title: Beta-blockers for congestive heart failure in children.
abstract: BACKGROUND
  Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009.
  
  
  OBJECTIVE
  To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied.
  
  
  METHODS
  Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure.
  
  
  METHODS
  Two review authors independently extracted and assessed data from the included trials.
  
  
  RESULTS
  We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers.However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses.
  
  
  CONCLUSIONS
  There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.
authors.affiliation: Department of Cardiovascular Science, The University of Sheffield, Sheffield, UK.
authors.forename: Samer
authors.initials: S
authors.lastname: Alabed
authors.forename: Ammar
authors.initials: A
authors.lastname: Sabouni
authors.forename: Suleiman
authors.initials: S
authors.lastname: Al Dakhoul
authors.forename: Yamama
authors.initials: Y
authors.lastname: Bdaiwi
authors.forename: Anne-Kristina
authors.initials: AK
authors.lastname: Frobel-Mercier
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002648:Child; D002675:Child, Preschool; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008790:Metoprolol / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol; D008790:Metoprolol