PDF(Pubmed)
Abstract：
The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and harms, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of these procedures in healthy or meconium-stained neonates at birth. We systematically searched PubMed, Scopus, Embase, Ovid, and the Cochrane Library databases from inception to February 9, 2023. We included only RCTs assessing the outcomes of gastric suction or lavage in neonates at birth. We calculated risk ratio (RR) and weighted mean differences with 95% confidence intervals (CIs) using a random-effects model. The primary outcomes were gastrointestinal symptoms including vomiting, retching, feeding intolerance, and secondary aspiration. The secondary outcomes included time to initiation of breastfeeding and potential adverse procedure-related events. Twelve RCTs with a total of 4,122 neonates were analyzed. All the studies compared neonates who received gastric suction or lavage with those who received usual care. Gastrointestinal symptoms were significantly reduced in neonates receiving gastric suction or gastric lavage compared with the control group (RR, 0.75; 95% CI, 0.63-0.89). Gastric lavage was beneficial for infants with meconium-stained amniotic fluid (RR 0.71; 95% CI, 0.60-0.84), while gastric suction had no significant benefit in reducing gastrointestinal symptoms in infants without meconium-stained amniotic fluid (RR 0.91; 95% CI, 0.61-1.37). Our findings suggest that gastric suction or lavage may reduce gastrointestinal symptoms in neonates; however, these procedures may only benefit infants born with meconium-stained amniotic fluid. Vigorous newborns without meconium-stained amniotic fluid may not benefit from these procedures. Furthermore, gastric suction may lead to adverse outcomes such as apnea and bradycardia. Registration: This study was registered in the PROSPERO International prospective register of systematic reviews in health and social care (CRD42023247780).
摘要：
新生儿常规吸胃或灌洗的益处仍不确定，尽管世界各地的普遍做法。调查潜在的优点和危害，我们对随机对照试验(RCT)进行了系统评价和荟萃分析,研究了这些手术对出生时健康新生儿或胎粪污染新生儿的影响.我们系统地搜索了PubMed,Scopus,Embase,奥维德,和Cochrane图书馆数据库从成立到2023年2月9日。我们仅纳入评估新生儿出生时吸胃或灌洗结果的RCT。我们使用随机效应模型以95％置信区间（CI）计算了风险比（RR）和加权平均差。主要结果是胃肠道症状，包括呕吐，干涩,喂养不耐受，和二次愿望。次要结局包括开始母乳喂养的时间和潜在的不良手术相关事件。分析了12个RCT，共有4,122名新生儿。所有研究都将接受胃抽吸或灌洗的新生儿与接受常规护理的新生儿进行了比较。与对照组相比，接受吸胃或洗胃的新生儿胃肠道症状显着减轻（RR，0.75；95%CI，0.63-0.89）。洗胃对羊水胎粪污染的婴儿有益（RR0.71;95％CI，0.60-0.84），而对于没有羊水粪染的婴儿,胃抽吸在减轻胃肠道症状方面无显著益处(RR0.91;95%CI,0.61~1.37).我们的研究结果表明，吸胃或灌洗可以减轻新生儿的胃肠道症状；然而，这些程序可能只会使出生时羊水被粪污染的婴儿受益。没有胎粪污染羊水的充满活力的新生儿可能无法从这些程序中受益。此外，胃抽吸可能导致呼吸暂停和心动过缓等不良后果.注册：本研究已在PROSPERO国际健康和社会护理系统评价前瞻性注册（CRD42023247780）中注册。
