Feeding Intolerance in Critically Ill Patients with Enteral Nutrition: A Meta-Analysis and Systematic Review.

Background: Feeding intolerance is a common yet serious complication in critically ill patients undergoing enteral nutrition. We aimed to conduct a meta-analysis to evaluate the risk factors of feeding intolerance in critically ill patients undergoing enteral nutrition, to provide insights to the clinical enteral nutrition treatment and care. Methods: Two researchers systematically searched PubMed, Medline, Web of Science, Cochrane Library, Chinanews. com, Wanfang and Weipu databases about the studies on the risk factors of feeding intolerance in severe patients with enteral nutrition up to August 15, 2023. Literature screening, data extraction and quality evaluation were carried out independently by two researchers, and Meta analysis was carried out with RevMan 5.3 software and Stata 15.0 software. Results: 18 studies involving 5564 enteral nutrition patients were included. The results of meta-analyses showed that age < 2 years old, age > 60 years old, APACHE II score ≥ 20, Hypokalemia, starting time of enteral nutrition > 72 hours, no dietary fiber, intra-abdominal pressure > 15mmHg, central venous pressure > 10cmH2O and mechanical ventilation were the risk factors of feeding intolerance in critically ill patients undergoing EN (all P<0.05). No publication biases were found amongst the included studies. Conclusion: The incidence of feeding intolerance in critically ill patients undergoing enteral nutrition is high, and there are many influencing factors. Clinical medical workers should take effective preventive measures according to the risk and protective factors of patients to reduce the incidence of feeding intolerance and improve the prognosis of patients.

Risk factors of malnutrition in children with congenital heart disease: a meta-analysis.

Background: The associated factors of malnutrition in children with congenital heart disease (CHD) must be evaluated to provide evidence for the treatment and care of such children. Methods: Two investigators searched the PubMed database until 25 June 2023 for literature about the associated factors of malnutrition in children with CHD. A meta-analysis of associated factors of malnutrition was performed by RevMan 5.3 software. Results: Thirteen studies involving 8,031 children with CHD were included. Pulmonary hypertension (OR = 3.81, 95% CI: 2.46-4.12), low birth weight (OR = 2.69, 95% CI: 1.25-5.77) and parents' height (OR = 2.15, 95% CI: 1.89-2.92) were the associated factors of growth retardation (all P < 0.05). Pulmonary hypertension (OR = 3.77, 95% CI: 3.13-4.24), low birth weight (OR = 3.04, 95% CI: 2.61-4.18) and pneumonia (OR = 2.35, 95% CI: 2.08-2.83) were the associated factors of low body weight of children with CHD (all P < 0.05). Conclusions: Medical staff should fully understand the risk factors, strengthen nutritional support and enhance nursing care for children with CHD to reduce malnutrition.

Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta-analysis of randomized controlled trials.

AIM: Peripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care. DESIGN: A meta-analysis. METHODS: We searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross-checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing. RESULTS: A total of 12 RCTs were included in this meta-analysis. Meta-analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one-time puncture success rate (relative risk [RR]  =  0.73, 95% confidence interval [CI]: 0.68-0.79) and the indwelling time (mean difference [MD] =  -3.60, 95% CI: -5.35 to -1.86), reduce the operation time (MD =  10.37, 95% CI: 7.48-13.26), estimated bleeding volume (MD =  0.55, 95% CI: 0.34-0.75), incidence of catheter ectopia (RR  =  2.46, 95% CI: 1.81-3.35), PICC-associated infection (RR  =  2.82, 95% CI: 1.65-4.83), exosmosis (RR  =  2.45, 95% CI: 1.49-4.04, p < .001) and phlebitis (RR  =  1.40, 95% CI: 1.03-1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR  =  1.20, 95% CI: 0.73-1.97, p = .48) was found. PUBLIC CONTRIBUTION: There are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.

Orthokeratology in controlling myopia of children: a meta-analysis of randomized controlled trials.

BACKGROUND: Delaying the development and lowering the progression of myopia in children is the focus of current ophthalmology researches. We aimed to evaluate the role of orthokeratology in controlling myopia of children, to provide insights to the clinical treatment and care of children with myopia. METHODS: Two investigators searched the The Cochrane Library, Embase, Pubmed, China national knowledge infrastructure, China biomedical literature database, WanFang and Weipu databases for randomized controlled trials(RCTs) on the role of orthokeratology in controlling myopia of children up to November 5, 2022. Two researchers independently searched, screened and extracted the studies according to the inclusion and exclusion standards. RevMan5.3 software was used for statistical analysis. RESULTS: A total of 14 RCTs involving 2058 children were included in this meta-analysis. Synthesized outcomes indicated that orthokeratology improved the uncorrected visual acuity(MD = 0.40, 95%CI: 0.05 ~ 0.74), reduced the diopter change(MD=-3.19, 95%CI: -4.42~-1.95), changes of corneal curvature(MD=-3.21, 95%CI: -3.64~-2.79), the length of ocular axis (MD=-0.66, 95%CI: -1.27~-0.06) and amount of ocular axis change(MD=-0.42, 95%CI: -0.64~-0.21) after 1 year of wearing orthokeratology(all P < 0.05). Besides, orthokeratology reduced the diopter change (MD=-3.22, 95%CI: -4.86~-1.58), the length of ocular axis (MD=-1.15, 95%CI: -2.25~-0.06) and the amount of ocular axis change after 2 year of wearing orthokeratology (MD=-0.53, 95%CI: -0.96~-0.11) after 2 year of wearing orthokeratology (all P < 0.05). No publication biases were found amongst the synthesized outcomes (all P > 0.05). CONCLUSIONS: Orthokeratology delays the progression of myopia in children, the long-term effects of orthokeratology need further investigations in future studies.

Effect of a BSHP process on clinical work ability of nurses in a children's cardiac intensive care unit.

Background: Nurse shift change is the key step to ensuring the integrity, dynamics, and continuity of clinical nursing in intensive care units. Objectives: To evaluate the effect of a bedside shift handover process (BSHP) on the clinical work ability of first-line clinical nurses in a children's cardiac intensive care unit (CICU). Methods: This quasi-experimental study was performed on the first-line clinical nurses working in a pediatric CICU at Children's Hospital of Nanjing Medical University between July and December, 2018. Participants were trained by the BSHP. This article is based on the STROBE checklist. Results: A total of 41 nurses were trained, with 34 women. The nurses in the intensive care unit showed significantly improved clinical work ability, including the ability to assess illness/find problems, master professional knowledge, standardized hands-on ability, ability to express communication, strain handling capacity, and humanistic care and accomplishment (all P < 0.05), after training. Conclusion: BSHP might improve the clinical work ability for pediatric CICU nurses through a standardization shift handover. The traditional oral shift change in CICU can easily cause an information distortion, and it is difficult or even impossible to arouse the nurses' enthusiasm. This study suggested that BSHP might be an alternative shift change process for pediatric CICU nurses.

Comparison of Incidence and Outcomes of Neuroblastoma in Children, Adolescents, and Adults in the United States: A Surveillance, Epidemiology, and End Results (SEER) Program Population Study.

BACKGROUND This United States (U.S.) population study aimed to compare the incidence of neuroblastoma and outcomes in children, adolescents, and adults using the Surveillance, Epidemiology, and End Results (SEER) program database. MATERIAL AND METHODS Patients with neuroblastoma were identified in the SEER database from 1975 to 2013. According to the age at diagnosis, patients were divided into "Children" (≤14 years old) and "Adolescents/Adults" group (>14 years old). Then, comparisons in basic characteristics, incidence rates (IRs) and long-term survival outcomes between patients in 2 groups were made. RESULTS A total of 4280 patients were identified, including 3998 children and 282 adolescent/adult patients. Adolescent/adult patients were more likely to have localized diseases than children and to be diagnosed with ganglioneuroblastoma (all P<0.05). The IR of neuroblastoma presented with upward and downward trends in children and adolescent/adult populations, respectively. Adolescents/adults had worse overall survival (OS) than children despite the earlier tumor stage. Lastly, multivariate Cox proportional hazards analyses showed that tumor stage, histology, sequence of primary malignancy, primary site, the administration of surgery, and treatment era were prognostic factors for children, and sequence of primary malignancy, primary site, undergoing surgery, and treatment era were tightly related to OS in adolescent/adult patients. CONCLUSIONS Analysis of the SEER program database between 1975 to 2013 showed that in the U.S., the incidence of neuroblastoma in children increased, but the incidence decreased in adolescents and adults. There was a trend for improved overall survival in all age groups despite the increased stage at presentation in children.

Is routine nasogastric decompression after hepatic surgery necessary? A systematic review and meta-analysis.

OBJECTIVES: Currently the nasogastric tube (NGT) is routinely inserted in clinical after abdominal surgery for decompression in China, yet the practice varies between regions, the role of NGT for the patients after hepatic surgery remains unclear. Therefore, this present meta-analysis aimed to assess the efficacy and safety of NGT placement after hepatic surgery. DESIGN: A systematic review and meta-analysis DATA SOURCES: PUBMED, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) and Wanfang Database (until Mar 30, 2019) were systematically searched. REVIEW METHODS: Randomized controlled studies (RCTs) comparing the efficacy and safety of NGT and no NGT treatment after hepatic surgery were included. Data were synthesized using a random-effects or fixed effect model according to the heterogeneity. Outcomes were presented as Mantel-Haenszel style odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals (95% CIs). RESULTS: Seven studies with 1306 patients were eligible for inclusion. Compared with NGT treatment, the no NGT decompression could shorten the time to first defecation (MD -0.59; -0.79, -0.39), reduce the time to start diet (MD -0.46; -0.90, -0.03), and decrease the length of hospital stay (MD 0.48; -0.93, -0.03), but it could also increase the risk of NGT re-intubation (OR 6.8; 1.77, 26.72), no significant differences were detected on the first passage of flatus (MD -0.34; -0.86, 0.18), the incidence of nausea (OR 0.81; 0.40, 1.67), vomiting (OR 1.06; 0.19, 5.93), abdominal distention (OR 0.87; 0.60, 1.25). CONCLUSION: Given that very limited information for some endpoints in this present meta-analysis, the routinely insertion of NGT after hepatic surgery is not justified, the no NGT decompression seems to be more beneficial to the prognosis of patients after hepatic surgery, more related studies on this issue are needed.

Is discard better than return gastric residual aspirates: a systematic review and meta-analysis.

BACKGROUND: The assessment of residual gastric volume is common practice in critical care units. However, the effects and safety of discarding or returning gastric aspirates remain uncertain. Therefore, we aimed to evaluate the role of discarding or returning gastric aspirates on the gastric residual volumes in critically ill patients. METHODS: A comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy and safety of discarding or returning gastric aspirates in critical ill patients was performed. Studies were identified by searching Pubmed and other databases (from inception to 31 Sept 2018). Summary odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated using fixed- or random-effects model for outcome assessment. RESULTS: Four RCTs, with a total number of 314 adult patients, were included in the analysis. No significant differences were found in the 48th hour residual volume (MD = 8.89, 95% CI: 11.97 to 29.74), the average potassium level (MD = 0.00, 95% CI: - 0.16 to 0.16), the episodes of gastric emptying delay (OR = 0.98, 95% CI: 0.35 to 2.80), the incidence of aspiration pneumonia (OR = 0.93, 95% CI: 0.14 to 6.17), the episodes of nausea or vomiting (OR = 0.53, 95% CI: 0.07 to 4.13) and diarrhea (OR = 0.99, 95% CI: 0.58 to 1.70). CONCLUSIONS: No evidence confirms that returning residual gastric aspirates provides more benefits than discarding them without increasing potential complications. Rigorously designed, multi-center, large-sample randomized controlled trials must be further conducted to validate the role of discarding or returning residual gastric aspirates.

Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis.

BACKGROUND: Several randomized controlled trials (RCTs) evaluated the role of Chlorhexidine-impregnated dressing for prophylaxis of central venous catheter (CVC) related complications, but the results remained inconsistent, updated meta-analyses on this issue are warranted. METHODS: A meta-analysis on the RCTs comparing Chlorhexidine-impregnated dressing versus other dressing or no dressing for prophylaxis of central venous catheter-related complications was performed. A comprehensive search of major databases was undertaken up to 30 Dec 2018 to identify related studies. Pooled odd ratio (OR) and mean differences (MDs) with 95% confidence intervals (CI) were calculated using either a fixed-effects or random-effects model. Subgroup analysis was performed to identify the source of heterogeneity, and funnel plot and Egger test was used to identify the publication bias. RESULTS: A total of 12 RCTs with 6028 patients were included. The Chlorhexidine-impregnated dressings provided significant benefits in reducing the risk of catheter colonization (OR = 0.46, 95% CI: 0.36 to 0.58), decreasing the incidence of catheter-related bloodstream infection (CRBSI) (OR = 0.60, 95% CI: 0.42 to 0.85). Subgroup analysis indicated that the Chlorhexidine-impregnated dressings were conducive to reduce the risk of catheter colonization and CRBSI within the included RCTs with sample size more than 200, but the differences weren't observed for those with sample less than 200. No publication bias was observed in the Egger test for the risk of CRBSI. CONCLUSIONS: Chlorhexidine-impregnated dressing is beneficial to prevent CVC-related complications. Future studies are warranted to assess the role and cost-effectiveness of Chlorhexidine-impregnated dressings.

Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis.

AIM: To compare and evaluate the efficacy and safety of continuous and intermittent control of cuff pressure. METHODS: We performed a comprehensive and systematic meta-analysis of randomized controlled trials (RCTs) assessing the continuous and intermittent control of Pcuff by searching PUBMED, EMBASE and other such databases (from inception to 31 March 2018). Summary odds ratios or mean differences with 95% confidence intervals were calculated using a fixed- or random-effects model. MEASUREMENTS AND MAIN RESULTS: Seven randomised controlled trials with 970 mechanically ventilated patients were included in this study. The continuous control of cuff pressure significantly reduced the incidence of cuff pressure < 20 cm H2 O (0.03 (OR) (95% CI: 0.01-0.07)), Pcuff > 30 cm H2 O (0.06 (95% CI: 0.03-0.15)) and VAP (0.39 (95% CI: 0.28-0.55)) when compared with intermittent control of cuff pressure. No significant differences in duration of MV (-1.94 (95% CI: -4.06 to -0.17)), length of ICU stay (-3.88 (95% CI: -9.00 to -1.23)) and mortality (0.99 (95% CI: 0.73-1.35)) were found between the two groups. CONCLUSIONS: Continuous control of cuff pressure offers more benefits in stabilizing the cuff pressure and reducing the incidence of VAP, and more studies are warranted to further evaluate the role of continuous control of cuff pressure. RELEVANCE TO PRACTICE: The continuous control of cuff pressure should be conducted whenever possible as it is the most ideal for the prognosis of MV patients.

The nasal oxygen practice in intensive care units in China: A multi-centered survey.

BACKGROUND: Nurses frequently administer nasal oxygen therapy for patients in intensive care units (ICUs). However, little is known about the current status, nurses' management and perception on the nasal oxygen therapy in China. Therefore, we aimed to investigate the nasal oxygen practice of ICUs in China to provide insights into future direction. METHODS: A cross-sectional survey on 10 hospitals was conducted. A self-designed questionnaire was administered to ICU nurses. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to analyze the respondents' questionnaires. RESULTS: A total of 580 respondents with a response rate of 96.67% were included in this study. The average correct answer rate was 58.28%. The current status of nasal oxygen administration in ICUs in Chinese hospitals lagged behind the recommendations of related guidelines. Nurses in China were eager to learn about the updated knowledge on oxygen therapy. The gender, age, clinical experience, degree, job title, and classification of working hospitals were not related to the oxygen therapy-related knowledge scores (all P>0.05). CONCLUSION: Many deficiencies are observed regarding the nasal oxygen practice in ICUs of Chinese hospitals. Increased efforts by authorities and medical staff are required to narrow the gap between the current status of oxygen practice and the recommendations from related guidelines.

N-methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen-activated protein kinase signaling pathway.

N-methyl pyrrolidone (NMP), a small bioactive molecule, has the potential to stimulate bone formation and inhibit osteoclast differentiation. The aim of the present study was to investigate the effect of NMP on the inflammatory response and underlying molecular mechanisms in MG-63 cells. The mRNA and protein expression of cytokines from peripheral blood in children with or without ankle fracture were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. MG-63 cells were pre-treated with/without NMP and stimulated with 1 µM bradykinin (BK). The production of cytokines from MG-63 cells was assessed by western blotting and RT-qPCR. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA and protein were measured using western blotting and/or RT-qPCR. Western blotting was used to examine the activation level of mitogen activated protein kinase. Compared with healthy children, levels of tumor necrosis factor (TNF-α), interleukin (IL)-1ß and IL-6 mRNA and protein were upregulated in children with ankle fracture. NMP treatment did not induce cytotoxicity in MG-63 cells. The BK-induced upregulation of TNF-α, IL-1ß, IL-6, iNOS and COX-2 mRNA and protein was reversed in a dose-dependent manner by NMP. Furthermore, NMP downregulated the activation of c-Jun NH2-terminal kinase and p38 pathways, but not the extracellular signal-related kinase pathway. Therefore, the results of the current study demonstrate that NMP inhibits inflammation dependent on the mitogen-activated protein kinase pathway in MG-63 cells, indicating that it may be beneficial in the healing of fractures.