• Resuscitation · Apr 2020

    Review Meta Analysis

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

    • Daniele Trevisanuto, Marya L Strand, Mandira Daripa Kawakami, Jorge Fabres, Edgardo Szyld, Kevin Nation, Myra H Wyckoff, Yacov Rabi, Henry C Lee, and International Liaison Committee on Resuscitation Neonatal Life Support Task Force.
    • Department of Woman's and Child's Health, University of Padova, Padova, Italy. Electronic address: daniele.trevisanuto@unipd.it.
    • Resuscitation. 2020 Apr 1; 149: 117-126.

    ContextThe International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid (MSAF).ObjectiveTo 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 SourcesMedline, EMBASE, the Cochrane Database of Systematic Reviews, and other registries were searched from 1966 to November 7, 2019.Study SelectionStudies were selected by pairs of independent reviewers in 2 stages.Data ExtractionReviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence for each outcome.ResultsFour 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.LimitationsThe certainty of evidence was low for survival at discharge and very low for all other outcomes.ConclusionsFor non-vigorous newborns delivered through MSAF, there is insufficient evidence to suggest routine immediate direct laryngoscopy with tracheal suctioning.ProsperoCRD42019122778.Clinical Trials RegistrationPROSPERO; CRD42019122778.Copyright © 2020 Elsevier B.V. All rights reserved.

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