Polyethylene Glycol Dosing for Constipation in Children Younger Than 24 Months: A Systematic Review yHelisa

Copyright © ESPGHAN and NASPGHAN. All rig Received August 1, 2019; accepted February 29, 2020. From the Department of Paediatrics, University of Melbourne, the yDepartment of Paediatric Surgery, The Royal Children’s Hospital, the zMurdoch Children’s Research Institute, the §Department of Urology, the jjDepartment of General Medicine, the Centre for Community Child Health, and the #Department of Gastroenterology and Clinical Nutrition, The Royal Children’s Hospital, Melbourne, Victoria, Australia. Address correspondence and reprint requests to Sebastian K. King, MBBS, PhD, FRACS, Department of Paediatric Surgery, The Royal Children’s Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia. (e-mail: sebastian.king@rch.org.au). PROSPERO Registration Number: CRD42018104593. Professor Goldfeld is supported by a National Health and Medical Research Council Practitioner Fellowship (AAP1155290). Associate Professor King’s and Associate Professor Teague’s positions as Academic Paediatric Surgeons are generously supported by The Royal Children’s Hospital Foundation. The remaining authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jpgn.org). Copyright # 2020 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000002786 JPGN Volume 71, Number 2, August 2020 Objectives: Evaluate safety and effectiveness of Polyethylene glycol (PEG) for chronic constipation in children aged younger than 24 months. Identify the optimum dose of PEG to manage chronic constipation in children aged younger than 24 months. Methods: In this systematic review, Embase, Medline Ovid, Pubmed, and the Cochrane Library were searched between January 1, 2000 and February 1, 2019. Studies investigating functional constipation, in which patients younger than 24 months of age were treated with PEG, were considered as potentially eligible for review. Two authors screened the studies against inclusion/ exclusion criteria. Study quality was assessed with the PEDro quality assessment, Cochrane risk of bias tool, and/or the Newcastle-Ottawa Scale. Results: Five studies (2 randomized controlled trials, 3 retrospective chart reviews) satisfied selection criteria (n1⁄4 459). All studies employed different dosage categories: mean effective maintenance dose, mean initial dose, mean short-term and long-term dose, and mean daily dose. Dosage regimens were variable, with 0.45 to 1.1 g kg 1 day 1 for PEG3350 and 0.48 to 0.65 g kg 1 day 1 for PEG4000. Adverse effects were transient across all studies for all types of PEG; these included diarrhea and abdominal pain. Conclusions: This systematic review provided evidence for a lack of reported side effects from PEG for children aged younger than 24 months. Evidence to establish appropriate dosage regimens does not exist. An infographic accompanying this article can be found at http://links.