Cochrane Review: Drug interventions for the treatment of obesity in children and adolescents

This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn.

Cochrane Library, 29th November 2016

‘I have to live with the decisions I make’: laying a foundation for decision making for children with life-limiting conditions and life-threatening illnesses

decision-agreement

Image source: Pixabay

In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician–parent relationship at progression or deterioration of life-limiting conditions or life-threatening illnesses.

Archives of Diseases in Children, 5th December 2016 (Open Access).

NICE guidance: End of life care for infants, children and young people with life-limiting conditions: planning and management

This guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

NICE Guidance NG61, published 7th December, 2016

Parenteral Nutrition in Critically Ill Children

Nilesh M. Mehta, M.D.
N Engl J Med 2016; 374:1190-1192 March 24, 2016

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Adequate nutrient delivery may help to offset the catabolic burden imposed by critical illness, preventing nutritional deterioration and improving outcomes. However, questions regarding the most appropriate dose of macronutrients, the route of delivery, and particularly the timing of supplemental parenteral nutrition in critically ill children remain unanswered (Areas of Consensus and Controversy in Critical Care Nutrition for Children.). Enteral nutrition is preferable in patients with a functioning gut but may not always be feasible. Intestinal failure was incompatible with life until the 1960s, when the development of stable intravenous amino acid solutions and lipid emulsions allowed the administration of life-sustaining nourishment through the parenteral route.1 Parenteral nutrition was subsequently extended to critically ill patients when enteral nutrition was insufficient or contraindicated. As awareness of the unintended side effects of parenteral nutrition has increased, patient selection and the timing of administration are being investigated and the optimization of enteral nutrition emphasized.2

Early versus Late Parenteral Nutrition in Critically Ill Children

Tom Fivez, M.D., Dorian Kerklaan, M.D., Dieter Mesotten, .et al.
Engl J Med 2016; 374:1111-1122 March 24, 2016

NHS_UCLH MATERNITY LABOUR 98-11484
Image source: NHS Photolibrary

Recent trials have questioned the benefit of early parenteral nutrition in adults. The effect of early parenteral nutrition on clinical outcomes in critically ill children is unclear.

Full text here

Child health services

models of careThe Nuffield Trust has published The future of child health services: new models of care. This briefing describes the current state of child health and quality of care in the UK, including problems around increasing use of hospitals to treat conditions that could be dealt with in other settings; capacity issues in primary care; and the often disjointed care provided between hospitals and the community. It then looks some examples of new models of care which have been emerging both within the Vanguard scheme and inspired by it and how they are responding to these issues.