A Case to Optimize Medications in Children With Severe Neurological Impairment

Musial, Abigail; Thomson, Joanna

doi:10.1001/jamanetworkopen.2020.29728

Cited by 2 publications

(2 citation statements)

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“…Given the prevalence of polypharmacy in children with complex needs, 54 the reduction in medication dependence as well as the reduced symptom burden is likely to greatly benefit child and family quality of life. 55,56 The increase in oral feeding, reported in four of the included studies ,43,47,49,51 was an interesting finding, and a potentially unexpected benefit. Mechanisms underpinning this are unclear, but theories have been proposed that it may be linked to resolution of GI symptoms, where nausea, gagging and retching may influence a child's willingness and enjoyment to accept oral feeds, as well as changes in complex appetite signalling mediated by GI microbiome.…”

Section: Study and Participantsmentioning

confidence: 88%

“…The reduction in GI symptoms is likely directly linked to the reduction in medication use seen in the studies in this review. Given the prevalence of polypharmacy in children with complex needs, 54 the reduction in medication dependence as well as the reduced symptom burden is likely to greatly benefit child and family quality of life 55,56 …”

Section: Discussionmentioning

confidence: 99%

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Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications

McCormack

Patel

Smith

2023

J Human Nutrition Diet

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Background Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised and synthesised the available evidence on the benefits and complications of BD versus commercial feeds. Methods A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022. Inclusion criteria: English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations or attitudes and (3) comparing commercial blends only. Data were synthesised using an established narrative synthesis approach using the Mixed Methods Appraisal Tool. Results Eight hundred and six database results were identified and 61 were sought for retrieval. A full‐text article review revealed seven eligible studies, involving 267 participants (age range 9 months to 26 years). Studies reported differences in gastrointestinal symptoms (n = 222), medication use (n = 119), growth (n = 189) and complications or adverse events (n = 91). The results indicate positive outcomes, particularly in gastrointestinal symptom control, with few reports of mild adverse events in the included studies. Conclusions There is a paucity of data in this area and much heterogeneity in the included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic, and more primary research, ideally using standardised reporting, is required to answer the key questions.

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Section: Study and Participantsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications

McCormack

Patel

Smith

2023

J Human Nutrition Diet

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Impact of Abnormal Potassium on Arrhythmia Risk During Pediatric Digoxin Therapy

et al. 2022

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Background: Digoxin is used in children with heart failure and tachyarrhythmia. Its use in patients with single ventricle anatomy has increased following evidence of improved interstage survival after the Norwood procedure. Digoxin has a narrow therapeutic window and may alter serum potassium balance, inducing arrhythmias. We hypothesized digoxin use in the setting of abnormal serum potassium levels is associated with arrhythmias.Methods: We reviewed all patients ≤18 years who received digoxin while admitted at our institution from 2014-2021. Admissions <2 nights were excluded. We compared patients with a hemodynamically signi cant arrhythmia to those without. We performed adjusted logistic regression with arrhythmia as the outcome variable and potassium status as the predictor variable; adjusting for weight, route of digoxin administration, digoxin indication, serum creatinine, and number of interacting drugs prescribed.Abnormal potassium was de ned as serum levels <3.5 mmol/L or >6.0 mmol/L.Results: There were 272 encounters in 172 patients. Potassium levels were abnormal in 72.9% of patients who experienced an arrhythmia during digoxin administration, compared to 40.3% who did not (p < 0.001). Odds of arrhythmia was 133% higher in patients with abnormal potassium receiving digoxin (AOR=2.33, 95% CI 1. 16 -4.68, p=0.02). Receiving intravenous digoxin was also associated with a 4.46 odds of cardiac arrhythmia (AOR 4.46, p=0.04, 95% CI 1.07 to 18.50).Conclusion: Odds of arrhythmia is increased during digoxin administration when pediatric patients have abnormal potassium levels. Vigilant attention to potassium levels is essential to prevent adverse outcomes during digoxin therapy.

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A Case to Optimize Medications in Children With Severe Neurological Impairment

Cited by 2 publications

References 8 publications

Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications

Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications

Impact of Abnormal Potassium on Arrhythmia Risk During Pediatric Digoxin Therapy

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