; 39 (2): 879187-91.

BackgroundIn 2015, the Neonatal Resuscitation Program (NRP) guidelines were updated to recommend that nonvigorous infants delivered through meconium-stained amniotic fluid (MSAF) do not require routine intubation and tracheal suction.ObjectiveExplore the implications of 2015 NRP guidelines on delivery room management and outcome of infants born through MSAF.DesignRetrospective cohort study.SettingsKing Abdul-Aziz University Hospital (KAUH).Patients And MethodsAll term ( greater than or equal 37 weeks) infants born in KAUH through MSAF between January 1, 2016, and December 31, 2017, were included. Patients were divided into two groups according to the date of birth: period 1 (January 1, 2016, to December 31, 2016), before the implementation of the new NRP guidelines; period 2 (January 1, 2017, to December 31, 2017), after the implementation.Main Outcome MeasuresOutcomes of infants born through MSAF.Sample Size420 infants.ResultsA majority of infants (n=261) were born in period 1 and 159 after in period 2. No differences were found in the booking status of mothers, cesarean section rate, and number of deliveries attended by physicians between the 2 cohorts. Infants in both cohorts were of similar gestational age, birth weight, and gender. A nonsignificant lower rate of intubation at birth (2.3% vs 0.6%), admission to neonatal intensive care unit (3.8% vs 3.1%), and meconium aspiration syndrome (1.5% vs 0.6%) were found in period 2 compared with period 1. Only 1 infant died in period 1.ConclusionAfter the implementation of 2015 NRP guidelines, fewer infants were intubated at birth for MSAF. No difference was observed in the rate of associated morbidities and mortality.LimitationsA single-center retrospective study of misclassification bias because some of the medical staff started practicing the new guidelines before the official implementation.Conflict Of InterestNone.

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