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

Area of Science:

• Neonatal Resuscitation
• Pediatric Critical Care
• Perinatal Medicine

Background:

• Delivery room resuscitation is critical for depressed newborns.
• Initial steps include drying and suctioning, but their optimal sequence is debated.
• Hypothermia and respiratory distress are significant risks in this vulnerable population.

Purpose of the Study:

• To compare the effects of suctioning first versus drying first on the composite outcome of hypothermia or respiratory distress in newborns requiring resuscitation.
• To evaluate the impact of initial resuscitation sequence on neonatal outcomes.

Main Methods:

• An open-label, randomized, parallel-group, controlled trial was conducted.
• 154 depressed newborns requiring resuscitation were randomized into two groups: suctioning first (n=77) or drying first (n=77).
• The primary outcome was the composite incidence of hypothermia at admission or respiratory distress at 6 hours of age.

Main Results:

• Maternal and neonatal characteristics were comparable between the groups.
• The composite outcome occurred in 59.7% of the suctioning-first group and 71.4% of the drying-first group (P=0.13).
• Incidences of hypothermia, respiratory distress, and oxygen saturation at 6 hours were similar between the groups.

Conclusions:

• The sequence of initial steps in delivery room resuscitation, whether suctioning first or drying first, had a comparable effect on the composite outcome.
• These findings suggest flexibility in the initial management of depressed newborns regarding the order of suctioning and drying.
• Further research may explore other nuanced aspects of neonatal resuscitation protocols.