Aim Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta‐analysis to examine the effectiveness of tongue‐tie treatment on breastfeeding difficulties. Methods We searched peer‐reviewed and grey literature in MEDLINE (OVID), PubMed, CINAHL Plus, EMBASE and PsycINFO, from 01/1970 to 09/2019. Inclusion: randomised and non‐randomised clinical trials, and quasi‐experimental study designs, involving breastfeeding interventions for full‐term singleton infants, using standardised measure of breastfeeding difficulty. Exclusion: qualitative and purely observational studies, lacked operational definition of breastfeeding difficulty, lacked control/comparison group. We assessed risk of bias, summarised study quality and results and conducted meta‐analysis using random effects modelling. Results Six studies on tongue‐tie division were included (4 randomised and 2 non‐randomised). Meta‐analysis of standardised mean differences in breastfeeding difficulty scores in four studies showed statistically significant differences in favour of frenotomy (Pooled SMD +2.12, CI:(0.17–4.08)p = 0.03). Similarly, a statistically significant difference in favour of frenotomy was observed for pain (Pooled SMD −1.68, 95% CI: (−2.87‐ −0.48). Conclusion Results support that infant frenotomy is effective for improving standardised scores on breastfeeding difficulty and maternal pain scales and could improve breastfeeding outcomes.

Background Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. Objectives To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over‐adjustment for later body size. Methods A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non‐SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non‐randomised Studies of Interventions [ROBINS‐I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta‐analysis using random‐effects models. We explored potential sources of heterogeneity. Results We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta‐analysis of 25 studies showed that preterm SGA, compared to preterm non‐SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI −0.10, 0.12, I2 = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI −0.10, 0.12), 22 studies, (I2 = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. Conclusions Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non‐SGA preterm infants.

BackgroundOverweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm.ObjectiveThe objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm.Data sourcesMEDLINE, EMBASE and CINAHL until October 2022.Study selection and data extractionStudies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non‐SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers.SynthesisWe meta‐analysed across studies using random‐effects models and explored potential heterogeneity sources.ResultsThirty‐nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (−0.66 kg/m2, 95% CI −0.79, −0.53; 32 studies, I2 = 16.7, n = 30,346), waist circumference (−1.20 cm, 95% CI −2.17, −0.23; 13 studies, I2 = 19.4, n = 2061), lean mass (−2.62 kg, 95% CI −3.45, 1.80; 7 studies, I2 = 0, n = 205) and height (−3.85 cm, 95% CI −4.73, −2.96; 26 studies, I2 = 52.6, n = 4174) compared with those preterm infants born non‐SGA. There were no differences between preterm SGA and preterm non‐SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains.ConclusionsCompared to their preterm non‐SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non‐SGA preterm infants.

Background Changing health care needs, growing public expectations for high quality and cost-effective care, a burned out and strained healthcare workforce, and market competitions are pushing countries to re-evaluate the efficiency, sustainability, and performance of their health systems. The aims of this study were to: 1) identify the prominent drivers of reforms and 2) examine the common patterns of health system reforms across multiple dimensions.Methods We conducted a targeted search of grey and peer-reviewed literature focusing on health system reforms across the 38 Organization for Economic Cooperation and Development (OECD) member countries. A thematic framework was developed by adapting an existing health system framework expanded to five dimensions: 1) financing; 2) population coverage; 3) governance; 4) service delivery; and 5) service coverage. Data were indexed and charted deductively by a single reviewer (NVivo 12).Results Reforms were most often undertaken at times of economic crises (e.g., recession, war), changes to the nation’s political climate (e.g., change in political party or system), or a drastic change in population needs (e.g., aging population, epidemic). Despite a variety in evolutionary paths to present day health systems, some common patterns emerged across the five dimensions with reform continual in most nations.Conclusion Health system reforms have historically been driven by the economic, political, and social context; a context similar to the current one. Therefore, policy makers could leverage the current context to call for structural reform to healthcare systems.

Aim To summarize the literature on the prevalence of pediatric hearing loss in low‐ and middle‐income countries (LMICs). Method A systematic review initially identified 2833 studies, of which 122 met the criteria for inclusion. Eighty‐six of those studies included diagnoses and were included in a meta‐analysis. Results The meta‐analysis indicated a 1% (95% confidence interval = 0.8–2.0) prevalence of childhood hearing loss across LMICs. There was significant heterogeneity between studies and evidence of publication bias. The prevalence of mild and moderate cases of hearing loss was higher than more severe cases and there were fewer cases of mixed hearing loss compared to conductive or sensorineural hearing loss. No differences were identified between the prevalence of unilateral versus bilateral hearing loss or hearing loss according to sex. The quality of the studies, age of participants, and location of data collection may have influenced the results. High variability in the reporting of etiology made the causes of hearing loss unclear. Interpretation The literature indicates that 1% of children in LMICs have hearing losses. However, most studies missed children with acquired hearing loss, which may lead to under‐reporting of global prevalence. This systematic review is an initial step toward developing and implementing population‐appropriate treatment and prevention programs for childhood hearing loss in LMICs. What this paper adds The prevalence of childhood hearing loss in low‐ and middle‐income countries is 1%. Reporting of hearing loss etiology was highly variable.