ORCID Profile
0000-0002-7485-4776
Current Organisations
Fiona Stanley Hospital
,
Malaysian Agricultural Research and Development Institute
,
University of Western Australia
,
Saint John of God Hospital Subiaco
,
Royal Australasian College of Physicians
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Publisher: Informa UK Limited
Date: 20-10-2017
DOI: 10.1080/14767058.2016.1193143
Abstract: To conduct a systematic review of strategies for the management of transient tachypnoea of the newborn (TTN). The Cochrane Collaboration and PRISMA guidelines were used for conducting and reporting this systematic review, respectively. The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases were searched in February 2016. Only randomised and quasi-randomised controlled trials (RCTs) assessing any intervention for the management of TTN in infants <7 days of age, born at 35 or more weeks with a clinical diagnosis of TTN were eligible for inclusion. Primary outcomes included the duration of respiratory support, oxygen support, tachypnoea and hospitalisation. Nine RCTs with moderate risk of bias were included. The interventions assessed included furosemide (2 trials, n = 100), inhaled salbutamol (2 trials, n = 94), inhaled epinephrine (1 trial, n = 20), restrictive fluids (2 trials, n = 146) and non-invasive ventilation (2 trials, n = 80). Amongst all interventions, inhaled salbutamol significantly reduced the duration of hospitalisation (2 trials, n = 94) [mean difference (MD) - 1.63 days (95% CI -2.71 to -0.55) p = 0.003] and duration of oxygen requirement (1 trial, n = 37) [MD - 43.10 h (95% CI -81.82 to -4.38 p = 0.03] without adverse effects. Limited low-quality evidence exists on the effects of different management strategies for TTN. The safety and efficacy of inhaled salbutamol in the treatment of TTN can be assessed in a large RCT.
Publisher: BMJ
Date: 05-12-2018
DOI: 10.1136/ARCHDISCHILD-2017-313840
Abstract: Antenatal corticosteroid (ANC) use before 25 weeks' gestation is controversial. Our previous systematic review (eight observational studies, n=10 109) showed that ANC exposure was associated with significantly reduced mortality and severe intraventricular haemorrhage (IVH) eriventricular leukomalacia (PVL) in neonates born <25 weeks. We update our review by adding data (n=3334) from a recent study. We used Cochrane methodology and summarised the results using GRADE (The Grading of Recommendations Assessment, Development and Evaluation) guidelines. Nine high-quality observational studies were included. Meta-analysis (random effects model) showed reduced mortality (n=13 443 OR=0.48 (95% CI 0.42 to 0.55) P<0.00001 level of evidence (LOE): moderate) and IVH or PVL (n=8418 OR=0.70 (95% CI 0.63 to 0.79), P<0.00001 LOE: moderate) in neonates born <25 weeks exposed to ANC. There was no difference in necrotising enterocolitis (NEC) ≥stage II (n=8737 OR=1.01 (95% CI 0.84 to 1.22), P=0.89 LOE: low) incidence of chronic lung disease (CLD) was higher (n=7983 OR=1.32 (95% CI 1.04 to 1.67), P=0.02 LOE: low) in ANC group. Composite outcomes of death/major morbidities (eg, severe IVH, NEC, CLD) were improved after ANC exposure.
Publisher: Informa UK Limited
Date: 11-08-2019
DOI: 10.1080/14767058.2019.1649650
Abstract: Over investigation and overuse of empirical antibiotics is a concern in management of neonatal early onset sepsis (EOS) using the Centers for Disease Control and Prevention guidelines. "Sepsis calculator" is a risk-based prediction model for managing neonates at risk of EOS. To compare outcomes of neonatal EOS using of sepsis calculator versus conventional approach. A systematic review of randomized controlled trials (RCT) and non-RCTs reporting on outcomes after implementation of sepsis calculator for EOS for neonates >34-week gestation was conducted using the Cochrane methodology. Databases PubMed, CINAHL, Embase, Cochrane Central library and Google Scholar were searched in May 2019. Primary outcomes were antibiotics usage and laboratory tests for managing EOS. Secondary outcomes included hospital admissions and readmissions, blood culture positive EOS and mortality. The level of evidence (LOE) was summarized using the GRADE guidelines. A total of 387 articles were retrieved after initial search. Six high quality non-RCTs fulfilled inclusion criteria. Meta-analysis (random effects model) showed that implementation of sepsis calculator was associated with reduced antibiotic usage [ Moderate quality evidence indicates that the implementation of a sepsis calculator was associated with reduced usage of antibiotics, laboratory tests and admission to neonatal unit with no increase in mortality and readmissions.
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000444075
Abstract: b i Background: /i /b A delayed passage of meconium is considered as a risk factor for feed intolerance in preterm neonates. b i Objectives: /i /b The aim of this study was to review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates. b i Methods: /i /b A systematic review of randomised controlled trials (RCTs) of different therapeutic agents for meconium evacuation in preterm neonates (gestation weeks and/or birth weight ,500 g) using the Cochrane systematic review methodology was undertaken. Databases including Google Scholar were searched in January 2016. The primary outcome was the time to reach full feeds (TFF ≥120 ml/kg feeds with stoppage of parenteral nutrition h). Secondary outcomes included necrotising enterocolitis (NEC), weight at discharge and adverse effects. The results were summarised as per the GRADE guidelines. b i Results: /i /b Six RCTs (2 each of glycerine suppository and enema, 1 normal saline enema and 1 oral osmotic contrast agent n = 442) with a low or unclear risk of bias were included. The pooled estimate (random effects model) showed no reduction in TFF [mean difference (MD) -0.03, 95% CI -2.47, 2.41, p = 0.98 level of evidence: low]. No differences in NEC [risk ratio (RR) 1.71, 95% CI 0.63, 4.65, p = 0.30 level of evidence: low] and weight at discharge (MD -0.08, 95% CI -0.30, 0.15, p = 0.50 level of evidence: low) were found. The trial assessing oral osmotic contrast agents reported a trend towards a higher incidence of NEC ≥ stage II. There were no other adverse effects. b i Conclusion: /i /b Limited low-quality evidence indicates that prophylactic glycerine suppository, small volume glycerine/normal saline enema or oral osmotic contrast agents to evacuate meconium did not reduce TFF in preterm neonates. Large, well-designed trials are essential to study this clinically significant issue.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.JPEDS.2015.01.040
Abstract: To evaluate the efficacy and safety of nebulized pentoxifylline for reducing the duration of oxygen supplementation in extremely preterm neonates at high risk of bronchopulmonary dysplasia (BPD). Single-center, randomized, double-blind, placebo-controlled trial was conducted. Infants of 23(0) to 27(6) weeks' gestational age requiring mechanical ventilation or ≥30% supplemental oxygen on continuous positive airway pressure at 72-168 hours were randomized to receive 20 mg/kg (1 mL/kg) nebulized pentoxifylline or an equal volume of normal saline placebo every 6 hours for 10 consecutive days via a vibrating mesh nebulizer. The primary outcome was the duration of oxygen supplementation at 40 weeks' postmenstrual age. We used Cox proportional hazards regression modeling to analyze outcomes. All infants had adequate data for analysis of the primary outcome. Intention-to-treat analysis revealed no differences in duration of oxygen supplementation at 40 weeks' postmenstrual age between pentoxifylline (n=41) and placebo (n=40) groups (median 2262 vs 2160 hours, adjusted hazard ratio: 1.14, 95% CI 0.72-1.80, P=.63). There was no difference in mortality and further secondary outcomes. No adverse effects were noted. Nebulized pentoxifylline is safe but did not reduce the duration of oxygen supplementation in extremely preterm infants at high risk of BPD. Dose-ranging studies and large, well-designed clinical trials are required to determine whether the use of nebulized or systemic pentoxifylline as a prophylactic therapy offers small but relevant benefits for prevention of BPD. Australian New Zealand Clinical Trials Registry: ACTRN12611000145909.
Publisher: Public Library of Science (PLoS)
Date: 09-05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
DOI: 10.1097/MPG.0000000000001298
Abstract: Eosinophilic esophagitis (EoE) is associated with significant morbidity in children. Strategies for optimizing its outcomes are hence essential. We aimed to review the strategies for medical management of EoE in children. We conducted a systematic review of randomized controlled trials (RCTs) of medical interventions in children with EoE, using the Cochrane methodology. Databases including PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched up to March 2016. Primary outcomes included histological (peak eosinophil count) and symptomatic remission. Secondary outcomes were improvement in endoscopic and other histological parameters and adverse effects. A total of 5 RCTs (N = 448) with low to unclear risk of bias were included. The interventions included topical oral steroids, swallowed enteral steroids and anti- interleukin (IL)5 agent. Pooling of data from all trials was not possible owing to significant heterogeneity in interventions. Meta-analysis of data (N = 141) from 3 RCTs (oral viscous budesonide: 2, fluticasone: 1) showed significant histological remission in the intervention versus control group participants (risk difference: 10.32 [95% confidence interval: 3.04, 35.03] P = 0.0002), level of evidence—low. Compared with anti-IL5 agent, the trials assessing steroids reported high rates of clinical remission. Clinical remission did not correlate with histological improvement in any trial. Except for systemic corticosteroids, there were no significant adverse effects related to other interventions. Limited low-quality evidence exists on the effects of various interventions in children with EoE. The beneficial effects of swallowed steroid need to be confirmed in large well-designed RCTs.
Publisher: Informa UK Limited
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 22-06-2019
DOI: 10.1007/S00431-019-03397-6
Abstract: Cow's milk protein allergy (CMPA) is the commonest food allergy in infancy and is associated with significant health burden. Given their immune modulatory properties, probiotics have been proposed as a strategy for management of CMPA. We aimed to systematically review efficacy and safety of probiotics in the management of CMPA. Databases PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched in August 2018 for randomized controlled trials (RCT) of probiotic supplementation as an adjunct in the management of infants with suspected roven CMPA. Primary outcomes were resolution of hematochezia and acquisition of tolerance to CMP at 6, 12, 24, and 36 months. Secondary outcomes included effect on allergic symptoms (SCORAD index), growth, gut microbiota, and adverse effects. A total of 10 RCTs (n = 845 probiotics, 422 control, 423) with low to unclear risk of bias were included. Meta-analysis showed probiotic supplementation was not associated with earlier resolution of hematochezia (n = 87 RR: 1.45 (95% CI: 0.96-2.18), p = 0.08 level of evidence (LOE), very low), in presumed CMPA. In confirmed CMPA, probiotics were associated with higher rate of acquisition of tolerance to CMP at the end of 3 years compared with placebo (N = 493 RR, 1.47 95% CI, (1.17-1.84) p = 0.0009 LOE, low]. Meta-analysis was not possible for other outcomes. There were no probiotic related adverse effects. Conclusion: Limited low-quality evidence indicates that probiotic supplementation may be associated with earlier acquisition of tolerance to CMP in children with CMPA. Large well-designed trials are essential to confirm these findings. What is Known: • Cow's milk protein allergy (CMPA) is one of the commonest food allergies in children. CMPA is associated with significant socioeconomic burden. • Elimination diet and extensively hydrolyzed formula is the mainstay of the management of CMPA. What is New: • This first systematic review of randomized controlled trials shows that probiotics as an adjuvant can lead to earlier acquisition of tolerance to CMP in children at 36 months of age. However, the evidence is low quality and influenced by data from one large study. • Probiotic supplementation was not associated with earlier resolution of hematochezia.
Publisher: Public Library of Science (PLoS)
Date: 22-03-2021
DOI: 10.1371/JOURNAL.PONE.0248774
Abstract: Administration of antenatal corticosteroids (ANC) for impending preterm delivery beyond 34 weeks of gestation continues to be a controversial issue despite various guidelines for obstetricians and gynaecologists. To compare outcomes following exposure to ANC for infants born between 34–36 +6 weeks’ gestation. A systematic review of randomised controlled trials (RCT) reporting neonatal outcomes after ANC exposure between 34–36+6 weeks’ gestation using Cochrane methodology. Databases including PubMed, Embase, Emcare, Cochrane Central library and Google Scholar were searched in May 2020. Primary outcomes: (1) Need for respiratory support (Mechanical ventilation, CPAP, high flow) or oxygen (2) Hypoglycemia. Secondary outcomes included respiratory distress syndrome (RDS), transient tachypnoea of newborn (TTN), need for neonatal resuscitation at birth [only in the delivery room immediately after birth (not in neonatal intensive care unit (NICU)], admission to NICU, mortality and developmental follow up. Level of evidence (LOE) was summarised by GRADE guidelines. Seven RCTs (N = 4144) with low to high risk of bias were included. Only one RCT was from high income countries, Meta-analysis (random-effects model) showed (1) reduced need for respiratory support [5 RCTs (N = 3844) RR = 0.68 (0.47–0.98), p = 0.04 I 2 = 55% LOE: Moderate] and (2) higher risk of neonatal hypoglycaemia [4 RCTs (N = 3604) RR = 1.61(1.38–1.87), p .00001 I 2 = 0% LOE: High] after ANC exposure. Neonates exposed to ANC had reduced need for resuscitation at birth. The incidence of RDS, TTN and surfactant therapy did not differ significantly. None of the included studies reported long-term developmental follow up. Moderate quality evidence indicates that ANC exposure reduced need for respiratory support, and increased the risk of hypoglycaemia in late preterm neonates. Large definitive trials with adequate follow up for neurodevelopmental outcomes are required to assess benefits and risks of ANC in this population.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2021
Publisher: Informa UK Limited
Date: 05-07-2021
Publisher: Informa UK Limited
Date: 31-08-2019
DOI: 10.1080/14767058.2017.1369520
Abstract: Neonatal jaundice requiring phototherapy is associated with significant socioeconomic burden including hospital readmission, prolonged hospital stay, and separation of the baby from mother. To assess the efficacy and safety of probiotics in reducing the need for phototherapy and its duration in neonatal hyperbilirubinemia. A systematic review of randomized controlled trials (RCTs) of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. Primary outcome was the duration of phototherapy. Secondary outcomes included incidence of jaundice, total serum bilirubin (TSB) level at 24, 48, 72, 96 h, and day 7, duration of hospital stay, and adverse effects (e.g. probiotic sepsis). Results were summarized as per GRADE guidelines. Nine RCTs (prophylactic: six trials, N = 1761 therapeutic: three trials, N = 279) with low to high risk of bias were included. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [N = 415, mean difference (MD): -11.80 (-17.47, -6.13) p < .0001 level of evidence (LOE): low]. TSB was significantly reduced at 96 h [MD: -1.74 (-2.92, -0.57) p = .004] and 7 d [MD: -1.71 (-2.25, -1.17) p < .00001 LOE: low] after probiotic treatment. Prophylactic probiotics did not reduce the incidence of jaundice significantly [N = 1582, relative risk (RR): 0.56 (0.25, 1.27) p = .16 LOE: low]. There were no probiotic-related adverse effects. Limited low-quality evidence indicates that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Routine use of probiotics to prevent or treat neonatal jaundice cannot be recommended. Large well-designed trials are essential to confirm these findings.
Publisher: Wiley
Date: 10-01-2017
DOI: 10.1111/GCB.13516
Publisher: Springer Science and Business Media LLC
Date: 29-03-2022
DOI: 10.1007/S00431-022-04452-5
Abstract: Sepsis due to the administered probiotic strain/s is a barrier against adoption of prophylactic probiotic supplementation in preterm infants to reduce the risk of necrotising enterocolitis (NEC ≥ Stage II), all-cause mortality, late-onset sepsis, and feeding intolerance. We aimed to conduct a systematic review for reports of probiotic sepsis in preterm infants (gestation < 37 weeks). Databases including PubMed, Embase, Emcare, Cochrane Central library, and Google Scholar were searched in August 2021 and updated in Jan 2022. Probiotic sepsis was defined as positive blood/CSF culture isolating administered probiotic strain with symptoms suggestive of infection. Data collection included birth weight, gestation, comorbidities (e.g. gut surgery, NEC), presence of central venous catheters, treatment, and outcome. Literature search revealed 1569 studies. A total of 16 reports [randomised control trial (RCT): none non-RCT: 1 case series: 8 case report: 7] involving 32 preterm infants with probiotic sepsis were included after exclusions for various reasons. Majority of the cases were born < 32 weeks' gestation. Bifidobacterium (N = 19) was the most commonly isolated organism followed by Lactobacillus (N = 10), and Saccharomyces (N = 3). A total of 25/32 cases were confirmed to be due to the administered probiotic strain on full genomic analysis. Two studies reported one neonatal death each. Twelve neonates had comorbidities. Majority were treated with antibiotics (29/32) whereas others (3/32) required antifungal treatment. Probiotics sepsis is relatively an uncommon event in preterm infants. Majority of the cases recovered after antibiotic or antifungal treatment. The importance of optimal surveillance and treatment of probiotic sepsis and research towards alternatives to probiotics (e.g. postbiotics) is emphasised. • Probiotics have been shown to reduce necrotising enterocolitis, late-onset sepsis, all-cause mortality, and time to reach full enteral feeds in preterm infants. • Despite the evidence, use of probiotics is not universal due to concerns regarding probiotic-associated sepsis in preterm infants. • This comprehensive systematic review showed that probiotic sepsis is a relatively rare phenomenon in preterm infants. • All except one case where the diagnosis was uncertain recovered after antimicrobial therapy.
Publisher: BMJ
Date: 03-06-2015
DOI: 10.1136/ARCHDISCHILD-2015-308292
Abstract: To evaluate the efficacy and safety of gastric lavage (GL) in neonates born through meconium-stained liquor (MSL). A systematic review of randomised controlled trials by searching databases MEDLINE (from 1966), EMBASE (from1980), CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar and proceedings of Pediatric Academic Society meetings (2002-2014). Delivery room/Neonatal ward. Neonates with gestation >34 weeks and birth weight ≥1800 g born through MSL. Prophylactic GL versus no intervention before first feed. Feeding intolerance, defined as inability to initiate/upgrade feeds due to problems such as retching, vomiting, regurgitation and gastric residuals. A total of six studies (GL: 918, no GL: 966) were included in the review. Meta-analysis using fixed-effects model showed decreased incidence of feed intolerance following GL ((81/918 (8.8%) vs 114/966 (11.8%) risk ratio (RR): 0.71 (95% CI 0.55 to 0.93)). However, the results were not significant when random-effects model was used (RR: 0.78 (95% CI 0.55 to 1.09)). No significant adverse effects of GL were reported. Routine GL immediately after birth may improve feed tolerance in neonates born through MSL. However, the evidence is limited, with probable small-study bias and high risk of bias in a number of the included studies. Well-designed studies with adequate s le size are essential to confirm these findings.
Location: Malaysia
No related grants have been discovered for Mangesh Deshmukh.