The Efficacy of CPAP in Neonates with Meconium Aspiration Syndrome: A Systematic Review and Meta-Analysis

Abstract

Background: In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS. Methods: Four engines were used to search randomized clinical trials (RCTs). We used relative risk (RR) and mean difference (MD) with 95% confidence intervals (95%CI) to assess the effect on dichotomous and continuous outcomes, respectively. In addition, we used the Paule–Mandel (PM) random effects model due to the anticipated lack of events. Results: Three RCTs were included (n = 432). No significant difference was found in mortality (RR = 0.82; 95%CI = 0.54–1.25; I2 = 71%; p = 0.36), need for ventilation (RR = 0.49; 95%CI = 0.15–1.56; I2 = 71%; p = 0.57), and incidence of pneumothorax (RR = 1.24; 95%CI = 0.30–5.12; I2 = 0%; p = 0.77) in the CPAP group compared to the ETI group. Regarding secondary outcomes, compared to the ETI group, no significant differences were found in APGAR at one minute (MD = −1.01; 95%CI −2.97 to 0.94; I2 = 98%; p = 0.31), APGAR at 5 min (MD = −1.00; 95%CI = −2.96 to 0.95; I2 = 99%; p = 0.32), days of hospitalization (MD = −0.52; 95%CI = −1.46 to 0.42; I2 = 94%; p = 0.28), and cord pH (MD = 0.003; 95%CI = −0.01 to 0.02; I2 = 0%; p = 0.79). Conclusions: In patients with MAS, there is no significant effect of CPAP use compared to ETI on primary, specifically on mortality, need for ventilation, the incidence of pneumothorax, and secondary outcomes.

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

“…Впродовж багатьох років значна кількість науковців переймалися питанням чому не всі діти, народжені крізь меконіальні води, реалізують синдром аспірації меконію, що стало причиною численних досліджень, мета-аналізів та систематичних оглядів [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. Патофізіологічні механізми попадання меконію в амніотичну рідину до народження дитини ще остаточно не вивчені, однак відомо, що вони пов'язані з переношеною вагітністю, інфекцією та гіпоксією [6,35,36,37].…”

Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

“…The mean duration of conventional and high frequency ventilation in the current study (2 and 3 days, respectively) was similar to other studies (3 and 5 days, respectively, with duration increasing in those requiring iNO or surfactant)(6).The most appropriate mode of ventilation for infants with MAS is unknown as there are no comparative studies of high frequency ventilation (HFV) and conventional modes of ventilation. No difference in mortality, need for ventilation, pneumothorax or length of hospitalization has been shown with the use of CPAP compared to mechanical ventilation(27). In the current study, neonates who required CPAP only, for possible MAS, were not included.…”