Lactobacillus rhamnosus Used in the Perinatal Period for the Prevention of Atopic Dermatitis in Infants: A Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: Numerous systematic reviews and meta-analyses have examined the effects of probiotics used perinatally on prevention or treatment of atopic disease in infants and children. However, to date, no review has examined randomized controlled trials of Lactobacillus rhamnosus, specifically, administered both prenatally and postnatally and its effect over a long period of time. OBJECTIVE: The objective was to determine if L. rhamnosus either used solely or in conjunction with other probiotics demonstrates a long-term preventive effect on atopic disease in pediatric patients when used perinatally. METHODS: A systematic review was undertaken to identify those studies where L. rhamnosus was used (either solely or in conjunction with other probiotics). The following databases were searched from the year 2000 through December 8, 2021: PubMed, Cochrane Reviews and Cochrane Central Database of Controlled Trials; systematic reviews were hand searched to identify randomized controlled trials (RCTs). Meta-analytic statistical techniques were then employed. Evaluation of the incidence of atopic eczema was also examined longitudinally based on timeframe. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments were employed to determine the quality of the evidence. RESULTS: Eleven randomized controlled trials were identified which examined L. rhamnosus in its effect on atopy. Risk of bias was low on the majority of the domains assessed. Meta-analysis of the timeframes ≤ 2 years (RR 0.60, 95% CI 0.47-0.75; p < 0.00001) and 6-7 years (RR 0.62, 95% CI 0.50-0.75; p < 0.00001) demonstrated statistically significant reductions in atopic eczema with use of L. rhamnosus. For the 4 to 5-year (RR 0.74, 95% CI 0.55-1.00; p = 0.05) and 10-11-year (RR 0.68, 95% CI 0.37-1.27; p = 0.23) timeframes there was no statistically significant reduction. GRADE assessment for each timeframe was considered moderate in two, owing to high attrition rates in all of the studies, and low in two due to imprecision. CONCLUSION: Based on the meta-analysis and GRADE assessments, the use of L. rhamnosus with or without other probiotics appears to have a positive effect in reducing the incidence of atopic eczema in pediatric patients at least out to 7 years. Attrition rates temper these findings.

Ultrasound-detected venous changes associated with peripheral intravenous placement in children.

HIGHLIGHTS: Ultrasound shows several venous changes in pediatric PIV-containing veins. Changes were visualized by ultrasound in the absence of physical exam findings. Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure. BACKGROUND: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. METHODS: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. RESULTS: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). CONCLUSION: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.

Effect of the PIVO Device on the Procedure of Phlebotomy from Peripheral IV Catheters.

Short peripheral catheters (SPC) are an existing conduit into many patients' veins and line draws from SPC are a desired method of routine blood collection especially in difficult venous access patients. The PIVO device facilitates blood collection through SPC and is being used clinically in a number of hospitals. This study aimed to determine the appropriate wait time following a flush and the minimum waste volume required to obtain an undiluted blood sample when using the PIVO device and how that differed from current guidelines from SPC line draws. A clinical study was conducted examining the analyte results of samples drawn with PIVO through a SPC at varying wait times following a saline flush. Both an initial waste volume and a postwaste sample were compared to a venipuncture control. The resulting samples showed no saline dilution as measured by sodium and creatinine results at all studied wait times. These findings suggest that blood collections using the PIVO device can produce a clinically valid sample with a 30-second wait following a SPC flush and no waste volume prior to sample collection.