Perhaps the most significant changes in airway management over the recent years have been in the management of an infant delivered through meconium- stained amniotic fluid( MSAF). MSAF occurs in approximately 10℅ to 20℅ of all deliveries and increases to over 30℅ in deliveries after 42 weeks gestation. Meconium aspiration syndrome ( MAS) occurs in about 2℅ to 5℅ of these cases with a high mortality rate. Although it is generally agreed that meconium staining of the amniotic fluid is associated with increased perinatal mortality and morbidity, the benefits of routine delivery- room intubation of the meconium- stained newborn have recently been questioned. Until well-designed prospective investigations are performed, reasonable guidelines to follow are those established by a joint committee of the American Academy of pediatrics( SAP) and the American Heart Association ( AHA) in 1992. Following obstetric oropharyngeal suctioning, the committee recommended that intratracheal suctioning be performed on all meconium- stained babies if (1) there is evidence of fetal in utero distress ( for example, abnormal electric fetal monitoring), (2) the neonate is depressed or requires positive pressure ventilation in the delivery room,(3) the meconium is thick or particulate in nature( this includes " moderately- thick" meconium), or(4) if obstetric pharyngeal suctioning was not performed at all. The remaining meconium- stained babies may not need intratracheal suction should there be thin- consistency MSAF , if the obstetrician has adequately suctioned the pharynx, and if the infant is vigorous.