Ocena skuteczności Lactobacillus rhamnosus ATC A07FA w zapobieganiu martwiczego zapalenia jelit wcześniaków z bardzo małą urodzeniową masą ciała: badanie z randomizacją (wstępne wyniki)

BackgroundEvidence suggests that probiotics, as a group, are reducing the risk of necrotizing enterocolitis (NEC). The efficacy of each probiotic strain needs to be evaluated separately.ObjectiveTo evaluate the efficacy of administering Lactobacillus rhamnosus ATC A07FA (L. rhamnosus) for the prevention of necrotizing enterocolitis (NEC) ≥2 by the criteria of Bell in very low-birth-weight preterm infants.MethodPreterm infants children fulfillingthe inclusion criteria (gestational age <32 weeks and birth weight <1500 g and partial orfull enteral feeding) were enrolled in a randomized, double-blind, placebo-controlled trial. They received L. rhamnosus (commercially available as Lakcid) at a dose of 1.2 × 10¹⁰ CFU or a placebo orally, twice daily, for the duration of the hospital stay. The primary outcome measures were NEC ≥2 by the criteria of Beli, sepsis and death.ResultsThe study was stopped prematurely because of slow recruitment. Data from 55 preterm infants were included in the fina? analysis. In the experimental group, compared with the placebo group, the risk of developing NEC ≥2 by the criteria of Beli was reduced, however the difference was not statistically significant (1/30; 3.3% versus A/25; 16%, RR 0.2, 95% Cl 0.02 do 1.75). L. rhamnosus did not significantly affect the risk of developing sepsis or death. There was also no difference between the probiotic and placebo groups for any of the other secondary outcomes. No adverse events were reported.ConclusionThe administration of L. rhamnosus ATC A07FA compared with placebo had no effect on the incidence of NEC. Further studies with sufficient sample size are warranted.     

Systematic Review of Randomized Controlled Trials: Fiber Supplements for Abdominal Pain-Related Functional Gastrointestinal Disorders in Childhood

Background: A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies. Aim: To systematically evaluate the effect of dietary fibers for treating abdominal pain-related FGIDs in children. Methods: In December 2011, MEDLINE, EMBASE and the Cochrane Library were searched for randomized controlled trials (RCTs) evaluating fiber supplementation in children with FGIDs. Results: Only 3 RCTs were identified, which enrolled a total of 167 children and adolescents (5-17 years old) with recurrent abdominal pain. Only 1 study used the Rome III criteria. Patients were supplemented with different dietary fiber types for 4-6 weeks. The use of dietary fibers did not influence the proportion of responders to treatment, and improvement did not occur in reported clinically relevant outcomes such as no pain or a significant decrease in pain intensity (risk ratio 1.17, 95% confidence interval 0.75-1.81). Conclusion: There is no evidence that supplementation with fiber as a dietary manipulation may be useful for treating children with FGIDs. However, one should not overlook the fact that the main limitation for recommendation of the routine fiber use in clinical practice derives from the weak quality and paucity of available studies.     

Oral rehydration solution containing a mixture of non-digestible carbohydrates in the treatment of acute diarrhea: a multicenter randomized placebo controlled study on behalf of the ESPGHAN working group on intestinal infections

OBJECTIVE: A randomized, double-blind, placebo-controlled multicenter study to evaluate efficacy and safety of a mixture of non-digestible carbohydrates (NDC) as an adjunct to oral rehydration therapy in treatment of acute infectious diarrhea in children with mild to moderate dehydration. METHODS: 144 boys aged 1 to 36 months with diarrhea defined as three or more watery stools per day for >1 day but <5 days with mild or moderate dehydration (World Health Organization criteria) were randomly assigned to receive hypotonic oral rehydration solution (ORS) (Na 60 mmol/L, glucose 111 mmol/L) with or without a mixture of NDC (soy polysaccharide 25%, alpha-cellulose 9%, gum arabic 19%, fructooligosaccharides 18.5%, inulin 21.5%, resistant starch 7%). RESULTS: Intention-to-treat analysis did not show significant differences in mean 48 hour stool volume (ESPGHAN-ORS with NDC versus ESPGHAN-ORS, 140 +/- 124 g/kg versus 143 +/- 114 g/kg; P = 0.41). Duration of diarrhea after randomization was similar in both groups (82 +/- 39 hours versus 97 +/- 76 hours, P = 0.24). There were no significant differences in the duration of hospital stay (111 +/- 44 hours versus 126 +/- 78 hours; P = 0.3). Unscheduled intravenous rehydration was similar in both groups (21.4% versus 16.2%, P = 0.42). CONCLUSION: In boys with acute non-cholera diarrhea with mild to moderate dehydration a mixture of non-digestible carbohydrates was ineffective as an adjunct to oral rehydration therapy.     

Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a randomized, double-blind trial

AIM: A randomized, double-blind study was conducted to evaluate whether use of protein hydrolysate-based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases. METHODS: Preterm infants (n = 122) with at least one first-degree relative (parent or sibling) with allergic disease were randomly assigned to receive an extensively or partially hydrolysed preterm formula (intervention groups) or a standard preterm formula until 4 to 5 mo of age. Infants whose parents preferred that they be breastfed received their mothers' fortified breast milk. RESULTS: Intention-to-treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4-5 and 12 mo of age. However, by 12 mo, use of the extensively hydrolysed versus the standard preterm formula had significantly reduced the risk of atopic dermatitis. At 4-5 and 12 mo, there was a significantly increased risk of non-acceptance of the extensively hydrolysed formula compared with the other formulas. CONCLUSIONS: This study failed to show that extensively or partially hydrolysed preterm formulas in comparison with a standard preterm formula reduced the overall incidence of allergic diseases in infants at high risk for atopic disease. However, use of the extensively hydrolysed compared with a standard preterm formula significantly reduced the incidence of atopic dermatitis observed at 12 mo. Infants who received extensively hydrolysed formulas were at increased risk for intervention discontinuation for any reason, particularly non-acceptance of the formula. Because of the small number of patients eligible for this analysis, these results should be interpreted with caution.     

Nondigestible carbohydrates in the diets of infants and young children: a commentary by the ESPGHAN Committee on Nutrition

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult. Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for "fiber" constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited. There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their "prebiotic" effects. Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.     

Local treatment of empyema in children: a systematic review of randomized controlled trials

The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video‐assisted thoracoscopic surgery (VATS) revealed no benefit of VATS. Conclusion: There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.     

Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials

BACKGROUND: It is hypothesized that the intake of long-chain polyunsaturated fatty acids (LC-PUFAs) throughout pregnancy is important to maternal health and fetal and infant development. OBJECTIVE: The objective was to evaluate systematically the effect of LC-PUFA supplementation of pregnant women's diets on pregnancy outcomes and growth measures at birth. DESIGN: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library through August 2005 and also searched the references in reviewed articles for randomized controlled trials (RCTs) comparing LC-PUFA supplementation with placebo or no supplementation. RESULTS: Of 6 included RCTs, only 1 was judged to be at low risk of bias. Supplementation with n-3 LC-PUFAs in these 6 RCTs (1278 infants) was associated with a significantly greater length of pregnancy [weighted mean difference (WMD): 1.57 d; 95% CI: 0.35, 2.78 d; findings stable on sensitivity analysis] than in control subjects. We found no evidence that supplementation influenced the percentage of preterm deliveries, the rate of low-birth-weight infants, or the rate of preeclampsia or eclampsia. We found no significant difference in the 6 RCTs (1278 infants) in birth weight (WMD: 54 g; 95% CI: -3.1, 111 g) and no significant difference in 5 RCTs (1262 infants) in birth length (WMD: 0.23 cm; 95% CI: -0.04, 0.5 cm), but, in 4 RCTs (729 infants), there was a significant increase in head circumference (WMD: 0.26 cm; 95% CI: 0.02, 0.49 cm; significance was lost on sensitivity analysis). CONCLUSIONS: n-3 LC-PUFA supplementation during pregnancy may enhance pregnancy duration and head circumference, but the mean effect size is small. The implications of these findings for later growth and development remain to be elucidated.