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

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

doi:10.1159/000528715

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

Neonatology. 2023;120(2):161-175. doi: 10.1159/000528715. Epub 2023 Feb 8.

Authors

Viraraghavan Vadakkencherry Ramaswamy¹, Tapas Bandyopadhyay², Sushma Nangia³, Gunjana Kumar³, Abdul Kareem Pullattayil⁴, Daniele Trevisanuto⁵, Charles Christoph Roehr^{6

7

8}, Satyan Lakshminrusimha⁹

Affiliations

¹ Ankura Hospital for Women and Children, Hyderabad, India, 19.vira@gmail.com.
² Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India.
³ Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.
⁴ Associate Librarian, Bracken Health Sciences Library, Queen's University, Kingston, Ontario, Canada.
⁵ Department of Woman and Child Health, University of Padua, University Hospital of Padua, Padua, Italy.
⁶ National Perinatal Epidemiology Unit, Division, Nuffield Department of Population Health, Medical Sciences, University of Oxford, Oxford, UK.
⁷ Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK.
⁸ University of Bristol, Faculty of Health Sciences, Bristol, UK.
⁹ Department of Pediatrics, University of California at Davis, Sacramento, California, USA.

PMID: 36754038
DOI: 10.1159/000528715

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.

Keywords: Meconium; Neonate; Non-vigorous neonates; Resuscitation; Tracheal suctioning.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Amniotic Fluid
Female
Humans
Infant
Infant, Newborn
Meconium Aspiration Syndrome* / prevention & control
Meconium*
Observational Studies as Topic
Randomized Controlled Trials as Topic
Respiration, Artificial