July 31, 2013

DynaMed EBM Journal Volume 8, Issue 31

DynaMed Weekly Updates

Quick Links

Join Mailing List



Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: July 31, 2013

Expiration Date: July 31, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158M


Last week 377 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 246 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Gentle Wiping of Face, Nose and Mouth Appears as Effective as Suction for Clearance of Secretions at Birth of Term Neonates
Reference: Lancet 2013 Jul 27;382(9889):326, (level 3 [lacking direct] evidence)

Oronasopharyngeal suction is frequently used immediately following routine delivery to clear the airway secretions of neonates both to prevent aspiration and to provide stimulation to start spontaneous respiration. However, due to an increase in the risk of bradycardia and apnea, guidelines from the American Heart Association recommend suction for babies born through clear amniotic fluid only in cases of obvious obstruction or need for mechanical ventilation (Circulation 2010 Nov 2;122(18 Suppl 3):S909). A recent randomized trial assessed the efficacy of simply wiping the mouth and nose at birth in 506 term neonates.

Infants born at ≥ 35 weeks gestational age (median 39 weeks) at a single hospital were randomized to gentle wiping of the face, mouth, and nose with a towel vs. suction of mouth and nostrils with a bulb syringe immediately after cutting of umbilical cord and were followed for 24 hours. After randomization, 15 nonvigorous neonates with meconium-stained amniotic fluid were intubated and excluded from analysis. The primary outcome to assess successful clearance of secretions was mean 24-hour respiratory rate.

The rates of crossover to the alternate treatment were high in both groups: 26% in the wiping group received suction, and 14% in the suction group received wiping. The mean 24-hour respiratory rates were 51 breaths/minute with wiping vs. 50 breaths/minute with suction in the intention-to-treat analysis (not significant). Respiratory rates also showed no significant differences in per-treatment and per-protocol analyses. There were also no significant differences in incidence of tachypnea (respiratory rate > 60 breaths/minute) (46% vs. 46%), need for advanced resuscitation at birth (10% vs. 7%), or 5-minute Apgar scores (9 vs. 9). Wiping was associated with a nonsignificant increase in need for admission to neonatal intensive care (18% vs. 12%, p = 0.07).

For more information, see the Overview of labor and delivery topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

Call for Peer Reviews

We are currently seeking reviewers for:

Cervical cancer

Postdates pregnancy

Learn more about DynaMed Contribution Opportunities

DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training

DynaMed is Hiring! We are looking for talented medical writers and editors to join our ever expanding team. Click here to learn what opportunities are available.