태변 염색 양수를 통해 태어난 활력이 없는 신생아의 출생 시 기관 흡입
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012671.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 16 junio 2021see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neonatología
- Copyright:
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- Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
SN conceived the review and will act as guarantor of the review.
AT and DC screened studies for inclusion, extracted data from studies, assessed the risk of bias, and performed the analysis.
DC wrote the draft review.
AT and SN reviewed and finalised the write‐up.
Sources of support
Internal sources
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No internal source of funding, India
Authors have not received any funding for conducting this review.
External sources
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Vermont Oxford Network, USA
Cochrane Neonatal Reviews are produced with support from Vermont Oxford Network, a worldwide collaboration of health professionals dedicated to providing evidence‐based care of the highest quality for newborn infants and their families.
Declarations of interest
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.
Acknowledgements
The methods section of this review is based on a standard template used by Cochrane Neonatal.
We would like to thank Cochrane Neonatal: Colleen Ovelman, Managing Editor, Jane Cracknell, Assistant Managing Editor, Roger Soll, Co‐coordinating Editor, and Bill McGuire, Co‐coordinating Editor, who provided editorial and administrative support. Carol Friesen, Information Specialist, designed and ran the literature searches. Colleen Ovelman peer reviewed the Ovid MEDLINE search strategy.
Thangaraj Abiramalatha and Jeffrey Horbar have peer reviewed and offered feedback on this review.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Jun 16 | Tracheal suction at birth in non‐vigorous neonates born through meconium‐stained amniotic fluid | Review | Sushma Nangia, Anu Thukral, Deepak Chawla | |
| 2017 May 23 | Tracheal suction at birth in non‐vigorous neonates born through meconium‐stained amniotic fluid | Protocol | Sushma Nangia, Anu Thukral, Deepak Chawla | |
Differences between protocol and review
We made the following changes to the published protocol (Nangia 2017).
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During the review, we observed that the need for advanced resuscitative measures, immediate resuscitation outcome and two additional outcomes may be influenced by the intervention (tracheal suction). Therefore, we added the following additional outcomes:
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need for chest compression during resuscitation;
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need for epinephrine during resuscitation;
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Apgar score less than seven at five minutes;
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culture‐positive sepsis;
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persistent pulmonary hypertension.
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In addition, the duration of hospitalisation which was mentioned in days in the protocol (Nangia 2017), is reported in hours in the review.
The following outcomes, although reported, are not part of the summary of findings table: duration of hospitalisation and incidence of neurodevelopmental delay.
We made the following changes to the proposed search methods:
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As of July 2019, Cochrane Neonatal no longer searches Embase for its reviews. RCTs and controlled clinical trials (CCTs) from Embase are added to the Cochrane Central Register of Controlled Trials (CENTRAL) via a robust process (see How CENTRAL is created). Cochrane Neonatal has validated their searches to ensure that relevant Embase records are found while searching CENTRAL (Ovelman 2020).
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Also starting in July 2019, Cochrane Neonatal no longer searches for RCTs and CCTs on the following platforms: ClinicalTrials.gov or from the World Health Organization’s International Clinical Trials Registry Platform (ICTRP), as records from both platforms are added to CENTRAL on a monthly basis (see How CENTRAL is created). Comprehensive search strategies are executed in CENTRAL to retrieve relevant records. The ISRCTN Registry (at www.isrctn.com/, formerly Controlled‐trials.com), is searched separately.
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Starting in September 2020, Cochrane Neonatal no longer searches for RCTs and quasi‐RCTs from CINAHL, as records are identified and added to CENTRAL on a monthly basis through Cochrane's Centralised Search Service project (see How CENTRAL is created at www.cochranelibrary.com/central/central-creation#CINAHL%20section).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Amniotic Fluid;
- Bias;
- Bronchodilator Agents [administration & dosage];
- Cardiopulmonary Resuscitation;
- Cause of Death;
- Confidence Intervals;
- Epinephrine [administration & dosage];
- Hypertension, Pulmonary [epidemiology];
- Hypoxia-Ischemia, Brain [epidemiology];
- Incidence;
- India;
- Infant Mortality;
- Intubation, Intratracheal [instrumentation];
- Meconium Aspiration Syndrome [*prevention & control];
- Randomized Controlled Trials as Topic;
- Respiration, Artificial [statistics & numerical data];
- Sepsis [epidemiology];
- Suction [instrumentation, *methods];
- *Trachea;
Medical Subject Headings Check Words
Humans; Infant; Infant, Newborn;
PICO
PRISMA flow diagram
Risk of bias graph: review authors' judgements about each risk of bias item
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 1: Meconium aspiration syndrome
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 2: All‐cause neonatal mortality
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 3: Hypoxic‐ischaemic encephalopathy
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 4: Need for chest compressions (during resuscitation)
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 5: Need for epinephrine (during resuscitation)
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 6: Apgar score less than 7 at 5 minutes after birth
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 7: Mechanical ventilation
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 8: Duration of oxygen therapy
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 9: Duration of mechanical ventilation (hours)
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 10: Non‐invasive ventilation
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 11: Pulmonary air leaks
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 12: Duration of hospital stay (hours)
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 13: Severe delay in mental development index at 9 months
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 14: Severe delay in motor development index at 9 months
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 15: Persistent pulmonary hypertension
Comparison 1: Tracheal suction versus no tracheal suction, Outcome 16: Culture positive sepsis
| Tracheal suction compared to no suction in non‐vigorous neonates born through meconium‐stained amniotic fluid (MSAF) | ||||||
| Patient or population: non‐vigorous neonates born through meconium‐stained amniotic fluid | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no tracheal suction | Risk with Tracheal suction | |||||
| Meconium aspiration syndrome (MAS) | Study population | RR 1.00 | 581 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of meconium aspiration syndrome. | |
| 346 per 1000 | 346 per 1000 | |||||
| All‐cause neonatal mortality assessed with: all‐cause neonatal deaths before discharge from hospital | Study population | RR 1.24 | 575 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of death before hospital discharge. | |
| 90 per 1000 | 112 per 1000 | |||||
| Moderate to severe hypoxic‐ischaemic encephalopathy (HIE) | Study population | RR 0.68 | 152 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of moderate to severe hypoxic‐ischaemic encephalopathy. | |
| 390 per 1000 | 265 per 1000 | |||||
| Any hypoxic‐ischaemic encephalopathy (HIE) | Study population | RR 1.05 | 175 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of any hypoxic‐ischaemic encephalopathy. | |
| 307 per 1000 | 322 per 1000 | |||||
| Need for mechanical ventilation assessed with: clinical and laboratory assessment of gas exchange before discharge from hospital | Study population | RR 0.99 | 581 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the need for mechanical ventilation. | |
| 154 per 1000 | 153 per 1000 | |||||
| Pulmonary air leaks (PAL) assessed with: clinical and radiological assessment before discharge from hospital | Study population | RR 1.22 | 449 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of pulmonary air leaks. | |
| 22 per 1,000 | 27 per 1,000 | |||||
| Persistent pulmonary hypertension (PPHN) assessed with: clinical or echocardiographic diagnosis before discharge from hospital | Study population | RR 1.29 | 406 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of persistent pulmonary hypertension. | |
| 54 per 1000 | 70 per 1000 | |||||
| Culture‐positive sepsis assessed with: blood culture before discharge from hospital | Study population | RR 1.32 | 406 | ⊕⊝⊝⊝ | We are uncertain whether tracheal suction has an effect on the incidence of culture‐positive sepsis. | |
| 29 per 1000 | 39 per 1000 | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded by three levels because of very serious risk of bias, serious inconsistency and serious imprecision (wide confidence interval crossing the line of no significance). Outcome assessors were masked to the study intervention in only two studies. Care providers were masked to the study intervention in only one of the two studies which reported this outcome. There was no allocation concealment in one study. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Meconium aspiration syndrome Show forest plot | 4 | 581 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.80, 1.25] |
| 1.2 All‐cause neonatal mortality Show forest plot | 4 | 575 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.24 [0.76, 2.02] |
| 1.3 Hypoxic‐ischaemic encephalopathy Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.3.1 Any hypoxic‐ischaemic encephalopathy | 1 | 175 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.68, 1.63] |
| 1.3.2 Moderate to severe hypoxic‐ischaemic encephalopathy | 1 | 152 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.43, 1.09] |
| 1.4 Need for chest compressions (during resuscitation) Show forest plot | 4 | 581 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.42, 2.06] |
| 1.5 Need for epinephrine (during resuscitation) Show forest plot | 4 | 581 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.37, 3.92] |
| 1.6 Apgar score less than 7 at 5 minutes after birth Show forest plot | 4 | 581 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.87, 1.42] |
| 1.7 Mechanical ventilation Show forest plot | 4 | 581 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.68, 1.44] |
| 1.8 Duration of oxygen therapy Show forest plot | 1 | 175 | Mean Difference (IV, Fixed, 95% CI) | 1.00 [‐0.83, 2.83] |
| 1.9 Duration of mechanical ventilation (hours) Show forest plot | 2 | 43 | Mean Difference (IV, Fixed, 95% CI) | ‐4.04 [‐20.41, 12.34] |
| 1.10 Non‐invasive ventilation Show forest plot | 1 | 132 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.36 [0.68, 2.74] |
| 1.11 Pulmonary air leaks Show forest plot | 3 | 449 | Risk Difference (M‐H, Fixed, 95% CI) | 0.00 [‐0.02, 0.03] |
| 1.12 Duration of hospital stay (hours) Show forest plot | 3 | 459 | Mean Difference (IV, Fixed, 95% CI) | ‐2.24 [‐9.27, 4.79] |
| 1.13 Severe delay in mental development index at 9 months Show forest plot | 1 | 86 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.23, 1.84] |
| 1.14 Severe delay in motor development index at 9 months Show forest plot | 1 | 86 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.33, 2.45] |
| 1.15 Persistent pulmonary hypertension Show forest plot | 3 | 406 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.29 [0.60, 2.77] |
| 1.16 Culture positive sepsis Show forest plot | 3 | 406 | Risk Difference (M‐H, Fixed, 95% CI) | 0.01 [‐0.03, 0.05] |
