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Correspondence

Indian Pediatr 2018;55: 617-618

Gastric Lavage in Infants Born with Meconium Stained Amniotic Fluid: Few Concerns

 

Sankalp Dudeja1 and Tapas Bandyopadhyay2

1Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh and 2Department of Neonatology, PGIMER and Dr.RML Hospital, New Delhi; India.
Email: [email protected]

   


We read with interest the article by Gidaganti, et al. [1] published recently in Indian Pediatrics, which concluded that gastric lavage does not reduce either meconium aspiration syndrome (MAS) or feed intolerance in vigorous infants born through meconium stained amniotic fluid (MSAF).

The practice of gastric lavage in babies born through MSAF is being followed at many centers. A recent systematic review by Deshmukh, et al. [2] concluded that routine gastric lavage may improve feed tolerance in neonates born through MSAF. However, well designed studies are still needed to confirm these findings. This trial, therefore, was need-based and addressed this clinically relevant issue. We would like to highlight a few important issues:

1. For sample size calculation, the authors have assumed the incidence of MAS in babies born with MSAF as 15%, based on an old unpublished study. However, most of the recent studies have reported the incidence of MAS as 5-8% [3,4]. Moreover, in the present study itself, the incidence of MAS is quite less (1.4% in intervention arm and 2.2% in control arm). The authors should have used information from these studies to calculate the sample size for adequate power of their study.

2. We clearly miss the definition of ‘vigorous infant’ in the entire manuscript. Also, whether the authors also included babies with respiratory distress soon after birth is not clear.

3. One of the exclusion criteria mentioned in the methodology is; mothers receiving methyldopa. It is not clear why these babies were specifically excluded.

4. In this study, chest X-ray was done in all participants within 4 hours of birth, irrespective of symptoms. We feel that doing X-ray in an asymptomatic baby is not ethically justified. Also, MAS is defined based on presence of clinical symptoms and abnormal chest X-ray. Chest X-ray could have been done only in babies with respiratory distress.

5. For lavage, normal saline (10mL/kg) was used. As lavage was done before the baby was weighed, the clinician must have used approximations to estimate birth weight. It would have been better if volume used for lavage was weight independent.

6. Apart from the adverse effects studied, another potential harm of this intervention is being an hindrance to routine care. If, not for this intervention, a vigorous baby born through MSAF would have received immediate skin to skin contact and early initiation of breastfeeding. However, the need to perform gastric lavage before feeding hinders this practice. This adverse effect of performing this procedure should appear in the manuscript.

References

1. Gidaganti S, Faridi MMA, Narang M, Batra P. Effect of gastric lavage on meconium aspiration syndrome and feed intolerance in vigorous infants born with meconium stained amniotic fluid – A randomized control trial. Indian Pediatr. 2018;55:206-10.

2. Deshmukh M, Balasubramanian H, Rao S, Patole S. Effect of gastric lavage on feeding in neonates born through meconium-stained liquor: A systematic review. Arch Dis Child Fetal Neonatal Ed. 2015;100:F394-9.

3. Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon J-B. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr. 2011;2012.

4. van Ierland Y, de Boer M, de Beaufort AJ. Meconium-stained amniotic fluid: discharge vigorous newborns. Arch Dis Childhood-Fetal Neonatal Ed. 2010;95:F69-71.


 

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