| dc.description.abstract | Lymphoedema is the presence of swelling in regions of the human body, caused by excessive retention of lymphatic fluid. In children, lymphoedema can be either due to primary or secondary causes. Primary lymphoedema is caused by genetic mutations, while secondary lymphoedema is caused by structural and functional damage to the lymphatic vasculature. Primary lymphoedema is the more common type of lymphoedema in children. Lymphoedema is a chronic condition, and therefore requires lifelong treatment. However, there appears to be little in the literature to guide how to treat paediatric lymphoedema most effectively. More problematically, the safety of the most common treatment, compression, for use with growing skeleton has not been investigated. The aim of this thesis, therefore, was: 1) to determine the efficacy of all kinds of treatments for paediatric lymphoedema, mainly including conservative, and surgical treatments; 2) to examine the growth pattern and describe the prescription of the compression in children with lymphoedema who have been treated with compression. There’s little evidence available currently to support the best way to treat paediatric lymphoedema. While, two previous systematic reviews have been undertaken, one on conservative treatments and one on surgical treatments, they both found only weak evidence underpinning the treatments for paediatric lymphoedema. However, as the earlier one was done six years ago and the more recent one didn’t extensively search a range of databases, it was timely to re-examine the literatures on the efficacy of both conservative and surgical treatments in children with lymphoedema. A comprehensive search strategy was undertaken in five databases: MEDLINE, CINAHL, EMBASE, Scopus and PEDro. Title, abstract and full paper screening and data extraction were done by two reviewers. The outcomes of interest was a change in limb volume assessed either volume or circumference. Twenty-one studies were eligible for inclusion, including 13 studies focused on primarily conservative treatments and eight focusing on primarily surgical treatments. For the studies looking at conservative treatments, two were cohort studies and the other 11 were case studies or case series. Nine of them suggested generally positive volume reduction in the lymphoedema limbs with their treatments. There were eight studies on surgical treatments, one cohort study and 7 case series or studies. Six of the surgical treatments were combined with conservative treatments. All studies on surgical treatments found positive outcomes for all patients. All studies were found have numerous issues which introduce risks of bias. While it appears that all of the treatments trialled for paediatric lymphoedema may be effective, the small sample sizes, significant risks of bias in each study and an inability to combine data from various studies due to different outcome measures, prevents firm conclusions from being made. Future research into the efficacy of treatments for paediatric lymphoedema is needed; however, first, if they are safe should be considered. Compression therapy, the mainstay of lymphoedema treatment in adults, is recommended to be used in children as well according to international guidelines. However, there is no evidence or guidelines to support the use of compression in children. Lower limbs are the most commonly area of paediatric lymphoedema affected, while it is unknown whether compression on growing skeleton has negative impact on growing skeleton or may lead to other adverse event. To provide preliminary evidence on the safety of compressing a growing skeleton, a retrospective study was conducted at the Children’s Hospital at Westmead and Sydney Children’s Hospital in New South Wales. Data including gender, type of lymphoedema, and age of onset location of swelling and medical history of conditions were extracted. Furthermore, all recorded height measurements were extracted across each individual patient’s period of care. Further data extracted for each individual patient visit on the type, use and changes to compression, as well as any clinical notes on adverse events or compliance with use of compression garments were extracted. Ninety-three patients were identified by the clinicians for inclusion, with 42 eligible for analysis of their growth data. All participants had been prescribed compression garments, with 22 also undergoing bandaging at some point. Height measurements were converted to percentiles, and compared to normative growth charts. A change of more than 15 percentiles was considered abnormal. Seventeen participants had under two years of growth and compression measurements, nine had 2-5 years and sixteen had more than 5 years of records. Overall 38 participants demonstrated no growth fluctuation of more than 15 percentiles at any time, indicating no growth pattern changes with the use of compression. A total of four participants demonstrated an increase in height percentile by more than 15 percentiles between the first and last height assessment, while none decreased by that amount. Only minor adverse events (redness) were reported from the use of compression in the clinical notes and adherence to compression treatments appeared to be good. This study, therefore provides preliminary safety evidence for the use of compression in children with lymphoedema. In conclusion, there’s still no strong evidence found to best treat paediatric lymphoedema. Compression, the mainstay of lymphoedema treatment in adults does not appear to impact on the growth of skeletal bones in children with lymphoedema, indicating it may be safe to use compression to treat lymphoedema in children; its efficacy, however, is not known. | en |
