Authors’ conclusions: there is an association between enterovirus infection, detected by molecular methods, and autoimmunity/type 1 diabetes.
Reviewers’ commentary: there a ppears to be an association bet ween enterovirus detectionand the presence of prediabetes/type 1 diabetes. This association can not be interpreted as causal due to design limitations of the individual studies. In order to establish the existence of causality it is necessary to conduct a prospective population-based cohort study.
Guarch Ibáñez B, Llerena Santa Cruz E, Buñuel Álvarez JC. Evid Pediatr. 2011;7:29
Authors' conclusion: among children 6 to 23 months of age with acute otitis media, treatment with amoxicillin-clavulanate for 10 days tended to reduce the time to resolution of symptoms and reduced the overall symptom burden and the rate of persistent signs of acute infection on otoscopic examination.
Reviewers' commentary: although authors find differences in symptom scores between the two study groups, they are modest. Adverse effects were more common among the treated group. The number needed-to treat (NNT) is 14, which is higher than the NNT found in other studies performed with amoxicillin, which is nine.
Authors’ conclusions: this review revealed deficiencies in the literature about the appropriate components to increase the rate of influenza vaccination among health care workers. Further studies are needed to determine the right design and components of campaigns targeting influenza vaccination in health workers.
Reviewers’ commentary: campaigns involving only education or vaccination promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.
Authors' conclusions: prenatal surgery for myelomeningocele reduced the need for referral and improved motor outcomes at 30 months but was associated with maternal and fetal risks.
Reviewers' commentary: modern techniques of fetal surgery as those carried out in this study seem to improve significantly the prognosis of these children, decreasing the morbidity associated to the malformation. More than 30 months follow-up studies are needed to determine the impact of fetal surgery on long term psychomotor development.
González de Dios J, Buñuel Álvarez JC. Evid Pediatr. 2011;7:32
Authors’ conclusions: children treated with vapor rub had more relief of symptoms of URTI than those who received petrolatum or no intervention.
Reviewers’ commentary: this study is a partially masked clinical trial involving the vapor rub manufacturing laboratory. Although this product appears to have a statistically significant effect, we cannot assess its clinical relevance. Therefore, and also due to certain limitations of the study, we cannot judge whether its effect compensates for the adverse effects that its use entails.
García Vera C, Buñuel Álvarez JC. Evid Pediatr. 2011;7:33
Authors' conclusion: non-smoking pregnant women exposed to second-hand smoke have 23% increase risk for stillbirth and 23% increase for any fetal malformations; spontaneous abortions risk was not increased.
Reviewers' commentary: this is a high quality systematic review with low possibility of bias that provides evidence of the harm provoked by second-hand smoke in pregnant women on the fetus and newborn. The review includes observational studies that even when they are considered low to moderate quality of evidence, the negligible costs and risks of implementing the advice versus the health benefits of avoiding second-hand smoke in pregnant women should imply a strong recommendation against the exposure.
Cuello García CA, Pérez Gaxiola G. Evid Pediatr. 2011;7:34
Authors' conclusions: adolescent men view an unintended pregnancy during their teenage years as a negative event because of the adverse effect having a baby will have on their future aspirations and life. Regarding the question of adolescent men's attitudes to pregnancy outcomes, the results suggest that there is a broad endorsement of a woman's right to have an abortion among adolescent men, but only under certain circumstances. For these results, two explanations stand out in importance: religiosity and social class. Adolescent men support the right to engage and participate in making decisions with their partners.
Reviewers' commentary: this is the first systematic review, which specifically explores adolescent men’s attitudes toward teenage pregnancy (maintenance, abortion, adoption, paternity). It’s needed more quantitative and qualitative research of high quality, in more countries, with the aim to implement more effective adolescent pregnancy prevention programs.
González Rodríguez MP, Velarde Mayol C. Evid Pediatr. 2011;7:35
Author's conclusions: intravitreal bevacizumab, as compared with conventional laser therapy, showed a significant benefit in infants with stage 3+ retinopathy of prematurity with zone I disease, but not zone II disease.
Reviewers' conclusions: intravitreal bevacizumab, which has showed efficacy and a simple way of administration, could became the first choice for treatment in infants with stage 3+ retinopathy of prematurity with zone I disease. Additional research is needed to determine criteria for its use in other stages of retinopathy and to asses its clinical safety.
González de Dios J, Molina Arias M. Evid Pediatr. 2011;7:36
Author's conclusions: in adolescent boys the relationship of diastolic blood pressure with mortality was more consistent than systolic blood pressure.
Reviewers' commentary: serial blood pressure measurement should be incorporated as an additional activity within the child health program. Due to the high prevalence of overweight among children and adolescents, the recommendations to avoid a sedentary lifestyle, to increase physical activity and to reduce salt intake, will be beneficial in hypertension prevention and are strongly recommended.
Author's conclusions: the study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents (teens who do notuseInternetorteens with heavy Internet use). Regular Internet use is consiered a normative behavior without major health consequences.
Reviewers' commentary: teens are increasingly using the Internet. Excessive use is associated with poorer health. As a result, health professionals who care for young people should include questions on Internet use, related to the amount of time spent online and the use of the Internet.
Authors’ conclusions: using the clinical findings of: 1) lack of lower extremity injuries, 2) lack of an abnormal physical pelvis examination, and 3) no need for abdominopelvic computerized tomography, pelvic fracture can be reliably excluded. Pelvic radiography can be eliminated in the evaluation of these patients, potentially decreasing time expenditure, radiation exposure, and cost.
Reviewers’ commentary: the risk of pelvic fracture in children with blunt trauma is very low, especially if there are no lower extremity injuries, the physical examination of the pelvis is normal and there is no need for abdominopelvic computerized tomography. It seems questionable the systematic implementation of pelvic radiography in these patients. However, it is necessary to validate these predictors of low risk in new independent and sufficiently numerous samples of patients before incorporating them to our clinical practice guidelines.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2011;7:39
Authors' conclusions: almost 25% of the health messages contained in school textbooks have an unknown level of evidence.
Reviewers' commentary: health recommendations in school textbooks should be based on the best available evidence, the same as clinical practice guidelines should. These recommendations should be written in an easily understandable language, taking always into account the type of people they are directed to.
Authors’ conclusion: in formula fed infants or infants weaned from maternal feeding before the age of four months, the introduction of solid foods before the age of four months was associated with increased odds of obesity at the age of three years.
Reviewers' commentary: the methodological limitations of this study prevent it from being included among those proving that early complementary food introduction in infants is a risk factor for obesity later in life.
Aparicio Rodrigo M, García Vera C. Evid Pediatr. 2011;7:41
Authors’ conclusions: evidence shows the effectiveness and superiority of adrenaline for outcomes of most clinical relevance among outpatients with acute bronchiolitis, and evidence from a single precise trial for combined adrenaline and dexamethasone.
Reviewers’ commentary: nebulised adrenaline may have some efficacy in infants with acute bronchiolitis, especially in patients attending emergency departments with a high risk of hospital admission. However, there is no clear cost-benefit ratio of routine use, especially in primary care; then, a selective use of adrenaline should be made.
Ochoa Sangrador C, González de Dios J. Evid Pediatr. 2011;7:42
Authors’ conclusions: zinc reduces the duration and severity of the common cold in healthy people. When supplemented for at least five months, it reduces cold incidence, school absenteeism and prescription of antibiotics in children. There are potential side effects. In view of this and the differences in study populations, dosages, formulations and duration of treatment, it is difficult to make firm recommendations about the dose, formulation and duration that should be used.
Reviewers’ commentary: though the initial results are promising, given the collateral disagreeable effects and the lack of efficacy of some formulations, a general recommendation for zinc in treatment of the common cold should not be done.
Carvajal Encina F, Puebla Molina SF. Evid Pediatr. 2011;7:43
Authors´ conclusions: nebulization with 5% hypertonic saline is safe and may be superior to current treatment for early outpatient treatment of bronchiolitis.
Reviewers´ commentary: hypertonic saline 5% associated with epinephrine improves discreetly the bronchiolitis severity score. However a multicenter trial with a larger sample size and longer follow-up to compare the efficacy between the concentration of 3 and 5%, and the role of saline hypertonic used alone or with other bronchodilators is needed to confirm these results.
Orejón de Luna G, Fernández Rodríguez MM. Evid Pediatr. 2011;7:44
Authors’ conclusion: intravenous indomethacin or ibuprofen administered to preterm infants older than 24 hours induced ductal closure, but other short-term benefits were not seen. Treatment with ibuprofen may increase the risk of chronic lung disease.
Reviewers’ commentary: both drugs are effective for patent ductus arteriosus closure. The choice between them will depend on safety criteria. We should take into account that the risk of chronic lung disease seems to be higher with ibuprofen, and oliguria is more frequent in patients treated with indomethacin.
de Armas Iglesias I, González de Dios J, Aparicio Sánchez JL. Evid Pediatr. 2011;7:45
Authors' conclusion: in allergic patients with moderate-severe persistent asthma, omalizumab reduces asthma exacerbations and corticosteroids without significant side effects in the short term.
Reviewers' comentary: omalizumab shows efficacy in patients with moderate to severe asthma. Adverse effects reported in trials were local reactions and anaphylaxis. More studies will be needed to assess the long term effects, especially in paediatrics patients.
Editorial
