What is the immediate management of meconium aspiration after birth?

• A. Nasal and oral suctioning immediately after head delivery and intubation for suctioning
• B. Immediate intubation without suctioning
• C. Delayed suctioning until 2 hours after birth
• D. Antibiotics before suctioning

Answer: (A)

Meconium in the birth canal can rapidly obstruct the airway and cause lung injury once the baby begins to breathe, so clearing the airway right away is the priority. Suctioning the mouth and nose immediately after the head is delivered helps remove meconium from the upper airway before the infant takes a first breath, reducing the risk of aspiration. If the newborn is nonvigorous or has poor respiratory effort or tone, this airway cleanup is followed by intubation with suctioning of the trachea to remove meconium from the lower airway, which is crucial for improving ventilation. Delaying suctioning or performing antibiotics before suctioning does not address the immediate risk of airway obstruction and lung injury from meconium. If the infant is vigorous, you still perform standard resuscitation without routine endotracheal suctioning, but the key immediate step when meconium is present is to clear the airway promptly, beginning with oral and nasal suctioning and proceeding to suctioning via the endotracheal tube if indicated.