Authors´ conclusions: Decreased level of consciousness, focal neurological signs, and abnormal behavior, have been associated with intracranial complications in children who suffered minor head trauma. Due to the absence of agreement/consensus, clinical decision rules could be useful to determine those patients who need neuroimaging or hospitalization.
Reviewers´ commentary: This study identifies clinical data useful to predict intracranial complications in pediatric minor head trauma. Clinical decision rules found in the literature and proposed by the authors seem useful to unify medical management of these patients. However, certain variability was found so it would be desirable to develop future studies to lay down clinical decision rules or to validate those already published.
Orejón de Luna G, Pavo García MR. Evid Pediatr. 2010;6:47
Authors’ conclusions: antibiotic prophylaxis and endoscopic correction reduce significantly febrile urinary tract infections recurrence in girls between 1 and 2 years of age with dilated vesico-ureteral reflux (grade III and IV) compared to no intervention.
Reviewers’ commentary: this trial has some methodological deficiencies, but it makes us think about the nowadays trend of stopping antibiotic prophylaxis in infants between 1 and 2 years of age with dilated vesico-ureteral reflux grade III or superior. No randomized, prospective and blind trial has demonstrated that we can abandon this clinical practice, in the same way, this article cannot demonstrate that antibiotic prophylaxis or endoscopic treatment is necessary
Espino Hernández MM, González de Dios J. Evid Pediatr. 2010;6:48
Authors’ conclusions: In children with egg allergy without history of anaphylaxis influenza vaccine may be administered in two divided doses with no need for a prior prick test with vaccine antigen.
Reviewers’ commentary: With currently available data from observational and experimental studies, it is concluded that administration of influenza vaccine is safe in children with egg allergy without anaphylaxis.
Buñuel Álvarez JC, González de Dios J. Evid Pediatr. 2010;6:49
Authors’ conclusions: in children under five years living in EE. UU., the introduction of rotavirus vaccine was associated with a drastic reduction in the percentage of hospital admissions for gastroenteritis.
Reviewers’ commentary: in developed countries rotavirus vaccine is effective in reducing the percentage of hospital admissions. However, the economic cost associated with the vaccine makes difficult its inclusion in the routine vaccination schedule, despite its obvious clinical benefit.
Llerena Santa Cruz E, Buñuel Álvarez JC. Evid Pediatr. 2010;6:50
Authors' conclusions: in children with epilepsy, a normal IQ, a disease onset over six years of age and receiving an adequate professional training are associated with an adequate job integration in adulthood.
Reviewers' commentary: it is essential that every child with epilepsy is adequately diagnosed and classified according to his/her particular epileptic syndrome, but it must also be attempted the most effective medical treatment for his/her type of epilepsy, always trying to control or minimize the phenomenon of labeling or social stigmatization that the word "epilepsy" still carries. More studies are needed to determine the individual prognosis of each epileptic syndrome.
Olivares Grohnert M, Buñuel Álvarez JC. Evid Pediatr. 2010;6:51
Authors’ conclusions: there is no evidence of association between water-purification by-products in water consumed by the mother and effects on fetal growth or prematurity. There has only been found a certain degree of relation with newborns small for gestational age.
Reviewers’ commentary: this systematic review and metanalysis of epidemiological studies may have included some biases due to the impossibility of a direct measure of the risk factor, and the possible mobility of the population. The conclusions have to be considered with precaution although the effects seem to be very small
Esparza Olcina MJ, García Vera C. Evid Pediatr. 2010;6:52
Authors’ conclusions: The administration of orange juice, which contains a modest dose of ascorbic acid, provides a significant increase in the absorption of ferrous fumarate in children without prior iron deficiency.
Reviewers’ commentary: The absorption of ferrous fumarate appears to be enhanced when it is administered together with ascorbic acid. It is not possible, however, to provide a direct comparison between ferrous fumarate and sulfate to know if the facilitating effect of the ascorbic acid absorption is similar for both forms of iron presentation. Studies in healthy children comparing the absorption of ferrous fumarate and ferrous sulfate administered with ascorbic acid are needed in order to determine which method of administration is the most effective and cost-effective.
Authors’ conclusions: organophosphate pesticides at doses commonly used in the U.S., may be associated with an increased diagnosis of attention deficit with / without hyperactivity disorder (ADHD).
Reviewers’ commentary: the type of study design, cross-sectional, does not allow inferring causal association between pesticide exposure and ADHD. To study this hypothesis prospective cohort studies are needed. Washing fruits and vegetables before consumption to reduce the concentration of pesticides in food is recommended.
Sánchez Bueno I, Buñuel Álvarez JC. Evid Pediatr. 2010;6:54
Authors´ conclusions: they are the result of a multidisciplinary expert consensus developed by the method RAND/ UCLA, stating that UGI endoscopy is not appropriate for all children with dyspeptic symptoms, but only for cases with a family history of peptic ulcer and/or Helicobacter pylori infection, older than 10 years of age, with symptoms persisting for more than 6 months and severe enough to affect activities of daily living.
Reviewers´ commentary: the methodological weaknesses of criteria according RAND/UCLA method, do not seem satisfactory to establish if an endoscopy indication is appropriate or inappropriate in a patient with dyspepsia, but physicians should use them as one factor among the many that contribute to any decision. Research should continue on way to improve the development of criteria and best way to incorporate them in clinical practice.
Ortega Páez E, Cuestas Montañés EJ. Evid Pediatr. 2010;6:55
Authors´ conclusions: the genetic markers for adult obesity are associated to greater early infancy gain in weight and lenght, and it can be on the pathway to adult obesity.
Reviewer´s commentary: growth in infancy and weight gain in the first years of life seem to have a genetic condition, although known genetic markers for obesity only determine a small percentage of the overweight.
Juanes de Toledo B, Ochoa Sangrador C. Evid Pediatr. 2010;6:56
Authors’ conclusions: human bocavirus was the most frequent virus detected in the most serious acute respiratory infections. However, bocavirus detection was not associated with presence of respiratory disease or specific respiratory symptoms in infants and young children attending daycare.
Reviewers’ commentary: human bocavirus is a frequent colonizer of the nasal mucosa, and although it is not possible to prove its etiological role in acute respiratory infections, it may be associated with increased duration of respiratory symptoms.
Authors’ conclusions: Hypertrophic pyloric stenosis in Danish children shows strong familial aggregation (relative risk in siblings is 18.5) and heritability (87%).
Reviewers’ commentary: Thanks to specific databases, familial aggregation of pyloric stenosis has been determined more accurately. The high rate ratios in relatives of probands have to be taken into account when evaluating a patient with a history of familial pyloric stenosis and vomits.
Aizpurua Galdeano P, Ibáñez Pradas V. Evid Pediatr. 2010;6:58
Authors’ conclusions: planned home birth is associated with fewer interventions and morbidity in the mother, but with a three-fold increase in mortality in the newborn.
Reviewers’ commentary: the results of this review are significant enough to improve care delivery scheduled at home (if that is the option chosen by the parents, after having received adequate information), with a good selection of candidates (low-risk pregnancies) and good care professionals with certification and experience in the care of the mother and newborn.
González de Dios J, Buñuel Álvarez JC. Evid Pediatr. 2010;6:59
Author’s conclusions: there is great quantity of research that analyzes the influence of major risk conducts in premature births, but it does provide solid evidence in relation to causal effects, other than a modest effect of smoking on premature birth.
Reviewer’s commentary: in spite of methodological limitations, the conclusions of this study reinforce the need to improve the quality of studies related to premature birth. Multivariate analysis could help solve this problem which undoubtedly has a multidimensional etiology.
Carvajal Encina F, Puebla Molina SF. Evid Pediatr. 2010;6:60
Authors' conclusions: in preterm infants between 24 and 28 weeks of gestation, low oxygen saturations (85-95% vs 91-95%) significantly reduced the incidence of severe retinopathy among survivors, but increase mortality. The increased mortality with low oxygen saturations is a factor to be taken into account when treating these patients.
Reviewers' commentary: This study is a warning about the effects that the administration of very low oxygen saturations (85-89%) may have on mortality. So far, the results of this study recommend that for extreme preterm infants, intermediate target saturations could be the safest.
Aparicio Rodrigo M, Balaguer Santamaría A. Evid Pediatr. 2010;6:61
Authors’ conclusions: adherence to the “Mediterranean diet” may provide some protection against wheezing and asthma in childhood.
Reviewers’ commentary: some foods related to “Mediterranean diet” may reduce the prevalence of wheezing and asthma in children. However, prospective longitudinal studies are needed to confirm this association.
Gimeno Díaz de Atauri Á, Bernaola Aponte G. Evid Pediatr. 2010;6:62
