{"title":"Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants","authors":"Damon Shorter, Timothy Hong, David A Osborn","doi":"10.1002/ebch.1891","DOIUrl":"10.1002/ebch.1891","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>Searches were performed in CENTRAL (<i>The Cochrane Library</i>), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>Three independent review authors assessed study eligibility and quality, and extracted data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.</p>\u0000 \u0000 <p>One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment.</p>\u0000 \u0000 <p>One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment.</p>\u0000 \u0000 <p>Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate.</p>\u0000 \u0000 <p>Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting.</p>\u0000 \u0000 <p>One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significa","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"8 1","pages":"11-54"},"PeriodicalIF":0.0,"publicationDate":"2013-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31600929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charles I Okwundu, Christy AN Okoromah, Prakeshkumar S Shah
{"title":"Cochrane Review: Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants","authors":"Charles I Okwundu, Christy AN Okoromah, Prakeshkumar S Shah","doi":"10.1002/ebch.1898","DOIUrl":"10.1002/ebch.1898","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>We searched the Cochrane Central Register of Controlled Trials (CENTRAL, T<i>he Cochrane Library</i>, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconj","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"8 1","pages":"204-249"},"PeriodicalIF":0.0,"publicationDate":"2013-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1898","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31600935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants","authors":"Khalid AlFaleh, Jasim Anabrees, Dirk Bassler, Turki Al-Kharfi","doi":"10.1002/ebch.1881","DOIUrl":"https://doi.org/10.1002/ebch.1881","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and associated morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC and/or sepsis in preterm infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>For this update, searches were made of MEDLINE (1966 to October 2010), EMBASE (1980 to October 2010), the Cochrane Central Register of Controlled Trials <i>(</i>CENTRAL, <i>The Cochrane Library,</i> Issue 2, 2010), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age and/or < 2500 g birth weight were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>Standard methods of the Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials, data collection and analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Sixteen eligible trials randomizing 2842 infants were included. Included trials were highly variable with regard to enrollment criteria (i.e. birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. Data regarding extremely low birth weight infants (ELBW) could not be extrapolated. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical RR 0.35, 95% CI 0.24 to 0.52) and mortality (typical RR 0.40, 95% CI 0.27 to 0.60). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.90, 95% CI 0.76 to 1.07). The included trials reported no systemic infection with the probiotics supplemental organism. The statistical test ","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"7 6","pages":"1807-1854"},"PeriodicalIF":0.0,"publicationDate":"2012-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137646442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher J. Cates, Elizabeth Stovold, Susan Wieland, Marta Oleszczuk, Denise Thomson, Lorne Becker
{"title":"The Cochrane Library and safety of regular long-acting beta2- agonists in children with asthma: an overview of reviews","authors":"Christopher J. Cates, Elizabeth Stovold, Susan Wieland, Marta Oleszczuk, Denise Thomson, Lorne Becker","doi":"10.1002/ebch.1889","DOIUrl":"10.1002/ebch.1889","url":null,"abstract":"<p><b>Background:</b> Two large randomized trials of regular salmeterol monotherapy in adults with asthma found an increased risk of asthma-related mortality for salmeterol versus placebo or regular salbutamol. There are no similar large trials in children, and the safety of monotherapy with salmeterol or other long-acting beta<sub>2</sub>-agonists in children with asthma is unclear. Current guidelines recommend that regular long-acting beta<sub>2</sub>-agonist therapy should be given only in combination with regular inhaled corticosteroids. However, the safety of combination therapy in children with asthma is also unclear.</p><p><b>Objectives:</b> We used the paediatric trial results from Cochrane systematic reviews to assess the safety of regular long-acting beta<sub>2</sub>-agonist therapy, either as monotherapy or as combination therapy with inhaled corticosteroids, in children with asthma.</p><p><b>Methods:</b> We searched the Cochrane Database of Systematic Reviews in May 2012 for Cochrane reviews relating to the safety of regular formoterol and salmeterol, and ran updated searches for trials for each of the Cochrane reviews. We used odds ratios (ORs) to summarize the direct randomized evidence on safety from trials comparing regular formoterol or regular salmeterol as monotherapy versus placebo and then as combination therapy with inhaled corticosteroids versus the same dose of inhaled corticosteroids. We indirectly compared the safety of monotherapy and combination therapy by testing for differences between the pooled ORs for monotherapy and for combination therapy. We used ORs to summarize the direct randomized evidence on safety from trials comparing regular formoterol with regular salmeterol. We also compared the safety of regular formoterol and regular salmeterol indirectly by calculating an OR for the pooled results of trials assessing formoterol and the pooled results of trials assessing salmeterol, and then combined the direct and indirect evidence by calculating an overall OR for this comparison.</p><p><b>Results:</b> We identified four Cochrane reviews examining the safety of regular formoterol or salmeterol as either monotherapy or combination therapy. The reviews included 19 trials in children and we found two additional studies on salmeterol combination therapy, for a total of 21 trials in 7318 children. We identified two Cochrane reviews comparing the safety of formoterol with salmeterol, which included a single trial in 156 children. We found a statistically significant increase in the odds of suffering a nonfatal serious adverse event in children on formoterol monotherapy [OR = 2.48; 95% confidence interval (CI) = 1.27–4.83, <i>I</i><sup>2</sup> = 0%, five trials, <i>N</i> = 1335] and smaller nonsignificant increases in odds for salmeterol monotherapy (OR = 1.30; 95% CI = 0.82–2.05, <i>I</i><sup>2</sup> = 17%, five trials, <i>N</i> = 1333), formoterol combination therapy (OR = 1.60; 95% CI = 0.80–3.28, <i>I</i><sup>2</sup> ","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"7 6","pages":"1798-1806"},"PeriodicalIF":0.0,"publicationDate":"2012-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77807678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca R Pillai Riddell, Nicole M Racine, Kara Turcotte, Lindsay S Uman, Rachel E Horton, Laila Din Osmun, Sara Ahola Kohut, Jessica Hillgrove Stuart, Bonnie Stevens, Alanna Gerwitz-Stern
{"title":"Cochrane Review: Non-pharmacological management of infant and young child procedural pain","authors":"Rebecca R Pillai Riddell, Nicole M Racine, Kara Turcotte, Lindsay S Uman, Rachel E Horton, Laila Din Osmun, Sara Ahola Kohut, Jessica Hillgrove Stuart, Bonnie Stevens, Alanna Gerwitz-Stern","doi":"10.1002/ebch.1883","DOIUrl":"https://doi.org/10.1002/ebch.1883","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>We searched CENTRAL in <i>The Cochrane Library</i> (2011, Issue 1), MEDLINE (1966 to April 2011), EMBASE (1980 to April 2011), PsycINFO (1967 to April 2011), Cumulative Index to Nursing and Allied Health Literature (1982 to 2011), Dissertation Abstracts International (1980 to 2011) and www.clinicaltrials.gov. We also searched reference lists and contacted researchers via electronic list-serves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Participants included infants from birth to three years. Only randomized controlled trials (RCTs) or RCT cross-overs that had a no-treatment control comparison were eligible for inclusion in the analyses. We examined studies that met all inclusion criteria except for study design (e.g. had an active control) to qualitatively contextualize results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>We refined search strategies with three Cochrane-affiliated librarians. At least two review authors extracted and rated 51 articles. Study quality ratings were based on a scale by Yates and colleagues. We analyzed the standardized mean difference (SMD) using the generic inverse variance method. We also provided qualitative descriptions of 20 relevant but excluded studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Fifty-one studies, with 3396 participants, were analyzed. The most commonly studied acute procedures were heel-sticks (29 studies) and needles (n = 10 studies). The largest SMD for treatment improvement over control conditions on pain reactivity were: non-nutritive sucking-related interventions (preterm: SMD -0.42; 95% CI -0.68 to -0.15; neonate: SMD -1.45, 95% CI -2.34 to -0.57), kangaroo care (preterm: SMD -1.12, 95% CI -2.04 to -0.21), and swaddling/facilitated tucking (preterm: SMD -0.97; 95% CI -1.63 to -0.31). For immediate pain-related regulation, the largest SMDs were: non-nutritive sucking-related interventions (pre","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"7 6","pages":"1905-2121"},"PeriodicalIF":0.0,"publicationDate":"2012-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137646444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"‘First, do no harm’: patient safety as the theme of this issue","authors":"Denise Thomson, Joan Robinson","doi":"10.1002/ebch.1888","DOIUrl":"10.1002/ebch.1888","url":null,"abstract":"","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"7 6","pages":"1793-1795"},"PeriodicalIF":0.0,"publicationDate":"2012-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74874337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}