FROM THE COCHRANE LIBRARY

Surfactant Therapy for Bronchiolitis In Critically Ill Infants

Viral bronchiolitis is a common cause of respiratory failure in infants and children, and accounts for a significant portion of intensive care unit (ICU) admissions during seasonal epidemics. Currently there is no evidence to support the use of anything but supportive care for this disease. Surfactant is a potentially promising therapy; alterations in its composition have been described in bronchiolitis, and it may play a role in the host immunity for this disease.

Objectives The objective of this review was to assess the efficacy of exogenous surfactant for the treatment of bronchiolitis in mechanically ventilated infants and children. Authors’ conclusions Available data on surfactant were not sufficient to provide reliable estimates of its effects in mechanically ventilated infants and children with bronchiolitis. Future studies should be adequately powered and will need to address unresolved questions regarding which surfactant preparation may be best suited for the treatment of bronchiolitis, the appropriate dose and administration interval, and how the choice of ventilator strategy may modify its effects. (From The Cochrane Database of Systematic Reviews 2006 Issue 3)

 Anti-histamines for prolonged non-specific cough in children Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including anti-histamines. Also, anti-histamines are advocated as an empirical treatment in adults with chronic cough.

Objectives To evaluate the effectiveness of anti-histamines in treating children with prolonged non-specific cough.

Authors’ conclusions This review has significant limitations. However, the finding of uncertain efficacy of anti-histamines for chronic cough are similar to that for acute cough in children. In contrast to recommendations in adults with chronic cough, anti-histamines cannot be recommended as empirical therapy for children with chronic cough. If anti-histamines were to be trialled in these children, current data suggest a clinical response (time to response) occurs within 2 weeks of therapy. However the use of anti-histamines in children with non-specific cough has to be balanced against the well known risk of adverse events especially in very young children. (From The Cochrane Database of Systematic Reviews 2006 Issue3)

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics.

Objectives To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.

 Authors’ conclusions The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting. (From The Cochrane Database of Systematic Reviews 2006 Issue 3)

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

Feeding preterm infants in response to their hunger and satiation cues (ad libitum or demand/semi demand) rather than at scheduled intervals might help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge.

Objectives To assess the effect of a policy of feeding preterm infants on an ad libitum or demand/semi-demand basis versus feeding prescribed volumes at scheduled intervals on growth rates and the time to hospital discharge. Authors’ conclusions There are insufficient data at present to guide clinical practice. A large randomised controlled trial is needed to determine if ad libitum of demand/semi-demand feeding of preterm infants affects clinically important outcomes. This trial should focus on infants in the transition phase from intragastric tube to oral feeding and should be of sufficient duration to assess effects on growth and time to oral feeding and hospital discharge. (From The Cochrane Database of Systematic Reviews 2006 Issue 3)

^ TOP ^