Meconium Suctioning

ROBERT BECK
Pediatrics 1987;80;461

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Copyright © 1987 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
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cuff. Any recommendations, including the current ones, of removing meconium without risk to the resuscitator,
are arbitrary. It was the consensus of the Task Force that the delivery room must first be stocked with a 10-F
a BP cuff that was slightly too narrow for the subject semistiff suction catheter with a side suction control
would create an overestimate of BP and that this would valve. Many delivery rooms do not have this in stock and
be potentially more deleterious to the subject than use of even if present this procedure requires two people. Sec-
a BP cuff slightly too wide which might underestimate ond, if the newborn requires assisted ventilation, the
BP. The intent of the report is conservative with specific finger device can be replaced by the original adaptor and
attention paid to the idea of not inappropriately labeling the baby can be bag ventilated without the need for a
children as hypertensive who, in fact, are not. second intubation.
The third issue that Dr Park raises is the Task Force PERRY EISNER, MD
critique of oscillometric devices. It should be stated that Department of Pediatrics
the Task Force felt compelled to itemize the problems Harbor/UCLA Medical Center
that can be encountered in the use of these instruments. 1000 W Carson St
These problems may not be experienced by everyone and Torrance, CA 90509
should not be construed as constraints for the use of
oscillometnic devices for which appropriate validity data
exist.
MICHAEL J. HORAN, MD, ScM
Hypertension and Kidney Diseases Branch
Division of Heart and Vascular Diseases
Cow’s Milk Protein Intolerance
National Heart, Lung, and Blood Institute
Bethesda, MD 20892 To the Editor.-
With regard to the diagnosis of cow’s milk protein
intolerance, we were interested by the findings of Kahn
et al (Pediatrics 1985;76:880-884) and Dr Lecks’ subse-
quent comments (Pediatrics 1986;78:378). A hitherto un-
described clinical feature that may contribute to the
Meconium Suctioning establishment of this diagnosis is the presence of hyper-
emia of the rectal mucosa in affected infants. Proctoscopy
To the Editor.- may readily be performed using a lubricated pediatric
With reference to Dr Eisner’s comment (Pediatrics otoscope. The procedure is well tolerated, inexpensive,
1986;78:713) that it is technically difficult to intubate a and takes only a few seconds. It is a useful adjunct to the
neonate’s trachea with a lange suction catheter, I would taking of a stool smear for eosinophil evaluation. Infants
reply that our neonatology group has enjoyed good suc- suspected of having cow’s milk protein intolerance are
cess in suctioning meconium from below the cords in frequently found to have a dark red mucosa of increased
more than 1,600 meconium deliveries during the past 2 vasculanity; dilated vessels and frank bleeding points are
years using wall suction and a 10-F semistiff suction sometimes demonstrable.
catheter with a side suction control valve (Superior suc- Further support for the diagnosis may be gained by
tion catheter, Cumberland, RI). In our system, the neona- repeat proctoscopy following the exclusion of cow’s milk
tologist visualizes the cords, passes the suction catheter from the child’s diet when the mucosa may be seen to
below the cords, then directs the delivery room nurse to return to a healthy pale pink color.
quickly move her thumb up and down over the control Histologic studies of rectal epithelial cells are in prog-
valve while the neonatologist moves the suction tip (with ness in an attempt to correlate this observation with the
side port) to and fro within the trachea. The presence of underlying immunologic mechanisms.
meconium can be readily appreciated as the catheter is NICOLA J. GILBERTSON, MB, MRCP
clear plastic, and several passes into the trachea can be Ealing Hospital
quickly accomplished. London
ROBERT BECK, MD DONALD BENTLEY, MBCHB, MRCP
The Fairfax Hospital Royal Postgraduate Medical School
3300 Gallows Rd Hammersmith Hospital
Falls Church, VA 22046
London

In Reply.- In Reply.-
The technique that I described is briefly as follows. The literature has been replete with discussions of
The finger device is removed from a standard suction cow’s milk protein hypersensitivity relevant to its diag-
catheter and attached to a 3.0- or 3.5-mm endotracheal nosis as well as clinical patterns of presentation since the
tube after removing the endotracheal tube’s adaptor. The entity was initially described by M. Rubin 40 years ago.
infant is intubated with this endotracheal tube and the Drs Gilbertson and Bentley now suggest a comparatively
wall suction tubing is attached with low wall suction simple diagnostic procedure for detecting cow’s milk pro-
applied. The technique has two advantages over Dr tein intolerance (hypersensitivity) by merely inspecting
Beck’s procedure. Although they both are effective means the rectal mucosa of the infant at risk. My criticism of

LETTERS TO THE EDITOR 461

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 Meconium Suctioning
ROBERT BECK
Pediatrics 1987;80;461
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