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
Setting: tertiary care hospitals in India
Intervention: tracheal suction
Comparison: no suction

Meconium aspiration syndrome (MAS)
assessed with: respiratory distress developing soon after birth in an infant born through MSAF with compatible radiological findings that cannot be otherwise explained

RR 1.00
(0.80 to 1.25)

581
(4 RCTs)

⊕⊝⊝⊝
VERY LOW^a

We are uncertain whether tracheal suction has an effect on the incidence of meconium aspiration syndrome.

All‐cause neonatal mortality 

assessed with: all‐cause neonatal deaths before discharge from hospital

RR 1.24
(0.76 to 2.02)

575
(4 RCTs)

⊕⊝⊝⊝
VERY LOW^b

We are uncertain whether tracheal suction has an effect on the incidence of death before hospital discharge.

Moderate to severe hypoxic‐ischaemic encephalopathy (HIE)
assessed with: clinical assessment within 72 hours of birth

RR 0.68
(0.43 to 1.09)

152
(1 RCT)

⊕⊝⊝⊝
VERY LOW^c

We are uncertain whether tracheal suction has an effect on the incidence of moderate to severe hypoxic‐ischaemic encephalopathy. 

Any hypoxic‐ischaemic encephalopathy (HIE)
assessed with: clinical assessment within 72 hours of birth

RR 1.05
(0.68 to 1.63)

175
(1 RCT)

⊕⊝⊝⊝
VERY LOW^d

We are uncertain whether tracheal suction has an effect on the incidence of any hypoxic‐ischaemic encephalopathy. 

Need for mechanical ventilation

assessed with: clinical and laboratory assessment of gas exchange before discharge from hospital

RR 0.99
(0.68 to 1.44)

581
(4 RCTs)

⊕⊝⊝⊝
VERY LOW^e

We are uncertain whether tracheal suction has an effect on the need for mechanical ventilation.

Pulmonary air leaks (PAL)

assessed with: clinical and radiological assessment before discharge from hospital

RR 1.22
(0.38 to 3.93)

449
(3 RCTs)

⊕⊝⊝⊝
VERY LOW^f

We are uncertain whether tracheal suction has an effect on the incidence of pulmonary air leaks.

Persistent pulmonary hypertension (PPHN)

assessed with: clinical or echocardiographic diagnosis before discharge from hospital

RR 1.29
(0.60 to 2.77)

406
(3 RCTs)

⊕⊝⊝⊝
VERY LOW^f

We are uncertain whether tracheal suction has an effect on the incidence of persistent pulmonary hypertension.

Culture‐positive sepsis

assessed with: blood culture before discharge from hospital

RR 1.32
(0.48 to 3.57)

406
(3 RCTs)

⊕⊝⊝⊝
VERY LOW^f

We are uncertain whether tracheal suction has an effect on the incidence of culture‐positive sepsis.

*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).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect