Pediatrics
Practical Way to Use Supraglottic Airway Device
We read a review of case reports published in Current Pediatric Reviews 2024 about the use of I-gel® in neonatal complicated intubation and we decided to write a commentary on the benefits and limitations of using supraglottic airways in neonatal age with a specific focus on I-gel. The use of supraglottic airway devices in neonatal ages is limited to particular conditions but further research is showing the utility of these devices as the first choice in neonatal resuscitation or airway stabilization. Our commentary highlights the broader practical applications of I-gel and reinforces its role as a valuable tool in neonatal resuscitation.
Mapping Systematic Reviews on the Management of Dental Caries in Primary Teeth: A Meta-research
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.
Cardiology Consult for the General Pediatrician after Cardiac Manifestations from a SARS-CoV-2 Infection
The novel Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus created a need for evidence-based guidelines for the evaluation management and follow-up after infection. Data have become rapidly available creating a challenge for medical providers to stay abreast of the ever-evolving recommendations. This article written collaboratively by pediatric cardiovascular experts pediatricians and sports medicine specialists is focused on SARS-CoV- 2-related pediatric cardiac manifestations. It aims to provide a systematic review of high-yield literature related to all cardiovascular entities as a tool for primary pediatric clinicians to utilize as they consider the cardiac consequences of acute SARS-CoV-2 infection MIS-C vaccine-related myocarditis return-to-play and long COVID-19 syndrome.
A Quantitative Review of Un-licensed and Off-label Medicines Use in Children Aged 0-2 Years in the Private Sector in South Africa: Extent, Challenges, and Implications
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 7th entry from 91973 total entries resulting in a final sample size of 13139. 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 13139 prescribed medicines 40% (5246) were off-label or unlicensed and 60% (7893) were on-label. Of the off-label/unlicensed medicines 16.85% (2214) were unlicensed and 23.08% (3032) 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.
The Association between Prenatal Antibiotic Use and the Risk of Autism Spectrum Disorders among Children: An Updated Meta-Analysis
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 6264831 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.
Effects of Breast Milk or Supplemented Formula Milk on Fecal Metabolomic Profile
Breast milk (BM) is the best option for the nutritional needs of an infant. In situations where breastfeeding is contraindicated donor human milk and formula milk (FM) are suggested as alternatives. This study highlights findings from two studies that evaluated how different dietary patterns (standard formula post-biotic fermented formula and breast milk) affected the intestinal microbiota and metabolome of late preterm and full-term infants. The metabolome of late preterm newborns showed a higher presence of metabolites-such as azelaic acid N-acetylglucosamine-6- sulfate and 13(S)-hydroperoxylinolenic acid-in those fed postbiotic-fermented formula similar to breastfed full-term newborns. The fecal metabolites of breast milk and substitute feeding systems are comparable in these preliminary studies confirming the effectiveness of formula preparations as breast milk substitutes. Furthermore newborns fed with postbiotic-supplemented formula or breast milk had several similarities in fecal metabolites. The addition of postbiotics to formula milk appears to be more efficient than standard formula milk and is considered a better alternative to breast milk.