ORCID Profile
0000-0002-5520-0080
Current Organisations
Royal Australasian College of Physicians
,
University of Sydney - Sydney Medical School Nepean
,
Nepean Hospital
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Publisher: Wiley
Date: 15-06-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2011
Publisher: Springer Science and Business Media LLC
Date: 29-05-2008
DOI: 10.1007/S00431-008-0720-3
Abstract: Naloxone is a pure opioid antagonist specifically indicated for respiratory depression due to opioid exposure. There is not enough data on safety of naloxone, especially in extremely preterm neonates. We report the case of a preterm neonate (gestation 27 weeks and 3 days, birth weight 485 g) who developed cardiac arrest following treatment with naloxone (dose 100 mcg/kg) for a tenfold morphine overdose on day 7 while being ventilated for respiratory distress syndrome. Asystolic cardiac arrest occurred immediately after administering naloxone and required full resuscitation, including adrenaline and external chest compression. Recovery from the cardiac arrest was complete. However, the neonate died on day 45 of life due to unrelated causes. Reports of similar adverse effects of the drug in adults as well as data from animal models raise concerns about safety of naloxone, especially in preterm neonates, given the lack of data on the pharmacokinetics of the drug in this high-risk population. Possible explanations for the adverse event under such a scenario include an idiosyncratic reaction, hypoxia, direct myocardial depressant effect and sympathoadrenal interactions. Awareness of this rare but potentially lethal complication of naloxone is necessary to optimise the response to such an adverse event.
Publisher: MDPI AG
Date: 28-03-2013
DOI: 10.3390/NU5041058
Publisher: American Academy of Pediatrics (AAP)
Date: 2018
Abstract: Lactobacillus reuteri DSM17938 has shown promise in managing colic, but conflicting study results have prevented a consensus on whether it is truly effective. Through an in idual participant data meta-analysis, we sought to definitively determine if L reuteri DSM17938 effectively reduces crying and/or fussing time in infants with colic and whether effects vary by feeding type. We searched online databases (PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Database of Abstracts of Reviews of Effects, and Cochrane), e-abstracts, and clinical trial registries. These were double-blind randomized controlled trials (published by June 2017) of L reuteri DSM17398 versus a placebo, delivered orally to infants with colic, with outcomes of infant crying and/or fussing duration and treatment success at 21 days. We collected in idual participant raw data from included studies modeled simultaneously in multilevel generalized linear mixed-effects regression models. Four double-blind trials involving 345 infants with colic (174 probiotic and 171 placebo) were included. The probiotic group averaged less crying and/or fussing time than the placebo group at all time points (day 21 adjusted mean difference in change from baseline [minutes] −25.4 [95% confidence interval (CI): −47.3 to −3.5]). The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points (day 21 adjusted incidence ratio 1.7 [95% CI: 1.4 to 2.2]). Intervention effects were dramatic in breastfed infants (number needed to treat for day 21 success 2.6 [95% CI: 2.0 to 3.6]) but were insignificant in formula-fed infants. There were insufficient data to make conclusions for formula-fed infants with colic. L reuteri DSM17938 is effective and can be recommended for breastfed infants with colic. Its role in formula-fed infants with colic needs further research.
Publisher: American Academy of Pediatrics (AAP)
Date: 05-2010
Abstract: Systematic reviews of randomized, controlled trials (RCTs) indicate lower mortality and necrotizing enterocolitis (NEC) and shorter time to full feeds after probiotic supplementation in preterm (& weeks' gestation) very low birth weight (VLBW birth weight & g) neonates. The objective of this study was to update our 2007 systematic review of RCTs of probiotic supplementation for preventing NEC in preterm VLBW neonates. We searched in March 2009 the Cochrane Central register Medline, Embase, and Cinahl databases and proceedings of the Pediatric Academic Society meetings and gastroenterology conferences. Cochrane Neonatal Review Group search strategy was followed. Selection criteria were RCTs of any enteral probiotic supplementation that started within first 10 days and continued for ≥7 days in preterm VLBW neonates and reported on stage 2 NEC or higher (Modified Bell Staging). A total of 11 (N = 2176), including 4 new (n = 783), trials were eligible for inclusion in the meta-analysis by using a fixed-effects model. The risk for NEC and death was significantly lower. Risk for sepsis did not differ significantly. No significant adverse effects were reported. Trial sequential analysis) showed 30% reduction in the incidence of NEC (α = .05 and .01 power: 80%). The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The dramatic effect sizes, tight confidence intervals, extremely low P values, and overall evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available.
Publisher: BMJ
Date: 12-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Publisher: Springer Science and Business Media LLC
Date: 02-08-2011
Abstract: Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates. To develop evidence-based guidelines for probiotic supplementation in preterm neonates. To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences these data were used in our updated systematic review. In this review, we present guidelines, including level of evidence, for the practical aspects (for ex le, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for ex le, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research. We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics.
Publisher: Elsevier BV
Date: 08-2016
Publisher: Elsevier BV
Date: 12-2014
Abstract: The optimization of enteral nutrition is a priority in preterm neonates worldwide. Probiotics are known to improve gut maturity and function in preterm neonates. To our knowledge, previous systematic reviews have not adequately assessed the effects of probiotic supplementation on enteral nutrition in preterm neonates. We assessed the evidence on effects of probiotics on enteral nutrition in preterm neonates. A systematic review of randomized controlled trials (RCTs) of probiotic supplementation in preterm (gestation <37 wk) or low-birth-weight (birth weight <2500 g) neonates was conducted. With the use of the Cochrane Neonatal Review Group strategy, we searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Cumulative Index of Nursing and Allied Health Literature databases and proceedings of Pediatric Academic Society meetings in April 2014. A total of 25 RCTs (n = 5895) were included in the review. A meta-analysis (random-effects model) of data from 19 of 25 trials (n = 4527) estimated that the time to full enteral feeds was shorter in the probiotic group (mean difference: -1.54 d 95% CI: -2.75, -0.32 d P < 0.00001, I(2) = 93%). Other benefits included fewer episodes of feed intolerance, better weight gain and growth velocity, decreased transition time from orogastric to breast feeds, and increased postprandial mesenteric flow. There were no adverse effects of probiotic supplementation. Probiotics reduced the time to full enteral feeds in preterm neonates. Additional research is necessary to assess the optimal dose, duration, and probiotic strain or strains used specifically for facilitating enteral nutrition in this population.
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/AJO.12328
Abstract: Survival of extremely preterm and critically ill neonates has improved significantly over the last few decades following advances in neonatal intensive care. These include antenatal glucocorticoids, surfactant, continuous positive airway pressure support, advanced gentle modes of ventilation and inhaled nitric oxide. Probiotic supplementation is a recent significant milestone in the history of neonatal intensive care. Very few, if any, interventions match the ability of probiotics to significantly reduce the risk of death and definite necrotising enterocolitis while facilitating enteral feeds in high-risk preterm neonates. Probiotics also have a potential to benefit neonates with surgical conditions with significant gastrointestinal morbidity. Current evidence for the benefits of probiotic supplementation for neonates in an intensive care unit is reviewed. The mechanisms for the benefits of probiotics in this population are discussed, and guidelines for clinicians are provided in the context of the regulatory framework in Australia.
Publisher: BMJ
Date: 12-2017
DOI: 10.1136/BMJOPEN-2017-017638
Abstract: Although there is an overall reduction in underfive mortality rate, the progress in reducing neonatal mortality rate has been very slow. Over the last 20 years, preterm births have steadily increased in low-income and medium-income countries (LMICs) particularly in sub-Saharan Africa and South Asia. Preterm birth is associated with increased mortality and morbidity, particularly in LMICs. Based on systematic reviews of randomised controlled trials (RCTs), many neonatal units in high-income countries have adopted probiotics as standard of care for preterm neonates. We aimed to systematically review the safety and efficacy of probiotics in reducing mortality and morbidity in preterm neonates in LMICs. Systematic review and meta-analysis of RCTs. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and E-abstracts from Pediatric Academic Society meetings and other paediatric and neonatal conference proceedings were searched in January 2017. RCTs comparing probiotics versus placebo/no probiotic in preterm neonates (gestation weeks) conducted in LMICs. Total 23 (n=4783) RCTs from 4 continents and 10 LMICs were eligible for inclusion in the meta-analysis using fixed effect model. The risk of necrotising enterocolitis (NEC greater than or equal to stage II) (risk ratio (RR) 0.46 (95% CI 0.34 to 0.61), P .00001, numbers needed to treat (NNT) 25 (95% CI 20 to 50)), late-onset sepsis (LOS) (RR 0.80 (95% CI 0.71 to 0.91), P=0.0009, NNT 25 (95% CI 17 to 100)) and all-cause mortality (RR 0.73 (95% CI 0.59 to 0.90), P=0.003, NNT 50 (95% CI 25 to 100)) were significantly lower in probiotic supplemented neonates. The results were significant on random effects model analysis and after excluding studies with high risk of bias. No significant adverse effects were reported. Probiotics have significant potential to reduce mortality and morbidity (eg, NEC, LOS) in preterm neonates in LMICs.
Publisher: S. Karger AG
Date: 23-11-2013
DOI: 10.1159/000354891
Abstract: Necrotizing enterocolitis (NEC) is a major cause of mortality (25%) and morbidity including recurrent sepsis, dependence on parenteral nutrition, need for surgery, and survival with short bowel syndrome in preterm very low birth weight infants. Mortality (45-100%) and morbidity including the risk of long-term neurodevelopmental impairment are higher in extremely preterm infants needing surgery for NEC. Systematic reviews of randomized controlled trials (RCT) indicate that probiotics significantly reduce the risk of NEC (RR 0.39 95% CI 0.29-0.52 p 0.00001) and all-cause mortality (RR 0.52 95% CI 0.40-0.69 p 0.00001) while facilitating enteral feeds in preterm infants. At present, data from 25 RCT (∼5,000 neonates) and reports on routine use (∼3,000 neonates) indicates that significant adverse effects of probiotics are rare. Despite the robust evidence, there is still reluctance in incorporating routine probiotic prophylaxis in clinical practice. If the goal is to have zero tolerance for NEC, then probiotic prophylaxis must be adopted as soon as possible. Current gaps in knowledge can be addressed by continued research while providing routine probiotic supplementation. We believe that the concept of evidence-based practice of medicine has been stretched too far in this case. Trial sequential analysis has already shown that the evidence for probiotic supplementation was conclusive after 10 trials. Results of the ongoing trials are unlikely to change the conclusions of the systematic reviews significantly. Currently we are at trial number 25 how many more trials do we need? What will it take to change clinical practice?
Publisher: American Medical Association (AMA)
Date: 10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
Publisher: American Academy of Pediatrics (AAP)
Date: 03-2016
Abstract: Late-onset sepsis (LOS) is a major cause of mortality and morbidity in preterm infants. Despite various preventive measures, its incidence continues to remain high, hence the urgent need for additional approaches. One such potential strategy is supplementation with probiotics. The updated Cochrane Review (2014) did not find benefits of probiotics in reducing the risk of LOS in preterm infants (19 studies, N = 5338). Currently there are & randomized controlled trials (RCTs) of probiotics in preterm infants that have reported on LOS. To conduct a systematic review including all relevant RCTs. PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in June and August 2015. RCTs comparing probiotics versus placebo/no probiotic were included. Relevant data were extracted independently by 3 reviewers. Pooled results from 37 RCTs (N = 9416) using fixed effects model meta analysis showed that probiotics significantly decreased the risk of LOS (675/4852 [13.9%] vs 744/4564 [16.3%] relative risk, 0.86 95% confidence interval, 0.78–0.94 P = .0007 I2 = 35% number needed to treat, 44). The results were significant even after excluding studies with high risk of bias. Probiotic supplementation reduces the risk of LOS in preterm infants.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2014
Location: Australia
No related grants have been discovered for Girish Deshpande.