Assessment of Change in Practice of Routine Tracheal Suctioning Approach of Non-Vigorous Infants Born through Meconium-Stained Amniotic Fluid: A Pragmatic Systematic Review and Meta-Analysis of Evidence outside Randomized Trials.

IF 2.6 3区医学 Q1 PEDIATRICS Neonatology Pub Date : 2023-01-01 DOI:10.1159/000528715

Viraraghavan Vadakkencherry Ramaswamy, Tapas Bandyopadhyay, Sushma Nangia, Gunjana Kumar, Abdul Kareem Pullattayil, Daniele Trevisanuto, Charles Christoph Roehr, Satyan Lakshminrusimha

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引用次数: 1

Abstract

Aim: The 2015 recommendation of the International Liaison Committee on Resuscitation of no routine tracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) was based on very low certainty of evidence (CoE) necessitating ongoing monitoring. The aim of this systematic review was to perform a meta-analysis of observational studies comparing the effect of implementing immediate resuscitation without routine tracheal suctioning versus with routine suctioning in neonates born through MSAF.

Methods: MEDLINE, Embase, CENTRAL, and Web of Science were searched. Observational studies with a before-and-after design were included. Two authors extracted data independently. CoE based on GRADE recommendations was performed.

Results: 13 studies were included. Clinical benefit or harm could not be excluded for the composite primary outcome of mortality or requirement of extracorporeal membranous oxygenation (ECMO) (relative risk, 95% confidence interval: 0.74 [0.47-1.17]), and mortality (0.68 [0.42-1.11]). "Routine tracheal suctioning" epoch had possibly lesser risk of meconium aspiration syndrome (MAS) when compared to "no routine tracheal suctioning" epoch (0.68 [0.47-0.99]). "Routine tracheal suctioning" epoch also possibly had a lower risk of hospital admission for respiratory symptoms, requirement of non-invasive respiratory support, invasive mechanical ventilation, surfactant treatment, air leak, and low-flow oxygen therapy. Clinical benefit or harm could not be excluded for the outcome of mortality or ECMO among those diagnosed with MAS (1.09 [0.86-1.39]), but "routine tracheal suctioning" was possibly associated with lower risk of respiratory morbidities among those diagnosed with MAS. The CoE was very low for most of the outcomes evaluated.

Conclusions: Due to the very low CoE for the outcomes evaluated, no definitive conclusions can be drawn warranting the need for additional studies.

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评估常规气管吸痰治疗羊水粪染色婴儿的改变:一项实用的系统评价和随机试验外证据的荟萃分析。

目的:2015年国际联络委员会对通过粪染羊水(MSAF)出生的非活力新生儿不进行常规气管吸引复苏的建议是基于非常低的证据确定性(CoE)，需要持续监测。本系统综述的目的是对观察性研究进行荟萃分析，比较通过MSAF出生的新生儿在不进行常规气管吸痰的情况下实施立即复苏与常规吸痰的效果。方法:检索MEDLINE、Embase、CENTRAL、Web of Science。纳入了前后对照设计的观察性研究。两位作者独立提取数据。根据GRADE建议执行CoE。结果:纳入13项研究。对于死亡率或体外膜氧合(ECMO)需求的复合主要结局(相对风险，95%置信区间:0.74[0.47-1.17])和死亡率(0.68[0.42-1.11])，不能排除临床利弊。“常规气管吸痰”时期发生胎粪吸入综合征(MAS)的风险可能低于“无常规气管吸痰”时期(0.68[0.47-0.99])。“常规气管吸引”时期因呼吸道症状、需要无创呼吸支持、有创机械通气、表面活性剂治疗、漏气和低流量氧疗而入院的风险也可能较低。对于诊断为MAS的患者的死亡率或ECMO结果，不能排除临床利弊(1.09[0.86-1.39])，但“常规气管吸引”可能与诊断为MAS的患者呼吸系统疾病风险较低有关。大多数评估结果的CoE都很低。结论:由于评估结果的CoE非常低，因此无法得出明确的结论，证明需要进行额外的研究。

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来源期刊

Neonatology 医学-小儿科

CiteScore

0.60

自引率

4.00%

发文量

审稿时长

6-12 weeks

期刊介绍： This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.

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