Children's Health UHL Evidence Update

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UHL Clinical Librarian Service

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Children's Health Evidence Update

December 2016

NICE National Institute for Health and Care Excellence

End of life care for infants, children and young people with life-limiting conditions: planning and management

Spasticity in under 19s: management

Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Psychosis and schizophrenia in children and young people: recognition and management

Children’s attachment

New and Updated Cochrane Systematic Reviews

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months
We searched the literature up to October 2016. This is an update of a review published in 2010. We did not find any new studies for this update.
Authors' conclusions: Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia.

Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children
Authors' conclusions: We found insufficient evidence to enable assessment of the effectiveness and safety of oral Astragalus as a sole intervention to prevent frequent ARTIs in children aged up to 14 years.

Drug interventions for the treatment of obesity in children and adolescents
Authors' conclusions: This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.

Interventions for promoting participation in shared decision-making for children with cancer
Authors' conclusions: No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. For this update, we included only RCTs and CCTs. Clearly more research is needed.

Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care
Authors' conclusions: Compared to usual care, moderate quality evidence from one study showed that trained GPs providing written information to parents of children with acute URTIs in primary care can reduce the number of antibiotics used by patients without any negative impact on reconsultation rates or parental satisfaction with consultation. Low quality evidence from two studies shows that, compared to usual care, GPs prescribe fewer antibiotics for acute URTIs but prescribe more antibiotics when written information is provided alongside prescribing feedback (compared to prescribing feedback alone). There was no evidence addressing resolution of patients' symptoms, patient knowledge about antibiotics for acute URTIs, or frequency of complications.

To fill evidence gaps, future studies should consider testing written information on antibiotic use for adults with acute URTIs in high- and low-income settings provided without clinician training and presented in different formats (such as electronic). Future study designs should endeavour to ensure blinded outcome assessors. Study aims should include measurement of the effect of written information on the number of antibiotics used by patients and prescribed by clinicians, patient satisfaction, reconsultation, patients' knowledge about antibiotics, resolution of symptoms, and complications.

Transcutaneous electrical stimulation (TES) for treatment of constipation in children
Authors' conclusions: The results for the outcomes assessed in this review are uncertain. Thus no firm conclusions regarding the efficacy and safety of TES in children with chronic constipation can be drawn. Further randomized controlled trials assessing TES for the management of childhood constipation should be conducted. Future trials should include clear documentation of methodologies, especially measures to evaluate the effectiveness of blinding, and incorporate patient-important outcomes such as the number of patients with improved CSBM, improved clinical symptoms and quality of life.

Exhaled nitric oxide levels to guide treatment for children with asthma
Authors' conclusions: In this updated review with five new included studies, tailoring asthma medications based on FeNO levels (in comparison with primarily guideline management) significantly decreased the number of children who had one or more exacerbations over the study period but did not impact on the day-to-day clinical symptoms or inhaled corticosteroid doses. Therefore, the use of FeNO to guide asthma therapy in children may be beneficial in a subset of children, it cannot be universally recommended for all children with asthma.

Further RCTs need to be conducted and these should encompass different asthma severities, different settings including primary care and less affluent settings, and consider different FeNO cut-offs.

Vitamin D supplementation for preventing infections in children under five years of age
Authors' conclusions: Evidence from one large trial did not demonstrate benefit of vitamin D supplementation on the incidence of pneumonia or diarrhoea in children under five years. To our knowledge, trials that evaluated supplementation for preventing other infections, including TB and malaria, have not been performed.

School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents
Authors' conclusions: There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.

***Have you seen ... Cochrane Clinical Answers - Child Health?***

Dynamed Point-of- Care Clinical Reference Tool

Topic: Noninvasive positive pressure ventilation (NPPV) in infants and children
In preterm infants with respiratory distress without previous respiratory support or surfactant, HFNC has higher overall treatment failure rate than nasal CPAP (N Engl J Med 2016 Sep 22)

Topic: Migraine in children and adolescents
Biofeedback might improve migraine frequency, duration, and intensity in children and adolescents with migraine (Pediatrics 2016 Aug)

Topic: Allergic rhinitis
Fish introduction before age 6-12 months associated with decreased risk of allergic rhinitis in children ≤ 4 years old (JAMA 2016 Sep 20)

Topic: Food allergy
Early egg or peanut introduction may decrease risk of egg or peanut allergy in infants (JAMA 2016 Sep 20)

Topic: Long-acting beta-2 agonists for asthma
Combination fluticasone/salmeterol does not appear to increase risk of serious asthma-related events compared to fluticasone monotherapy in children using daily asthma medications (N Engl J Med 2016 Sep)

Topic: Cancer pain, Hodgkin lymphoma (HL)
Music therapy or music medicine interventions may reduce anxiety, pain, depression, and fatigue in patients with cancer (Cochrane Database Syst Rev 2016 Aug 15)

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Joanna Briggs Institute Systematic Reviews

Evidence Summary
PICO Question: What is the best available evidence regarding the effectiveness of hydrotherapy in children diagnosed with cerebral palsy?
Autism Spectrum Disorder (Children): Hydrotherapy

Evidence Summary
PICO Question: What is the best available evidence regarding the effectiveness of hydrotherapy in children with autism spectrum disorders?
Cerebral Palsy (Children): Hydrotherapy

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UpToDate

What's new in pediatrics

Recently Published Research and Guidelines

National Paediatric Asthma Audit
The British Thoracic Society has published the BTS National Paediatric Asthma Audit. This audit examined the demographic profile, severity at presentation, processes of care and outcomes of children over 1 year of age admitted to hospital in the UK with an acute attack of wheezing/asthma during the month of November 2015.

Brain tumours in children toolkit
The Royal College of GPs has launched the Brain Tumours in Children toolkit. This toolkit has been designed to help GPs and other primary care professionals to spot signs of brain tumours in children as early as possible by highlighting ‘red flag’ symptoms to look out for, and providing up-to-date guidance and training resources all in one place.

Proposed changes to the children’s epilepsy surgery services
Public Health England has published Epidemiological assessment on proposed change to England’s children’s epilepsy surgery service specification. This assessment provides independent epidemiological evidence on how the children’s epilepsy surgery service specification (CESS) may be affected if the proposed changes to the current service specification are implemented. The proposed changes are: to expand the list of operations to be undertaken at designated CESS centres; and to change the current service specification so that children of all ages needing epilepsy surgery have their operations at one of the four designated CESS centres.

NIHR Signals
The National Institute for Health Research has published the following Signals. Signals are summaries of recently published research. Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children

Information sourced with thanks to HEES Daily Health Bulletin.

NHS Behind The Headlines - Media stories explained

Study recommends screening toddlers for heart disease risk

Lack of sleep may disrupt development of a child's brain

Men's attitude towards fatherhood 'affects child behaviour'

Parent training may benefit children with severe autism

Smartphones and tablets 'disrupt children's sleep'

Table of Contents
Annals of Pediatric Cardiology
Archives of Disease in Childhood
Child: Care, Health and Development
Clinical Pediatrics
European Journal of Pediatrics
Journal for Specialists in Pediatric Nursing
Journal of Pediatric Healthcare
Journal of Pediatric Nursing
Journal of Pediatric Surgery
Journal of Pediatrics
Pediatric Anaesthesia
Pediatrics

View our other Evidence Updates

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