Author’s conclusion: despite the fact that several drugs to prevent migraines have been studied in children, most trials have small size and poor design. Flunarizine and propranolol are the best studied drugs although the clinical evidence is not consistent enough. In relation to topiramate, its effectiveness has to be confirmed in more adequately designed studies.
Reviewers’ commentary: topiramate and flunarizine show acceptable evidence reducing frequency and intensity of migraines in children. Propranolol has controversial evidence, so it is advisable to keep it for second choice. All three drugs are safe. There is an urgent need to perform well designed and large trials to establish solid evidence with topiramate, flunarizine and propranolol.
Frías García ME, García Lara NR. Evid Pediatr. 2010;6:3
Authors’ conclusions: The protection provided by three or four doses of monovalent HB vaccine persists for at least two decades in the great majority of immunocompetent indiviuals.
Reviewers’ commentary: long term, it isn´t seems necessary, a booster dose of HB vaccine in immunocompetent indiviuals. Perhaps it would be necessary to ascertain whether booster doses at risk subgroups of studies with higher methodological quality.
Juanes de Toledo B, Ruiz-Canela Cáceres J. Evid Pediatr. 2010;6:4
Authors’conclusions: enemas and polyethylene glycol (PEG) were equally effective in the treatment ofrectal fecal impaction (RFI) in children. Compared with enemas, PEG caused more fecal incontinence, with comparable behavior scores. The treatments should be considered equally as first-line therapy for RFI.
Reviewer’scommentary:taking into account the frequency of fecal impaction in patients with constipation, itis important to have oral medication that is effective and well tolerated bychildren as enemas are sometimes rejected by the discomfort that they suppose. Enema therapy could be used in those cases not responding to PEG. There would be necessaryto conduct further well designed clinical trials to determine more accurately the real effect of PEG in the treatment of childhood constipation.
Authors’ conclusions: the exposure to acetaminophen increases the risk of asthma in both children and adults.
Reviewers’ commentary: epidemiologic and observational studies have showed that the use of acetaminophen increases the risk of asthma, even if the exposure happens during the prenatal period. The results of this metaanalysis are consistent with the association between acetaminophen and asthma, but some confounding biases must be considered. We cannot, with the available evidence, to recommend against the use of acetaminophen but we suggest taking these new data into consideration.
Gimeno Díaz de Atauri Á, Rivas Juesas C. Evid Pediatr. 2010;6:6
Authors' conclusions: there are not two identical definitions of suspected flu cases among all the reviewed ones. This fact may compromise the final validity of the accumulated data.
Reviewers' commentary: the variability of the case definition of suspected influenza among autonomous communities is not justified by scientific criteria. We propose the existence of a state-level health institution with jurisdiction over this issue and others in which there is also unjustified variability.
Buñuel Álvarez JC, Murga Cabero S. Evid Pediatr. 2010;6:7
Authors’ conclusions: apnoea and retinal haemorrhages are clinical findings that have a strong association with brain damage secondary to child abuse.
Reviewers’ commentary: the PPV and OR of seven clinical findings is evaluated to establish their relation with the causes of brain injury. The findings with the strongest statistical association with iBI (inflicted brain injury) are apnoea (OR 17) and/or retinal haemorrhage (OR 3,5). Even though rib fractures, seizures and bone fractures are more frequent in iBI and cranial fractures and bruising of head/neck in niBI (non inflicted brain injury) these differences are non significant and therefore, not useful to discriminate one type of injury from the others. In any case none of these findings are exclusive of iBI.
González de Dios J, Perdikidis Olivieri L. Evid Pediatr. 2010;6:8
Authors’ conclusions: the present study does not support a strong relationship between streptococcal infections (SI) a neuropsychiatry syndromes such as obsessive-compulsive disorder (OCD), Tourette syndrome (TS) and tics in a large community-based sample of children and young adults between 2 and 25 years.
Reviewers’ commentary: this is a case-control study of a large primary care database, with a considerable number of patients. They compared cases of children with tic or OCD diagnoses to controls, and studied possible exposure to SI in the 2 to 5 years prior to tic/OCD diagnosis. The limitations include the possibilities of diagnostic misclassification of both the exposures and the behavioural outcomes. The diagnosis of SI was based on clinical impression, without bacterial culture. And the diagnosis of behavioural outcomes was based on general practitioner records, and therefore the validity of diagnosis could no be confirmed. However the results are in consonance with other publications and argue against a strong causal relationship between SI and clinical symptoms of tics or OCD at least in the majority of cases.
Authors’ conclusions: the appearance of bilateral multiple subependymal pseudocysts or choroid plexus cysts should provide enough reason for concern and force the clinician to undertake investigation even if the findings are incidental in an otherwise normal patient.
Reviewers’ commentary: although the author’s conclusions are credible, some methodological limitations found in the study design make necessary new studies to confirm them
Aparicio Sánchez JL, Balaguer Santamaría A. Evid Pediatr. 2010;6:10
Authors’ conclusions: the mothers who bed share and breast feed their infants at three months, are more probable to do so at one year.
Reviewers’ commentary: the relation of bed sharing and long breast feeding is clear in the present study although there cannot be stated a causative relation and safe bed sharing practices must be explained clearly.
Esparza Olcina MJ, Aizpurua Galdeano P. Evid Pediatr. 2010;6:11
Authors’ conclusions: although the prophylactic administration of acetaminophen at the time of vaccination decreases significantly the febrile reactions, it should not be routinely recommended because it reduces the antibody responses to several vaccine antigens.
Reviewers’ commentary: these findings should be confirmed in other independent, randomized, blind, placebo controlled trials. Until consistent and conclusive results are obtained, acetaminophen can be used in selected cases.
Authors’ conclusions: atropine, fentanyl and succinylcholine as premedication for non urgent intubation in newborns favors a minor number of attempts and better conditions of intubation, without adverse events.
Reviewers’ commentary: observational study with significant methodological limitations, which does not provide evidence of acceptable quality in relation to previous studies.
Carvajal Encina F, Puebla Molina SF. Evid Pediatr. 2010;6:13
Authors’ conclusions: varicella vaccine substantially decreases the risk of herpes zoster among vaccinated children and its widespread use will likely reduce overall herpes zoster burden in the United States. The increase in herpes zoster incidence among 10 to 19-year-olds could not be confidently explained and needs to be confirmed from other data sources.
Reviewers’ commentary: due to the lack of similar studies with longer follow-up it is too early to assume that varicella vaccination significantly reduces the incidence of herpes zoster in children, although there is a tendency to be less severe. The expanded indication for immunization against chickenpox is still valid while further research about epidemiological changes of herpes zoster is needed.
Chalco Orrego JP, Bada Mancilla CA, Rojas Galarza RA. Evid Pediatr. 2010;6:14
Authors’ conclusions: results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection.
Reviewers’ commentary: although the utilization of Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and may reduce nosocomial infection, it seems that the effect size of the program might be unspecific and therefore difficult to quantify its impact and specially its applicability to other environments.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2010;6:15
Authors’ conclusions: celiac disease patients are less responders to hepatitis B vaccination than healthy children
Reviewers’ commentary: celiac patients may have a decreased response to hepatitis B vaccination, but before recommending a systematic assessment of their seroprotection status and revaccinationwe should have more methodologically powerful studies.
Bonillo Perales A, Ortega Páez E. Evid Pediatr. 2010;6:16
Author’s conclusion: there was no effect of the parent baby interaction programme on infant development at 2 years of corrected age. Parenting interventions may be more effective if delivered after discharge or targeted for preterm infants with high biological and social risk.
Reviewers’ commentary: this study found no benefit in cognitive or motor development of very preterm infants, despite performig an educational program to parents. However, the number of sessions to parents may have been insufficient or given in a “bad moment”, to achieve some benefit. To confirm these results, further studies are needed.
Pérez Gaxiola G, Llerena Santa Cruz E. Evid Pediatr. 2010;6:17
Authors´ conclusions: montelukast does not represent an adequate alternative to corticosteroids after outpatient stabilization in mild to moderate acute asthma exacerbations.
Reviewers´ commentary: despite limitations in the selection and sample size, and based on the results, oral montelukast should not be used as treatment of mild-moderate acute asthma exacerbations
Authors’ conclusions education of the primary carer is an important modifiable factor that must be targeted in plans of prevention of childhood obesity. Interventions should show families that they can implement lifestyle changes.
Reviewers’ commentary: with the limitations of a cohort study not specifically designed for childhood obesity interventions, the authors' conclusions agree with other publications in some risk factors and the importance of family centred educational interventions to treat childhood obesity.
Aparicio Rodrigo M, García Vera C. Evid Pediatr. 2010;6:19
