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

Abstract

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. 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. 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. 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 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. 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. 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. 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。 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。 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 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。 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。 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。 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。 目前無概要