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.


OBJECTIVE
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.


METHODS
The search was made from Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE and information obtained from knowledgeable practising neonatologists.


METHODS
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.


METHODS
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.


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.


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.
Halliday
H L
HL
Department of Child Health, Queen's University of Belfast, Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK, BT12 6BB. h.halliday@qub.ac.uk
D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013396:Suction