Authors´ conclusion: the systematic review concludes that there is not enough evidence to recommend or not the use of antibiotic prophylaxis in children with vesicoureteral reflux. The guideline practice, with a C evidence level, does not recommend antibiotic prophylaxis for children with I-III grade vesicoureteral reflux. Finally the randomized controlled trial shows that antibiotic prophylaxis in children 1-30 months with vesicoureteral reflux grade I-IV is not effective in reducing the rate of infection or the incidence of renal damage or progression.
Reviewers´ commentary: as evidence shows, antibiotic prophylaxis in children 1-30 months old with vesicoureteral reflux grade I-IV is not effective in preventing urinary tract infections. Even though it is not clear the role of urinary infections in the progressive damage of renal parenchyma in children with vesicoureteral reflux, it seems acceptable that an early and correct diagnosis and prompt treatment remain the basis of the management of these children.
Authors' conclusions: Five-grass-pollen sublingual immunotherapy (SLIT) tablets (300 IR) reduce both symptom scores and rescue medication use in children and adolescentes with grass pollen-related rhinoconjunctivitis.
Reviewers' commentary: Sublingual immunotherapy is a therapeutic option in allergic rhinoconjunctivitis for adults and children. In this study the efficacy and security of a tablet presentation is evaluated. Small benefit in symptoms and need for rescue medication is demonstrated compared with placebo. These results have been published in previous systematic reviews. More studies are needed to asses the utilization of this treatment.
Authors' conclusions: Infants and preschoolers with recurrent wheezing or asthma had less wheezing/asthma exacerbations and improve their symptoms and lung function during treatment with inhaled corticosteroids.
Reviewers' commentary: Given the difficulties of an accurate diagnosis of asthma in infants and preschoolers and considering the potential benefits of prophylactic therapy with inhaled corticosteroids in some of them, it could be sensible to test this therapy in those with persistent symptoms or frequent exacerbations.
García Vera C, Aizpurua Galdeano P. Evid Pediatr. 2009;5:37
Authors' conclusions: nowadays there is no evidence to use drug therapies in preventing or treating renal disease in Henoch-Schönlein purpura (SHP).
Reviewers´ commentary: there is no evidence to prescribe corticoids at the beginning of SHP in preventing persistent renal disease, neither to treat severe nephritis with inmunossupresors. Results about the use of steroids contradict the conclusions of a previous systematic review, based on poor quality trials
González de Dios J, Rivas Juesas C. Evid Pediatr. 2009;5:38
Authors´ conclusions: rates of meningitis caused by the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) serotypes have decreased, but there is an increase in non-PCV7 serotypes.
Reviewers´ commentary: although it is an ecologic analysis and cases may have been missed, the study does show a decrease in meningitis caused by PCV7 serotypes and an increase in non-PCV7 serotypes, which invites to consider new prevention strategies
Pérez Gaxiola G, Llerena Santa Cruz E. Evid Pediatr. 2009;5:39
Authors´ conclusions: video-thoracoscopy is the alternative therapy to fibrinolysis in patients with empyema. The results of this trial demonstrate that surgery as first option does not offer shorter hospitalization length or faster improvement of clinical parameters and, on the other hand, results in higher hospital charges.
Reviewers´ commentary: despite the lack of information in some aspects, this clinical trial confirms previous results. Therefore, surgery should be recommended only in cases of failure of fibrinolysis therapy
Ibáñez Pradas V, Balaguer Santamaría A. Evid Pediatr. 2009;5:40
Authors´ conclusions: educational programmes addressing the attitudes of male adolescents on condom use, as well as providing help in dealing and according condom use with sexual partners, may help to diminish sexual transmitted infections and undesired pregnancies in adolescents.
Reviewers´ commentary: due to methodological problems, it is difficult to draw conclusions with validity in other populations; nevertheless the study reveals important social factors (age, occasional or steady sexual relationship, age of sexual partner, having received or not sexual education...) that can condition condom use among adolescents.
Esparza Olcina MJ, García Vera C. Evid Pediatr. 2009;5:41
Authors´ conclusions: cytomegalovirus (CMV) glycoprotein B vaccine has te potential to decrease incident cases of maternal CMV infection.
Reviewers´ commentary: Implications for practice: CMV glycoprotein B vaccine vaccine seems to be a efficacious vaccine against CMV infection in CMV seronegative women. Implication for investigation: more studies are needed to confirm the efficacy and safety of the cytomegalovirus vaccines in order to include it in immunization of women, before the first pregnancy.
Authors´ conclusions: the incidence of mastoiditis has remained stable over recent years and most of the episodes are not related with an antecedent of otitis media.
Reviewers´ commentary: the findings of this work continue the line of treatment recommended in current clinical practice guidelines, which call for a reasonable use of antibiotics in otitis media episodes.
Martín Muñoz P, Ruiz-Canela Cáceres J. Evid Pediatr. 2009;5:43
Authors´ conclusions: girls with the diagnosis of celiac disease (CD) and patients of both sexes with a family history of CD have a different pattern of seasonality of birth from the general population. This is suggestive of a perinatal virus infection as a plausible candidate for the primary trigger.
Reviewers´ commentary: the rhythm of birth in patients with CD differs from that one of the general population. The work does not allow establishing the association with rhythms of infectious agents.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2009;5:44
Authors´ conclusions: currently there is a lack of evidence that applied behavioral intervention has better outcomes than standard care for children with autism.
Reviewers´ commentary: the meta-analysis has methodological weaknesses that make the results vulnerable to bias. There is a need for further meta-analysis that adhere to strict scientific methodology and for primary studies that make comparisons between different treatment options with an adequate number of participants and a long-term follow up. In the meantime, it is suggested that clinical care be based on patient needs and availability of resources.
Cuestas Montañés EJ, Olivares Grohnert M. Evid Pediatr. 2009;5:45
Authors´ conclusions: complementary and alternative medicine (CAM) use was twice as common with the inflammatory bowel disease (IBD) group compared with the chronic constipation group. Regional variations exist with the types of therapy used. Half of pediatric patients with IBD may be using CAM in conjunction with or as an alternative to standard treatments.
Reviewers´ commentary: the use of CAM is a reality nowadays in different countries. This report shows the use of CAM in three tertiary hospitals in EEUU. The use of CAM is lower in Europe, included Spain. Although several study limitations make difficult to extent the results to EEUU population, it suggests that a part of patients with IBD could be using CAM. This is an aspect that we have to take into account when giving information and following up these patients.
Juanes de Toledo B, Aparicio Rodrigo M. Evid Pediatr. 2009;5:46
Authors´ conclusions: breastfeeding reduced the risk of sudden infant death syndrome (SIDS) by 50% at all ages throughout infancy. We recommend including the advice to breastfeed through six months of age in sudden infant death syndrome risk-reduction messages.
Reviewers´ commentary: according to this well designed case control study with survival analysis, it seems reasonable to include breastfeeding during the first six months of age, among the messages to reduce the risk of SIDS.
Authors´ conclusions: breastfeeding during at least four months is related with better lung function at 10 years of age.
Reviewers´ commentary: this study has a series of methodological limitations: the lack of adjustment by factors associated with pulmonary function like atopy, maternal smoking habit or asthma and the absence of comparative reference data. This could explain the difference of the effect in relation with other studies that point to the importance of other factors involved in pulmonary function other than breastfeeding.
Fernández Rodríguez MM, Perdikidis Olivieri L. Evid Pediatr. 2009;5:48
Authors´ conclusions: in preschool children presenting to a hospital with mild-to-moderate wheezing associated with a viral infection, oral prednisolone was not superior to placebo.
Reviewers´ commentary: oral prednisolone should not be used routinely in preschool children presenting to a hospital with mild to moderate wheezing associated with a viral infection.
Aparicio Sánchez JL, Bernaola Aponte G. Evid Pediatr. 2009;5:49
Authors´ conclusions: in the studied population of 2-7-year old children with autism, the use of oxygen hyperbaric to 1.3 atm and 24 % of oxygen is sure and can improve certain behaviors as overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air. Of the obtained results and of other previous studies it seems that the hyperbaric treatment is a promising therapy in children with autism.
Reviewers´ commentary: different results were obtained according to whom were the observers, parents or physicians, so the hyperbaric therapy with 1,3 atm and 24% of oxygen presents ambiguous effects. Children in the treatment group had significantly better improvements in the subscale of irritability. Additional studies are needed to investigate these results.
