Aim: To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis. Methods: A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity. Results: Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled β₂ agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement. Conclusion: Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.

A cohort of 138 children with 144 hematopoietic stem cell transplantation (HSCT) performed in 1997–2006 were analyzed to evaluate risk factors and mortality predictors of hepatic veno-occlusive disease (VOD). Nineteen patients (13.2%) developed VOD (nine boys, median age 3.5 years) at 1–21 days after HSCT (median 13 days). Age ⩽2 years at transplant (odds ratio (OR)=5.25, P=0.011), BU–CY conditioning (OR=5.16, P=0.001), thalassemia major (OR=3.97, P=0.015), platelet engraftment beyond day +21 (OR=8.67, P=0.025) were univariate risk factors for VOD. The first two remained significant in multivariate regression. Seven patients (36.8%) with VOD died, at a median of 44 days post transplant (range, 30–421 days). The 5-year survival was 62%. All surviving patients had normal liver function on follow-up at 0.5–9 years. Patients with VOD had higher 100-day mortality (16.3 vs 9.6%, P=0.024). Mortality predictors included donors other than autologous or matched sibling (hazard ratio (HR)=23.6, P=0.006), hepatic and cutaneous GVHD (HR=8.15, P=0.038), maximal weight gain >9% (HR=6.81, P=0.023), pleural effusion, intensive care unit admission, peak bilirubin >300 μmol l⁻¹ (HR=13.6, P=0.016), day +21 bilirubin >200 μmol l⁻¹ (HR=33.9, P=0.001), and rise of bilirubin >15 μmol l⁻¹ per day within the first week (HR=19.8, P=0.006). Mortality was substantially higher if >3 predictors were present (HR=33.9, P=0.001). Meticulous monitoring in high-risk patients and early treatment should be considered before VOD progresses beyond salvage.

BACKGROUND: The authors studied the survival and long‐term morbidities of children with nasopharyngeal carcinoma (NPC).METHODS: This was a retrospective review of children with NPC who were treated at St. Jude Children's Research Hospital between 1961 and 2004. Prognostic factors and long term effects of therapy were analyzed.RESULTS: Fifty‐nine patients (median age, 14.1 years) were identified. Most were male (66.1%) and black (54.2%) and had lymphoepithelioma (93.2%). Thirty‐five patients had stage IV disease (59.3%), 20 patients had stage III disease (33.9%), and 4 patients had stage II disease (6.8%). All patients received radiotherapy (RT) to the primary tumor, and most received cervical RT (98.3%) and chemotherapy (88.1%). The 15‐year survival and event‐free survival (EFS) rates were 67.2% ± 7.5% and 63.5% ± 7.8%, respectively. Five patients (8.5%) developed subsequent malignancies 8.6 to 27 years after NPC diagnosis. EFS was improved in patients who were diagnosed after 1980 (74.8% ± 10% vs 45.5% ± 10.1%; P = .031), in patients who had stage III disease compared with patients who had stage IV disease (79.3% ± 9.6% vs 56.2% ± 11.8%; P = .049), in patients who received cisplatin (81% ± 10.7% vs 45.8% ± 9.7%; P = .013), and in patients who received ≥50 grays of RT (71.4% ± 9.3% vs 43.8% ± 11.6%; P = .048). White patients had higher distant failure rates than black patients (41.7% ± 10.4% vs 15.6 ± 6.5%; P = .045). The 15‐year cumulative incidence (CI) of any morbidity was 83.7% ± 5.4%, the CI of sensorineural hearing loss was 52.9% ± 6.7%, the CI of primary hypothyroidism was 42.7% ± 6.6%, and the CI of growth hormone deficiency (GHD) was 14.1% ± 4.7%. Dose‐response relations were observed between the RT dose and primary hypothyroidism and GHD.CONCLUSIONS: The outcome of children with NPC improved over the past 4 decades with the use of cisplatin‐based chemotherapy and higher RT doses. However, many survivors had long‐term treatment‐related morbidities. Cancer 2011. © 2010 American Cancer Society.