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Maeda T, Sato Y, Hirakawa A, Nakatochi M, Kinoshita F, Suzuki T, Ichimura S, Ito R, Kudo R, Suzuki M, Hoshino S, Sugiyama Y, Muramatsu H, Kidokoro H, Kawada JI, Takahashi Y. Design of a prospective multicenter randomized controlled trial evaluating the effects of gastric lavage on coffee-ground emesis in neonates: study protocol. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:227-232. [PMID: 31239591 PMCID: PMC6556448 DOI: 10.18999/nagjms.81.2.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neonates who swallow a considerable amount of maternal blood may exhibit vomiting and suckling disorder during the first few days of the postnatal period. Some clinicians treat these neonates with gastric lavage (GL) to prevent vomiting and the establishment of enteral feeding empirically, but there was no study assessing the effect of GL for neonates with coffee-ground emesis. We designed a multicenter randomized controlled trial to evaluate the efficacy and safety of GL in neonates with coffee-ground emesis. Vigorous neonates with birth weight ranging from 2500 g to 3999 g and gestational age between 37w0d and 41w6d who presented with coffee-ground emesis on more than twice and diagnosed as false melena, were divided into two groups using computerized randomization. We defined feeding intolerance (FI) as (1) ≥2 vomiting episodes in 4h or ≥3 episodes in 24h and/or (2) feeding failure on at least two occasions because of retching or poor sucking. Primary outcome is percentage of infants who present FI within 24 hours from admission. We also assessed the residual volumes, number of vomiting episodes, percentage of weight reduction at postnatal day 4, rates of body weight gain at 1 month of age, and peak serum total bilirubin value before discharge. To our knowledge, this is the first study to evaluate the safety and efficacy of GL for neonates with coffee-ground emesis. This trial is registered at UMIN Clinical Trials Registry as UMIN000026483.
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Affiliation(s)
- Takashi Maeda
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Nakatochi
- Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Fumie Kinoshita
- Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Takeshi Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shintaro Ichimura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoichi Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuji Kudo
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michio Suzuki
- Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Shin Hoshino
- Department of Pediatrics, Kasugai City Hospital, Kasugai, Japan
| | | | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shah L, Shah GS, Singh RR, Pokharel H, Mishra OP. Status of gastric lavage in neonates born with meconium stained amniotic fluid: a randomized controlled trial. Ital J Pediatr 2015; 41:85. [PMID: 26518433 PMCID: PMC4628437 DOI: 10.1186/s13052-015-0194-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022] Open
Abstract
Background Neonates born with meconium stained amniotic fluid (MSAF) can develop feed intolerance during first few days of post -natal period. A randomized controlled trial was conducted with the objectives of to find out the incidence of feed intolerance in vigorous neonates with MSAF who received gastric lavage (GL) as compared to those in whom it was not performed. Methods This was a randomized controlled trial on 500 neonates satisfying the inclusion criteria, 230 were allocated to GL and 270 to no lavage group through computer generated random numbers. Results No significant difference in the incidence of vomiting was found between GL and no lavage group (8.7 % vs 11.5 %, p = 0.305). Feed intolerance had no relationship with gestational age, gender, birth weight and mode of delivery. No neonates of GL group developed any complications related to the procedure. Conclusion Thus, it may be concluded that gastric lavage is not required in neonates born with MSAF.
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Affiliation(s)
- Lokraj Shah
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Gauri Shankar Shah
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | - Hanoon Pokharel
- Department of Obstetrics and Gynaecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Om Prakash Mishra
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Sharma P, Nangia S, Tiwari S, Goel A, Singla B, Saili A. Gastric lavage for prevention of feeding problems in neonates with meconium-stained amniotic fluid: a randomised controlled trial. Paediatr Int Child Health 2014; 34:115-9. [PMID: 24199655 DOI: 10.1179/2046905513y.0000000103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The role of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid is uncertain, and no there are no definitive guidelines. OBJECTIVE To evaluate the effect of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid. METHODS This was an open-label, parallel, randomized controlled trial conducted in the labour room, postnatal and neonatal wards of a tertiary-care teaching hospital. Vigorous neonates of ≧34 weeks gestation with meconium-stained amniotic fluid were randomised into two groups using block randomisation. Infants requiring oxygen, in respiratory distress or with major congenital malformations were excluded. Infants in the study group received elective gastric lavage in the labour room after initial stabilisation. No gastric lavage was done in the control group. The newborns were assessed for retching, vomiting and secondary meconium aspiration syndrome in the first 48 hrs of life or until discharge from the hospital, whichever was later. RESULTS A total of 267 newborns were randomly assigned to the gastric lavage group and 269 to the no gastric lavage group. There were no statistical differences in overall feeding between the two groups (6·74% vs 10·78%). Feeding of two newborns in the no-lavage group had to be omitted for the initial few hours because of vomiting; this did not happen in any newborn in the lavage group. No newborn in either group developed secondary meconium aspiration syndrome. CONCLUSION Gastric lavage in newborns with meconium-stained amniotic fluid does not prevent or reduce the occurrence of feeding problems or secondary meconium aspiration syndrome.
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Perforación esofágica con neumomediastino en un recién nacido de extremado bajo peso. An Pediatr (Barc) 2007; 67:403-4. [DOI: 10.1016/s1695-4033(07)70663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Patnaik S, Raju U, Arora M. Neonatal Pharyngeal Perforation. Med J Armed Forces India 2007; 63:275-6. [PMID: 27408016 DOI: 10.1016/s0377-1237(07)80154-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 03/19/2007] [Indexed: 10/18/2022] Open
Affiliation(s)
- S Patnaik
- MO (Paediatrics), Military Hospital, Sagar Cantt
| | - U Raju
- Senior Advisor (Paediatrics & Neonatology), Command Hospital (SC), Pune
| | - M Arora
- Senior Advisor (Surgery & Paediatric Surgery), Command Hospital (SC), Pune
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Cuello-García C, González-López V, Soto-González A, López-Guevara V, Fernández-Ortiz SJ, Cortez-Hernández MC. [Gastric lavage in healthy term newborns: a randomized controlled trial]. An Pediatr (Barc) 2006; 63:509-13. [PMID: 16324616 DOI: 10.1016/s1695-4033(05)70250-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Gastric lavage is still used in Mexico and other countries without evidence to support this practice. We performed a randomized controlled trial to test the hypothesis that elimination of amniotic fluid from the stomach of the newborn reduces nausea and vomiting and improves tolerance on the first feedings of breast or formula milk. PATIENTS AND METHODS A randomized, single-blind, controlled trial was conducted in a rural general hospital in the north of Mexico. Eligible healthy term newborns were randomly allocated to receive gastric lavage (n = 63) or observation (n = 61). The primary outcome measures were the presence of nausea and/or emesis in the first 24 hours of life and the breastfeeding failure rate, evaluated by a nurse blinded to the group assignment. RESULTS Of the 63 patients in the gastric lavage group, 13 had at least one episode of nausea or vomiting compared with 15 out of 61 patients in the control group (relative risk: 0.84; 95 % CI: 0.43 to 1.61). Breastfeeding failure occurred in seven mother-child pairs in the gastric lavage group compared with five in the control group (P = 0.8; relative risk: 0.96; 95 % CI: 0.86 to 1.08). Other variables such as sex or cesarian section rate were unrelated to outcome. There were no complications that could be attributed to the procedure. All the newborn infants were discharged without problems. CONCLUSIONS Gastric aspiration or lavage in the healthy full-term newborn is a common procedure that should be abandoned as it confers no advantages.
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Affiliation(s)
- C Cuello-García
- Departamento de Pediatría. Escuela de Medicina. Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico.
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Doménech Martínez E, Perapoch López J, Sánchez-Luna M, Losada Martínez A, Izquierdo Macián I, López-Herrera MC. ¿Está indicado realizar un lavado gástrico a los recién nacidos sanos? An Pediatr (Barc) 2005; 63:514-5. [PMID: 16324617 DOI: 10.1016/s1695-4033(05)70251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- E Doménech Martínez
- Miembros de la Comisión de Estándares de la Sociedad Española de Neonatología, Spain.
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Seefelder C, Elango S, Rosbe KW, Jennings RW. Oesophageal perforation presenting as oesophageal atresia in a premature neonate following difficult intubation. Paediatr Anaesth 2001; 11:112-8. [PMID: 11123743 DOI: 10.1046/j.1460-9592.2001.00591.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Iatrogenic oesophageal perforation in neonates is well recognized in the medical and surgical literature with intubation injury listed as a possible contributing mechanism besides nasogastric tube placement and suctioning. Diagnosis can be difficult and sometimes confused with other entities. With early diagnosis, nonsurgical management often leads to complete resolution in neonates. We report the case of a 1-day-old premature neonate who was brought to the operating room with the preliminary diagnosis of proximal oesophageal atresia with stump perforation and distal tracheo-esophageal fistula. His intubation for respiratory distress at birth had been difficult due to Pierre-Robin sequence with micrognathia. Oesophagoscopy in the operating room revealed a patent oesophagus but perforations in the pharynx and in the proximal oesophagus with the nasogastric tube entering the pharyngeal perforation. Oesophageal perforation and the limitations of the difficult airway algorithm in small neonates are discussed.
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Affiliation(s)
- C Seefelder
- Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA
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