Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country

Kumar, Gunjana; Goel, Srishti; Nangia, Sushma; Ramaswamy, Viraraghavan Vadakkencherry

doi:10.1055/a-1797-7005

Cited by 3 publications

(11 citation statements)

References 44 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since the revised NRP guidelines in the seventh and eighth editions, several researchers have been trying to answer this controversy using data from their centers, but there are variations in the study population composition and outcomes. 22,[24][25][26][27][28][29][30]45 Similar to our study, an observational study by Chiruvolu et al 22 reported an increased incidence of NICU admissions, need for mechanical ventilation, oxygen therapy, and use of surfactant after implementing the new guidelines, while the incidence of MAS was not different in the two groups. Kalra et al 27 reviewed the California Perinatal Quality Care Collaborative database and found a decrease in the incidence or severity of MAS.…”

Section: Discussionsupporting

confidence: 88%

“…A subsequent single-center cohort study by Kalra et al 29 on nonvigorous infants born through MSAF revealed a higher incidence of MAS (15 vs. 53%) and NICU admission for respiratory distress (18 vs. 57%). Another recent study by Kumar et al 30 showed no change in the incidence of MAS and decreased incidence of HIE in nonvigorous neonates in the no Note: Outcomes adjusted for the male gender and subsequent intubation in DR.…”

Section: Discussionmentioning

confidence: 96%

“…22,[24][25][26][27][28][29] Our observational cohort study to assess the effect of such intervention in a tertiary care center with a considerable number of cases of MSAF at birth can potentially add to the available pool of scientific evidence at this time. 30…”

mentioning

confidence: 99%

See 2 more Smart Citations

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates

et al. 2022

View full text Add to dashboard Cite

Objective: To evaluate the effect of the 2015 NRP recommendations of no routine endotracheal suctioning for non-vigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. Design: This was a single-center retrospective cohort study. We recorded data on Non-vigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n=95 (before the new guidelines, Jan 01, 2013-Dec 31, 2015) and prospective period 2, n=91 (after the implementation of new guidelines, Jan 01, 2017- Dec 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. Results: No significant differences in the occurrence of MAS ( 11% vs. 17% ) (Odds ratio of 1.46 (95% CI- 0.59-3.55)) or death (1% vs. 3% ) (Odds Ratio of 2.00 (95% CI- 0.18-21.57)) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37% vs. 61%), with an Odds Ratio of 2.31 (95% CI -1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12% vs. 28%) with an Odds ratio (OR) of 2.03 (95% CI- 1.02-4.51); p-value of 0.05). Conclusion: Our study did not observe a significant difference in the incidence of MAS or Death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates

et al. 2022

View full text Add to dashboard Cite

show abstract

“…При наявності задишки, яка виникає внаслідок розвитку термінального стану в плода, відбувається зміна градієнтів тиску в амніотичній рідині та дихальних шляхах і порушення опору останніх, що призводить до аспірації навколоплідних вод та їх вмісту [4,44]. Даний механізм внутрішньоутробної аспірації пояснює знижену ефективність інтратрахеального відсмоктування вмісту трахеї у новонароджених крізь навколоплідні води у випадку їх аспірації задовго до народження [20,51,52,53,54]. Вплив гіпоксії на пасаж меконію в амніотичну рідину та його подальшу внутрішньоутробну аспірацію підтверджує велика кількість раніше проведених досліджень, у яких зв'язок з гіпоксично-ішемічними явищами та САМ показує низький pH пуповинної крові та низьку оцінку за Апгар на 5-й хвилині [11,44,45,55,56].…”

Section: вступunclassified

The Influence of Perinatal Risk Factors on the Development of Meconium Aspiration Syndrome in Newborn: Important in the Routine Practice of Doctor-Neonatologist

Kiselova¹,

Komar²

2022

Neonatol. hìr. perinat. med.

View full text Add to dashboard Cite

The article summarizes the data on known risk factors for meconium aspiration syndrome (MAS) and those that continue to be studied to increase the effectiveness of the organization and provision of primary resuscitation for newly born, intensive care fornewborns with MAS, prevention of aspiration pneumonia and complications of MAS, including early and late neonatal sepsis. MAS hasnot lost its relevance in recent years, despite studies of this problem on all continents and in almost every country in the world, which is associated with a high incidence of MAS, aspiration pneumonia, persistent pulmonary hypertension, and pneumothorax. The frequency of meconium in amniotic fluid is from 10 to 24%, and the implementation of meconium aspiration syndrome occurs in 3-12% of cases. MAS increases the frequency of antenatal, intranatal fetal death, as well as neonatal mortality to 4.2% in the case of severe meconiumaspiration. Despite the scientifically proven link between the occurrence of meconium amniotic fluid and individual factors, includingpregnancy, infection and hypoxia, which play a key role in the development of MAS, the degree of influence of these factors at differentstages of pregnancy is still being studied. A study of the effect of hypoxia and infection on the imbalance between fetal defecation,urination, swallowing, respiratory tract secretion and amniotic fluid clearance. The differences between the value of physiological intrauterine defecation and pathological discharge of meconium in utero against the background of the infectious process in the mother (microbial colonization of the amniotic cavity funisitis), and fetal distress are shown. The role of delayed pregnancy, infection, andhypoxia during pregnancy in the development of MAS is emphasized, with an emphasis on the chronic course of these processes. It waspointed out that gestational age over 41 weeks cannot be considered a primary factor, in the risk of developing MAS, and the fact that body weight at birth is also important in the appearance of amniotic fluid contaminated with meconium and the development of MAS. If a pregnant woman has a microbial invasion of the amniotic cavity: chorioamnionitis or funisitis, the development of MAS is possible in a child born prematurely. Emphasized diagnostic value of intrauterine infection - a risk factor for MAS due to an increase in the normof several inflammatory mediators identified in umbilical cord blood. The influence of circulatory disorders occurring in utero under theinfluence of stress and shock factors (functional disorders in the mother-placenta-fetus system, hypertension, late hestosis in the mother,dehydration, infection, metabolic disorders, bad habits). The additional focus of neonatologists to ensure objective monitoring of thecondition of the fetus in maternity hospitals during the briefing, predicting the course of MAS will be insufficient justification for theindications for the use of oxytocin. Timely detection of new risk factors for MAS, the addition of importance in the development of MASwill help to improve and timely update birth protocols, in the presence of amniotic fluid contaminated with meconium, resuscitation andpost-resuscitation care for newborns, optimize clinical routes.

show abstract

“…Many of them were from high income countries (HICs) and aimed to evaluate the impact of this policy change on the various outcomes of NV-MSAF neonates. (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Traditionally, meta-analyses are restricted exclusively to RCTs as the CoE derived from them are relatively higher when compared to that from observational studies. (21) Recent literature has indicated the usefulness of synthesizing data from observational studies, often termed as real-world evidence (RWE).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

Self Cite

View full text Add to dashboard Cite

Aim: The 2015 recommendation of the International Liaison Committee on Resuscitation of no routine tracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) was based on very low certainty of evidence (CoE) necessitating ongoing monitoring. The aim of this systematic review was to perform a meta-analysis of observational studies comparing the effect of implementing immediate resuscitation without routine tracheal suctioning versus with routine suctioning in neonates born through MSAF. Methods: MEDLINE, Embase, CENTRAL, and Web of Science were searched. Observational studies with a before-and-after design were included. Two authors extracted data independently. CoE based on GRADE recommendations was performed. Results: 13 studies were included. Clinical benefit or harm could not be excluded for the composite primary outcome of mortality or requirement of extracorporeal membranous oxygenation (ECMO) (relative risk, 95% confidence interval: 0.74 [0.47–1.17]), and mortality (0.68 [0.42–1.11]). “Routine tracheal suctioning” epoch had possibly lesser risk of meconium aspiration syndrome (MAS) when compared to “no routine tracheal suctioning” epoch (0.68 [0.47–0.99]). “Routine tracheal suctioning” epoch also possibly had a lower risk of hospital admission for respiratory symptoms, requirement of non-invasive respiratory support, invasive mechanical ventilation, surfactant treatment, air leak, and low-flow oxygen therapy. Clinical benefit or harm could not be excluded for the outcome of mortality or ECMO among those diagnosed with MAS (1.09 [0.86–1.39]), but “routine tracheal suctioning” was possibly associated with lower risk of respiratory morbidities among those diagnosed with MAS. The CoE was very low for most of the outcomes evaluated. Conclusions: Due to the very low CoE for the outcomes evaluated, no definitive conclusions can be drawn warranting the need for additional studies.

show abstract

Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country

Cited by 3 publications

References 44 publications

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates

The Influence of Perinatal Risk Factors on the Development of Meconium Aspiration Syndrome in Newborn: Important in the Routine Practice of Doctor-Neonatologist

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

Contact Info

Product

Resources

About