Success Rate In Children Research Articles

Hearing outcomes in pediatric tympanoplasty and factors affecting surgical outcomes in the current era.

Type-1 tympanoplasty continues to be the treatment of choice for tympanic membrane perforations resulting from chronic suppurative otitis media (CSOM) in children, which is a principal cause of correctable hearing loss in the pediatric population. There is an ongoing debate about the surgical success rate, the factors affecting success as well as the best intervention time for this population group. This study assessed the outcome of Type-1 tympanoplasty in children in terms of 1) graft uptake and 2) hearing improvement as assessed by audiology. The study involved 40 patients aged 6 to ≤14 years suffering from tubotympanic chronic suppurative otitis media. The patients in the study had a central perforation of the pars tensa of the tympanic membrane. Pre-op investigations included Pure tone audiometry, Eustachian tube function test and nasopharyngeal x-ray. Type-1 tympanoplasty was performed on all patients. They were followed up at end of two months, six months, and one year postoperatively to assess surgical success and hearing outcomes. Overall graft uptake and the surgical success rate was 80%. Postoperatively air-bone gap closure up to 5dB was achieved in 62.5% of patients at the end of one year. A normal type A tympanometry curve was achieved in 75% of patients. There was a significant reduction in hearing handicap. The best results were obtained in the 9-10 years age group. Tympanoplasty has a high success rate in children. There is a significant improvement in hearing post-surgery. There is a minimal impact of traditionally believed confounding factors. Considering the positive impact of improved hearing and reduced hearing disability, the authors suggest that surgeons should take young children up for tympanoplasty.

Clinical features of idiopathic epiretinal membrane in children and the factors influencing postoperative visual acuity.

To describe the characteristics and surgical outcomes of idiopathic epiretinal membrane (iERM) in children and to determine the factors associated with postoperative visual acuity (VA). We retrospectively reviewed the medical records of 17 patients with iERM (age, < 18years) who had undergone ERM surgery from 2009 to 2021. Spectral-domain optical coherence tomography features were documented. The eyes with iERMs involving the fovea were assigned to the localized and diffused groups depending on the morphological description of the membrane. Multiple linear regression analysis was used to explore the factors associated with the final VA. The mean age was 9.2 ± 3.8years. The mean follow-up period was 38.9 ± 45.4months. After surgery, the central foveal thickness and the best-corrected VA (BCVA) improved significantly (all, P < 0.05). Fourteen eyes with iERMs showed involvement of the foveal area (localized group, six eyes; diffused group, eight eyes). There were no significant differences in the preoperative BCVA between the two groups (P = 0.064). However, the final BCVA was better in the diffused group than in the localized group (P = 0.043). Multiple regression analysis indicated that the localized membrane (P = 0.042) and lower preoperative BCVA (P = 0.043) were factors associated with a worse final VA in pediatric iERMs. Surgical removal of ERM showed a high anatomical and functional success rate in children. In pediatric patients with iERMs involving the fovea, a good VA was more common when the membrane was diffused than when it was localized.

Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter

Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; &gt; 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P &lt; 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P &lt; 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.

Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter

Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; &gt; 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P &lt; 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P &lt; 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.

PENINGKATAN KEMAMPUAN PERBENDAHARAAN KATA MELALUI PERMAINAN BONEKA TANGAN

Low Vocabulary Ability of Children in Group A Kindergarten Tunas Bangsa, Sukamaju District, North Luwu Regency. Action research cycle refers to Mc Kernan's action research model which divides into 7 stages, namely situation analysis (reconnaissance), problem formulation and clarification, action hypothesis, action planning, implementation of action with monitoring, evaluation of action results, reflection and decision making for further development . Overall, the average vocabulary ability through hand puppets increased from an average of 8.12 or 34% in cycle 1 to 19.24 or 80% in cycle 2 with an average increase of 11.12 or 46%, thus the success rate of children's abilities based on Mills' action success criteria ≥71% vocabulary ability through hand puppets in group A TK Tunas Bangsa, Sukamaju District, North Luwu Regency was found to have experienced success.

Peran Komunikasi Interpersonal Orang Tua Dual Career Marriage di Surabaya dalam Mengawasi Pembelajaran Daring Anak Remaja Awal di Masa Pandemi Covid-19

Interpersonal communication is one of the communications commonly used to convey persuasive messages and increase intimacy as well as a form of communication that can be a bridge for expressing a thought or opinion so that it can lead to a solutive and positive goal. Interpersonal communication between parents and children can affect the success of children's education. During the COVID-19 pandemic, children's face-to-face learning was shifted to online, this tightened the role of parents in supervising their children because children were required to use automatic gadgets for children to deal directly with the online world for quite a long time. Therefore, the results of research from three family informants show that the role of parents is very important in different ways in each family, some interpersonal communication roles are associated with several functions including affective functions (affection), educational functions, religious functions, protective functions and recreational functions, which helps researchers find out how the role of each dual career marriage parent in supervising children's online learning and from four types of families there are only three types of family that occur in three family informants, namely consensual, pluralistic, protective, none of which is in the tolerant category. This research was conducted in Surabaya using a qualitative descriptive approach and phenomenological methods. The results showed that the type of family determines how the role of parents' interpersonal communication with their children because the role of parents' interpersonal communication in supervising children's learning has an impact on the success rate of children's education.

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access.

BackgroundLoss of available central vein access sites for parenteral nutrition delivery represents one of the main indications for intestinal transplantation in children with intestinal failure. Placement of central venous catheters can be challenging in advanced loss of patent venous pathways. We recently described the hybrid technique (interventional plus surgical approach) of central line placement in children. The aim of this study was to describe and analyze the interventions used during the hybrid procedures regarding feasibility, safety and outcome.MethodsWe retrospectively analyzed the course of all children in our intestinal rehabilitation program undergoing hybrid central line placement. We evaluated patients' conditions, interventional techniques and surgical peculiarities as well as outcome.Results203 children were treated in our intestinal rehabilitation program between 2010 and 2021. Due to loss of venous access, hybrid technique was performed in 53 children during 76 interventions. In 40 cases the same vessel was reused via Seldinger technique. Among the 30 ultrasound-guided new vessel punctures, 12 were performed by puncture of collateral vessels. Extended interventions due to thoracic central venous obstruction and/or thrombosis requiring additional access via a femoral vein for rehabilitation of the vascular system was performed during 29 procedures including catheter extraction (1), angioplasties (18), stent placement (1), revascularization (5) and thrombectomy (4). Placement of a central line was not possible in 6 children which eventually underwent extended thoracic/vascular surgery: in three children the previously placed catheter could not be removed, in one child, placement of a thrombectomy-catheter was not possible because of inferior vena cava occlusion, and in two children, revascularization failed. Intestinal transplantation was considered in one patient because of impending loss of vascular access. Two self-limiting minor extravasations and one intervention-associated pericardial effusion occurred.ConclusionsHybrid interventions for central venous catheter placement and vascular rehabilitation enable a high success rate in children with intestinal failure and end-stage vascular access, circumventing the need for intestinal transplantation or advanced surgery. The relevant procedures are complex and require a foresighted and individualized approach with a wide range of interventional techniques. If performed with expertise, this combined interventional/surgical approach is feasible and safe.

Pengembangan Kemampuan Eksplorasi Anak Usia 5-6 Tahun melalui Kegiatan Bermain Plastisin di TKN Pembina Syamtalira Bayu

The purpose of applying the plasticine playing method is expected to be able to develop the fine motor skills of children aged 5-6 years so that they are able to draw according to their ideas, imitate shapes, use stationery correctly, cut according to patterns, paste pictures correctly, express themselves through detailed drawing movements and perform exploration with various media and activities. Qualitative research approach with the type of classroom action research. Sources of data in this study were children in the B3 group at Pembina Syamtalira Bayu TKN which consisted of 18 children and one teacher in the B3 group at Pembina Syamtalira Bayu TKN. Data collection techniques used are observation, documentation, and interviews. Data analysis techniques are data reduction, describing data, and making conclusions. The results obtained are: 1) through initial observations, it 6was found that 12 children had not been able to arrange blocks as expected and only 6 children were able to arrange blocks into building shapes like those made by the teacher and could make various other buildings themselves so that it can be concluded that children's exploration abilities undeveloped. 2) After taking action in cycle 1, the condition of children's exploration abilities changed for the better with details: (a) 0% developed very well, (b) 16.67% developed as expected, (c) 15% began to develop, and (d) 0% undeveloped. 3) Based on the results in the second cycle, the results obtained are: (a) 94.44% of children's ability levels are very well developed, (b) 5.6% are developing as expected, (c) 0% are starting to develop, and (d) 0% are not yet developed. The success rate of children's exploration abilities can be said to be successful very good predicates. Besides being able to develop fine motor skills for children, the application of the play method can also develop children's logical thinking skills in recognizing shapes, sizes, or colors in the process of forming plasticine. In addition, teachers.

P162 Heated humidified high flow nasal cannula versus continuous positive airway pressure therapy for obstructive sleep apnoea in children: the patients’ perspective

Abstract Introduction Approximately 30% of otherwise healthy children will have residual obstructive sleep apnoea (OSA) after first line therapy with adenotonsillectomy (AT) with lower success rates in children with risk factors. Continuous positive airway pressure (CPAP) is often the next treatment option and, whilst highly effective therapy, can be challenging to sustain in children. A pilot study is underway at our centre to evaluate the efficacy of heated humidified high flow nasal cannula therapy (HFNC) compared to CPAP in children with residual OSA. A secondary aim of this study is to determine which therapy (HFNC versus CPAP) the patients prefer. This abstract will report preliminary findings. Methods Children under 18 years old identified as requiring a CPAP trial for residual OSA management were invited to undergo an additional polysomnography, where they underwent a trial of HFNC overnight, which was undertaken in a similar manner to the CPAP trial. Participants and caregivers completed a questionnaire regarding comfort level following both the HFNC and CPAP titration nights. Results 11 participants (4 males) between 4 months and 15 years old have completed the study to date. Using an 11-point Likert scale, the average reported comfort level grading for HFNC was 1.5 points higher than CPAP. Discussion This preliminary data suggests that on average caregivers and participants found HFNC more comfortable than CPAP. Alternative therapies such as HFNC may be effective in managing OSA and may be better tolerated in children non-adherent to CPAP.

Social and pedagogical support of children with disabilities in conditions of general secondary educational establishments

The article is devoted to the analysis of the problem of social and pedagogical support of children with visual impairments in the conditions of secondary education establishments. Socio-pedagogical support is considered as a system of consistent, comprehensive, socially oriented pedagogical activity of a team of specialists, which provides processes of individualization of the student's personality, creates conditions for his self-determination at the expense of capabilities and abilities, protects student’s rights. The article presents social and pedagogical support method of children with profound visual impairments in the educational and rehabilitation centre. The main components of the methodology of socio-pedagogical child support are determined: experimental, productive, normative, corrective, informational, and its functions within the educational process: diagnostic support, counseling, informational and methodological support, organization and management. The main indicators of social and pedagogical methods’ support efficiency in various spheres of the child socialization are defined: in the sphere of leading activity; of interpersonal relations and communication; of self-awareness. Based on the indicators of the effectiveness of socio-pedagogical support and criteria, three generalized levels of socialization of children with profound visual impairments are identified. A set of socio-pedagogical technologies for organizing the process of students with visual impairments socialization based on the case method has been worked out and tested. The effectiveness of experimental technology introduction was confirmed: the success rate in children's educational activities, the level of integrative skills’ development, the average indicators of social activity and morality were increased. The number of children with a high level of socialization has increased.

Pediatric Prehospital Advanced Airway Management by Anesthesiologist and Nurse Anesthetist Staffed Critical Care Teams.

Prehospital pediatric tracheal intubation (TI) is a possible life-saving intervention that requires adequate experience to mitigate associated complications. The pediatric airway and respiratory physiology present challenges in addition to a relatively rare incidence of prehospital pediatric TI. The aim of this study was to describe characteristics and outcomes of prehospital TI in pediatric patients treated by critical care teams. This is a sub-group analysis of all pediatric (<16 years old) patients from a prospective, observational, multi-center study on prehospital advanced airway management in the Nordic countries from May 2015 through November 2016. The TIs were performed by anesthesiologists and nurse anesthetists staffing six helicopter and six Rapid Response Car (RRC) prehospital critical care teams. In the study, 74 children were tracheal intubated, which corresponds to 3.7% (74/2,027) of the total number of patients. The pediatric patients were intubated by very experienced providers, of which 80% had performed ≥2,500 TIs. The overall TI success rate, first pass success rate, and airway complication rate were in all children (<16 years) 98%, 82%, and 12%. The corresponding rates among infants (<2 years) were 94%, 67%, and 11%. The median time on scene was 30 minutes. This study observed a high overall prehospital TI success rate in children with relatively few associated complications and short time on scene, despite the challenges presented by the pediatric prehospital TI.

Prediction of artificial insemination and Timing Based on Vedic Astrology

Vedic Astrology is an ancient Indian science which explains planetary motions and positions with respect to time and their effect on humans and other entities on earth. With the individual birth charts one can predict various stages of events in humans like Education, Jobs, Health, Marriage, Children, and Prosperity etc. According to the Indian Society of Assisted Reproduction, infertility currently affects about 10 to 14 per cent of the Indian population, with higher rates in urban areas where one out of six couples is impacted. Nearly 27.5 million couples actively trying to conceive suffer from infertility in India. Now a days many childless couples are resorting to Artificial insemination methods. The success rate of children is only 10-30% depends upon the type of methods used. In this paper, it is discussed how Vedic Astrology is useful for predicting time for going to Artificial insemination methods and increase the success rate of having children.

Comparison of two vital pulp therapies in β-Thalassemic children

Aim: Beta-thalassemia (β-thalassemia) major is one of the most common inherited genetic blood disorders and is characterized by many systemic manifestations and skeletal problems. Children with β-thalassemia have a high caries index and must receive proper dental treatment to achieve better oral health. The aim of study is to compare two types of vital pulp therapies in children with β-thalassemia major. Methods: Sixty-five children with β-thalassemia major having carious primary molars were selected from Ain Shams University and the Hereditary Blood Disorders Clinic at the National Research Centre to be treated at Pediatric Dentistry, Department, Faculty of Dentisrtry, Ain Shams University . Patients received one of both types of vital pulp therapies: mineral trioxide aggregate (MTA) pulpotomy and indirect pulp capping. The children were divided into two groups as follow: Group I (n=30) received MTA pulpotomy and Group II (n=35) received indirect pulp capping using high viscosity glass ionomer cement. Clinical and radiographic follow-ups were done at the baseline, six months, and after one year. Patient preferences for types of vital pulp therapies were evaluated at the end of treatment. Comparison of the groups with qualitative data was done using Chi-square test. Comparison of the groups with quantitative data and a parametric distribution was done using an independent t-test at significance level 0.05. Results: The findings revealed success rates of 90% in Group I and 100% in Group II. There was 10% clinical and radiographic failure in Group I and 0% in Group II but the difference between the two groups when compared to each other was statistically not significant (p= 0.055). Conclusions: Both types of vital pulp therapies showed high success rates in children with β-thalassemia major and thus can be used safely in these patients. However, minimally invasive types of dental treatment may be preferred in children with β-thalassemia major as indirect pulp capping for being less invasive and requires less effort, fatigue and time.

Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population

Introduction:Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients.Materials and Methods:The authors retrospectively reviewed the management and outcome of 36 failed VP shunts in pediatric patients for the treatment of hydrocephalus. The surgeries were performed between November 2010 and January 2016 in a tertiary care hospital. The minimal follow-up period was 3 months. We divided the patients into the following age groups: <1 year (eight infants), 1–10 years (18 children), and 10–18 years (10 children). The success of the procedure was determined by age, sex, type of hydrocephalus, and the number of shunt revisions and malfunction before ETV. Children with different age (P = 0.839) and sex group did not show any significant data (P = 0.798). Children with communicating hydrocephalus had a success rate of 52.9% (17 patients), and children with noncommunicating hydrocephalus had a success rate of 84.2% (19 patients). The success rate in children with only one shunt malfunction was 57.1% (21 patients), whereas in 15 children with two or more shunt malfunctions, the success rate of ETV was 86.7%.Conclusions:The authors conclude that ETV is an effective alternative for the treatment of hydrocephalus in children. Age does not present a contraindication for ETV in failed VP shunt.

PENINGKATAN KETERAMPILAN FISIK MOTORIK MELALUI NYANYIAN DAN GERAKAN DALAM BERWUDHU PADA ANAK USIA DINI

This study aims to determine the Physical Motor Skills through singing and movement in Ablution in Children 5-6 years (Group B) in PAUD Insan Cita of Bengkulu City. This type of research is Classroom Action Research. The design in this study uses two cycles namely, Cycle I and Cycle II where in each cycle consists of two meetings. Each cycle consists of planning, implementing, observing and reflecting. From the data analysis that has been done, the results of the study show that the implementation of learning to improve ablution skills in early age group B can be categorized as "very good" at 3.95. Children's success rate in learning to improve ablution skills in learning is categorized as "developing as expected" because it has an average of 92%.

Ultrasound-guided central venous catheter insertion in pediatric patients

In pediatric patients, central venous catheterization (CVC) is necessary for administration of fluids, drugs, high concentration electrolytes, vasopressors or inotropic drugs, transfusion, intravenous nutrition, and dialysis. Using an anatomical landmark for the CVC insertion may have a low success rate in children due to the positional variation between the deep vein and the landmarks, the small size of body and blood vessels, low insertion frequency, and operator skill. In order to improve the success rate, ultrasound guided CVC insertion is recommended in critically ill children. It is also expected to reduce mechanical complications, which are more common with subclavian CVC insertion. However, the association between the insertion site and the infection or thrombosis is unclear. Since thrombosis is relatively common, further studies are needed on the association between the incidence rate and insertion sites. Key Words: Central Venous Catheters; Infections; Pediatrics; Thrombosis; Ultrasonography

Effect of iRoot BP Plus Pulpotomy for Immediate Repair in Children with Young Permanent Teeth Crown Fracture

Objective: To explore the clinical effect of iRoot BP Plus pulpotomy for immediate repair in children with young permanent teeth crown fracture. Methods: From September 2017 to October 2018, 80 children (80 affected teeth) with young permanent teeth crown fracture who treated in the hospital were selected as the research objects. Random number table method was used to divide them into observation and control groups with each group of forty patients (40 affected teeth). The children in the control group were treated with calcium hydroxide resin, while the observation group were treated with iRoot BP Plus for immediate repair. The surgical success rate was compared between the two groups, and the pulp vitality before and after treatment were compared. Results: At 3 months and 6 months after surgery, the success rate of children in the observation group was higher than that in the control group, and the difference was statistically significant (P&lt;0.05). The percentage of children with negative pulp activity in the observation group was higher than that in the control group, and the difference was statistically significant (P&lt;0.05). Conclusion: Immediate repair with iRoot BP Plus pulpotomy in children with young permanent teeth crown fracture has significant clinical effect.

Ultrasound-guided techniques for peripheral intravenous placement in children with difficult venous access.

Peripheral intravenous placement in children can be challenging. Different techniques have been used to improve first pass success rates in children with known history of difficult venous access including surface landmarking, local warming, transillumination, ultrasonography, epidermal nitroglycerin, central venous access, intraosseous placement, and venous cutdown. Among these, ultrasound guidance has garnered the most interest among anesthesiologists. The cumulative literature surrounding the utility of ultrasound-guided peripheral intravenous placement in children with and without difficult venous access has shown mixed results. Literature on the utility of ultrasound guidance for peripheral intravenous placement in children under deep sedation or anesthesia is limited but encouraging. This review summarizes the overall evidence for ultrasound-guided peripheral intravenous placement in children with difficult venous access under deep sedation or general anesthesia. Furthermore, five subtly varying approaches to ultrasound-guided peripheral intravenous placement with their advantages and disadvantages will be discussed. One of these five approaches is Dynamic Needle Tip Positioning. Utilizing a short axis out of plane ultrasound view, this promising technique allows for accurate needle tip localization and may increase the success rate of peripheral intravenous placement, even in small children, under deep sedation, or general anesthesia.

When poorly conducted systematic reviews and meta-analyses can mislead: a critical appraisal and update of systematic reviews and meta-analyses examining the effects of probiotics in the treatment of functional constipation in children

Recent systematic reviews and meta-analyses on the efficacy of probiotics in the treatment of functional constipation in children have yielded conflicting results. The aim of this study was to critically review and update the evidence in this field by mapping all the steps involved against those reported in previous reviews, in an attempt to understand the nature of their conflicting results. Four literature databases, trial registries, and citations were searched through December 1, 2018. We included randomized controlled trials (RCTs) that assessed the effects of probiotics compared with placebo or treatment as usual on defecation frequency [bowel movements (BMs)/wk] or treatment success rates in children with functional constipation. Independent reviewers extracted the data and assessed risk of bias in each RCT. Data were pooled with (inverse variance) random-effects models. We identified 17 RCTs, of which 14 and 11 provided sufficient data to enable meta-analysis of the effects of probiotics compared with control on defecation frequency (n=965) or treatment success (n=835), respectively. When compared to (any) control intervention, probiotics did not significantly increase defecation frequency [weighted mean difference (WMD): 0.28 BMs/wk; 95% CI: -0.12, 0.69; P=0.165] but were more efficacious in achieving treatment success (RR: 1.24; 95% CI: 1.03, 1.50; P=0.024). These effects did not differ by type of control (i.e., active or inactive) intervention. However, in analyses confined to the RCTs that were free of high risk of bias (only 5), probiotics did not confer any beneficial effects on defecation frequency (WMD: -0.55 BMs/wk; 95% CI: -1.37, 0.26; P=0.185) and achievement of treatment success (RR: 1.01; 95% CI: 0.90, 1.13; P=0.873), compared with control interventions. The current evidence thus does not support the use of probiotics as a single or coadjuvant therapy for treatment of functional constipation in children and refutes recently published reviews reporting favorable effects of probiotics. Conflicting findings of previous reviews resulted from methodologic errors, highlighting the susceptibility of evidence synthesis to oversights in study selection, quality assessments, and data extraction and collation. This review was registered at PROSPERO as CRD42019119109.

Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis.

BackgroundAn estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children.Methods and findingsTo inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%–19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%–48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15–20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0–8.3, p = 0.041 and aOR 5.9, 95% CI 1.7–20.5, p = 0.007, respectively). These findings for high-dose isoniazid may have been affected by site effect, as the majority of patients came from Cape Town. Limitations of this study include the difficulty of estimating the treatment effects of individual drugs within multidrug regimens, only observational cohort studies were available for inclusion, and treatment decisions were based on the clinician’s perception of illness, with resulting potential for bias.ConclusionsThis study suggests that children respond favorably to MDR-TB treatment. The low success rate in children infected with HIV who did not receive ART during their MDR-TB treatment highlights the need for ART in these children. Our findings of individual drug effects on treatment outcome should be further evaluated.