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Review| Volume 149, P117-126, April 2020

Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis

      Abstract

      Context

      The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid (MSAF).

      Objective

      To complete a systematic review and meta-analysis comparing endotracheal intubation and suctioning to immediate resuscitation without intubation for non-vigorous infants born at ≥34 weeks gestation delivered through MSAF.

      Data sources

      Medline, EMBASE, the Cochrane Database of Systematic Reviews, and other registries were searched from 1966 to November 7, 2019.

      Study selection

      Studies were selected by pairs of independent reviewers in 2 stages.

      Data extraction

      Reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence for each outcome.

      Results

      Four randomized controlled trials (RCTs) included 581 patients and one observational study included 231 patients. No significant differences were observed between the group treated with tracheal suctioning compared with immediate resuscitation for survival at discharge (4 RCTs; risk ratio [RR] = 1.01; 95 % CI, 0.96–1.06; p = 0.69; observational study; no deaths), hypoxic ischemic encephalopathy and meconium aspiration syndrome.

      Limitations

      The certainty of evidence was low for survival at discharge and very low for all other outcomes.

      Conclusions

      For non-vigorous newborns delivered through MSAF, there is insufficient evidence to suggest routine immediate direct laryngoscopy with tracheal suctioning.

      PROSPERO

      CRD42019122778.
      Clinical Trials Registration: PROSPERO; CRD42019122778.

      Keywords

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