Suctioning First or Drying First During Delivery Room Resuscitation: A Randomized Controlled Trial

To compare the effect of suctioning first or drying first on the composite outcome of hypothermia or respiratory distress in depressed newborns requiring delivery room resuscitation.

Open-label, randomized, parallel-group, controlled trial.

Delivery room and neonatal intensive care unit of a tertiary-care teaching hospital.

Depressed newborns (n=154) requiring initial steps of resuscitation at birth. Intervention: During delivery room resuscitation eligible new-borns were randomly allocated to receive either suctioning first or drying first (77 newborns in each group).

Composite incidence of hypothermia at admission or respiratory distress at 6 hours of age.

Both groups were comparable with regard to maternal and neonatal characteristics. Composite outcome was similar in both the groups [46 (59.7%) vs 55 (71.4%)] in suctioning first and drying first, respectively [RR (95% CI), 0.84 (0.66-1.05); P=0.13]. Incidence of hypothermia, respiratory distress at admission and oxygen saturation at 6 hours were also similar. On admission to NICU, hypothermia was observed in 26 (33.8%) neonates in suctioning first group and 33 (42.8%) neonates in drying first group but by one hour of age the proportion of hypothermic neonates was 13 (16.9%) and 14 (18.1%), respectively.

In newborns depressed at birth, the sequence of performing initial steps, whether suctioning first or drying first, had comparable effect on composite outcome of hypothermia at admission or respiratory distress at 6 hours of age.