Conservative management of lymphoedema in children: A systematic review

Abstract

PURPOSE: A systematic literature review was conducted to determine best practice conservative management of pediatric lymphoedema. METHOD: The PRISMA protocol was followed; a search of Ovid Medline, Cinahl and Scopus was conducted using the search terms children OR pediatric OR adolescent AND lymphoedema OR lymphedema. Studies about management or treatment of lymphoedema in children were included while studies about filariasis, imaging, pathology, secondary lymphoedema, surgical techniques, central lymphoedema and those with participants with a median age greater than 18 years were excluded. RESULTS: Of 738 possible studies identified, eight studies were eligible for inclusion in the review: four case reports, two retrospective service reviews and two prospective studies investigating different interventions. All studies were rated using the NHMRC hierarchy of evidence and appraised by both authors using the McMaster University Critical Review Form. Studies were of low quality with poor descriptions of management, small sample size, unclear and inconsistent methodology and irreproducible outcome measures. CONCLUSION: This review identified low level evidence to support the use of pneumatic compression in the management of pediatric lymphoedema. Further research is required to identify optimal parameters for application of pneumatic compression and to investigate the use of other interventions for conservative management of pediatric lymphoedema.

Near-Infrared Fluorescence Lymphatic Imaging of a Toddler With Congenital Lymphedema

“…Finally, it is noteworthy that, before presenting to our Vascular Anomalies Clinic and consistent with a recent report on the lack of guidelines for management of pediatric lymphedema, 4 the subject's parents were instructed not to begin lymphedema treatments of MLD and bandaging until the child grew older. Although the scope of our conclusions based on this single case study may be limited in the broader pediatric population, the imaging results presented in this report provide evidence that treatments to stimulate the lymphatic pump could be useful at young ages, whereas surgical strategies to correct lymphatic blockage would not.…”

“…3 In addition, there are no guidelines or evidence for its effective, physical treatment. 4 Management of pediatric lymphedema is typically based on adult treatments, which include manual lymphatic drainage (MLD), bandaging, and compression, all of which lack evidence for effective use in the pediatric population. Given the long-term disability in the affected child and the financial impact of this chronic, progressive condition, better treatment algorithms are critical to the management of pediatric lymphedema.…”

Low-stretch bandages to treat primary lower limb lymphoedema: a cohort of 48 children

“…For juvenile lymphoedema, different management strategies are proposed, including conservative, e.g. intermittent pneumatic compression, low‐stretch bandages, manual lymph drainage, eventually replaced by self/parental drainage, exercises and compression . As for adults, this composite therapy is recommended without clear evidence of which component most effectively reduces volume.…”

“…intermittent pneumatic compression, lowstretch bandages, manual lymph drainage, eventually replaced by self/parental drainage, exercises and compression. 7 As for adults, this composite therapy is recommended without clear evidence of which component most effectively reduces volume. The intensive phase enables the child and/or parents, if necessary, to learn bandaging, 2-3 times a week.…”

A Study Using Visual Art Methods to Explore the Perceptions and Barriers of Self-Management in Children and Adolescents with Lymphedema

“…The systematic review by Phillips and Gordon excluded studies, which looked at psychological support and treatment of children in adult services. 8 In the eight studies they reviewed, they concluded that the research was generally of poor quality. The studies they looked at suggested that exercise is an important factor in the management of the condition but concluded that it is difficult to suggest how much is required.…”