Physiological-based cord clamping in very preterm infants - Randomised controlled trial on effectiveness of stabilisation.

AIM: To test whether stabilising very preterm infants while performing physiological-based cord clamping (PBCC) is at least as effective as the standard approach of time-based delayed cord clamping (DCC). METHODS: A randomised controlled non-inferiority study was performed in two centres from May until November 2018, including preterm infants born below 32 weeks of gestational age. Infants were allocated to PBCC or standard DCC. Infants receiving PBCC were stabilised on a purpose-built resuscitation table with an intact umbilical cord. The cord was clamped when the infant had regular spontaneous breathing, heart rate ≥100 bpm and SpO2 >90% while using FiO2 <0.40. In infants receiving DCC, the cord was clamped at 30-60 seconds after birth before they were transferred to the standard resuscitation table for further treatment and stabilisation. Primary outcome was time to reach respiratory stability. RESULTS: Thirty-seven infants (mean gestational age 29 + 0 weeks) were included. Mean cord clamping time was 5:49 ±â€¯2:37 min in the PBCC (n = 20) and 1:02 ±â€¯0:30 min in the DCC group (n = 17). Infants receiving PBCC needed less time to reach respiratory stability (PBCC 5:54 ±â€¯2:27 min; DCC 7:07 ±â€¯2:54 min; mean difference corrected for gestational age -1:19 min, 95% CI [-3:04-0:27]), showing non-inferiority with the pre-defined limit of 1:15 min. No significant differences between the groups were found for maternal blood loss, postpartum haemorrhage, infant temperature at admission or short-term neonatal outcomes. CONCLUSION: Stabilisation of very preterm infants with physiological-based cord clamping is at least as effective as with standard DCC. CLINICAL TRIAL REGISTRATION: Netherlands Trial Register (NTR7194/NL7004).

[Paediatric breathlessness caused by aspiration of a foreign body in food]. / Benauwd kind door aspiratie van een corpus alienum uit de voeding.

Two one-year-old boys were seen by a paediatrician with symptoms of increasing breathlessness and inspiratory stridor. Upon the probable diagnosis subglottic laryngitis and toddler's asthma, respectively, they were admitted to hospital for medical treatment. Because they failed to recover sufficiently with this treatment, an ENT specialist subsequently performed a laryngotracheobronchoscopy under general anaesthesia. A fish-bone and chicken-bone, respectively, were found and removed from the larynx. In retrospect, the parents of both children realized that onset of symptoms followed a choking incident. These case histories illustrate the importance of active questioning concerning the onset of symptoms in order to differentiate between possibly causes. Endoscopy of the airways is required when parents mention a triggering moment or if the course of respiratory complaints is atypical.

Adenoidectomy for otitis media in children.

BACKGROUND: Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with otitis media. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed. OBJECTIVES: To assess the effectiveness of adenoidectomy versus non-surgical management or tympanostomy tubes in children with otitis media. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009. SELECTION CRITERIA: Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes only in children with otitis media. The primary outcome studied was the proportion of time with otitis media with effusion (OME). Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with either acute otitis media (AOM) or otitis media with effusion (OME), as well as mean hearing level. Tertiary outcome measures included atrophy of the tympanic membrane, tympanosclerosis, retraction of the pars tensa and pars flaccid and cholesteatoma. DATA COLLECTION AND ANALYSIS: Two authors assessed trial quality and extracted data independently. MAIN RESULTS: Fourteen randomised controlled trials (2712 children) studying the effectiveness of adenoidectomy in children with otitis media were evaluated. Most of these trials were too heterogeneous to pool in a meta-analysis. Loss to follow up varied from 0% to 63% after two years.Adenoidectomy in combination with a unilateral tympanostomy tube has a beneficial effect on the resolution of OME (risk difference (RD) 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at six and 12 months, respectively (n = 3 trials)) and a very small (< 5 dB) effect on hearing, compared to a unilateral tympanostomy tube only. The results of studies of adenoidectomy with or without myringotomy versus non-surgical treatment or myringotomy only, and those of adenoidectomy in combination with bilateral tympanostomy tubes versus bilateral tympanostomy tubes only, also showed a small beneficial effect of adenoidectomy on the resolution of the effusion. The latter results could not be pooled due to large heterogeneity of the trials.Regarding AOM, the results of none of the trials including this outcome indicate a significant beneficial effect of adenoidectomy. The trials were too heterogeneous to pool in a meta-analysis.The effects of adenoidectomy on changes of the tympanic membrane or cholesteatoma have not been studied. AUTHORS' CONCLUSIONS: Our review shows a significant benefit of adenoidectomy as far as the resolution of middle ear effusion in children with OME is concerned. However, the benefit to hearing is small and the effects on changes in the tympanic membrane are unknown. The risks of operating should be weighed against these potential benefits.The absence of a significant benefit of adenoidectomy on AOM suggests that routine surgery for this indication is not warranted.

Adenoidectomy for recurrent or chronic nasal symptoms in children.

BACKGROUND: Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with recurrent or chronic nasal symptoms. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed. OBJECTIVES: To assess the effectiveness of adenoidectomy versus non-surgical management in children with recurrent or chronic nasal symptoms. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009. SELECTION CRITERIA: Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes alone in children with recurrent or chronic nasal symptoms. The primary outcome studied was the number of episodes, days per episode and per year with nasal symptoms and the proportion of children with recurrent episodes of nasal symptoms. Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with nasal obstruction alone. DATA COLLECTION AND ANALYSIS: Two authors assessed trial quality and extracted data independently. MAIN RESULTS: Only one study included children scheduled for adenoidectomy because of recurrent or chronic nasal symptoms or middle ear disease. In this study no beneficial effect of adenoidectomy was found. The numbers in this study were, however, small (n = 76) and the quality of the study was moderate. The outcome was improvement in episodes of common colds. The risk differences were non-significant, being 2% (95% CI -18% to 22%) and -11% (95% CI -28% to 7%) after 12 and 24 months, respectively.A second study included children with recurrent acute otitis media (n = 180). As otitis media is known to be associated with nasal symptoms, the number of days with rhinitis was studied as a secondary outcome measure. The risk difference was non-significant, being -4 days (95% CI -13 to 7 days). AUTHORS' CONCLUSIONS: Current evidence regarding the effect of adenoidectomy on recurrent or chronic nasal symptoms or nasal obstruction alone is sparse, inconclusive and has a significant risk of bias.High quality trials assessing the effectiveness of adenoidectomy in children with recurrent or chronic nasal symptoms should be initiated.