title: Effect of gastric lavage on feeding in neonates born through meconium-stained liquor: a systematic review.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of gastric lavage (GL) in neonates born through meconium-stained liquor (MSL).
  
  
  METHODS
  A systematic review of randomised controlled trials by searching databases MEDLINE (from 1966), EMBASE (from1980), CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar and proceedings of Pediatric Academic Society meetings (2002-2014).
  
  
  METHODS
  Delivery room/Neonatal ward.
  
  
  METHODS
  Neonates with gestation >34 weeks and birth weight ≥1800 g born through MSL.
  
  
  METHODS
  Prophylactic GL versus no intervention before first feed.
  
  
  METHODS
  Feeding intolerance, defined as inability to initiate/upgrade feeds due to problems such as retching, vomiting, regurgitation and gastric residuals.
  
  
  RESULTS
  A total of six studies (GL: 918, no GL: 966) were included in the review. Meta-analysis using fixed-effects model showed decreased incidence of feed intolerance following GL ((81/918 (8.8%) vs 114/966 (11.8%); risk ratio (RR): 0.71 (95% CI 0.55 to 0.93)). However, the results were not significant when random-effects model was used (RR: 0.78 (95% CI 0.55 to 1.09)). No significant adverse effects of GL were reported.
  
  
  CONCLUSIONS
  Routine GL immediately after birth may improve feed tolerance in neonates born through MSL. However, the evidence is limited, with probable small-study bias and high risk of bias in a number of the included studies. Well-designed studies with adequate sample size are essential to confirm these findings.
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
authors.forename: Mangesh
authors.initials: M
authors.lastname: Deshmukh
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
authors.forename: Haribalakrishna
authors.initials: H
authors.lastname: Balasubramanian
authors.affiliation: Department of Neonatal Paediatrics, Princess Margaret Hospital, Subiaco, Western Australia, Australia.
authors.forename: Shripada
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patole
mesh_terms: D000653:Amniotic Fluid; D005247:Feeding Behavior; D005751:Gastric Lavage / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D057045:Laryngopharyngeal Reflux / Q000517:prevention & control*; D008470:Meconium; D014839:Vomiting / Q000517:prevention & control*
keywords: Neonatology; Nursing Care; Nutrition