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Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review) 为两岁以下儿童的健康和营养用多种微量营养素粉末家庭强化食品(审查)
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1895
Luz Maria De-Regil, Parminder S Suchdev, Gunn E Vist, Silke Walleser, Juan Pablo Peña-Rosas

Background

Vitamin and mineral deficiencies, particularly those of iron, vitamin A and zinc, affect more than two billion people worldwide. Young children are highly vulnerable because of rapid growth and inadequate dietary practices. Micronutrient powders (MNP) are single-dose packets containing multiple vitamins and minerals in powder form that can be sprinkled onto any semi-solid food.The use of MNP for home or point-of-use fortification of complementary foods has been proposed as an intervention for improving micronutrient intake in children under two years of age.

Objectives

To assess the effects and safety of home (point-of-use) fortification of foods with multiple micronutrient powders on nutritional, health and developmental outcomes in children under two years of age.

Search methods

We searched the following databases in February 2011: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (1948 to week 2 February 2011), EMBASE (1980 to Week 6 2011), CINAHL (1937 to current), CPCI-S (1990 to 19 February 2011), Science Citation Index (1970 to 19 February 2011), African Index Medicus (searched 23 February 2011), POPLINE (searched 21 February 2011), ClinicalTrials.gov (searched 23 February 2011), mRCT (searched 23 February 2011), and World Health Organization International Clinical Trials Registry Platform (ICTRP) (searched 23 February 2011). We also contacted relevant organisations (25 January 2011) for the identification of ongoing and unpublished studies.

Selection criteria

We included randomised and quasi-randomised trials with either individual or cluster randomisation. Participants were children under the age of two years at the time of intervention, with no specific health problems. The intervention was consumption of food fortified at the point of use with multiple micronutrient powders formulated with at least iron, zinc and vitamin A compared with placebo, no intervention or the use of iron containing supplements, which is the standard practice.

Data collection and analysis

Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies and assessed the risk of bias of the included studies.

Main results

We included eight trials

维生素和矿物质缺乏，特别是铁、维生素A和锌的缺乏，影响着全世界20多亿人。幼儿由于生长迅速和不适当的饮食习惯而极易受到伤害。微量营养素粉末(MNP)是一种单剂量的粉末，含有多种维生素和矿物质，可以撒在任何半固体食物上。已建议将MNP用于家庭或使用点辅食强化，作为改善两岁以下儿童微量营养素摄入量的干预措施。目的评估家庭(使用点)强化含有多种微量营养素粉末的食品对两岁以下儿童的营养、健康和发育结果的影响和安全性。我们于2011年2月检索了以下数据库:Cochrane中央对照试验登记(Central) (Cochrane图书馆)、MEDLINE(1948年至2011年2月2日)、EMBASE(1980年至2011年6周)、CINAHL(1937年至今)、CPCI-S(1990年至2011年2月19日)、Science Citation Index(1970年至2011年2月19日)、African Index Medicus(2011年2月23日检索)、POPLINE(2011年2月21日检索)、ClinicalTrials.gov(2011年2月23日检索)、mRCT(2011年2月23日检索)、和世界卫生组织国际临床试验注册平台(ICTRP)(2011年2月23日检索)。我们还联系了相关组织(2011年1月25日)，以确定正在进行和未发表的研究。我们纳入了随机和准随机试验，可采用个体随机或集群随机。参与者是在干预时两岁以下的儿童，没有具体的健康问题。干预措施是食用在使用时添加了至少含有铁，锌和维生素A的多种微量营养素粉末的食物，与安慰剂相比，不进行干预或使用含铁补充剂，这是标准做法。资料收集和分析两位综述作者根据纳入标准独立评估研究的合格性，从纳入研究中提取数据并评估纳入研究的偏倚风险。我们纳入了在亚洲、非洲和加勒比低收入国家进行的8项试验(3748名参与者)，在这些国家，贫血是一个公共卫生问题。干预持续了2到12个月，粉末配方含有5到15种营养素。六项试验比较了MNP与不干预或安慰剂的使用，另外两项试验比较了MNP与每日铁滴剂的使用。大多数纳入的试验被评估为低偏倚风险。家庭强化MNP可减少31%的贫血(6项试验，RR 0.69;95% CI 0.60 ~ 0.78)和缺铁51%(4项试验，RR 0.49;(95% CI 0.35 ~ 0.67)，与不干预或安慰剂相比，但我们没有发现对生长的影响。与每日补铁相比，使用MNP对贫血产生相似的结果(一项试验，RR 0.89;95% CI 0.58 - 1.39)和血红蛋白浓度(两项试验，MD -2.36 g/L;95% CI -10.30 ~ 5.58);然而，由于数据量有限，这些结果应谨慎解释。试验中没有死亡报告，关于副作用和发病率(包括疟疾)的资料很少。在贫血和疟疾流行率不同的环境中生活的6至23个月的婴幼儿中，MNP的使用似乎是有效的，无论干预是持续2个月、6个月还是12个月，也无论接受者是男性还是女性。作者的结论:家庭强化含有多种微量营养素粉末的食物是减少6个月至23个月大的儿童贫血和缺铁的有效干预措施。提供MNP优于不干预或安慰剂，可能与常用的每日补铁相当。这种干预作为儿童生存策略或对发展结果的益处尚不清楚。缺乏对疟疾结果的影响的数据，需要进一步调查发病率结果。 含有多种营养素的微量营养素粉末被广泛接受，但依从性是可变的，在某些情况下与接受以滴剂或糖浆形式的标准铁补充剂的婴儿和幼儿所取得的效果相当。在食用辅食之前立即使用维生素和矿物质混合粉来强化辅食，改善两岁以下儿童的健康和营养全世界大约有一半的婴儿和两岁以下儿童缺乏维生素和矿物质，特别是缺乏铁、维生素a和锌。建议纯母乳喂养至6个月，并继续母乳喂养至少两年，以保持儿童的充分健康和营养。6个月后，婴儿开始接受半固体食物，但维生素和矿物质的数量可能不足以满足成长中的婴儿的所有需求。微量营养素粉末(MNP)是单剂量的粉末包，含有铁、维生素A、锌和其他维生素和矿物质，可以洒在家中或任何其他使用地点的任何半固体食物上，以增加婴儿在此期间饮食中必需营养素的含量。这是在不改变婴儿日常饮食的情况下完成的。本综述包括8项高质量试验，涉及来自亚洲、非洲和加勒比低收入国家的3748名婴幼儿。我们发现，含有5至15种维生素和矿物质的各种MNP配方已被给予2至12个月大的婴儿和6至23个月大的幼儿。在家庭强化食品中使用至少含有铁、锌和维生素A的MNP，可以降低两岁以下儿童患贫血和缺铁的风险。研究没有发现对生长有任何影响。虽然这种创新干预的可接受性很高，但通常推荐的铁滴剂或糖浆没有额外的益处，然而很少有研究比较这些不同的干预措施。试验中没有死亡报告，关于副作用和发病率(包括疟疾)的资料很少。MNP的使用对6至23个月大的男女婴儿和幼儿有益，无论他们是否生活在不同贫血和疟疾背景的环境中，也无论干预是提供2个月、6个月还是12个月。最适当的使用安排(每日或间歇性)、适当的维生素和矿物质组成的粉末混合物以及如何在公共卫生方案中有效地提供这种干预措施，以解决多种微量营养素缺乏症，目前仍不清楚。
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引用次数: 212
Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants Cochrane综述:新生儿髋关节发育不良的筛查方案
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1891
Damon Shorter, Timothy Hong, David A Osborn

Background

Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.

Objectives

To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.

Search methods

Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.

Selection criteria

Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.

Data collection and analysis

Three independent review authors assessed study eligibility and quality, and extracted data.

Main results

No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.

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.

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.

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.

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.

One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significa

背景:未纠正的发育性髋关节发育不良(DDH)与步态异常、慢性疼痛和退行性关节炎等长期发病率相关。目的探讨不同DDH筛查方案对晚期先天性髋关节脱位发生率的影响。检索方法在CENTRAL (The Cochrane Library)、MEDLINE和EMBASE(2011年1月)中进行检索，并辅以临床试验注册、会议记录、交叉参考文献和联系专家线人的检索。选择标准:比较DDH筛查方案有效性的随机、准随机或聚类试验。数据收集和分析三位独立的综述作者评估了研究的资格和质量，并提取了数据。没有研究检查筛查(临床和/或超声)和早期治疗与不筛查和晚期治疗的效果。一项研究报道，与单独的临床检查相比，普遍超声检查并没有导致晚期诊断的DDH或手术的显著减少，但与治疗的显著增加有关。一项研究报道，与单独的临床检查相比，靶向超声并没有导致晚期诊断DDH或手术的显著减少，治愈率也没有显著差异。两项研究的荟萃分析发现，与靶向超声相比，通用超声并没有显著减少晚期诊断的DDH或手术。报告对治愈率影响的研究之间存在异质性。两项研究的荟萃分析发现，对于髋关节不稳定(但未脱位)的婴儿，延迟超声和靶向夹板与立即夹板相比，在晚期诊断的DDH发生率上没有显著差异。两项研究都报道了使用延迟超声和靶向夹板治疗的显著减少。一项研究报道，对患有轻度髋关节发育不良的婴儿，超声检查延迟超声和靶向夹板与立即夹板相比，晚期诊断的DDH无显著差异，但治疗显著减少。两组婴儿均未接受手术治疗。作者的结论没有足够的证据给出明确的实践建议。有不一致的证据表明，与单独使用靶向超声或临床检查相比，普遍超声导致治疗显著增加。两种超声策略都没有被证明可以改善临床结果，包括晚期诊断的DDH和手术。这些研究基本上不足以发现晚期发现的DDH或手术的罕见事件的显著差异。对于髋关节不稳定或轻度发育不良的婴儿，使用延迟超声和有针对性的夹板可以减少治疗，而不会显著增加晚期诊断的DDH或手术的发生率。新生儿髋关节脱位或畸形的筛查方法髋关节为球窝关节。新生儿的髋关节可能不在髋臼内(脱臼)或髋关节形状不正确(发育不良)。髋发育不良的危险因素包括有类似问题的家族史和女婴采用臀位分娩。大多数新生儿的髋部在出生后和婴儿期都会进行临床检查，以确定它们是否稳定、不稳定或脱位。髋关节发育不良的筛查可以避免晚期治疗的需要，后者与长期髋关节畸形、步态障碍和关节炎有关。然而，早期筛查可以增加治疗。由于血液供应受损(缺血性坏死)而对髋关节造成损害，治疗可能会变得复杂。本综述没有发现比较早期筛查与不筛查髋关节问题的收益和成本的研究。比较在临床检查中加入超声的研究报告称，当对所有婴儿进行超声检查时，治疗率增加，但晚期发现的发育不良或手术率没有显著差异。
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引用次数: 168
Commentary on ‘Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age’ 关于“为两岁以下儿童的健康和营养在食品中添加多种微量营养素粉末”的评论
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1896
Marzia Lazzerini

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: De-Regil L, Suchdev PS, Vist GE, Walleser S, Pena-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. N.: CD008959. DOI: 10.1002/14651858.CD008959.pub2. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

这是对发表在本期《EBCH》上的Cochrane综述的评论，最初以De-Regil L, Suchdev PS, Vist GE, Walleser S, Pena-Rosas JP发表。为促进两岁以下儿童的健康和营养，家庭强化含有多种微量营养素粉末的食品。《Cochrane数据库系统评价》2011年第9期。艺术。N: CD008959。cd008959.pub2 DOI: 10.1002/14651858.。版权所有©2013科克伦协作网。John Wiley &出版;儿子,有限公司科克伦协作组
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引用次数: 8
Cochrane Review: Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants Cochrane综述:预防性光疗预防早产儿或低出生体重儿黄疸
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1898
Charles I Okwundu, Christy AN Okoromah, Prakeshkumar S Shah

Background

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.

Objectives

To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g).

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 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).

Selection criteria

Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants.

Data collection and analysis

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.

Main results

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

背景低出生体重和早产儿是可导致胆红素脑病的夸张高胆红素血症和黄疸的主要风险。光疗是新生儿高胆红素血症最常见的治疗方法，如果预防性地开始，光疗可以最有效地预防高胆红素血症的后遗症。目的评价预防性光疗治疗早产儿的疗效和安全性。37周孕龄)或低出生体重儿(出生体重<我们于2011年3月31日检索了Cochrane中央对照试验注册库(Central, the Cochrane Library，第3期)，MEDLINE(1950年至2011年3月31日)，EMBASE(1980年至2011年3月31日)和CINAHL(1982年至2011年3月31日)。评估预防性光疗对早产儿或低出生体重儿的效果的随机对照试验或准随机对照研究。数据收集和分析两位作者独立地从已发表的文章中获取数据。我们对结果进行了固定效应荟萃分析:换血率、脑瘫或其他神经发育障碍、血清胆红素峰值水平和全因死亡率。主要结果纳入9项研究，共3449名受试者。在一项自由输血标准的研究中，交换输血率降低(风险比(RR) 0.20;95%可信区间(CI) 0.13至0.31)，但在其他两项最新的严格标准研究中没有(典型RR 0.66;95% CI 0.19 - 2.28)。两组脑瘫发生率比较差异无统计学意义(典型RR 0.96;95% CI 0.50 ~ 1.85;两项研究，756名参与者)。然而，一项关于神经发育障碍(包括脑瘫在内的综合结果)的大型研究发现，预防性光疗的神经发育障碍发生率略低(RR 0.85;95% CI 0.74 ~ 0.99;1804名参与者)。预防性光疗组胆红素峰值较低(平均差值(MD) -2.73;95% CI -2.89 ~ -2.57;6项研究，2319名参与者)和较少的新生儿出现峰值未结合血清胆红素水平>10 mg/dl(典型RR 0.27;95% CI 0.22 ~ 0.33;3项研究，1090名参与者)或峰值非结合血清胆红素水平>15 mg/dl(典型RR 0.13;95% CI 0.07 ~ 0.23;四项研究，1116名参与者)。两组患者全因死亡率差异无统计学意义(典型RR 1.08;95% CI 0.93 ~ 1.26;4项研究，3044名参与者)。作者的结论:预防性光疗有助于维持较低的血清胆红素浓度，并可能对交换输血率和神经发育障碍的风险有影响。然而，需要进一步精心设计的研究来确定预防性光疗对包括神经发育结果在内的长期预后的有效性和安全性。预防性光疗预防早产儿及极低出生体重儿黄疸37周孕龄)或低出生体重(LBW;出生体重<与足月或正常出生体重的婴儿相比，体重2500克的婴儿患黄疸的风险更大。这可能令人担忧，因为黄疸(由血清未结合胆红素高水平引起)可能导致永久性脑损伤和/或死亡。在这篇综述中，我们评估了预防性光疗预防早产儿或低体重儿黄疸的有效性和安全性。共纳入9项临床试验，涉及3449名婴儿。研究结果表明，对于早产或低出生体重婴儿，在出生后不久(36小时内)进行光疗可能会防止血清胆红素达到需要交换输血的水平，并可能降低大脑和中枢神经系统发育受损的风险。然而，需要进一步精心设计的研究来评估预防性光疗对大脑和中枢神经系统发育以及其他长期结果的影响。
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引用次数: 18
Erratum: The Cochrane Library and treatment of patent ductus arteriosus: an overview of reviews 勘误:Cochrane图书馆与动脉导管未闭的治疗:综述
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1900
J. Harrold, T. Lacaze-Masmonteil, L. Hartling, M. Oleszczuk

The above article was published in EBCH 7:1185–1195 (2012). DOI:10.1002/ebch.1855 Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

上述文章发表于EBCH:1185 - 1195(2012)。DOI: 10.1002 / ebch.1855版权所有©2013科克伦协作网。John Wiley &出版;儿子,有限公司科克伦协作组
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引用次数: 0
Commentary on ‘Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants’ 《预防性光疗预防早产儿和低出生体重儿黄疸》综述
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-09 DOI: 10.1002/ebch.1899
Mark W. Davies
This is a commentary on a Cochrane review, published in this issue of EBCH, first published as:Okwundu CI, Okoromah CAN, Shah PS. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD007966. DOI: 10.1002/14651858.CD007966.pub2. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
这是对发表在本期《EBCH》上的Cochrane综述的评论，首次发表的标题为:Okwundu CI, Okoromah CAN, Shah PS.预防性光疗预防早产儿或低出生体重儿黄疸。Cochrane Database of Systematic Reviews 2012，第1期。艺术。不。: CD007966。cd007966.pub2 DOI: 10.1002/14651858.。版权所有©2013科克伦协作网。John Wiley &出版;儿子,有限公司科克伦协作组
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引用次数: 1
Cochrane Review: Osmotic and stimulant laxatives for the management of childhood constipation (Review) Cochrane综述:渗透性和刺激性泻药治疗儿童便秘(综述)
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-01-03 DOI: 10.1002/ebch.1893
Morris Gordon, Khimara Naidoo, Anthony K Akobeng, Adrian G Thomas

Background

Constipation within childhood is an extremely common problem. Despite the widespread use of osmotic and stimulant laxatives by health professionals to manage constipation in children, there has been a long standing paucity of high quality evidence to support this practice.

Objectives

We set out to evaluate the efficacy and safety of osmotic and stimulant laxatives used to treat functional childhood constipation.

Search methods

The search (inception to May 7, 2012) was standardised and not limited by language and included electronic searching (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register), reference searching of all included studies, personal contacts and drug companies.

Selection criteria

Randomised controlled trials (RCTs) which compared osmotic or stimulant laxatives with either placebo or another intervention, with patients aged 0 to 18 years old were considered for inclusion. The primary outcome was frequency of defecation. Secondary endpoints included faecal incontinence, disimpaction, need for additional therapies and adverse events.

Data collection and analysis

Relevant papers were identified and the authors independently assessed the eligibility of trials. Methodological quality was assessed using the Cochrane risk of bias tool.The Cochrane RevMan software was used for analyses. Patients with final missing outcomes were assumed to have relapsed. For continuous outcomes we calculated a mean difference (MD) and 95% confidence interval (CI) using a fixed-effect model. For dichotomous outcomes we calculated an odds ratio (OR) and 95% confidence intervals (95% CI) using a fixed-effect model. The chi square and I2 statistics were used to assess statistical heterogeneity. A random-effects model was used in situations of unexplained heterogeneity

Main results

Eighteen RCTs (1643 patients) were included in the review. Nine studies were judged to be at high risk of bias due to lack of blinding, incomplete outcome data and selective reporting. Meta-analysis of two studies (101 patients) comparing polyethylene glycol (PEG) with placebo showed a significantly increased number of stools per week with PEG (MD 2.61 stools pe

GRADE分析表明，由于数据稀疏、不一致(异质性)和合并分析中研究的高偏倚风险，主要结局(每周大便次数)的总体证据质量较低或非常低。因此，由于质量和方法学方面的考虑，以及临床异质性和随访时间短，合并分析的结果应谨慎解释。然而，PEG似乎是安全且耐受性良好的。也有证据表明液体石蜡(矿物油)的有效性，它也有良好的耐受性。虽然缺乏安慰剂对照研究，但没有证据表明乳果糖比其他药物更有优势。长期使用PEG治疗儿童便秘，以及液体石蜡的作用有待进一步研究。儿童便秘的治疗通便药儿童便秘是一个非常普遍的问题。尽管卫生专业人员广泛使用泻药来治疗儿童便秘，但长期以来缺乏证据支持这种做法。本综述包括18项研究，共1643名患者，将9种不同的药物与安慰剂(非活性药物)或彼此进行比较。本综述的结果表明，聚乙二醇制剂可能会增加便秘儿童的排便频率。聚乙二醇通常是安全的，与其他药物相比，其轻微副作用的发生率较低。常见的副作用包括胀气、腹痛、恶心、腹泻和头痛。也有一些证据表明，液体石蜡(矿物油)增加了便秘儿童的排便频率，也是安全的。液体石蜡常见的副作用包括腹痛、腹胀和水样便。虽然没有将乳果糖与安慰剂进行比较的试验，但没有证据表明乳果糖优于其他研究的药物。由于纳入研究的方法学质量和统计问题，应谨慎解释综述的结果。此外，这些研究的持续时间相对较短，因此很难评估这些药物治疗儿童便秘的长期有效性。鉴于这一问题在儿童中往往是慢性的，长期有效是很重要的。
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引用次数: 50
Commentary on ‘Non-pharmacological management of infant and young child procedural pain’ with a response from the review authors 对“婴幼儿程序性疼痛的非药物治疗”的评论以及综述作者的回应
Evidence-based child health : a Cochrane review journal
Pub Date : 2012-11-06 DOI: 10.1002/ebch.1884
Patrick J. McGrath, Jill Chorney, Rebecca Pillai Riddell, Nicole Racine, Kara Turcotte, Lindsay Uman, Diana Lisi

These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern A. Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD006275. DOI: 10.1002/14651858. CD006275.pub2.

Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

以下是发表在本期《EBCH》上的一篇Cochrane综述的评论:Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern a .婴幼儿程序性疼痛的非药物管理。《Cochrane数据库系统评价》2011年第10期。艺术。不。: CD006275。DOI: 10.1002 / 14651858。CD006275.pub2。关于Cochrane综述的更多信息可以在本期EBCH的摘要文章中找到。版权所有©2012科克伦协作网。John Wiley &出版;儿子,有限公司科克伦协作组
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引用次数: 3
Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants Cochrane综述:益生菌预防早产儿坏死性小肠结肠炎
Evidence-based child health : a Cochrane review journal
Pub Date : 2012-11-06 DOI: 10.1002/ebch.1881
Khalid AlFaleh, Jasim Anabrees, Dirk Bassler, Turki Al-Kharfi

Background

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.

Objectives

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.

Search methods

For this update, searches were made of MEDLINE (1966 to October 2010), EMBASE (1980 to October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2010), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010).

Selection criteria

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.

Data collection and analysis

Standard methods of the Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials, data collection and analysis.

Main results

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

背景:坏死性小肠结肠炎(NEC)和院内败血症与早产儿发病率和死亡率增加有关。预防性肠内益生菌(活微生物补充剂)可以通过防止细菌在粘膜上的迁移、竞争性排除致病菌和增强宿主的免疫反应，在减少NEC和相关发病率方面发挥作用。目的比较预防性肠内益生菌与安慰剂或不治疗预防早产儿严重NEC和/或败血症的疗效和安全性。检索方法:检索MEDLINE(1966年至2010年10月)、EMBASE(1980年至2010年10月)、Cochrane中央对照试验登记册(Central, the Cochrane Library，第2期，2010年)和儿科研究学会年会摘要(1995年至2010年)。选择标准:仅纳入早产儿的随机或准随机对照试验;37周孕龄和/或<2,500 g出生体重。如果试验涉及肠内给药任何活微生物补充剂(益生菌)并测量至少一个预先指定的临床结果，则纳入试验。采用Cochrane协作网及其新生儿组的标准方法评估试验、数据收集和分析的方法学质量。主要结果纳入16项符合条件的试验，随机选取2842名婴儿。纳入的试验在入组标准(即出生体重和胎龄)、对照组NEC基线风险、时间、剂量、益生菌制剂和喂养方案方面变化很大。关于极低出生体重婴儿(ELBW)的数据无法推断。在试验数据的荟萃分析中，补充肠道益生菌可显著降低严重NEC (II期或以上)的发生率(典型RR 0.35, 95% CI 0.24至0.52)和死亡率(典型RR 0.40, 95% CI 0.27至0.60)。没有证据表明院内败血症显著减少(典型RR 0.90, 95% CI 0.76 ~ 1.07)。纳入的试验报告益生菌补充菌没有全身性感染。NEC、死亡率和败血症的异质性统计检验不显著。作者的结论肠内补充益生菌可以预防早产儿严重NEC和全因死亡。我们对现有证据的最新回顾支持实践的改变。需要更多的研究来评估低体重婴儿的疗效，并评估最有效的配方和剂量。摘要益生菌预防早产儿坏死性小肠结肠炎(坏死性小肠结肠炎)是一种严重的疾病，在生命的最初几周内影响早产儿的肠道。虽然NEC的病因尚不完全清楚，但母乳喂养和细菌生长起了一定作用。益生菌(含有潜在有益细菌或酵母的膳食补充剂)已被用于预防NEC。我们对研究的回顾发现，使用益生菌可以减少出生体重小于1500克的早产儿NEC的发生和死亡。关于对出生时体重小于1000克的高危婴儿的益处和潜在不良影响的数据不足。
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引用次数: 0
The Cochrane Library and safety of regular long-acting beta2- agonists in children with asthma: an overview of reviews Cochrane图书馆和常规长效β 2-受体激动剂在儿童哮喘中的安全性:综述
Evidence-based child health : a Cochrane review journal
Pub Date : 2012-11-06 DOI: 10.1002/ebch.1889
Christopher J. Cates, Elizabeth Stovold, Susan Wieland, Marta Oleszczuk, Denise Thomson, Lorne Becker

Background: 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 beta2-agonists in children with asthma is unclear. Current guidelines recommend that regular long-acting beta2-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.

Objectives: We used the paediatric trial results from Cochrane systematic reviews to assess the safety of regular long-acting beta2-agonist therapy, either as monotherapy or as combination therapy with inhaled corticosteroids, in children with asthma.

Methods: 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.

Results: 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, I2 = 0%, five trials, N = 1335] and smaller nonsignificant increases in odds for salmeterol monotherapy (OR = 1.30; 95% CI = 0.82–2.05, I2 = 17%, five trials, N = 1333), formoterol combination therapy (OR = 1.60; 95% CI = 0.80–3.28, I2

背景:两项针对成人哮喘患者常规沙美特罗单药治疗的大型随机试验发现，沙美特罗与安慰剂或常规沙丁胺醇相比，哮喘相关死亡率风险增加。在儿童中没有类似的大型试验，沙美特罗或其他长效β 2激动剂单药治疗哮喘儿童的安全性尚不清楚。目前的指南建议，常规长效β -受体激动剂治疗应仅与常规吸入皮质类固醇联合使用。然而，联合治疗儿童哮喘的安全性也尚不清楚。目的:我们使用Cochrane系统评价的儿科试验结果来评估常规长效β -受体激动剂治疗的安全性，无论是单药治疗还是与吸入皮质类固醇联合治疗，都适用于哮喘儿童。方法:我们于2012年5月检索Cochrane系统评价数据库，检索与常规福莫特罗和沙美特罗安全性相关的Cochrane评价，并对每一篇Cochrane评价的试验进行更新检索。我们使用比值比(or)来总结从比较常规福莫特罗或常规沙美特罗作为单药治疗与安慰剂，然后与吸入皮质类固醇联合治疗与相同剂量吸入皮质类固醇联合治疗的试验中得出的直接随机安全性证据。我们通过测试单药治疗和联合治疗的累积or值之间的差异，间接比较了单药治疗和联合治疗的安全性。我们使用ORs来总结比较常规福莫特罗和常规沙美特罗的试验中关于安全性的直接随机证据。我们还通过计算福莫特罗和沙美特罗评估试验汇总结果的OR间接比较了常规福莫特罗和常规沙美特罗的安全性，然后通过计算这种比较的总OR将直接和间接证据结合起来。结果:我们确定了四篇Cochrane综述，检查了常规福莫特罗或沙美特罗作为单药或联合治疗的安全性。综述包括19项儿童试验，我们发现另外两项关于沙美特罗联合治疗的研究，共计21项试验，涉及7318名儿童。我们确定了两篇Cochrane综述，比较了福莫特罗和沙美特罗的安全性，其中包括156名儿童的单一试验。我们发现，接受福莫特罗单药治疗的儿童发生非致命性严重不良事件的几率在统计学上显著增加[OR = 2.48;95%可信区间(CI) = 1.27-4.83, I2 = 0%， 5项试验，N = 1335)，沙美特罗单药治疗的风险增加较小(OR = 1.30;95% CI = 0.82-2.05, I2 = 17%， 5项试验，N = 1333)，福莫特罗联合治疗(OR = 1.60;95% CI = 0.80-3.28, I2 = 32%， 7项试验，N = 2788)和沙美特罗联合治疗(OR = 1.20;95% CI = 0.37-2.91, I2 = 0%， 5项试验，N = 1862)。单药治疗严重不良事件的总OR值(OR = 1.60;95% CI = 1.10-2.33, 10项试验，N = 2668)和联合治疗(OR = 1.50;95% CI = 0.82-2.75, 12项试验，N = 4650)。然而，在6个月的单药治疗中，每1000名儿童中发生任何原因的严重不良事件的儿童绝对增加了21名(95% CI = 4-45)，而在3个月的联合治疗中，每1000名儿童中发生严重不良事件的儿童绝对增加了3名(95% CI = 1少12多)。比较常规沙美特罗与常规福美特罗安全性的证据有限，即使将直接和间接证据结合起来，围绕严重不良事件影响的CI也太宽，无法判断福美特罗与沙美特罗的相对安全性是否存在差异(OR = 1.26;95% ci = 0.37-4.32)。在所有试验中只有一名儿童死亡，因此无法评估对死亡率的影响。作者的结论:虽然常规联合治疗可能比单一治疗对哮喘儿童更安全，但常规联合治疗福莫特罗或沙美特罗对儿童的安全性仍不确定，特别是在死亡率方面。福莫特罗和沙美特罗的相对安全性也不清楚。目前正在进行的大型监测研究可能会阐明儿童和青少年哮喘联合治疗的风险。版权所有©2012科克伦协作网。John Wiley &出版;儿子,有限公司科克伦协作组
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