1.
Importance of systematic reviews and meta-analyses in pediatric nutrition.
Szajewska, H
World review of nutrition and dietetics. 2013;:1-10
Abstract
To address information overload, systematic methods have been developed to identify, assess, and synthesize information. This chapter provides an overview of the basic principles of systematic review and meta-analysis of randomized controlled trials, which are considered to be the best study design for answering questions about the effectiveness of an intervention. It also discusses the problems and limitations of using a meta-analytical approach. As the number of systematic reviews and meta-analyses is increasing rapidly, also in the field of pediatric nutrition, it is essential that the strengths as well as the limitations and caveats of this approach are well understood.
2.
Critical systematic review of the level of evidence for routine use of probiotics for reduction of mortality and prevention of necrotizing enterocolitis and sepsis in preterm infants.
Mihatsch, WA, Braegger, CP, Decsi, T, Kolacek, S, Lanzinger, H, Mayer, B, Moreno, LA, Pohlandt, F, Puntis, J, Shamir, R, et al
Clinical nutrition (Edinburgh, Scotland). 2012;(1):6-15
Abstract
BACKGROUND & AIMS Probiotics have been suggested to prevent severe necrotizing enterocolitis (NEC) and decrease mortality in preterm infants. The aim of this paper was to systematically analyze the level of evidence (LoE) of published controlled randomized trials (RCTs) on probiotics in preterm infants. METHODS Literature searches were made up to November 2010. LoE of recommendations based on single trials or meta-analyses were scored following the Oxford Center for Evidence based Medicine approach (1a - meta-analyses of 1b LoE studies; 1b - well designed RCT; 2a - meta-analyses which include 2b LoE studies; 2b - lesser quality RCT). RESULTS Fifteen trials were included (Two 1b LoE trials and thirteen 2b LoE trials). Methodological assessment revealed considerable heterogeneity. Some probiotics may be beneficial in relation to reduction of severe NEC (2b LoE) and reduction of mortality (2b LoE). Probiotics do not accelerate feeding advancement (1b and 2b LoE). There was no convincing benefit with regard to prevention of sepsis (1b and 2b LoE). CONCLUSION There is insufficient evidence to recommend routine probiotics. However, there is encouraging data (2b LoE) which justifies the further investigation regarding the efficacy and safety of specific probiotics in circumstances of high local incidence of severe NEC.