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Journal of Pediatric Orthopedics Aug 2021Fractures involving the distal tibia growth plate are common in children. Injury or treatment that damages the growth plate may result in progressive angular deformity...
BACKGROUND
Fractures involving the distal tibia growth plate are common in children. Injury or treatment that damages the growth plate may result in progressive angular deformity or leg length discrepancy. There is no consensus on treatment and follow-up of these injuries. This study aims to describe which factors increase the risk of premature physeal closure (PPC).
MATERIAL AND METHODS
A systematic review and meta-analysis were performed. Altogether 395 articles were reviewed, and ultimately 12 of them were found eligible, comprising 1997 patients. The most usual type of fracture was Salter-Harris (SH) II (n=855, 49%) followed by SH III (n=296, 17%) and SH I (n=261, 15%). The risk of PPC according to number of reduction attempts, method of treatment, and residual displacement was the primary outcome.
RESULTS
The total rate of PPC was 13% (n=245). The PPC rate varied from 0.2% to 42% across the studies. Patients with SH IV fractures were most likely to develop PPC (20%), followed by those with SH II (12%) (P<0.05) and repeated (>2) reduction maneuvers were associated with a higher risk of PPC (pooled odds ratio, 8.5; 95% confidence interval, 6.3-12.17; P<0.05). Open reduction was associated with a lower risk of PPC when analyzing only displaced fractures (odds ratio, 0.63; 95% confidence interval, 0.38-0.91; P<0.05).
INTERPRETATION
This meta-analysis implies that residual displacement after reduction is the most significant factor in predicting PPC. It seems that open reduction might reduce the PPC rate among patients with dislocated fractures. In addition, there is some evidence that a higher number of reduction attempts correlates positively with the risk of PPC.
PubMed: 33843787
DOI: 10.1097/BPO.0000000000001833 -
Cureus Jan 2021The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are... (Review)
Review
The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.
PubMed: 33643731
DOI: 10.7759/cureus.12860 -
Frontiers in Pediatrics 2021There is an ongoing debate on the optimal management of patent ductus arteriosus (PDA) in preterm infants. Identifying subgroup of infants who would benefit from...
There is an ongoing debate on the optimal management of patent ductus arteriosus (PDA) in preterm infants. Identifying subgroup of infants who would benefit from pharmacological treatment might help. To investigate the modulating effect of the differences in methodological quality, the rate of open-label treatment, and patient characteristics on relevant outcome measures in randomized controlled trials (RCTs). Electronic database search between 1950 and May 2020. RCTs that assessed pharmacological treatment compared to placebo/no treatment. Data is extracted following the PRISMA guidelines. Outcome measures were failure to ductal closure, surgical ligation, incidence of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, periventricular leukomalacia, intraventricular hemorrhage (IVH) grade ≥3, retinopathy of prematurity and mortality. Forty-seven studies were eligible. The incidence of IVH grade ≥3 was lower in the treated infants compared to the placebo/no treatment (RR 0.77, 95% CI 0.64-0.94) and in the subgroups of infants with either a gestational age <28 weeks (RR 0.77, 95% CI 0.61-0.98), a birth weight <1,000 g (RR 0.77, 95% CI 0.61-0.97), or if untargeted treatment with indomethacin was started <24 h after birth (RR 0.70, 95% CI 0.54-0.90). Statistical heterogeneity caused by missing data and variable definitions of outcome parameters. Although the quality of evidence is low, this meta-analysis suggests that pharmacological treatment of PDA reduces severe IVH in extremely preterm, extremely low birth weight infants or if treatment with indomethacin was started <24 h after birth. No other beneficial effects of pharmacological treatment were found.
PubMed: 33634058
DOI: 10.3389/fped.2021.626262 -
The Cochrane Database of Systematic... Jan 2021Symptomatic patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. In these infants, prophylactic use of indomethacin, a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Symptomatic patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. In these infants, prophylactic use of indomethacin, a non-selective cyclooxygenase inhibitor, has demonstrated short-term clinical benefits. The effect of indomethacin in preterm infants with a symptomatic PDA remains unexplored.
OBJECTIVES
To determine the effectiveness and safety of indomethacin (given by any route) compared to placebo or no treatment in reducing mortality and morbidity in preterm infants with a symptomatic PDA.
SEARCH METHODS
We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 7), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 31 July 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs.
SELECTION CRITERIA
We included RCTs and quasi-RCTs that compared indomethacin (any dose, any route) versus placebo or no treatment in preterm infants.
DATA COLLECTION AND ANALYSIS
We used the standard methods of Cochrane Neonatal, with separate evaluation of trial quality and data extraction by at least two review authors. We used the GRADE approach to assess the certainty of evidence for the following outcomes: failure of PDA closure within one week of administration of the first dose of indomethacin; bronchopulmonary dysplasia (BPD) at 28 days' postnatal age and at 36 weeks' postmenstrual age; proportion of infants requiring surgical ligation or transcatheter occlusion; all-cause neonatal mortality; necrotizing enterocolitis (NEC) (≥ Bell stage 2); and mucocutaneous or gastrointestinal bleeding.
MAIN RESULTS
We included 14 RCTs (880 preterm infants). Four out of the 14 included studies were judged to have high risk of bias in one or more domains. Indomethacin administration was associated with a large reduction in failure of PDA closure within one week of administration of the first dose (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.23 to 0.38; risk difference (RD) -0.52, 95% CI -0.58 to -0.45; 10 studies, 654 infants; high-certainty evidence). There may be little to no difference in the incidence of BPD (BPD defined as supplemental oxygen need at 28 days' postnatal age: RR 1.45, 95% CI 0.60 to 3.51; 1 study, 55 infants; low-certainty evidence; BPD defined as supplemental oxygen need at 36 weeks' postmenstrual age: RR 0.80, 95% CI 0.41 to 1.55; 1 study, 92 infants; low-certainty evidence) and probably little to no difference in mortality (RR 0.78, 95% CI 0.46 to 1.33; 8 studies, 314 infants; moderate-certainty evidence) with use of indomethacin for symptomatic PDA. No differences were demonstrated in the need for surgical PDA ligation (RR 0.66, 95% CI 0.33 to 1.29; 7 studies, 275 infants; moderate-certainty evidence), in NEC (RR 1.27, 95% CI 0.36 to 4.55; 2 studies, 147 infants; low-certainty evidence), or in mucocutaneous or gastrointestinal bleeding (RR 0.33, 95% CI 0.01 to 7.58; 2 studies, 119 infants; low-certainty evidence) with use of indomethacin compared to placebo or no treatment. Certainty of evidence for BPD, surgical PDA ligation, NEC, and mucocutaneous or gastrointestinal bleeding was downgraded for very serious or serious imprecision.
AUTHORS' CONCLUSIONS
High-certainty evidence shows that indomethacin is effective in closing a symptomatic PDA compared to placebo or no treatment in preterm infants. Evidence is insufficient regarding effects of indomethacin on other clinically relevant outcomes and medication-related adverse effects.
Topics: Bias; Bronchopulmonary Dysplasia; Cause of Death; Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Gastrointestinal Hemorrhage; Humans; Incidence; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Ligation; Oxygen Inhalation Therapy; Placebos; Randomized Controlled Trials as Topic
PubMed: 33448032
DOI: 10.1002/14651858.CD013133.pub2 -
The Journal of Pediatrics Mar 2021To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate technical success and safety of percutaneous patent ductus arteriosus closure in infants ≤1.5 kg.
STUDY DESIGN
A systematic review and meta-analysis was performed. Data sources included Scopus, Web of Science, Embase, CINAHL, Cochrane, and PubMed from inception to April 2020. Publications were included if they had a clear definition of the intervention as percutaneous patent ductus arteriosus closure in infants ≤1.5 kg. Data extraction was independently performed by multiple observers. Primary outcome was technical success and secondary outcomes were adverse events (AEs). Subgroup analysis was performed in infants ≤6.0 kg. Data were pooled by using a random-effects model.
RESULTS
We included 28 studies, including 373 infants ≤1.5 kg and 69 studies enrolling 1794 infants ≤6.0 kg. In patients ≤1.5 kg, technical success was 96% (95% CI, 93%-98%; P = .16; I = 23%). The overall incidence of AE was 27% (95% CI, 17%-38%; P < .001; I = 70%) and major AEs was 8% (95% CI, 5%-10%; P = .63; I = 0%). There were 5 deaths related to the procedure (2%; 95% CI, 1%-4%; P = .99; I = 0%); 4 of these deaths occurred in infants <0.8 kg. The probability of technical failure was inversely related to age at the time of the procedure (OR, 0.9; 95% CI, 0.830-0.974; P = .009). Weight at intervention has decreased over time and procedural success has increased.
CONCLUSIONS
Percutaneous patent ductus arteriosus closure is feasible in infants ≤1.5 kg with few major AEs. The procedural success rate is high, despite performing the intervention in smaller patients.
PROSPERO REGISTRATION
CRD42020145230.
Topics: Cardiac Catheterization; Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Treatment Outcome
PubMed: 33098843
DOI: 10.1016/j.jpeds.2020.10.035 -
Systematic review of mortality associated with neonatal primary staged closure of giant omphalocele.Journal of Pediatric Surgery Apr 2021Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and... (Review)
Review
INTRODUCTION
Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and atomized.
OBJECTIVE
To analyze the studies about of mortality associated with neonatal primary staged closure of giant omphalocele.
METHODS
Systematic review in three databases using ex-ante search protocol and selection of studies following the phases suggested by PRISMA and MOOSE criteria. Reproducibility and evaluation of methodological quality were guaranteed by using CARE and STROBE.
RESULTS
Seven studies of clinical cases with nine patients, and six cross-sectional studies with 85 individuals were analyzed. These were conducted in the USA mainly, between 1985 and 2018. In the case studies, the death was 11.1% owing to hepatic necrosis and portal system angiomatosis. On the cross-sectional studies, mortality was registered in 18.8% of patients owing to coarctation of the aorta, heart, kidney, intestinal, respiratory or multiple organ failure, an anomaly of venous return, prematurity, ruptured omphalocele, pulmonary hypoplasia, trisomy 13, ARDS, sepsis, and septic shock. The main complication was wound infection with subsequent confection of the silo, found in 5.4% of patients.
CONCLUSION
Only a few studies on staged closure of giant omphalocele were found on a low number of patients. The high survival rate and the low percentage of complications on the 94 analyzed patients suggest the effectiveness and safety of the procedure.
LEVELS OF EVIDENCE
According to the Journal of Pediatric Surgery this research corresponds to type of study level II for retrospective studies, and level IV for case series with no comparison group.
Topics: Cross-Sectional Studies; Hernia, Umbilical; Humans; Infant, Newborn; Infant, Newborn, Diseases; Reproducibility of Results; Retrospective Studies
PubMed: 32981659
DOI: 10.1016/j.jpedsurg.2020.08.019 -
European Journal of Pediatrics Mar 2021Patent ductus arteriosus (PDA), one of the most common disorders in newborns, is associated with many complications in premature infants such as respiratory distress... (Meta-Analysis)
Meta-Analysis Review
Patent ductus arteriosus (PDA), one of the most common disorders in newborns, is associated with many complications in premature infants such as respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). However, the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) is still an ongoing debate. The relationship between platelet parameters and hsPDA has been explored in many studies over the last decade, but there is still no definite conclusion. We aim to explain the relationship between platelet parameters and hsPDA through this meta-analysis. Therefore, we used PubMed, Embase, the Cochrane Library, and Web of Science databases as well as the Google Scholar to search for studies up to May 2020. Three reviewers independently screened the articles, evaluated the quality of the articles, and collected the data. The random-effects model and fixed-effects model were used to evaluate pooled results. We used the I-square (I) test to examine heterogeneity and the funnel plot; Egger's test and meta-regression analysis were used to test for publication bias. Influence analysis was also carried out in this study. Stata version 12.0 software was used for data analysis. Fourteen studies, which included 3330 newborns, were extracted from 986 studies. The weighted mean difference (WMD) of the platelet count was - 17.98 (p < 0.001), the platelet distribution width (PDW) was 0.27 (p = 0.266), the mean platelet volume (MPV) was 0.01 (p = 0.958), the plateletcrit (PCT) was - 0.03 (p < 0.001), and the platelet mass was - 150.10 (p = 0.001).Conclusion: Platelet count, PCT, and platelet mass of the first 3 days of life are potentially helpful in identifying premature infants at risk of hsPDA. More prospective studies on the relationship between different degrees of thrombocytopenia and platelet function and hsPDA should be conducted. What is Known: • Platelets are involved in the formation of thrombi during closure of the arterial duct. • The diagnosis of hsPDA by Doppler echocardiography and clinical signs is not precise enough. What is New: • Preterm newborns with hsPDA in the first week of life demonstrated a significant reduction in platelet count, platelet mass, and plateletcrit in the first 3 days of life. • No significant difference was shown between hsPDA and non-hsPDA infants in platelet distribution width and mean platelet volume in the first 3 days of life.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Prospective Studies; Respiratory Distress Syndrome, Newborn
PubMed: 32949292
DOI: 10.1007/s00431-020-03802-5 -
Indian Heart Journal 2020This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of oral acetaminophen compared to oral ibuprofen for patent... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of oral acetaminophen compared to oral ibuprofen for patent ductus arteriosus (PDA) in preterm infants.
METHODS
We performed a systematic literature search on topics that assesses the use of oral paracetamol compared to oral ibuprofen in preterm neonates diagnosed with PDA from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, ClinicalTrials.gov, and hand-sampling from potential articles.
RESULTS
There were 1547 subjects from 10 selected studies. Primary closure rate was similar in both groups. Subgroup analysis on studies enrolling neonates with ≤30 weeks gestational age showed that ibuprofen was superior (OR 0.52 [0.31, 0.90], I: 0%). On the other hand, paracetamol was superior neonates with ≤34 weeks gestational age (OR 1.73 [1.01, 2.94], I: 30%). Reopening rate, surgical closure rate, mortality, intraventricular hemorrhage, and necrotizing enterocolitis were similar in both groups. Rate of renal dysfunction (OR 0.27 [0.10, 0.77], I: 0%) and gastrointestinal bleeding (OR 0.31 [0.11, 0.88], I: 0%) were lower in paracetamol group. Subgroup analysis of randomized controlled studies (RCTs) showed similar results. Meta-regression analysis showed that the primary closure rate was not influenced by gestational age, birth weight, and gender. GRADE demonstrates a low level of certainty for primary closure and mortality. Renal dysfunction and gastrointestinal bleeding havea moderate level of certainty.
CONCLUSION
There was no significant difference between the efficacy of oral paracetamol and oral ibuprofen. However, the rate of renal dysfunction and gastrointestinal bleeding were higher in oral ibuprofen.
Topics: Acetaminophen; Administration, Oral; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Gestational Age; Humans; Ibuprofen; Infant, Newborn; Infant, Premature; Treatment Outcome
PubMed: 32768013
DOI: 10.1016/j.ihj.2020.05.012 -
International Journal of Paediatric... Nov 2020Information about the functional and morphological consequences that occur following the premature loss of anterior teeth is still insufficient. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Information about the functional and morphological consequences that occur following the premature loss of anterior teeth is still insufficient.
AIM
To evaluate the consequences in children's speech and arch integrity following premature loss of primary anterior teeth compared to those without premature losses.
DESIGN
Electronic searches were performed based on the PECO criteria. Observational studies in children (P) who suffered premature loss or extraction of primary anterior teeth (E) compared to children presenting normal occlusion development (C) and the consequences to speech and dental arch perimeter (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of premature loss of primary anterior teeth in articulatory speech disorders (distortion, omission, and substitution) and space loss in the dental arches. Random- and fixed-effect models were used, and heterogeneity was tested. The certainty of evidence was estimated using the GRADE approach.
RESULTS
From a total of 2.234 studies, six studies were included in the qualitative synthesis, and four in speech disorders meta-analysis. Despite it was not possible to perform space loss meta-analysis due to the absence of available data, qualitative analysis showed that there was no space loss after premature loss of mandibular primary incisors; a space loss, however, could be observed in children who lost primary canines at an early stage of dental development. For speech disorders results, children who lost anterior tooth presented higher chance of suffering speech distortion, than children without tooth loss (OR 5.466 [1.689, 17.692] P = .005) with low certainty of evidence. On the other hand, there were no statistically differences between premature loss of primary anterior teeth and omission (OR (a) 1.157 [0.439, 3.049] P = .767 and (OR (b) 1.393 [0.434, 4.70] P = .577) or substitution (OR (a) 1.071 [0.581, 1.974] P = .827 and OR (b) 1.218 [0.686, 2.163] P = .5), both with very low certainty of evidence.
CONCLUSIONS
Premature loss of primary anterior teeth may affect children phonation causing speech distortion. Consequences of space loss to primary dental arch still need to be further studied. Despite the speech distortion results, included articles present low-level evidence-based quality, thus new studies should be performed.
Topics: Child; Dental Arch; Humans; Incisor; Mandible; Speech; Tooth, Deciduous
PubMed: 32243000
DOI: 10.1111/ipd.12644 -
Frontiers in Pediatrics 2019Indomethacin and ibuprofen, two commonly used prostaglandin inhibitors, are the drugs of choice for patent ductus arteriosus. However, paracetamol is an alternative...
Indomethacin and ibuprofen, two commonly used prostaglandin inhibitors, are the drugs of choice for patent ductus arteriosus. However, paracetamol is an alternative choice when these drugs are ineffective or contraindicated. This study aimed to confirm paracetamol's efficacy and safety compared with those of other drugs or placebos for patent ductus arteriosus closure in premature infants. We conducted a literature search using the Cochrane Library, PubMed, CINAHL, and EMBASE databases for randomized controlled trials and quasi-randomized controlled trials. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to direct the process and PICO (P, population; I, intervention/interest; C, comparator; O, outcome) principle to constitute the theme. We combined the research data through qualitative summaries or meta-analyses. The final analyses included 15 trials ( = 1,313). No significant differences were noted between paracetamol and ibuprofen except for shorter mean days needed for patent ductus arteriosus closure, lower risk of gastrointestinal bleeding, and hyperbilirubinemia. No significant difference existed between paracetamol and indomethacin. Oral paracetamol was more effective than placebo in infants weighing 1,501-2,500 g. Our study findings tentatively conclude that paracetamol can induce early patent ductus arteriosus closure without significant side effects but that its efficacy is not superior to that of indomethacin.
PubMed: 32133328
DOI: 10.3389/fped.2019.00568