Background and Aims Aspiration of the secretions at birth is a step performed in the care of the newborn immediately after delivery, but it is not supported by evidence-based data. Our study aim is to prove the suction of the secretions is a necessary step in neonatal resuscitation and care at delivery.

Method We studied 1154 consecutive cesarean section deliveries The care at birth was according to the AAP Resuscitation Guidelines, except the neonates were randomized to mandatory aspiration of the secretions at delivery by suction catheter (S group) or clearing the secretions from the mouth when they are visible by gentle aspiration of the mouth (C group). There were noted the time to first breath, need for bag and mask ventilation, occurrence of respiratory distress, need for mechanical ventilation, blood gas values at delivery.

Results 25/577 of the neonates in the S group developed respiratory grunting after delivery compared with 42/577 neonates in the C group (p<0.001). The need of bag and mask ventilation at birth was similar between the groups (10/577 C; 11/577 S group). When stratified for gestational age(GA), 12/253 neonates in the S group with GA less than 38 weeks presented with respiratory distress and grunting after delivery compared with 35/260 in the C group (p<0.001).

Conclusions Aspiration of the secretions at birth is a necessary step in the care at birth of the newborns born by cesarean section, especially if they are 38 weeks or less gestational age.