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A Model of Practice in Optimal Neonatal Care: A Comprehensive Approach in Wiping,

Not Suctioning of Healthy Term Newborn Secretions at Birth

Crystal Ann M. Tadiamon, RN

Medina College

MAN 133: Nursing Service Administration II

Dr. Frances Gay Pia-Acuna

January 31, 2024

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A Model of Practice in Optimal Neonatal Care: A Comprehensive Approach in Wiping, Not

Suctioning of Healthy Term Newborn Secretions at Birth.

Over time, neonatal care has undergone tremendous change due to continuous efforts to

improve and optimize procedures that promote the health and well-being of infants. One such

area of exploration is the traditional practice of suctioning healthy newborns immediately after

birth, a routine procedure that has been deeply ingrained in obstetric and neonatal protocols.

Sometimes, it's difficult to break old habits. Naturally, people assume that a newborn

who is breathing is healthy; therefore, the first thing that comes to mind for everyone in the room

when a new baby is born is usually, "Is the baby breathing?”. Humans have naturally concluded

that breathing equates to being healthy. However, this is not always true, and especially in the

case of the newborn baby, not breathing does not always equal being healthy. Fetal-to-newborn

transition does not happen with the snap of the fingers. Instead, a complex chemical, hormonal,

and physical response process initiates the infant's first breath (Harper 2000).

It takes some newborns longer than others to adjust. When a newborn baby gurgles,

splutters, or gags, it can be unsettling for midwives, medical professionals, and parents. It is

pretty simple to grab the bulb syringe and squeeze out the fluid to hasten the newborn's

transition. It has been standard procedure for many years to suction the newborn's airways

immediately to clear any possible obstructions and promote unhindered breathing. Although this

intervention is essential when babies show symptoms of aspiration of meconium or respiratory

distress, its longer use with all newborns has drawn criticism. The current conversation around

neonatal care is moving toward a more personalized and nuanced approach by emphasizing the

value of evidence-based methods that put healthy infants' physiological requirements first.

Research and studies show that oro-nasopharyngeal suctioning (with the bulb) does not improve

outcomes (Mercer 2007), and it can actually be harmful to the newborn infant (Velaphi and

Vidyasagar 2008).

According to current recommendations, suction should not be used on a regular basis to

clear the airways in neonates born with clear amniotic fluid who start breathing on their own or

in those who don't start breathing on their own until after the baby is dried, stimulated, and

positive-pressure ventilation is initiated. Initially, suction should only be applied to infants who

have a clear impediment to their own breathing or whose mouth or nose is overflowing with
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secretions. A variety of suction techniques, such as bulb syringes, suction catheters connected to

negative pressure-generating devices, and towel-wiping of the mouth and nose, are advised and

utilized in delivery rooms. Wiping the airway with a towel is an appealing intervention that may

be done anywhere and at no expense, as suction catheters and bulb syringes may not always be

available at the time of delivery (Wyllie J & Perlman 2010)

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Review of Related Literature

A healthy baby's respiratory system has about 20 milliliters of lung fluid at term.

According to research on fetal animals, pulmonary microcirculation absorbs lung fluid

discharges, which start to decrease toward the end of gestation. It is believed that the majority of

the lung fluid that remains is expelled through the infant's trachea and oronasopharynx during

birth due to chest compression. The fluids remaining in the mouth, nose and pharynx that are

traditionally suctioned out with the bulb syringe are minimal (Waltman 2004). This raises the

question, "If the majority of the baby's pulmonary fluid, how much fluid is actually being

suctioned out during childbirth, and what use does it serve to use these devices, considering that

fluid discharges are either absorbed or squeezed out of the body?”

Neither the American Academy of Pediatrics nor the American Congress of Obstetricians

and Gynecologists recommend the practice of routine bulb suctioning of the newborn (Waltman

2004). Furthermore, research on the routine use of DeLee suction catheters to remove secretions,

mucus, and lung fluids has not been shown to be beneficial for oxygenation. Additionally, there

was no statistically significant difference between the suctioned and non-suctioned neonates'

Apgar scores. These studies recommended that the routine use of oro-naso pharyngeal catheter

suctioning at birth be abandoned (Waltman 2004).

In 1971, a retrospective review of the records of all newborns with a heart rate of 120-

180 beats per minute before bulb or DeLee catheter suction showed significant heart rate

disturbances with or without apnea in 15% of the infants who received nasopharyngeal

suctioning with the DeLee catheter. "The researchers concluded that blind suctioning of the

nasopharynx with a nasogastric tube in the first few minutes of life is a hazardous procedure"

(Velaphi and Vidyasagar 2008).

Researchers looked at 15 newborns in 1997 who was given a suction for the oro-naso

pharynx and 15 who did not acquire a suction right away following birth. They discovered that

the average arterial oxygen saturation was significantly lower in the suctioned group within the

first six minutes of life. It also took the suctioned infants significantly longer to reach oxygen

saturations of 86% and 92% (Velaphi and Vidyasagar 2008).

Researchers examined the oxygen saturation levels of 70 babies who were suctioned and

70 babies who were not in 2005. Once more, compared to the non-suctioned newborns, the
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suctioned group had lower oxygen saturation levels in the first six minutes of life and required a

longer time to reach saturation levels of greater than 85% (Velaphi and Vidyasagar 2008).

These investigations show that routine oronaso-pharyngeal suctioning using a bulb or

DeLee catheter did not improve lung mechanics or oxygenation, and instead, delayed reaching

normal oxygen saturation levels and caused both apnea and heartrate disturbances. (Velaphi and

Vidyasagar 2008).

Oro-naso pharyngeal suctioning can potentially have an impact on breastfeeding and

bonding of mother and baby . When a rubber bulb or plastic tube is used to repeatedly traumatize

an infant's mouth, the infant may exhibit signs of oral aversion and keep their mouth securely

clenched to prevent more pain, trauma, or harm. (Lothian 2005).

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Description of the Model