Impact of Delivery Room Gastric Lavage on Exclusive Breastfeeding Rates Among Neonates Born Through Meconium-Stained Amniotic Fluid: A Randomized Controlled Trial.

BACKGROUND

Delivery-room gastric lavage reduces feeding intolerance and respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF).

OBJECTIVES

To evaluate the effects of gastric lavage on exclusive breastfeeding and skin-to-skin contact in neonates delivered through MSAF.

DESIGN

Randomized controlled trial.

PARTICIPANTS

110 late preterm and term neonates delivered through MSAF not requiring resuscitation beyond initial steps.

METHODS

Participants randomized into gastric lavage (GL) (n=55) and no-GL (n=55) groups. The primary outcome was the rate of exclusive breastfeeding at 72±12 hours of life. Secondary outcomes were time to initiate breastfeeding and establish exclusive breastfeeding, rate of exclusive breastfeeding at discharge, time to initiate skin-to-skin contact and its duration, rates of respiratory distress, feeding intolerance, and the procedure-related complications of gastric lavage monitored by pulse oximetry and videography.

RESULTS

Both the groups were similar in baseline characteristics. 49 (89.1%) neonates in GL group could achieve exclusive breast-feeding at 72 hours compared to 48 (87.3%) in no-GL group [RR (95% CI) 1.02 (0.89-1.17); P=0.768]. Initiation of skin-to-skin contact was significantly delayed and the total duration was significantly less in GL group compared to no-GL group. No difference in respi-ratory distress and feeding intolerance was observed. Procedure-related complications included retching, vomiting, and mild desaturation.

CONCLUSION

Gastric lavage did not help to establish exclusive breastfeeding, delayed the initiation of skin-to-skin contact in delivery room and reduced its total duration. Moreover, the procedure of gastric lavage was associated with neonatal discomfort.