Cochrane Database of Systematic Reviews
Base administration or fluid bolus for preventing morbidity and mortality in preterm infants with metabolic acidosis
Cochrane Database of Systematic Reviews
Lawn CJ, Weir FJ, McGuire W Base administration or fluid bolus for preventing morbidity and mortality in preterm infants with metabolic acidosis http://www2.cochrane.org/reviews/en/ab003215.html
Editorial Group: Neonatal Group
This version first published online: April 20. 2005
Last assessed as up-to-date: August 25. 2010
Abstract Background Metabolic acidosis in the early newborn period is associated with adverse outcomes in preterm infants. The most commonly used strategies to correct metabolic acidosis are intravascular infusion of base, for example sodium bicarbonate, and intravascular infusion of a fluid bolus, usually a crystalloid or colloid solution.
Objectives To determine the effect of either infusion of base or of a fluid bolus on mortality and adverse neurodevelopmental outcomes in preterm infants with metabolic acidosis.
Search strategy
We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), CINAHL (1982 to January 2005).
The search was updated in 2010.
Selection criteria Randomised or quasi-randomised controlled trials that evaluated the following treatments for preterm infants with metabolic acidosis:
1. Infusion of base versus no treatment;
2. Infusion of fluid bolus versus no treatment;
3. Infusion of base versus fluid bolus.
Data collection and analysis We extracted the data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors, and synthesis of data using relative risk and risk difference.
Main results We found two small randomised controlled trails that fulfilled the eligibility criteria (Corbet 1977; Dixon 1999) and one unpublished pilot trial (Lawn 2005). Corbet 1977 compared treating infants with sodium bicarbonate infusion (N = 30) versus no treatment (N = 32) and did not find evidence of an effect on mortality [relative risk (RR) 1.39 (95% confidence interval 0.72 to 2.67)] or in the incidence of intra/periventricular haemorrhage [RR 1.24 (95% confidence interval 0.47 to 3.28)]. Addition of the unpublished data of Lawn 2005 does not change the overall estimate of effect on mortality [typical RR 1.45 (95%CI 0.82 to 2.56)]. Dixon 1999 compared treatment with sodium bicarbonate (N = 16) versus fluid bolus (N = 20). The primary outcome assessed was arterial blood pH/base excess two hours after the intervention. Other clinical outcomes were not reported. Neither trial assessed longer term neurodevelopmental outcomes.
Authors' conclusions There is insufficient evidence from randomised controlled trials to determine whether infusion of base or fluid bolus reduces morbidity and mortality in preterm infants with metabolic acidosis. Further large randomised trials are needed.
Actualidades en el tratamiento quirúrgico de las cardiopatías congénitas
Riera-Kinkel Actualidades en el tratamiento quirúrgico de las cardiopatías congénitas Rev Mex Pediatr 2010; 77 (5)
RESUMEN
Con objeto de entender el tratamiento quirúrgico de los niños con cardiopatías congénitas, el médico debe responder, de una manera secuencial las siguientes preguntas: ¿Es una cardiopatía con o sin cianosis? ¿Involucra uno o los dos ventrículos? ¿El niño tiene pulsos normales en las extremidades? Después, la radiografía de tórax, el ecocardiograma (en sus diferentes modalidades) y los otros estudios de diagnóstico de mayor complejidad ¿son normales? Es en este sentido que se hace una revisión actualizada del diagnóstico y manejo quirúrgico que se recomienda en las cardiopatías congénitas comunes en los neonatos, lactantes o en primera infancia.
Palabras clave: Cardiopatías congénitas, manejo quirúrgico, niñez temprana, niñez tardía.
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El juego de la asfixia: un juego potencialmente mortal
Barbería-Marcalain E, Corrons-Perramon J, Suelves JM, Crespo Alonso S, Castellá-García J, Medallo-Muñiz J. El juego de la asfixia: un juego potencialmente mortal, An Pediatr (Barc). 2010;73:264-7.
Resumen
Los juegos asfícticos son un comportamiento conocido entre los adolescentes, pero no descrito hasta el momento en la literatura científica española. Se trata de comportamientos que buscan una breve euforia debida a la disminución del flujo de oxígeno en el cerebro. Presentamos el caso de un adolescente de 15 años que falleció en una habitación de su domicilio habitual debido a una ahorcadura accidental durante un juego asfíctico. Se analizan las características del caso y se procede a una revisión de la literatura publicada. El juego de la asfixia es una actividad peligrosa, potencialmente mortal. Casos como el descrito pueden ayudar a que los pediatras y médicos en general conozcan tanto el fenómeno como la peligrosidad del mismo. Su conocimiento es importante para la prevención y detección precoz de comportamientos de riesgo entre los adolescentes.
Palabras clave: Juego de la asfixia. Asfixia. Prevención de daños. Autopsia médico
legal. Medicina forense. Salud pública. Conductas de riesgo
Enfermedad de Kawasaki refractaria con aneurismas coronarios tratada con infliximab
Salas Salguero J, Gómez-Pastrana Durán D, Salido Peracaula C, Ruiz-Berdejo Iznardi C, Ortiz Tardío J. Enfermedad de Kawasaki refractaria con aneurismas coronarios tratada con infliximab An Pediatr (Barc). 2010;73:268-71.
Resumen
El tratamiento clásico de la enfermedad de Kawasaki con inmunoglobulina y ácido acetil salicílico consigue una respuesta favorable en hasta el 90% de los pacientes disminuyendo significativamente el riesgo de afectación coronaria. En los pacientes que no responden, no está consensuado el tratamiento a seguir como terapia de segunda línea: nuevas dosis de inmunoglobulina, corticoides o infliximab entre otros. Sin embargo aún son escasos los estudios y casos clínicos publicados con este último fármaco. Presentamos el caso de un lactante de 5 meses de edad, con enfermedad de Kawasaki refractaria y desarrollo de aneurismas coronarios, no respondedor a dos dosis de inmunoglobulina y tres megapulsos de corticoides, que se trata definitivamente con una dosis de infliximab, con buena respuesta clínica posterior.
Palabras clave: Enfermedad de Kawasaki. Infliximab. Aneurismas coronarios
Cochrane Database of Systematic Reviews
Statins for multiple sclerosis
Cochrane Database of Systematic Reviews
Wang J, Xiao Y, Luo M, Zhang X, Luo H Statins for multiple sclerosis
http://www2.cochrane.org/reviews/en/ab008386.html
Editorial Group: Multiple Sclerosis Group
This version first published online: December 8. 2010
Last assessed as up-to-date: October 6. 2010
Abstract
Background Multiple sclerosis is an inflammatory demyelinating disease of the human central nervous system. Statins, prescribed as cholesterol lowering agents, have shown beneficial effects for treating MS in experimental and preliminary clinical studies.
Objectives To evaluate the efficacy and safety of statins administered alone or as add-on to approved treatments for MS.
Search strategy We searched the Cochrane MS Group Trials Register (April 2010), the Cochrane Central Register of Controlled Trials (The
Cochrane Library, Issue 3, 2010), MEDLINE (PubMed) (January 1966 to April 2010), EMBASE (January 1974 to April 2010), the Chinese Biomedical Database (CBM) (1979 to April 2010) and the Chinese National Knowledge Infrastructure (CNKI) (1979 to April 2010). We searched trials registers and conference proceedings and contacted pharmaceutical companies and authors of included studies included for additional information.There were no language restrictions.
Selection criteria Randomised controlled trials comparing statins with placebo, or comparing statins in combination with approved treatments alone in for patients with MS.
Data collection and analysis Three review authors independently assessed trial quality and extracted data.
Main results Two trials involving 71 participants were included. Both trials compared atorvastatin plus beta interferon with beta interferon alone for treating MS. Only one was assessed of good methodological quality while the other one of poor methodological quality. Neither of them showed statistically significant difference between both treatment groups in reducing relapses, preventing disease progression or developing new T2 or gadolinium-enhanced lesions on MRI after 9 or 24 months follow up period. When combined with beta interferon, atorvastatin resulted to be safe and well tolerated, no serious adverse effects were reported. Changes on quality of life after receiving statins were not reported in the trials. Six trials which assess simvastatin or atorvastatin monotherapy or added to beta interferon for MS are still ongoing or awaiting publication.
Authors' conclusions There is insufficient evidence to support statins as an effective treatment for patients with MS. Future high quality randomised controlled trials are needed.
Improvements in methodology in trials which are ongoing or awaiting publication, are required for meaningful synthesis of data.
