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

BACKGROUND The role of gastric lavage in neonates delivered through meconium-stained amniotic fluid remains unclear. OBJECTIVES 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. DESIGN Systematic review and meta-analysis. DATA SOURCES AND SELECTION CRITERIA 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. RESULTS 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. CONCLUSIONS 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 important patient outcomes are needed before recommending the practice of gastric lavage.