Articles: child.
-
Cochrane Db Syst Rev · Aug 2022
Review Meta AnalysisTocolytics for delaying preterm birth: a network meta-analysis (0924).
Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions to allow time for administration of corticosteroids for fetal lung maturation, magnesium sulphate for neuroprotection, and transport to a facility with appropriate neonatal care facilities. However, there is still uncertainty about their effectiveness and safety. ⋯ Compared with placebo or no tocolytic treatment, all tocolytic drug classes that we assessed (betamimetics, calcium channel blockers, magnesium sulphate, oxytocin receptor antagonists, nitric oxide donors) and their combinations were probably or possibly effective in delaying preterm birth for 48 hours, and 7 days. Tocolytic drugs were associated with a range of adverse effects (from minor to potentially severe) compared with placebo or no tocolytic treatment, although betamimetics and combination tocolytics were more likely to result in cessation of treatment. The effects of tocolytic use on neonatal outcomes such as neonatal and perinatal mortality, and on safety outcomes such as maternal and neonatal infection were uncertain.
-
Meta Analysis
Levosimendan in paediatric cardiac anaesthesiology: A systematic review and meta-analysis.
Low cardiac output syndrome (LCOS) after congenital cardiac surgery has an incidence of up to 25%. Preventing and treating LCOS is of pivotal importance as LCOS is associated with excess morbidity and mortality. ⋯ The prophylactic use of levosimendan in children undergoing cardiac surgery reduced the incidence of LCOS and increased cardiac index compared with other inotropes or placebo. This effect did not translate into an improvement of other clinical endpoints.
-
Critical care medicine · Aug 2022
Meta AnalysisProbiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
To determine the safety and efficacy of probiotics or synbiotics on morbidity and mortality in critically ill adults and children. ⋯ Low certainty RCT evidence suggests that probiotics or synbiotics during critical illness may reduce VAP, HAP, ICU and hospital LOS but probably have no effect on mortality.
-
Case Reports Meta Analysis
Complete Corpus Callosotomy for Refractory Epilepsy in Children: a video article.
Corpus callosotomy is an interhemispheric disconnection by callosal commissural fiber ablation. Its rationale is the disruption of ictal spread to prevent seizure generalization. The objective pursued is alleviation of intractable, debilitating, and injurious manifestations of generalized epilepsy.1 Eight decades of experience support this procedure's safety and effectiveness for appropriately selected patients with drug-resistant epilepsy not amenable to optimal resection; particularly, favorable outcomes for tonic or atonic seizures with drop attacks have been reported.2,3 Children may benefit more than adults from callosotomy for improved daily function, psychosocial adjustment, and family satisfaction.4 A meta-analysis found a better seizure reduction from total than partial callosotomy (88.2% vs. 58.6% of worthwhile reduction) comprising drop-attacks (77.8% vs. 45.4%) with an increased but transient (i.e., resolution within 6 weeks) risk of significant disconnection syndromes (12.5% vs. none).5 Here, we present the illustrative case of a 4-year-old boy with Lennox-Gastaut syndrome who underwent open single-stage complete callosotomy. ⋯ We showcase critical steps such as dissection of cingulate gyri and anterior and then posterior callosotomy while highlighting crucial anatomic landmarks. This procedure may be accessible for epilepsy surgeons worldwide in resource-constrained environments6 while serving as a basis for promising high-technology development (e.g., endoscopic, radiosurgical, laser interstitial thermal therapy, or magnetic resonance-guided focused ultrasound callosotomies). In this video article, we aim to provide a streamlined and stepwise approach to this rare but important epilepsy surgery.
-
Cochrane Db Syst Rev · Jul 2022
Review Meta AnalysisStimulant and non-stimulant drug therapy for people with attention deficit hyperactivity disorder and epilepsy.
Attention Deficit Hyperactivity Disorder (ADHD) can co-occur in up to 40% of people with epilepsy. There is debate about the efficacy and tolerability of stimulant and non-stimulant drugs used to treat people with ADHD and co-occurring epilepsy. ⋯ In children with a dual-diagnosis of epilepsy and ADHD, there is some evidence that use of the stimulant drug OROS-MPH is not associated with significant worsening of epilepsy, but higher doses of it may be associated with increased daily risk of seizures; the evidence is of low-certainty. OROS-MPH is also associated with improvement in ADHD symptoms. However, this treatment was also associated with a large proportion of treatment withdrawal compared to placebo. In relation to the non-stimulant drug omega-3, there is some evidence for reduction in seizure frequency in children who are also on risperidone and ASM, compared to children who are on risperidone and ASM alone. Evidence is inconclusive whether omega-3 increases or decreases the risk of adverse drug events. We identified only two studies - one each for OROS-MPH and omega-3 - with low to high risk of bias. We assessed the overall certainty of evidence for the outcomes of both OROS-MPH and omega-3 as low to moderate. More studies are needed. Future studies should include: 1. adult participants; 2. a wider variety of stimulant and non-stimulant drugs, such as amphetamines and atomoxetine, respectively; and 3. additional important outcomes, such as seizure-related hospitalisations and quality of life. Clusters of studies which assess the same drug - and those that build upon the evidence base presented in this review on OROS-MPH and omega-3 - are needed to allow for meta-analysis of outcomes.