Continued from part 1

The procedure for a meconium baby is different.

Before the baby can breathe,  direct laryngoscopy is performed.  That means
a special "L" shaped flashlight is inserted into the throat and the
resuscitator actually looks at the vocal cords to determine how far down
the meconium has traveled. If there is meconium in the trachea (the
breathing pipe that goes from the mouth to the lungs) an ET tube
(endotrachial tube) is passed down the trachea, through the vocal cords if
necessary and the tube is connected to suction and the meconium hopefully
is completely removed.  This may need to be done several times in
succession in bad cases.

After the infant is stabilized the stomach is then suctioned to prevent
aspiration of meconium containing stomach contents.

Why do this invasive stuff in the meconium baby?  This is the stuff that
oral aversion comes from.

Well, the reason is that enough meconium in the lungs can (and does) kill
babies that are perfectly healthy otherwise.  Yes, there is a heart lung
machine called ECMO that does help a lot of these babies out.   Some babies
only get a little meconium in their lungs and just have a week or so stay
in the NICU - some on ventilators, some just on oxygen.

Now you know why it's done - the stakes are very high.

An orally defensive baby - I had two particularly difficult ones this month
- is going to do better on breastfeeding in my nursery with LC help than if
he were intubated and on a ventilator in the NICU for a week.

continued part 3
Gail
Gail Hertz, MD, IBCLC
Pediatric Resident
author of the little green breastfeeding book - disclaimer: owner of Pocket
Publications