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Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial

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Abstract

The current version of Neonatal Resuscitation Program no longer favors routine endotracheal suctioning (ETS) in non-vigorous newborns with meconium-stained amniotic fluid (MSAF) due to possibility of procedure-related harms and questionable benefits. However, it calls for additional research on this procedure to provide a definitive answer. The present study was conducted to evaluate the role of ETS in non-vigorous neonates of ≥ 34 weeks’ gestation born through MSAF on the incidence of meconium aspiration syndrome (MAS). In this open-label randomized controlled trial, 132 non-vigorous neonates with MSAF were randomized to receive ETS (n = 66) or no-ETS (n = 66) during delivery room resuscitation (DRR). Primary outcome variable was incidence of MAS. Secondary outcome variables were requirement of DRR, need of respiratory support, development of complications, duration of hospitalization, and mortality. Both the groups were comparable with respect to maternal and neonatal characteristics. Incidence of MAS was 21 (31.8%) and 15 (22.7%) cases in ETS and no-ETS groups, respectively (relative risk (RR), 1.400, 95% confidence interval (CI), 0.793–2.470). The two groups did not differ with regard to DRR, need for respiratory support, and development of complications. Nine (13.6%) neonates in ETS group, and 5 (7.5%) in no-ETS group died (p > 0.05). Median (interquartile range) duration of hospital stay was 54 (31–141) h and 44 (26–102) h in ETS and no-ETS groups, respectively (p > 0.05).

Conclusions: Routine ETS at birth is not useful in preventing MAS in non-vigorous neonates of ≥ 34 weeks’ gestation born through MSAF.

Trial registration: Clinical Trials Registry of India (CTRI/2015/04/008819).

What is Known:

• Routine endotracheal suctioning is of questionable benefit in non-vigorous newborns with meconium stained amniotic fluid and may have a possibility of procedure-related harms.

What is New:

• Routine endotracheal suctioning at birth is not useful in preventing meconium aspiration syndrome in non-vigorous newborns of ≥ 34 weeks’ gestation born through meconium stained amniotic fluid.

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Abbreviations

CI:

Confidence interval

DRR:

Delivery room resuscitation

ETS:

Endotracheal suctioning

MAS:

Meconium aspiration syndrome

MSAF:

Meconium-stained amniotic fluid

NRP:

Neonatal resuscitation program

PPHN:

Persistent pulmonary hypertension of newborn

RR:

Relative risk

SD:

Standard deviation

TTN:

Transient tachypnea of newborn

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Author information

Authors and Affiliations

  1. Neonatal Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Ashok Kumar & Preetam Kumar

  2. Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India

    Sriparna Basu

Authors
  1. Ashok Kumar
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  2. Preetam Kumar
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  3. Sriparna Basu
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Contributions

Prof Ashok Kumar and Prof Sriparna Basu conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Preetam Kumar designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ashok Kumar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The trial was ethically approved by the Institute Ethics Committee of Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Clinical trial registration

The trial was registered under Clinical Trials Registry of India (CTRI/2015/04/008819).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Patrick Van Reempts

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Kumar, A., Kumar, P. & Basu, S. Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial. Eur J Pediatr 178, 1825–1832 (2019). https://doi.org/10.1007/s00431-019-03463-z

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  • DOI: https://doi.org/10.1007/s00431-019-03463-z

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