How should the airway be cleared if meconium-stained fluid is present?

When meconium-stained fluid is present, it is critical to clear the airway effectively to prevent aspiration and ensure the establishment of adequate ventilation in the newborn. The recommended procedure is to suction the mouth before the nose. This approach is essential because the risk of aspirating meconium into the lungs can be significant, especially if the meconium is thick. By clearing the mouth first, you can remove the meconium that might be present there, allowing for safer breathing once the baby begins to cry or breathe spontaneously.

Suctioning the mouth before the nose is also consistent with airway management practices aimed at ensuring that the upper airway is as clear as possible before any airway pressures, such as from bag-mask ventilation, are applied. Clearing the mouth first can also help prevent potential obstruction by any retained secretions that may lead to further complications like respiratory distress.

Other methods suggested, such as using bag-mask ventilation or applying supplemental oxygen, are typically indicated after the airway is cleared and the newborn is assessed for breathing adequacy. Rubbing the back is not considered an appropriate technique for clearing the airway and does not address the presence of meconium directly. Therefore, suctioning the mouth before clearing the nose effectively prioritizes airway safety in the context