Current Pediatric Reviews - Current Issue

Systematic reviews (SRs) represent the most robust source of evidence for informing decision-making. While there are rigorous protocols for properly conducting SRs, sometimes the methodological biases in the primary studies are accounted for in the conclusions of the SRs.

This study aimed to map the evidence regarding the management of caries lesions in primary teeth.

Two reviewers conducted a systematic search up to March 2024 in electronic databases. Any SR concerning the management of caries lesions in primary teeth was considered eligible.

About 162 SRs were included. Among these, 80 focused on restorative treatments, 64 on endodontic treatments, and 18 on non-invasive treatments. Only 42.6% presented a study registration protocol. The majority (67.9%) performed a meta-analysis, while a minority exclusively carried out qualitative data analysis. Despite 92.6% of the SRs evaluating the methodological quality or risk of bias of the primary studies using some tool, only 24% assessed the certainty of evidence using the GRADE approach, resulting in classifications ranging from very low to moderate.

There is a limited adherence to study registration protocols, indicating a need for improvements in this practice. Additionally, among the few SRs that used the GRADE approach, the majority demonstrated levels of very low to moderate certainty.

The global lack of suitable formulations for children leads to off-label and unlicensed medicine use, posing significant risks of adverse effects. Understanding this usage on a national level can help guide interventions for better formulations. This study aimed to measure the prevalence of off-label and unlicensed medicines among children in South Africa's private sector.

The study used a point prevalence methodology to review medicine use in children aged 0-2 years enrolled in a selected pharmaceutical benefit management company in South Africa from January to June 2022. A sample size of 1055 prescriptions was calculated using a 90% confidence interval, 50% prevalence rate, and 5% error margin. A systematic random sampling approach selected every 7^th entry from 91,973 total entries, resulting in a final sample size of 13,139. Data included patient age, number and characteristics of medicines, quantity, and indications. Descriptive statistics analysed and reported the prevalence of unlicensed and off-label medicine use.

Among the 13,139 prescribed medicines, 40% (5,246) were off-label or unlicensed, and 60% (7,893) were on-label. Of the off-label/unlicensed medicines, 16.85% (2,214) were unlicensed, and 23.08% (3,032) were off-label. Methylprednisolone was the top off-label medicine, probiotics were the top unlicensed, and the ICD10 code Z76.9 was the top diagnosis.

The study found that 40% of children aged 0-2 years were prescribed unlicensed or off-label medicines in South Africa's private healthcare sector between January and June 2022. This suggests a widespread practice of off-label or unlicensed prescriptions in paediatric treatment in the South African private sector.

Studies on prenatal antibiotic use and Autism Spectrum Disorder (ASD) risk have yielded inconsistent results.

This study aimed to resolve these discrepancies by conducting a meta-analysis on the relationship between prenatal antibiotic use and ASD in children.

A comprehensive search was conducted in four main databases: Medline (OVID) PubMed, Scopus, and Web of Science, up to August 1, 2024. The analysis employed random-effect models to estimate effect sizes, including hazard ratios (HR) and odds ratios (OR). Publication bias was assessed using Begg's test and Egger's regression test. Subgroup analyses explored variations in the association based on the trimester of pregnancy. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).

In this meta-analysis, which included twelve studies with a total population of 6,264,831, prenatal antibiotic use was associated with an increased risk of Autism Spectrum Disorder (ASD). The estimated HR for this risk was 1.08 (95% CI: 1.05, 1.12), and the OR was 1.16 (95% CI: 1.09, 1.23), with no detected heterogeneity among studies. The analysis found no publication bias. Significant associations were observed for each trimester: first trimester (HR: 1.11; 95% CI: 1.04, 1.18), second trimester (HR: 1.10; 95% CI: 1.06, 1.14), and third trimester (HR: 1.09; 95% CI: 1.01, 1.18).

The analysis showed that prenatal antibiotic use is a risk factor for ASD. Prenatal antibiotic use was associated with an increase in the risk of ASD across all trimesters of pregnancy. Future research should focus on elucidating the mechanisms underlying this association by examining the effects of specific antibiotic classes, dosages, and timing during critical developmental periods. Longitudinal studies with comprehensive control for confounding factors are essential for strengthening causal inferences and guiding clinical recommendations regarding antibiotic use during pregnancy.

CRD42024574755.