Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010–2020

2021 ◽  
pp. fetalneonatal-2021-322634
Author(s):  
Grace Y Lai ◽  
Nathan Shlobin ◽  
Roxanna M Garcia ◽  
Annie Wescott ◽  
Abhaya V Kulkarni ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Meta Analysis ◽  
Intraventricular Haemorrhage ◽  
Bank Lending ◽  
Inclusion Criteria ◽  
Geographical Regions ◽  
Study Designs ◽  
Economic Regions ◽  
Reporting Rates ◽  
Study Inclusion

ObjectiveTo investigate differences and calculate pooled incidence of any intraventricular haemorrhage (IVH), severe IVH (Grade III/IV, sIVH) and ventriculoperitoneal shunt (VPS) placement in preterm infants across geographical, health and economic regions stratified by gestational age (GA).DesignMEDLINE, Embase, CINAHL and Web of Science were searched between 2010 and 2020. Studies reporting rates of preterm infants with any IVH, sIVH and VPS by GA subgroup were included. Meta-regression was performed to determine subgroup differences between study designs and across United Nations geographical regions, WHO mortality strata and World Bank lending regions. Incidence of any IVH, sIVH and VPS by GA subgroups<25, <28, 28–31, 32–33 and 34–36 weeks were calculated using random-effects meta-analysis.ResultsOf 6273 publications, 97 met inclusion criteria. Incidence of any IVH (37 studies 87 993 patients) was: 44.7% (95% CI 40.9% to 48.5%) for GA <25 weeks, 34.3% (95% CI 31.2% to 37.6%) for GA <28 weeks, 17.4% (95% CI 13.8% to 21.6%) for GA 28–31 weeks, 11.3% (95% CI 7.3% to 17.0%) for GA32–33 weeks and 4.9% (95% CI 1.4% to 15.2%) for GA 34–36 weeks. Incidence of sIVH (49 studies 328 562 patients) was 23.7% (95% CI 20.9% to 26.7%) for GA <25 weeks, 15.0% (95% CI 13.1% to 17.2%) for GA <28 weeks, 4.6% (95% CI 3.5% to 6.1%) for GA 28–31 weeks, 3.3% (95% CI 2.1% to 5.1%) for GA 32–33 weeks and 1.8% (95% CI 1.2% to 2.8%) for GA 34–36 weeks. Europe had lower reported incidence of any IVH and sIVH relative to North America (p<0.05). Proportion of VPS across all GA groups was 8.4% (95% CI 4.7% to 14.7%) for any IVH and 17.2% (95% CI 12.2% to 26.2%) for sIVH. Heterogeneity was high (I2 >90%) but 64%–85% of the variance was explained by GA and study inclusion criteria.ConclusionsWe report the first pooled estimates of IVH of prematurity by GA subgroup. There was high heterogeneity across studies suggesting a need for standardised incidence reporting guidelines.

Second-hand smoke and the risk of tuberculosis: a systematic review and a meta-analysis

2015 ◽  
Vol 143 (15) ◽  
pp. 3158-3172 ◽  
Author(s):  
O. F. DOGAR ◽  
N. PILLAI ◽  
N. SAFDAR ◽  
S. K. SHAH ◽  
R. ZAHID ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Statistical Significance ◽  
Epidemiological Studies ◽  
Second Hand Smoke ◽  
Significant Heterogeneity ◽  
Inclusion Criteria ◽  
Tb Treatment ◽  
Marked Variability ◽  
Shs Exposure ◽  
Study Designs

SUMMARYThere is limited evidence and lack of consensus whether second-hand smoke (SHS) increases risk of tuberculosis (TB), which has substantial implications for unrestricted smoking indoors and TB control policies. We aimed to establish the association between SHS and the risk of acquiring and worsening of TB in non-smokers. We identified 428 articles in the initial search and 12 comparative epidemiological studies met our inclusion criteria. Exposure to SHS was found to have a higher risk of TB infection [risk ratio (RR) 1·19, 95% confidence interval (CI) 0·90–1·57] compared to non-exposure; however, this did not reach statistical significance. There was marked variability (I2 = 74%, P = 0·0008) between studies’ results, which could be explained by the differences in the diagnostic criteria used. Exposure to SHS was found to be statistically significantly associated (RR 1·59, 95% CI 1·11–2·27) with the risk of TB disease. There was significant heterogeneity (I2 = 77%, P = 0·0006) between studies’ results, which was sourced to the internal characteristics of the studies rather than combining different study designs. We did not find any studies for SHS and TB treatment-related outcomes. Thus, we conclude that SHS exposure may increase the risk of acquiring TB infection and progression to TB disease; however, the evidence remains scanty and weak.

Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

2018 ◽  
Vol 104 (2) ◽  
pp. F128-F136 ◽  
Author(s):  
Jinglan Huang ◽  
Li Zhang ◽  
Jun Tang ◽  
Jing Shi ◽  
Yi Qu ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Protective Factor ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Current Evidence ◽  
Inclusion Criteria ◽  
Formula Group ◽  
Milk Feeding

ObjectiveTo summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants.DesignWe searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study.ResultA total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance.ConclusionBoth exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.

Association of maternal diabetes mellitus with preterm infant outcomes: a systematic review and meta-analysis

2020 ◽  
pp. fetalneonatal-2020-320054
Author(s):  
Abdul Razak ◽  
Maheer Faden
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Periventricular Leukomalacia ◽  
Intraventricular Haemorrhage ◽  
Maternal Diabetes ◽  
Infant Outcomes ◽  
Meta Analyses

ContextThe association between maternal diabetes and outcomes of infants who are born preterm is unclear.ObjectiveTo perform a systematic review and meta-analysis of clinical studies exploring the association between maternal diabetes and preterm infant outcomes.MethodsMedline, PubMed and Cumulative Index of Nursing and Allied Health Literature databases were searched without language restriction from 1 January 2000 until 19 August 2019. Studies examining preterm infants <37 weeks gestational age and reporting prespecified outcomes of this review based on maternal diabetes as primary exposure variable were included.ResultsOf 7956 records identified through database searches, 9 studies were included in the study. No significant association was found between maternal diabetes and in-hospital mortality (adjusted RR (aRR) 0.90 (95% CI 0.73 to 1.11); 6 studies; participants=1 191 226; I2=83%). Similarly, no significant association was found between maternal diabetes and bronchopulmonary dysplasia (aRR 1.00 (95% CI 0.92 to 1.07); 4 studies; participants=107 902; I2=0%), intraventricular haemorrhage or cystic periventricular leukomalacia (aRR 0.91 (95% CI 0.80 to 1.03); 3 studies; participants=115 050; I2=0%), necrotising enterocolitis (aRR 1.13 (95% CI 0.90 to 1.42); 5 studies; participants=142 579; I2=56%) and retinopathy of prematurity (ROP) (aRR 1.17 (95% CI 0.85 to 1.61); 5 studies; participants=126 672; I2=84). A sensitivity analysis where low risk of bias studies were included in the meta-analyses showed similar results; however, the heterogeneity was lower for in-hospital mortality and ROP.ConclusionMaternal diabetes was not associated with in-hospital mortality and severe neonatal morbidities in preterm infants. Future studies should explore the association between the severity of maternal diabetes with preterm infant outcomes.

scholarly journals The Prevalence and Predictors of Herbal Medicines’ Use in Cancer: A systematic Review and Meta-analysis of Observational Studies.

2020 ◽  
Author(s):  
John Baptist Asiimwe ◽  
Sarki Ahmed ◽  
Mauda Mugisha Kamatenesi ◽  
Esther Atukunda ◽  
Prakash PN ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Cancer Patients ◽  
Observational Studies ◽  
Meta Analysis ◽  
Herbal Medicines ◽  
Medicines Use ◽  
Geographical Regions ◽  
The World ◽  
Economic Regions

The study aims to estimate the prevalence of herbal medicines use in cancer patients across the various regions of the world (geographical regions, economic regions) and establish the key predictors of herbal medicines use in those regions. The study will only synthesize literature from primary observational studies (cohorts and crosssectional study) reported in english between 2000 and 2020 (current). This study is evisaged to provide updated data on the magnitude of herbal medicine in cancer, that will in the end guide healthcare policy.

scholarly journals Umbilical cord milking in preterm infants: a systematic review and meta-analysis

2020 ◽  
Vol 105 (6) ◽  
pp. 572-580
Author(s):  
Haribalakrishna Balasubramanian ◽  
Anitha Ananthan ◽  
Vaibhav Jain ◽  
Shripada C Rao ◽  
Nandkishor Kabra
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Umbilical Cord ◽  
Meta Analysis ◽  
Intraventricular Haemorrhage ◽  
Reference List ◽  
Delayed Cord Clamping ◽  
Neurodevelopmental Outcomes ◽  
Cord Clamping ◽  
Umbilical Cord Milking

ObjectiveTo conduct a systematic review and meta-analysis of the efficacy and safety of umbilical cord milking in preterm infants.DesignRandomised controlled trials comparing umbilical cord milking with delayed cord clamping/immediate cord clamping in preterm infants were identified by searching databases, clinical trial registries and reference list of relevant studies in November 2019. Fixed effects model was used to pool the data on various clinically relevant outcomes.Main outcome measuresMortality and morbidities in preterm neonates.ResultsNineteen studies (2014 preterm infants) were included. Five studies (n=922) compared cord milking with delayed cord clamping, whereas 14 studies (n=1092) compared milking with immediate cord clamping. Cord milking, as opposed to delayed cord clamping, significantly increased the risk of intraventricular haemorrhage (grade III or more) (risk ratio (RR): 1.95 (95% CI 1.01 to 3.76), p=0.05). When compared with immediate cord clamping, cord milking reduced the need for packed RBC transfusions (RR:0.56 (95% CI 0.43 to 0.73), p<0.001). There was limited information on long-term neurodevelopmental outcomes. The grade of evidence was moderate or low for the various outcomes analysed.ConclusionUmbilical cord milking, when compared with delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage in preterm infants, especially at lower gestational ages. Cord milking, when compared with immediate cord clamping, reduced the need for packed RBC transfusions but did not improve clinical outcomes. Hence, cord milking cannot be considered as placental transfusion strategy in preterm infants based on the currently available evidence.

scholarly journals The impact of selection criteria and study design on reported survival outcomes in extracorporeal oxygenation cardiopulmonary resuscitation (ECPR): a systematic review and meta-analysis

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Sameer Karve ◽  
Dominique Lahood ◽  
Arne Diehl ◽  
Aidan Burrell ◽  
David H. Tian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Prospective Studies ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Newcastle Ottawa Scale ◽  
Study Designs ◽  
Based Medicine ◽  
The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially. However, reported outcomes vary considerably due to differing study designs and selection criteria. This review assessed the impact of pre-defined selection criteria on ECPR survival. Methods Systematic review applying PRISMA guidelines. We searched Medline, Embase, and Evidence-Based Medicine Reviews for RCTs and observational studies published from January 2000 to June 2021. Adult patients (> 12 years) receiving ECPR were included. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Outcomes included overall and neurologically favourable survival. Meta-analysis and meta-regression were performed. Results 67 studies were included: 14 prospective and 53 retrospective. No RCTs were identified at time of search. The number of inclusion criteria to select ECPR patients (p = 0.292) and study design (p = 0.962) was not associated with higher favourable neurological survival. However, amongst prospective studies, increased number of inclusion criteria was associated with improved outcomes in both OHCA and IHCA cohorts. (β = 0.12, p = 0.026) and arrest to ECMO flow time was predictive of survival. (β = -0.023, p < 0.001). Conclusions Prospective studies showed number of selection criteria and, in particular, arrest to ECMO time were associated with significant improved survival. Well-designed prospective studies assessing the relative importance of criteria as well as larger efficacy studies are required to ensure appropriate application of what is a costly intervention.

Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis

2019 ◽  
Vol 105 (4) ◽  
pp. 432-439 ◽  
Author(s):  
Andreea Matei ◽  
Louise Montalva ◽  
Alexa Goodbaum ◽  
Giuseppe Lauriti ◽  
Augusto Zani
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Periventricular Leukomalacia ◽  
Intraventricular Haemorrhage ◽  
Cochrane Collaboration ◽  
Necrotising Enterocolitis ◽  
Cerebral Lesions ◽  
Neurodevelopmental Impairment ◽  
The Impact

AimTo determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.MethodsSystematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.ResultsOf 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%–64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).ConclusionsThis study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.Trial registration numberCRD42019120522.

A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies

2020 ◽  
Vol 133 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Anthony T. Lee ◽  
John F. Burke ◽  
Pranathi Chunduru ◽  
Annette M. Molinaro ◽  
Robert Knowlton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Meta Analysis ◽  
Small Sample ◽  
Seizure Freedom ◽  
Level I ◽  
Study Designs ◽  
Medically Refractory Epilepsy

OBJECTIVERecent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions.METHODSThe authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012–April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort.RESULTSThe overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2< 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93–29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni’s multiple comparison test).CONCLUSIONSThe overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.

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