Effect of Gastric Lavage in Preventing Feeding Problems in Babies Born With Meconium Stained Amniotic Fluid
Condition: Gastritis of Newborn; Other Vomiting of Newborn; Meconium in Amniotic Fluid
MeSH terms: Gastritis; Vomiting
Study type: Interventional

Summary: 
      The purpose of the study is to evaluate the role of gastric lavage in preventing feeding
      problems in babies born through meconium stained amniotic fluid. It is a routine practice in
      many hospitals to perform gastric lavage in all babies born with meconium stained amniotic
      fluid after stabilisation without any supporting evidence. It is believed that meconium is an
      irritant and its presence in stomach causes gastritis and vomiting and hence the basis for
      this practice. Orogastric tube insertion and subsequent gastric lavage is not without
      complications. Potential complications will be prevented and health resources will be saved
      if this procedure is not proven to be beneficial. Therefore the investigators decided to
      study if gastric lavage reduces incidence of vomiting and other feeding difficulties as well
      as incidence of respiratory difficulties in babies born with MSAF.
    

Detailed description: 
      Meconium passage in newborn infants is a developmentally programmed event normally occurring
      within first 24-48 hours of birth. The meconium staining of amniotic fluid occurs in 12% of
      all live births per annuum.

      The routine use of gastric lavage in MSAF babies has been advocated for a long time as a part
      of the conventional treatment. Meconium in stomach is hypothesized to act as an irritant and
      cause vomiting and retching. Surprisingly this recommendation is also made in some textbooks
      without supporting evidence.

      Orogastric tube insertion and subsequent gastric lavage can cause complications like
      bradycardia, apnea, vomiting, trauma, aspiration and esophageal or gastric perforations. Some
      researchers have found that gastric suction done at birth is associated with long term risk
      for functional intestinal disorder. The sequence of prefeeding behaviour is disrupted in
      children who undergo gastric suction and it can delay initiation of breast feeding. Small
      elevation in mean arterial blood pressure, increased retching have also been reported The
      role of gastric lavage in preventing feeding problems and secondary meconium aspiration
      syndrome has not been systematically evaluated. If this procedure is not proven to be
      beneficial it will prevent potential complications which may arise due to it in a significant
      number of babies. Also in a resource limited country the cost of materials required and time
      of medical personnel will be saved. Hence the purpose of this prospective randomized
      controlled trial is to compare the incidence of feeding problems and secondary meconium
      aspiration syndrome, in gastric lavage group vs no lavage group.
    

Intervention name(s): Gastric lavage
Intervention type(s): Procedure
Intervention description(s): 8 Fr feeding tube was inserted orally with length equal to distance from the bridge of the nose to the earlobe and from the earlobe to a point halfway between the xiphoid process and the umbilicus. 20ml normal saline was used for gastric lavage. It was ensured that entire amount of normal saline used was removed from stomach.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Gastric lavage; Neonate; Meconium stained amniotic fluid; Feeding problems