Treatments for gestational diabetes: a systematic review and meta-analysis

An investigation into the effectiveness of different treatments for gestational diabetes mellitus | BMJ Open

Design: Systematic review, meta-analysis and network meta-analysis.

Methods: Data sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial).

Results: Forty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide.

Conclusions: Evidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed.

full reference: Farrar D, et al. (2017) Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open. 7:e015557.

Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers

Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting | Journal of Trauma and Acute Care Surgery

Background: Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification. It is hypothesized that ACS verified Pediatric Trauma Centers (vPTCs) have an increased prevalence of NAT due to this additional experience and training when relative to non-ACS vPTCs.

Conclusions: The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians.

Full reference: Bogumil, D.D.A. et al. (2017) Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers. Journal of Trauma and Acute Care Surgery: Published online: 20 June 2017

 

Cochrane reviews show impact of lifestyle changes on obesity

Two Cochrane reviews, published today, show that a combination of diet, physical activity and behavioural change interventions may reduce weight in children and adolescents | OnMedica

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The two reviews look at the effects of diet, physical activity and behavioural interventions in treating children with overweight or obesity from six years old to early adulthood. They summarise the results of 114 studies which involved over 13,000 children and young people.

Risk Factors Associated With Early Childhood Hearing Loss

In this study, we examined the association between risk factors for hearing loss and early childhood hearing status (normal hearing, congenital hearing loss, or delayed-onset hearing loss) | American Journal of Audiology

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Method: A retrospective data review was completed on 115,039 children born from 2010 to 2012. Data analyses included prevalence rates, odds ratios, and Fisher exact tests of statistical significance.

Results: Ninety percent of children were born with no risk factors for hearing loss; of those, 99.9% demonstrated normal hearing by 3 years of age. Of the 10% of children born with risk factors, 96.3% demonstrated normal hearing by age 3, 1.4% presented with congenital hearing loss, and 2.3% demonstrated permanent hearing loss by age 3. Factors that placed children at the highest risk of congenital hearing impairment were neurodegenerative disorders, syndromes, and congenital infections. Factors that placed children at the highest risk of developing permanent postnatal hearing loss were congenital cytomegalovirus, syndromes, and craniofacial anomalies.

Conclusions: Certain risk factors place a child at significantly greater risk of congenital hearing impairment or developing permanent hearing loss by age 3. Follow-up diagnostic testing should remain a priority for children with certain risk factors for hearing loss.

Full reference: Dumanch, K.A. et al. (2017) High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review. American Journal of Audiology, June 2017, Vol. 26, 129-142

Postnatal mental illness

The National Childbirth Trust (NCT) has published The hidden half: bringing postnatal mental illness out of hiding.

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Image source: http://www.nct.org.uk

The Hidden Half campaign surveyed 1,000 women who had recently had a baby and found that half had a mental health or emotional problem postnatally or during pregnancy. Of these, nearly half hadn’t had their problem identified by a health professional and hadn’t received any help or treatment. Many of these new mothers said they were too embarrassed or afraid of judgement to seek help.

The document can be downloaded here

Additional link: RCGP press release

Child protection in the UK

The National Society for the Prevention of Cruelty to Children (NSPCC) has published How safe are our children? 2017: the most comprehensive overview of child protection in the UK.

This fifth annual report compiles and analyses the most up-to-date child protection data that exists across the UK for 2017. It sets out twenty different indicators, each of which looks at the question of ‘how safe are our children?’ from a different perspective. The report also includes historic data, to help track progress over time.

Reducing baby deaths and injuries

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth. Adherence to best practice on fetal monitoring and neonatal care also identified as crucial to improving outcomes

The Royal College of Obstetricians and Gynaecologists has published Each Baby Counts: 2015 Summary Report. The report provides a detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 and identifies the key clinical actions needed to improve the quality of care and prevent future cases. These clinical actions include: improving fetal monitoring; enhancing neonatal care; and reducing human factors by understanding ‘situational awareness’ to ensure the safe management of complex clinical decisions.

The full report can be downloaded here

Additional links: Each Baby Counts project | Royal College of Midwives news | BBC News report