Is gastric aspiration needed for neonate management in delivery room?

Introduction: Adaptation of the neonate to extrauterine life is a physiological and developmental process. During the delivery activity, the applications in postpartum period at birth and immediately after birth (drugs that are applied to the mother during the delivery activity, clamping time of the umbilical cord, oronasopharyngeal and/or gastric aspiration protocols, anti-heat loss methods, oxygen usage of 100% in resuscitation, etc) affect postnatal adaptation process. The efficiency of the applications during the nursing of neonates immediately after the delivery has not been proved. Medical centers in the world and our country apply the protocols that they determined.Objective: In this study, determination of the effect of gastric aspiration on vital findings, oxygenation, and nutrition during management of neonate after the delivery and examination of short term prognosis of the cases are aimed.Method: 310 neonates with normal birth weight that are term, born between September 2008 and May 2009 were included in the study. Neonates were grouped randomly before the delivery. Gastric aspiration process was applied to neonates in study group; and not applied to neonates in control group. Also, two subgroups were determined according to the type of delivery. The babies born through C/S were taken to the 1st group; babies born through vaginal delivery were taken to the 2nd group.During 20 minutes, SaO2, heart rate, cyanosis, retraction score according to Silverman-Andersen retraction scoring were recorded minutely; blood pressure, number of breath, neuroadaptive capacity score were recorded once in every five minutes. Apgar scores of 1st and 5th minutes were recorded. Physical examination and information taken from their mothers related to nutrition and vomiting of the neonates were recorded on postnatal 1st day. Information about health status of the babies (nutrition, jaundice) was taken from their mothers by making visit by telephone on postnatal 7th day to the neonates.Results: 309 neonates complying with study criteria were included in the study. It is found that fetal and maternal demographical characteristics were similar in study and control groups.No statistical difference was determined between the groups in terms of 1st and 5th minutes Apgar scores. No difference was determined between two groups with regard to mean SaO2 values and the times of reaching at 85%, 92%, and 95% of SaO2. It is seen that there was no difference between two groups in terms of mean heart rate. It is found that means of systolic blood pressure of the babies whose gastric aspiration were carried out were higher at 1st and 5th minutes. It is found that mean of systolic blood pressure at 5th minute was meaningfully higher in study group while no statistical difference was determined between study and control groups in terms of mean of systolic blood pressure at 1st minute (p=0,003). No statistical difference was determined between two groups in terms of mean and diastolic blood pressure. When respiratory distress findings in neonates were evaluated, it was seen that tachypnea was present in 15 neonates in study group (9,6%) and 10 in control group (6,4%); mild or severe respiratory distress was present in five neonates (3,2%) in study group and four in control group (2,6%) according to Silverman Andersen retraction scoring (p>0,05). Retraction score was determined to be ? 1 in 36 of neonates (23,2%) whose gastric aspiration was performed and in 36 of them (11,6%) whose gastric aspiration wasn?t performed. It is found that retraction frequency was meaningfully high in the group to which gastric aspiration was applied (p=0,008). No difference was determined between two groups in terms of mean values of neuroadaptive capacity score. The babies whose gastric aspiration was performed started breastfeeding at 61st minute (±20,9), babies in other group at 60th minute (±18,1) (p>0,05). Vomiting was observed in 10 babies (6,4%) in study group, in 16 babies (10,3%) in control group (p>0,05). Apnea was developed in one neonate during gastric aspiration.Conclusion: Positive effect of gastric aspiration in neonate care in delivery room wasn?t observed on the adaptation of healthy term neonates to extrauterine life. On the other hand, it was found that systolic blood pressure at 5th minute was higher in babies whose gastric aspiration was performed. Retraction frequency was found to be higher in babies whose gastric aspiration was carried out, while severity of retraction scores was similar. In addition to these findings, no positive effect of gastric aspiration was seen on feeding behavior of the neonates.Keywords: Delivery room, neonate, gastric aspiration.