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Meta-Analysis
. 2021 Jun 16;6(6):CD012671.
doi: 10.1002/14651858.CD012671.pub2.

Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid

Sushma Nangia  1 , Anu Thukral  2 , Deepak Chawla  3
Affiliations
Meta-Analysis

Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid

Sushma Nangia et al. Cochrane Database Syst Rev. .

Abstract

Background: Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartum asphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS. However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult. OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid.

Search methods: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020).

Selection criteria: We included studies enrolling non-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began. Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; and persistent pulmonary hypertension. We used the GRADE approach to assess the certainty of evidence.

Main results: We included four studies (enrolling 581 neonates) in the review. All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation. Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risks of MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-cause neonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE (RR 1.05, 95% CI 0.68 to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF. We are also uncertain as to the effect of tracheal suction on other outcomes such as incidence of mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates), persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06; 3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05; 3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence.

Authors' conclusions: We are uncertain about the effect of tracheal suction on the incidence of MAS and its complications among non-vigorous neonates born through MSAF. One study awaits classification and could not be included in the review. More research from well-conducted large trials is needed to conclusively answer the review question.

PubMed Disclaimer

Conflict of interest statement

SN has no interest to declare.

AT works as Associate Professor, Department of Pediatrics, AIIMS, New Delhi.

DC works as a Professor of Neonatology, Government Medical College Hospital, Chandigarh, India.

Figures

1
1
PRISMA flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 1: Meconium aspiration syndrome
1.2
1.2. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 2: All‐cause neonatal mortality
1.3
1.3. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 3: Hypoxic‐ischaemic encephalopathy
1.4
1.4. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 4: Need for chest compressions (during resuscitation)
1.5
1.5. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 5: Need for epinephrine (during resuscitation)
1.6
1.6. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 6: Apgar score less than 7 at 5 minutes after birth
1.7
1.7. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 7: Mechanical ventilation
1.8
1.8. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 8: Duration of oxygen therapy
1.9
1.9. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 9: Duration of mechanical ventilation (hours)
1.10
1.10. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 10: Non‐invasive ventilation
1.11
1.11. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 11: Pulmonary air leaks
1.12
1.12. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 12: Duration of hospital stay (hours)
1.13
1.13. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 13: Severe delay in mental development index at 9 months
1.14
1.14. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 14: Severe delay in motor development index at 9 months
1.15
1.15. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 15: Persistent pulmonary hypertension
1.16
1.16. Analysis
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 16: Culture positive sepsis
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References

References to studies included in this review

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