Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: A systematic review and narrative synthesis.

Autor:	Relan P; Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA., Garbern SC; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., O'Reilly G; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Bills CB; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA., Schultz M; Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI, USA., Kivlehan S; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA., Trehan I; Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA., Becker TK; Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2023 Jun 09; Vol. 13, pp. 04065. Date of Electronic Publication: 2023 Jun 09.
DOI:	10.7189/jogh.13.04065
Abstrakt:	Background: Severe acute respiratory infections (SARIs) are the leading cause of paediatric death globally, particularly in low- and middle-income countries (LMICs). Given the potential rapid clinical decompensation and high mortality rate from SARIs, interventions that facilitate the early care are critical to improving patient outcomes. Through this systematic review, we aimed to evaluate the impact of emergency care interventions on improving clinical outcomes of paediatric patients with SARIs in LMICs. Methods: We searched PubMed, Global Health, and Global Index Medicus for peer-reviewed clinical trials or studies with comparator groups published before November 2020. We included all studies which evaluated acute and emergency care interventions on clinical outcomes for children (29 days to 19 years) with SARIs conducted in LMICs. Due to observed heterogeneity of interventions and outcomes, we performed narrative synthesis. We assessed bias using the Risk of Bias 2 and Risk of Bias in Non-Randomized Studies of Interventions tools. Results: We screened 20 583, 99 of which met the inclusion criteria. Conditions studied included pneumonia or acute lower respiratory infection (61.6%) and bronchiolitis (29.3%). Studies evaluated medications (80.8%), respiratory support (14.1%), and supportive care (5%). We found the strongest evidence of benefit for decreasing risk of death for respiratory support interventions. Results were inconclusive on the utility of continuous positive airway pressure (CPAP). We found mixed results for interventions for bronchiolitis, but a possible benefit for hypertonic nebulised saline to decrease hospital length of stay. Early use of adjuvant treatments such as Vitamin A, D, and zinc for pneumonia and bronchiolitis did not appear to have convincing evidence of benefit on clinical outcomes. Conclusions: Despite the high global burden of SARI in paediatric populations, few emergency care (EC) interventions have high quality evidence for benefit on clinical outcomes in LMICs. Respiratory support interventions have the strongest evidence for benefit. Further research on the use of CPAP in diverse settings is needed, as is a stronger evidence base for EC interventions for children with SARI, including metrics on the timing of interventions. Registration: PROSPERO (CRD42020216117). Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests. (Copyright © 2023 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
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