Gastric Lavage for Prevention of Feeding Intolerance in Neonates Delivered Through Meconium-Stained Amniotic Fluid: A Systematic Review and Meta-Analysis

Abstract

The role of gastric lavage in neonates delivered through meconium-stained amniotic fluid remains unclear. This study evaluated the effects of gastric lavage, compared to no gastric lavage, on the incidences of feeding intolerance, respiratory distress, meconium aspiration syndrome, time to establish breastfeeding, hospitalization and procedure-related complications in late-preterm and term neonates delivered through meconium-stained amniotic fluid. Systematic review and meta-analysis. MEDLINE, EMBASE, CENTRAL, and other databases were searched for randomized controlled trials and quasi-randomized controlled trials using search terms: neonate OR newborn infant, meconium OR meconium-stained amniotic fluid, and lavage OR gastric lavage from inception to May 2020. Data were pooled in RevMan and analyzed in GRADE. Pooled effects (9 randomized controlled trials, number=3668), showed a significant reduction in the incidence of feeding intolerance (relative risk 0.70; 95% confidence interval 0.58,0.85, I2=0) after gastric lavage. No difference was observed for the incidence of meconium aspiration syndrome (4 studies) or procedure-related complications (7 studies). Only one study, reporting the proportion of neonates with low oxygenation (SpO2<85%), did not find any significant difference. No study evaluated the effects of gastric lavage on respiratory distress, breastfeeding, and hospitalization. Low-quality evidence supported the role of gastric lavage for the prevention of feeding intolerance in late-preterm and term neonates born through meconium-stained amniotic fluid. Applicability of results was limited by the high risk of bias. Well-conducted randomized controlled trials with impor-tant patient outcomes are needed before recommending the practice of gastric lavage.