Halliday H L
Department of Child Health, Queen's University of Belfast, Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK, BT12 6BB.
Cochrane Database Syst Rev. 2001(1):CD000500. doi: 10.1002/14651858.CD000500.
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, MEDLINE 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.
REVIEWER'S 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.
基于非随机研究的证据，有人建议所有通过黏稠胎粪分娩的婴儿都应进行气管插管，以便能够对其气道进行抽吸。目的是降低胎粪吸入综合征的发生率和严重程度。然而，对于出生时活力良好的足月儿，气管插管可能既困难又不必要。
确定对于出生时活力良好、有胎粪污染的足月儿，出生时气管插管及气道抽吸是否比包括口咽抽吸在内的常规复苏更有益。
检索了牛津围产期试验数据库、考克兰对照试验注册库、医学期刊数据库，并从经验丰富的新生儿科医生处获取信息。
比较在出生时对活力良好、有胎粪污染的足月儿进行即刻处理时，常规使用气管插管和抽吸与不使用（或选择性使用）气管插管和抽吸的随机试验。
提取有关临床结局的数据，包括死亡率、胎粪吸入综合征、其他呼吸系统疾病、气胸、补充氧气的需求、喘鸣、惊厥和缺氧缺血性脑病，并使用Revman 4.1进行分析。
确定了四项关于出生时对活力良好、有胎粪污染的足月儿进行气管插管的随机对照试验。对这些试验的荟萃分析不支持对出生时活力良好、有胎粪污染的婴儿常规使用气管插管以降低死亡率、胎粪吸入综合征、其他呼吸道症状或疾病、气胸、氧气需求、喘鸣、缺氧缺血性脑病和惊厥。然而，在已报道的试验中，许多这些结局的发生率较低，无法对治疗效果进行可靠估计。
对于出生时活力良好、有胎粪污染的足月儿，尚未证明出生时常规气管插管优于包括口咽抽吸在内的常规复苏。在有更多研究结果之前，不建议对活力良好的婴儿采用此操作。
