Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis

Abstract

Objective Meconium is a common finding in amniotic fluid and placental specimens, particularly in term and post-term pregnancies. The objective of this paper was to perform a meta-analysis to examine the impact of endotracheal suctioning on the occurrence of meconium aspiration syndrome (MAS), mortality, and complications. Study Design PubMed, EMBASE, and the Cochrane library were systematically searched for comparative studies. Odds ratios (ORs), weighted mean differences (WMDs), and corresponding 95% confidence intervals (CIs) were used to compare the outcomes. Results Twelve studies were included in the meta-analysis. There were no significant impacts of endotracheal suctioning on the occurrence of MAS (OR = 3.05, 95% CI: 0.48–19.56), mortality (OR = 1.25, 95% CI: 0.35–4.44), the need for mechanical ventilation (OR = 4.20, 95% CI: 0.32–54.72), the occurrence of pneumothorax (OR = 0.99, 95% CI: 0.34–2.85), persistent pulmonary hypertension of the newborn (PPHN), (OR = 1.31, 95% CI: 0.58–2.98), hypoxic-ischemic encephalopathy (HIE) (OR = 0.82, 95% CI: 0.52–1.30), and length of stay (WMD = −0.11, 95% CI: −0.99–0.77). Conclusion Routine endotracheal suctioning at birth is not useful in preventing MAS, mortality, mechanical ventilation, PPHN, HIE, and prolonged length of stay in neonates born through MSAF. Key Points

Assessment of Change in Practice of Routine Tracheal Suctioning Approach of Non-Vigorous Infants Born through Meconium-Stained Amniotic Fluid: A Pragmatic Systematic Review and Meta-Analysis of Evidence outside Randomized Trials

“…The results of our systematic review differ from the recent ILCOR systematic review by Trevisanuto et al, and many other systematic reviews published on this PICO [48][49][50][51]. In the meta-analysis by Trevisanuto et al, four RCTs [4][5][6][7] and one observational study [9] were included, and all of them had small sample sizes.…”

“…The results of our systematic review differ from the recent ILCOR systematic review by Trevisanuto et al and many other systematic reviews published on this PICO. (48)(49)(50)(51) In the meta-analysis by Trevisanuto et al, four RCTs (4-7) and one observational study (9) were included and all of them had small sample sizes. While 3,018 neonates from observational studies were evaluated by our systematic review for the outcome of MAS, Trevisanuto et al's meta-analysis had a sample size of 581 neonates from the RCTs and 231 neonates from a single observational study.…”

Once We Find Grade III Meconium Stained Amniotic Fluid, Must We Act as Early as Possible?

“…Researchers have even put forward the view that “MSAF is more like a symptom rather than a syndrome”, 27 but no clinical practice guidelines have been developed by any international organization such as the world health organization or gynecological and obstetrical society. Although it is well-known that intensive delivery room and continuous fetal heart monitoring by the midwife regarding the intrapartum management, 15 and non-necessary routine endotracheal suctioning at birth in vigorous term meconium-stained babies 28 and other routine postnatal care. However, the observation time once MSAF is found remains unknown.…”