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. 2000;2001(2):CD000500.
doi: 10.1002/14651858.CD000500.

Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term

H L Halliday  1
Affiliations

Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term

H L Halliday. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: On the basis of evidence from non-randomised studies, it has been recommended that all babies born through thick meconium should have their tracheas intubated so that suctioning of their airways can be performed. The aim is to reduce the incidence and severity of meconium aspiration syndrome. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary.

Objectives: To determine if endotracheal intubation and suction of the airways at birth in vigorous term meconium-stained babies is more beneficial than routine resuscitation including aspiration of the oro-pharynx.

Search strategy: The search was made from Oxford Database of Perinatal Trials, the Neonatal Trials Registry of the Cochrane Neonatal Collaborative Review Group and information obtained from knowledgeable practising neonatologists.

Selection criteria: Randomised trials which compared a policy of routine vs no (or selective) use of endotracheal intubation and aspiration in the immediate management of vigorous term meconium-stained babies at birth.

Data collection and analysis: Data regarding clinical outcomes including mortality, meconium aspiration syndrome, other respiratory conditions, pneumothorax, need for oxygen supplementation, stridor, convulsions and hypoxic-ischaemic encephalopathy were abstracted and analysed using Revman 3.1.1.

Main results: Four randomised controlled trials of endotracheal intubation at birth in vigorous term meconium-stained babies were identified. Meta-analysis of these trials does not support routine use of endotracheal intubation at birth in vigorous meconium-stained babies to reduce mortality, meconium aspiration syndrome, other respiratory symptoms or disorders, pneumothorax, oxygen need, stridor, HIE and convulsions.

Reviewer's conclusions: Routine endotracheal intubation at birth in vigorous term meconium-stained babies has not been shown to be superior to routine resuscitation including oro-pharyngeal suction. This procedure cannot be recommended for vigorous infants until more research is available.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 2 Pneumothorax.
1.3
1.3. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 3 Oxygen need.
1.4
1.4. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 4 Meconium aspiration syndrome.
1.5
1.5. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 5 Stridor.
1.6
1.6. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 6 Convulsions.
1.7
1.7. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 7 Hypoxic ischemic encephalopathy.
1.8
1.8. Analysis
Comparison 1 Routine tracheal intubation/suction vs control, Outcome 8 Respiratory symptoms.
See this image and copyright information in PMC

References

References to studies included in this review

Daga 1994 {published data only}
    1. Daga SR, Dave K, Mehta V, Pai V. Tracheal suction in meconium stained infants: a randomized controlled study. Journal of Tropical Pediatrics 1994;40:198‐200. - PubMed
Linder 1988 {published data only}
    1. Linder N, Aranda JV, Tsur M, Matoth I, Yatsiv I, Mandelberg H, Rottem M, Feigenbaum D, Ezra Y, Tamir I. Need for endotracheal intubation and suction in meconium‐stained neonates. Journal of Pediatrics 1988;112:613‐615. - PubMed
Liu 1998 {published data only}
    1. Liu WF. Delivery room intubation of thin meconium in the low‐risk newborn: a clinical trial [abstract]. Pediatric Research 1998;43:182A. - PubMed
    1. Liu WF, Harrington T. The need for delivery room intubation of thin meconium in the low‐risk newborn: a clinical trial. American Journal of Perinatology 1998;15:675‐82. - PubMed
Wiswell 2000 {published data only}
    1. Wiswell TE, Gannon CM, Jacob J, et al. Delivery room management of the apparently vigorous meconium‐stained neonate: results of the multicenter, international collaborative trial. Pediatrics 2000; Vol. 105:1‐7. - PubMed

Additional references

Carson 1976
    1. Carson BS, Losey RW, Bowes WA, Simmons MA. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome. American Journal of Obstetrics and Gynecology 1976;126:712‐5. - PubMed
Gregory 1974
    1. Gregory GA, Gooding CA, Phibbs RH, Tooley WH. Meconium aspiration in infants: a prospective study. Journal of Pediatrics 1974;85:848‐52. - PubMed
Ting 1975
    1. Ting P, Brady JP. Tracheal suction in meconium aspiration. Obstetrics and Gynecology 1975;122:767‐71. - PubMed

References to other published versions of this review

Halliday 2000
    1. Halliday HL. Endotracheal intubation at birth for prevention of mortality and morbidity in vigorous, meconium‐stained infants born at term. Cochrane Database of Systematic Reviews 2000, Issue 1. [DOI: 10.1002/14651858.CD000500] - DOI - PubMed
Halliday 2001
    1. Halliday HL. Endotracheal intubation at birth for prevention of mortality and morbidity in vigorous, meconium‐stained infants born at term. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD000500] - DOI - PubMed

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