Intervention Review

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

  1. Henry L Halliday1,*,
  2. David G Sweet2

Editorial Group: Cochrane Neonatal Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 30 OCT 2002

DOI: 10.1002/14651858.CD000500


How to Cite

Halliday HL, Sweet DG. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000500. DOI: 10.1002/14651858.CD000500.

Author Information

  1. 1

    Royal-Jubilee Maternity Service, Perinatal Room, Belfast, Northern Ireland, UK

  2. 2

    Royal Maternity Hospital, Regional Neonatal Unit, Belfast, Ireland

*Henry L Halliday, Perinatal Room, Royal-Jubilee Maternity Service, Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, UK. h.halliday@qub.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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

Meconium is the first stool of a newborn baby, greenish-black in colour and rather sticky in consistency.  If a baby is distressed before birth meconium may be passed into the amniotic fluid and if the baby then gasps the meconium-stained fluid may pass into the lungs.  Once in the lungs the meconium can make the baby ill by obstructing the airways and causing inflammation this is called meconium aspiration syndrome.  It is possible to reduce the amount of meconium getting into the lungs by sucking it from the baby’s throat and windpipe (trachea) soon after birth but it is not certain if this leads to overall benefit for the vigorous term newborn baby.  Furthermore, placing a tube in the windpipe (endotracheal intubation) of a vigorous term baby is not always easy and could cause harm.  Four studies enrolled 2844 term infants and randomly allocated them to intubation to clear the airways or routine resuscitation without intubation.  No benefit was found from routine intubation compared to routine resuscitation for vigorous term babies.  The outcomes reported included: meconium aspiration syndrome, lung air leaks, need for oxygen, noisy breathing (stridor) and fits but there were no significant differences between the two groups.  Routine endotracheal intubation of vigorous term babies born through meconium-stained amniotic fluid cannot be recommended.  For non-vigorous babies endotracheal intubation is probably indicated until more information becomes available.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於胎便染色但活力十足的足月產嬰兒而言,出生時就執行氣管內管插管是否能預防致病率和死亡

根據非隨機抽樣研究的證據基礎,建議出生時羊水有胎便濃染的新生嬰兒應該插入氣管內管以利氣道抽吸。此舉目的是降低胎便吸入症候群的發生率和嚴重度。然而,對於足月產且出生時活力十足的嬰兒而言,氣管內插管可能是既困難又不必要的。

目標

探討對於胎便染色但活力十足的足月產嬰兒,出生時就執行氣管內插管及氣道抽吸,是否比包括口咽抽吸的常規復甦術更有利。

搜尋策略

搜尋內容來自牛津週產期試驗資料庫,考科藍登記的有對照組試驗(考科藍資料庫,2002年第三期), MEDLINE醫學文獻資料庫1966到2002九月,以及來自知識淵博的臨床新生兒科專科醫師之資料。

選擇標準

比較對胎便染色但活力十足的足月產嬰兒,在出生後常規使用或不(或選擇性)使用氣管內插管及抽吸的隨機試驗

資料收集與分析

使用Rev Man4.1版抽取並分析與臨床預後有關的資料,包括:死亡率、胎便吸入症候群、其他呼吸狀況、氣胸、氧氣供應需求、喘鳴、痙攣、和缺氧缺血性腦病變。

主要結論

有四個針對胎便染色但活力十足的足月產嬰兒氣管內插管的隨機對照組試驗被採用。這些研究結果經由統合分析後,並不支持對於胎便染色但活力十足的足月產嬰兒,常規的於出生時就執行氣管內管插管,來降低死亡率、胎便吸入症候群、其他呼吸症狀或疾病、氣胸、氧氣需求、喘鳴、缺氧缺血性腦病變和痙攣。不過,這些預後的發生率在報告的試驗中發生率低,而使得可信的評估治療成效是不可能的。

作者結論

對於胎便染色但活力十足的足月產嬰兒,出生時就執行氣管內插管,並沒有比包括口咽抽吸的常規復甦術更好。直到有更多的研究可參考前,對於活力十足的嬰兒不建議這樣的治療方式。

翻譯人

本摘要由臺中榮民總醫院李昌俊翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前無概要