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The review presents meta-analysis of two randomized controlled trials of endotracheal intubation at birth in meconium-stained, full-term, vigourous babies published by Linder et al.(1), and Daga et al.(2). A total of 334 babies were randomized to the intervention (oropharyngeal suction and intubation) group and 287 to the control group (only oropharyngeal suction). The results of the meta-analysis failed to reveal any significant differences between the groups with respect to the clinical outcomes measured, i.e. mortality, meconium aspiration syndrome (MAS), pneumothorax, need for oxygen, stridor, convulsions and hypoxic-ischaemic encephalopathy (HIE). It may be pertinent to note that the last three outcome variables were not uniformly reported by both studies. However, the reviewer considers the lack of any significant difference between the groups for mortality and MAS alone as sufficient justification to recommend that routine intubation of meconium-stained, full-term, vigourous babies should be abandoned until further evidence becomes available.

One of the main drawbacks of the studies included in the review is the lack of robustness of the randomization techniques used. Linder et al. (1) randomized the babies based on the alphabetic order of the participating paediatricians' names, and also included non-randomized babies into the intervention group. Daga et al., (2), have not provided details of the randomization method used.

The meta-analysis of the two trials did not find any benefit of the intervention. Therefore, it would have been useful for the reviewer to comment on the power of the individual studies and of the meta-analysis to be able to show a meaningful difference.

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