Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis.

BACKGROUND: Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS: We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS: Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS: Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.

Challenges in Diagnosing Intermediate Maple Syrup Urine Disease by Newborn Screening and Functional Validation of Genomic Results Imperative for Reproductive Family Planning.

Maple syrup urine disease is caused by a deficiency of branched-chain alpha-ketoacid dehydrogenase, responsible for degradation of leucine, isoleucine, and valine. Biallelic pathogenic variants in BCKDHA, BCKDHB, or DBT genes result in enzyme deficiency. We report the case of a female infant who presented with mild gross motor delay at 4 months, and seizures with hypoglycaemia at 5 months. Newborn screening returned total leucine/isoleucine at the 99.5th centile of the population; however, as second-tier testing reported minimal alloisoleucine, the results were considered inconsistent with MSUD. Plasma amino acid and urine organic acid analyses at 5 months were, however, consistent with a diagnosis of MSUD. A brain MRI showed bilateral symmetrical T2 hyperintense signal abnormalities involving white matter, globus pallidus, thalamus, brainstem, and dentate nuclei with restricted diffusion. A repeat MRI 10 months post-dietary-intervention showed the resolution of these changes and progression in myelination. Her clinical phenotype, including protein tolerance, correlated with intermediate MSUD. Molecular analysis of all three genes identified two variants of uncertain significance, c.434-15_434-4del and c.365A>G (p. Tyr122Cys) in the DBT gene. The rate of leucine decarboxylation in fibroblasts was reduced, but not to the extent observed in classical MSUD patients, supporting an intermediate form of MSUD. Previously reported mRNA splicing studies supported a deleterious effect of the c.434-15_434-4del variant. This functional evidence and confirmation that the variants were in trans, permitted their reclassification as pathogenic and likely pathogenic, respectively, facilitating subsequent prenatal testing. This report highlights the challenges in identifying intermediate MSUD by newborn screening, reinforcing the importance of functional studies to confirm variant pathogenicity in this era of molecular diagnostics.

Parent-targeted home-based interventions for increasing fruit and vegetable intake in children: a systematic review and meta-analysis.

Context: Parent interventions delivered in the home represent a valuable approach to improving children's diets. Objective: This review aims to examine the effectiveness of parent-targeted in-home interventions in increasing fruit and vegetable intake in children. Data Sources: Five electronic databases were searched: MEDLINE, Embase, PubMed, CINAHL, and PsycINFO. Study Selection: Randomized and nonrandomized trials conducted in children aged 2 to 12 years and published in English from 2000 to 2016 were eligible. Data Extraction: Eighteen publications were reviewed, and 12 randomized trials were analyzed. Studies were pooled on the basis of outcome measure and type of intervention, resulting in 3 separate meta-analyses. Results: Nutrition education interventions resulted in a small but significant increase in fruit intake (Hedges' g = 0.112; P = 0.028). Taste exposure interventions led to a significant increase in vegetable intake, with a moderate effect (Hedges' g = 0.438; P < 0.001). Interventions involving daily or weekly sessions reported positive outcomes more frequently than those using monthly sessions. Conclusions: Future interventions should incorporate regular taste exposure to maximize increases in vegetable intake in children. This is particularly important because fewer children meet national recommendations for vegetable intake than for fruit intake.

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study.

BACKGROUND: Despite the importance of nutrition support in preventing malnutrition in pediatric oncology, the decision to initiate and choose which nutrition support method is most appropriate can be difficult for parents and healthcare professionals. Decision aids are decision-focused patient information materials. They can improve knowledge, reduce decisional conflict, improve patients' risk perception, and increase patient participation in the decision-making process. They have never been evaluated for pediatric oncology nutrition decisions. We aimed to develop and pilot test a decision aid to assist parents making these decisions in collaboration with their healthcare team. MATERIALS AND METHODS: The decision aid was developed in accordance with the International Patient Decision Aid Standards guidelines and evaluated in a single-center pilot study. The parents and healthcare professionals of pediatric oncology patients were eligible. Participants read the decision aid and completed a questionnaire assessing acceptability, usability, and improvement in understanding. RESULTS: Thirty-one parents and 15 healthcare professionals participated. Parents found the decision aid balanced, relevant, and satisfactory overall. Some parents reported the decision aid was too long (26%). Healthcare professionals positively rated the development process, usefulness to parents, and content and format of the decision aid. Forty-three percent reported that using the decision aid would save them time. There were no significant associations between health literacy, decisional satisfaction, decisional regret, acceptability, and improvement in understanding. CONCLUSION: The decision aid appears acceptable and usable for our target population. Decision aid feedback provided critical data to make modifications before evaluating the decision aid in a randomized controlled trial.