Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisCooling for newborns with hypoxic ischaemic encephalopathy.
Newborn animal and human pilot studies suggest that mild hypothermia following peripartum hypoxia-ischaemia in newborn infants may reduce neurological sequelae, without adverse effects. ⋯ Although two small randomised controlled trials demonstrated neither evidence of benefit or harm, current evidence is inadequate to assess either safety or efficacy of therapeutic hypothermia in newborn infants with hypoxic ischaemic encephalopathy. Therapeutic hypothermia for encephalopathic asphyxiated newborn infants should be further evaluated in well designed randomised controlled trials.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisCot-nursing versus incubator care for preterm infants.
An optimal thermal environment is desirable for preterm infants. These infants are usually nursed in incubators, but cot-nursing may provide an alternative. Measures to assist the maintenance of body temperature for smaller infants in open cots include extra clothing/bedding, warming up the nursery and heating the cot mattress. Recently a heated water-filled mattress has been developed to maintain the temperature of a cot-nursed preterm infant. While there may be benefits of nursing preterm infants in open cots, there may be potential risks such as nosocomial infection caused by more handling due to easier access. ⋯ Due to the small numbers of trials included and infants studied, and the resulting imprecision in the measures of effect for all outcomes, the review does not give a clear indication for the role of cot-nursing for preterm infants. Further assessment of the role of cot nursing for preterm infants using randomised controlled trials is necessary.
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Cochrane Db Syst Rev · Jan 2003
ReviewNasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants.
Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population. ⋯ nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisAmitriptyline versus other types of pharmacotherapy for depression.
For many years amitriptyline has been considered one of the reference compounds for the pharmacological treatment of depression. However, new tricyclic drugs, heterocyclic compounds and the selective serotonin reuptake inhibitors have been introduced on the market with the claim of a more favourable tolerability/efficacy profile. ⋯ This present systematic review indicates that amitriptyline is at least as efficacious as other tricyclics or newer compounds. However, the burden of side-effects in patients receiving it was greater. In comparison with the selective serotonin reuptake inhibitors amitriptyline was less well tolerated, and although counterbalanced by a higher proportion of responders, the difference was not statistically significant.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisLow molecular weight heparins versus unfractionated heparin for acute coronary syndromes.
Acute coronary syndromes (ACS) are an important source of morbidity and mortality. Despite weak evidence for the use of unfractionated heparin (UFH) for acute coronary syndromes it is considered an accepted treatment for unstable angina and non-ST segment elevation myocardial infarction (MI). However, evidence suggests low molecular weight heparins (LMWH) are safer and more effective than UFH in the treatment and prevention of other thrombotic disorders. ⋯ LMWH and UFH had similar risk of mortality, recurrent angina, and major or minor bleeding but LMWH had decreased risk of MI, revascularization and thrombocytopenia. New Trials with longer follow up are required.