The practice of clearing a newborn’s airway immediately after birth is a fundamental step in helping the infant transition to life outside the womb. This procedure, known as oropharyngeal suctioning, involves removing secretions from the mouth and nose. The specific sequence—suctioning the mouth before the nose—is a safety protocol designed to prevent a dangerous reflex action. This order manages the risk of the newborn inhaling fluid or mucus still present in the upper airway, ensuring a clear pathway for their first breaths.
Why Newborn Airway Clearance is Necessary
Airway clearance is sometimes needed because the newborn is making a significant biological shift from a water-based environment to an air-based one. Before birth, the baby’s lungs are filled with fetal lung fluid, and oxygen is supplied through the umbilical cord. When labor begins, the pressure exerted by the birth canal helps squeeze out a significant portion of this fluid.
However, some fluid, mucus, or other secretions like meconium (fetal stool) may remain in the mouth and throat upon delivery. The presence of these substances can interfere with the infant’s ability to take a full, unobstructed breath. While most healthy newborns clear their airways naturally through crying and coughing, intervention is sometimes necessary for those who are struggling. Removing these residual materials ensures that the tiny air sacs in the lungs, the alveoli, can fully expand with air.
The Physiological Rationale for Mouth Before Nose
The reason for suctioning the mouth first is rooted in the newborn’s involuntary reflexes, which are protective but can become hazardous if triggered at the wrong time. Newborns are obligate nose breathers, meaning they instinctively prefer to breathe through their noses. Stimulating the nasal passages with a suction device can trigger a sudden, deep inhalation reflex, or gasp.
If the nose is suctioned first while the mouth and throat are still full of fluid, that gasp can cause the infant to suck the secretions deep into the lungs. This event, known as aspiration, can lead to serious respiratory complications, including pneumonia and airway obstruction. Clearing the mouth first removes any material that could be inhaled before the nasal stimulation occurs.
The back of the throat (posterior pharynx) is also a highly sensitive area. Stimulating this area, especially with deep suctioning, can trigger the vagus nerve, which runs from the brainstem to the abdomen. Vagal stimulation can cause a sudden drop in heart rate (bradycardia) or cause the infant to momentarily stop breathing. The mouth-first sequence minimizes the risk of fluid aspiration into the lower airways and reduces the potential for adverse vagal responses.
Tools and Techniques for Safe Suctioning
The tools used for newborn suctioning vary depending on the setting and the amount of secretion present. In the delivery room, healthcare professionals typically use either a small, sterile bulb syringe or a mechanical suction device with a catheter. The bulb syringe is the most common tool and is also the one parents are taught to use at home for mild congestion.
When using a bulb syringe, the bulb must be compressed before the tip is placed into the infant’s mouth or nose to create the necessary vacuum. For the mouth, the tip is gently inserted into one side, sweeping the cheek and tongue to collect secretions. After removing the syringe, the bulb is emptied and recompressed before gently inserting the tip a short distance into one nostril.
The technique must always be gentle, as overly vigorous or deep suctioning can cause mucosal trauma or unintentionally stimulate the vagus nerve. Professionals limit the depth and duration of suctioning to a few seconds to prevent these complications. Suctioning should only be performed when there is clear evidence of obstruction or distress, as routine suctioning is generally not recommended for vigorous newborns.