Authors' conclusions: exposure to anaesthesia before the age of four years has a small association with academic or cognitive performance in adolescence. While more vulnerable groups of children may exist, the low overall difference in academic performance after childhood exposure to surgery is reassuring.
Reviewers' commentary: although this is a minimal and doubtful effect, this information should be taken into account when assessing toddlers for whom we are considering programmed surgery for indications that could be postponed.
Jullien S, Pérez-Moneo Agapito B. Evid Pediatr. 2017;13:3
Authors’ conclusions: fluoxetine is probably the best option among antidepressant agents when pharmacological treatment is indicated for major depressive disorders in children and adolescents.
Reviewers’ commentary: studies on the use of antidepressants in children and adolescents have limitations on quality and differences that make it difficult to compare. When pharmacological treatment is considered, the limited effect and adverse effects should be taken into account. Follow up and assessment of the potential risk of suicide should be accomplished. The antidepressant with the best benefit risk balance in major depression is fluoxetine, although more studies are needed to establish the dominant side of this balance.
Fernández Rodríguez M, Esparza Olcina MJ. Evid Pediatr. 2017;13:4
Authors' conclusions: among adolescents and adults with predominantly moderate-to-severe asthma, treatment with budesonide-formoterol was associated with a lower risk of asthma exacerbations than budesonide and a similar risk of serious asthma-related events.
Reviewers' commentary: although safety doubts about the combination of formoterol and budesonide are not completely clarified, it seems to be safe and effective in the management of moderate or severe asthma in patients over 12 years of age without life-threatening episodes. Doubts remain about children under 12 years of age. In order to definitively recommend its use, independent studies of safety, efficacy and cost-effectiveness comparing it with budesonide alone would be required.
de Lucas García N, Gimeno Díaz de Atauri Á. Evid Pediatr. 2017;13:5
Authors' conclusions: among vertex-presenting singletons with a gestational age of between 24 to 30 weeks, better survival and intraventricular hemorrhage-free survival were associated with administration of antenatal steroids (ANS), independent of mode of delivery. In infants at 24 to 25 weeks gestation the combination of ANS/cesarean section was associated with improvement in both outcomes.
Reviewers' commentary: despite clinical relevance of the results (reduction of mortality, possibility of avoiding serious neurological sequelae), important limitations in the study design make it necessary to postpone decision-making until new studies are available.
Authors' conclusions: among premature infants, exclusive breastfeeding is associated with a reduced risk of necrotizing enterocolitis (NEC) and death due to NEC, with lower health costs.
Reviewers' commentary: according to the results exclusive maternal feeding in extremely low birth weight infants would decrease incidence and mortality of NEC and health costs. The relevance of these results is diminished by the weaknesses of the design and the difficulty of taking it to the habitual practice to obtain the feeding with exclusive breast milk. The real economic efficiency of efforts to support breastfeeding in these children remains to be determined.
Modesto i Alapont V, Ortega Páez E. Evid Pediatr. 2017;13:7
Authors' conclusions: the association between decreased survival and tracheal intubation in cardiac arrest attendance in hospitalized children questions current recommendations for early intubation during CPR.
Reviewers' commentary: this study, of good methodological quality, seems to question the practice of immediate tracheal intubation during resuscitation maneuvers in children admitted to hospitals in a clinical situation of cardiac arrest. However, they could have existed unadjusted biases in the analysis that could have influenced the results. For this reason, with the information available, we cannot encourage intubation, nor can we advise against it.
Ruiz-Canela Cáceres J, García Vera C. Evid Pediatr. 2017;13:8
Authors' conclusions: in UK children, the two-dose Bexsero® priming schedule is highly effective in preventing meningococcal disease B.
Reviewers' commentary: if a two-dose vaccination schedule of Bexsero® was implanted in our population, with the current rates of meningococcal disease it would be necessary to vaccinate 388 652 children to prevent a case; however, the severity of the disease, the potential sequelae it can cause and the possible increase in disease rates at any time make the vaccine impact certainly much more favorable.
Martín Masot R, Ortega Páez E. Evid Pediatr. 2017;13:9
Authors' conclusions: the evaluation of antibiotic consumption in the neonatal intensive care unit can reduce its use by 27%, through personalized interventions, without affecting the safety of patients.
Reviewers' commentary: the use of antibiotics in neonatal intensive care units can be reduced by re-evaluating empirical antibiotics at 48 hours and shortening the treatment of pneumonia and clinical sepsis.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2017;13:10