INTRODUCTION

The purpose of systematic reviews and meta-analyses is to find an answer to a particular question which can help to improve clinical practices or to implement improvement in our daily clinical management of patients [1]. The ideal systematic review and meta-analyses comprise well conducted randomized controlled trials and evidence raised from these analyses can guide recommendations of high level evidence which can be used to treat or manage patients. In pediatrics and neonatology randomized controlled studies are not always easy to realize for several reasons namely the number of patients, informed consent approval, ethical concerns and so on. A lot of trials in these fields are prospective, observational and retrospective. The recent systematic review and meta-analysis on ERAS in children [2,3] is part of a vast and extended thesis project concerning the impact of goal directed therapies on postoperative outcome in the pediatric population [4-9].

This systematic review and meta-analysis concerned 6 non randomized trials in 1620 pediatric surgical patients and for this reason the level of evidence of this trial was low.

However despite this observation, the results of this systematic review are important and promising enough to recommend continuing to develop randomized controlled trials in this field to reappraise and confirm these results in children. While awaiting the development of these studies, ERAS can be put into practice using the existing evidence. 

This systematic review concerned appendicetomy, hypospadias and idiopathic scoliosis surgery. If ERAS reduces postoperative complications in terms of infections, reoperations, readmission and LOS in these settings. It is worthwhile to investigate other pediatric surgical specialties to have a more complete view and impact of these protocols in general in pediatric surgery.

CONCLUSION

There is still a lot to be done to develop ERAS in children compared to what has been achieved in adults. Based on this systematic review and meta-analysis, there is enough evidence to encourage the development of randomized controlled trials to appraise and confirm the impact of ERAS on post-operative outcome in children.

CONFLICT OF INTEREST

The author declared no conflict of interest.

FUNDING

There was no funding.

ACKNOWLEDGEMENT

To all the collaborators of this project.

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2.       Kumba C, Blanc T, De Cock A, Willems A, Harte C, et al. (2019) Protocol for rapid recovery pathways after surgery in children: A systematic review and meta-analysis. J Anesth Crit Open Access 11: 42-44.

3.       Kumba C, Blanc T, De Cock A, Willems A, Harte C, et al. (2019) Rapid recovery pathways after surgery in children: A systematic review and meta-analysis (CRD42018103518). Med J Clin Trials Case Stud 3: 000211.

4.       Kumba C, Mélot C (2019) The era of goal directed therapies in pediatric anesthesia and critical care. EC Emerg Med Crit Care 3: 306-309.

5.       Kumba C (2019) Do goal directed therapies improve post-operative outcome in children? (Perioperative goal directed fluid and hemodynamic therapy; transfusion goal directed therapy using viscoelastic methods and enhanced recovery after surgery and postoperative outcome): A study research protocol. Acta Scientific Pediatr 2: 17-19.

6.       Kumba C, Cresci F, Picard C Thiry C, Albinni S, et al. (2017) Transfusion and morbi-mortality factors: An observational descriptive retrospective pediatric cohort study. J Anesth Crit Care Open Access 8: 00315.

7.       Kumba C, Querciagrossa S, Blanc T, Tréluyer JM (2018) Transfusion and post-operative outcome in pediatric abdominal surgery. J Clin Res Anesthesiol 1: 1-8.

8.       Kumba C, Lenoire A, Cairet P, Dogaru-Dedieu E, Belloni I, et al. (2018) Is transfusion an independent risk factor of post-operative outcome in pediatric orthopedic surgical patients? A retrospective study. J Emerg Med Critical Care 4: 7.

9.       Kumba C, Taright H, Terzi E, Télion C, Beccaria K, et al. (2018) Blood product transfusion and post-operative outcome in pediatric neurosurgical patients. EC Anesth 4: 288-298.