Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term

Cochrane Review by Halliday HL, Sweet D

This record should be cited as: Halliday HL, Sweet D. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000500. DOI: 10.1002/14651858.CD000500.

ABSTRACT

Title

Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term

Background

On the basis of evidence from non-randomised studies, it has been recommended that all babies born through thick meconium should have their tracheas intubated so that suctioning of their airways can be performed. The aim is to reduce the incidence and severity of meconium aspiration syndrome. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary.

Objectives

To determine if endotracheal intubation and suction of the airways at birth in vigorous term meconium-stained babies is more beneficial than routine resuscitation including aspiration of the oro-pharynx.

Search strategy

The search was made from Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE from 1966 to September 2002, and information obtained from knowledgeable practising neonatologists.

Selection criteria

Randomised trials which compared a policy of routine vs no (or selective) use of endotracheal intubation and aspiration in the immediate management of vigorous term meconium-stained babies at birth.

Data collection and analysis

Data regarding clinical outcomes including mortality, meconium aspiration syndrome, other respiratory conditions, pneumothorax, need for oxygen supplementation, stridor, convulsions and hypoxic-ischaemic encephalopathy were abstracted and analysed using Revman 4.1.

Main results

Four randomised controlled trials of endotracheal intubation at birth in vigorous term meconium-stained babies were identified. Meta-analysis of these trials does not support routine use of endotracheal intubation at birth in vigorous meconium-stained babies to reduce mortality, meconium aspiration syndrome, other respiratory symptoms or disorders, pneumothorax, oxygen need, stridor, HIE and convulsions. However, the event rates of many of these outcomes is low in the reported trials making reliable estimates of treatment effect impossible.

Authors' conclusions

Routine endotracheal intubation at birth in vigorous term meconium-stained babies has not been shown to be superior to routine resuscitation including oro-pharyngeal suction. This procedure cannot be recommended for vigorous infants until more research is available.

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