Archives of Disease in Childhood最新文献

Background: Our objective was to update a 2015 systematic review of the literature which identified associations between chronic health conditions before age 18 years and economic outcomes in adulthood.

Methods: The following databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, EconLit, EBM Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Web of Science Core collection, ERIC and British Education Index. Eligible papers were assessed for quality.

Results: There were 24 eligible studies. Childhood illnesses were grouped into chronic mental health (n=15), chronic health conditions (n=7) and neurodiverse conditions (n=6); some papers reported outcomes for more than one group. For chronic mental health conditions in childhood, for example anxiety and depression, meta-analysis found increased risk in adulthood for unemployment (OR 2.1 (95% CI 1.5, 2.9)), not being in employment, education or training (NEET) (OR 1.6 (95% CI 1.2, 2.0)) and for being in receipt of benefits (OR 2.6 (95% CI 1.7, 3.9)). Chronic physical health conditions in childhood were associated with adverse economic outcomes in adulthood in five of the seven studies. Only one of the three studies showed a risk of being NEET. Attention-deficit hyperactivity disorder (ADHD) in childhood was associated with increased risk of adult unemployment in three of five studies, increased risk of receiving benefits in three of four studies and with reduced income in the two studies where it was reported.

Conclusions: Chronic mental illness and ADHD in childhood are associated with adverse economic outcomes in adulthood in most populations identified. Future research should determine whether early identification and interventions for childhood-onset mental illness and ADHD improve economic outcomes in adulthood.

Prospero registration number: CRD42023440899.

Background: The role of intravenous magnesium sulfate in asthma exacerbation is unclear.

Aims: To determine the efficacy and safety of intravenous magnesium sulfate in managing asthma exacerbation in children.

Methods: We searched MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and the Web of Science up to May 2024. We included randomised controlled trials and followed the international guidelines for conducting systematic reviews. Outcomes included morbidity, escalation of care, length of hospital stay, lung functions, adverse events, and mortality.

Results: Nine studies (total participants=473) were included. Hospitalisation rate and the need for non-invasive ventilation were less among the intravenous magnesium sulfate group (mean difference (MD)=0.70, 95% CI 0.54 to 0.90, I² 7%, n=115) and (risk ratio (RR)=0.17, 95% CI 0.15 to 0.54, p=0.003, n=143), respectively. Asthma severity scores (MD=-0.18, 95% CI -1.35 to 0.98, I² 2%, n=115), length of hospital stay (MD=-78.86, 95% CI -200.37 to 42.66, I² 99%, n=284) and the need for invasive ventilation (RR=0.35, 95% CI 0.11 to 1.17, I² 0%, n=237) were similar. There was no difference in the Paediatric Intensive Care Unit (PICU) admission rate (p=0.43 n=61). Peak expiratory flow improved in the intravenous magnesium group (p<0.001, n=20). No serious adverse events were reported.

Conclusion: We found low-certainty evidence that intravenous magnesium sulfate results in a lower hospitalisation rate and less need for non-invasive ventilation. Asthma scores, PICU admission, invasive ventilation and length of hospital stay were similar. While the evidence base is weak, the favourable safety profile suggests that intravenous magnesium sulfate can be considered a treatment for asthma exacerbations.

Prospero registration number: CRD42023405261.

Objective: Severe dengue in children may present with a hyperinflammatory phenotype resembling cytokine storm or secondary haemophagocytic lymphohistiocytosis, characterised by refractory shock, hepatic dysfunction and multiorgan failure. We evaluated the use of interleukin 1 receptor antagonist therapy (anakinra) in children with severe dengue.

Design: We conducted a retrospective study of children admitted to a tertiary paediatric intensive care unit in India between May 2021 and December 2023 with confirmed severe dengue who received anakinra. Cytokine storm was suspected based on clinical and laboratory criteria including elevated ferritin levels and hepatic dysfunction.

Intervention: Anakinra was administered intravenously and titrated according to clinical response. Adjunctive therapies included corticosteroids, intravenous immunoglobulin and plasmapheresis.

Main outcome measures: The primary outcome was survival and is summarised descriptively.

Results: Of 49 children with severe dengue, 45 met the inclusion criteria. The median age was 48 months; median ferritin level was 16 433 ng/mL; peak levels exceeded 100 000 ng/mL in four children. Anakinra was used as monotherapy in 49%, and in combination with other immunomodulators in the remainder. Overall survival was 73% (36/49); when the four children who died within 24 hours of admission were excluded, survival was 80% (36/45). Improvement in fluid requirements, ferritin levels and hepatic transaminases was noted following anakinra initiation. Mortality was 100% in those with ferritin levels >100 000 ng/mL.

Conclusions: Anakinra may represent a valuable adjunct in the management of severe dengue with hyperinflammation. Prospective, controlled studies are warranted to establish its efficacy, timing and optimal dosing.

Importance: The role of intravenous short-acting beta-2 agonist (SABA) in acute asthma in childhood is unclear.

Objectives: To assess the safety and efficacy of intravenous SABA versus placebo for acute asthma.

Data selection and extraction: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Web of Science and the Cumulative Index to Nursing and Allied Health Literature up to May 2024. We included only randomised controlled trials (RCTs) and followed the international guidelines for conducting systematic reviews. Outcomes measured were morbidity, escalation of care, length of hospital stay, adverse events, mortality and changes in lung functions.

Results: Four RCTs were included (total participants=183). Intravenous SABA group had better asthma severity scores (risk ratio (RR)=0.38, 95% CI 0.19 to 0.78, p=0.009), similar need for mechanical ventilation (RR=0.13, 95% CI 0.01 to 2.42, p=0.17), similar escalation of intravenous treatment (RR=1.51, 95% CI 0.60 to 3.82, p=0.38), shorter duration of hospital stay (hours) (mean difference (MD)=-18.68, 95% CI -36.76 to -0.61) and less duration of oxygen supplementation (days) (MD=-1.73, 95% CI -3.01 to -0.45, p=0.008). Adverse events were tachycardia, hypotension and hypokalaemia. One study reported a single participant with arrhythmia and a non-significant increase in troponin I among the intravenous SABA group.

Conclusion: This review found low-to-moderate certainty evidence that intravenous SABA would improve acute asthma severity with infrequent adverse events reported. However, this evidence is limited due to the limited number of included studies.

Prospero registration number: CRD42023405119.

Importance: Evidence regarding second-line treatment for severe asthma is limited.

Objectives: To evaluate the safety and efficacy of intravenous aminophylline, intravenous short-acting beta agonist (SABA), intravenous magnesium sulphate, intravenous ketamine or subcutaneous adrenaline as a second-line treatment for severe asthma.

Methods: We included only randomised controlled trials (RCTs) and followed the international guidelines for conducting systematic reviews. We performed a comprehensive literature search up to May 2024. Outcomes included morbidity, escalation of care, length of hospital stay, adverse events, mortality and changes in lung functions.

Results: Nine RCTs were included (total participants=546). Compared with other treatments, intravenous aminophylline showed no significant difference in the duration of hospital stay in hours, except for critically ill ventilated patients who had a shorter stay (mean difference (MD)=-12.99, 95% CI -33.13 to 7.15). The need for additional intravenous medications (RR=2.17, 95% CI 0.48 to 9.71) and asthma severity scores postinterventions (MD=0.97, 95% CI -0.91 to 2.85) was similar. More nausea and emesis were observed in the intravenous aminophylline group. The intravenous SABA group showed no difference in hospital stay (MD=-10.12, 95% CI -45.74 to 25.49) or need for ventilation (RR=0.25, 95% CI 0.03 to 2.21). There were no frequent serious adverse events. The intravenous magnesium sulphate group had a lower hospitalisation rate (RR=1.52, 95% CI 1.26 to 1.84), reduced need for additional intravenous medication (RR=6.30, 95% CI 2.62 to 15.17) and a rapid improvement in asthma severity scores (p<0.05).

Conclusion: There is low-to-very-low certainty evidence demonstrating the superiority of any intravenous second-line treatment options for acute asthma.

Prospero registration number: CRD42023405226.