Authors´ conclusions: this review, based on published studies, describes the results of a systematic review that shows a limited capability to determine the risk-benefit balance of the different medical therapies tested for eosinophilic esophagitis. The second one, a randomized clinical trial testing topic budesonide, demonstrated a reduction of esophageal eosinophilic infiltrated, and an improvement of symptoms.
Reviewers´ commentary: new studies will be necessary in order to determine the effectiveness and safety of topic steroids for this disease, as a consequence of methodological limitations of published studies
Rivas Juesas C, Ibáñez Pradas V. Evid Pediatr. 2010;6:73
Authors' conclusions: the long-term prognosis of epilepsy is favorable. Epilepsy remains active in only 30% of cases and is intractable in 10%. Mortality is higher than in the general population only in cases of remote symptomatic etiology.
Reviewers' commentary: this is a prospective study on the prognosis of epilepsy with a follow-up of 15 years. The methodology is in general terms appropriate and the findings are relevant for clinical practice.
Ramos Lizana J, Ruiz-Canela Cáceres J. Evid Pediatr. 2010;6:74
Authors´ conclusions: the immune suppression by Dichlorodiphenyldichloroethylene (DDE) detected in previous experimental studies may explain the relationship between DDE and lower respiratory tract infection (LRTI). DDE exposure during prenatal life may be critical for the development of immune and respiratory system.
Reviewers´ commentary: although previous transverse studies have related DDE to different diseases in children, this study has methodological weaknesses that make it difficult to draw any definite conclusions about the association between prenatal DDE levels and infant LRTI. New high-quality studies would be needed in order to confirm this association.
Ortega Páez E, de Lucas García N. Evid Pediatr. 2010;6:75
Authors conclusion: our results show that although oral sucrose does reduce observed pain behaviour, it has no significant effect on the magnitude of spinal nociceptive reflexes or on the acute activation of pain networks in the brain.
Reviewers commentary: sucrose is effective for reducing crying time and behaviours suggestive of pain in neonates, outcomes that are clinically important and patient oriented. Change in electroencephalography is a surrogate outcome.
Pérez Gaxiola G, Cuello García CA. Evid Pediatr. 2010;6:76
Authors’ conclusions: Drug trials funded by industry were less likely published within 2 years of study completion and were more likely to report positive outcomes than were trials funded by other sources.
Reviewers’ commentary: Sponsor bias, which may be present despite increasingly stringent regulations governing the design and implementation of a clinical trial, is a reality and must be taken into careful consideration when reading industry funded trials.
Buñuel Álvarez JC, González de Dios J. Evid Pediatr. 2010;6:77
Authors´ conclusions: infants aged 1-12 months administered sucrose or glucose before immunization had moderately reduced incidence and duration of crying.
Reviewers´ commentary: immunization is the most common cause of iatrogenic pain in childhood. The administration of sweet solutions during painful procedures decreases moderately the pain. This also happens in infants who were breastfed before, during and alter the procedure. Both interventions for reducing injection pain should be implemented in inpatient and outpatient settings.
González Rodríguez MP, González de Dios J. Evid Pediatr. 2010;6:78
Authors’ conclusions: results of this study support the existence of an association between obesity and the presence of adenovirus 36 antibodies in children. If a causal effect could be proven, this fact would have important implications for prevention and treatment of childhood obesity.
Reviewers’ commentary: data provided by the study show that there are important confounding factors such as age, which could be directly related to the presence or absence of anti-adenovirus 36 and have not been considered in the statistical analysis. Variables such as caloric intake or physical activity have not been taken intoaccount. Therefore, we can not conclude the presence of a causal association.
García Vera C, Buñuel Álvarez JC. Evid Pediatr. 2010;6:79
Authors’ conclusions: there is no association between exposure to mobile phone base stations during pregnancy and cancer during the first four years of life.
Reviewers’ commentary: the large geographical area covered by the study, its community setting, the use of population-based registries and the application of multivariate analysis techniques endorse the authors’ conclusions. In order to study the possible long-term risk (more than four years of age) or the potential risk of postnatal exposure to electromagnetic radiation sources new studies, specifically designed for that purpose, are needed.
Authors´conclusions: a restrictive immunization policy with palivizumab is recommended, verifying an appropriate cost-effectiveness ratio only immunizing children with bronchopulmonary dysplasia in high-risk months.
Reviewers´commentary: palivizumab prophylaxis results in a high cost per episode of hospitalization avoided. There are significant differences depending on the moment of the epidemic season, which in some scenarios may exceed those caused by other risk factors. The recommendations for use should consider this variable to limit the onset and duration of prophylaxis.
González de Dios J, Ochoa Sangrador C. Evid Pediatr. 2010;6:81
Authors’ conclusions: among 12-23-month-olds receiving their first dose of Measles-Mumps-Rubella (MMR) vaccine, the risk of fever and febrile seizures are elevated 7 to 10 days after vaccination. This already known risk increases with the Measles-Mumps-Rubella-Varicella (MMRV) vaccine, resulting in 1 additional febrile seizure for every 2,300 doses of this vaccine.
Reviewers’ commentary: this study, involving nearly half a million children, provides results that confirm prelicensure safety data about the increasing risk of febrile seizures 7 to 10 days after vaccination with the new MMRV vaccine, compared to separate MMR and Varicella vaccines. This risk is estimated to be 1 per 2,300 doses of the new vaccine. Paediatricians should be aware of this risk when recommending or not recommending this vaccine.
García Vera C, Aizpurua Galdeano P. Evid Pediatr. 2010;6:82
Authors’ conclusions: the protection provided by the inactivated influenza vaccine in children declines by four to eight months postvaccination. For matched strains, data suggest that the relative efficacy of the live attenuated vaccine versus the inactivated vaccine in young children increases over time. Relative efficacy against mismatched strains was similar over time. Further research is needed to confirm these findings and to characterize the duration of protection provided by inactivated vaccine in children.
Reviewers’ commentary: it seems that the inactivated virus vaccine produces less protection than the attenuated virus vaccine, especially after the fourth month of vaccination. New studies are needed to know the type of vaccine more suitable for use in children, considering its effectiveness, safety and cost-effectiveness.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2010;6:83
Authors’ conclusions: in Scotland, passage of smoke-free legislation in 2006 was associated to a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke.
Reviewers’ commentary: implementing a smoke-free legislation aimed at all public and enclosed places is a clearly useful measure in preventing respiratory diseases among workers. Apparently this measure would result in a "voluntary" restriction at home, which would have an extra impact in children’s respiratory morbidity.
Authors´ conclusions: the findings from this large-scale population-based study indicate that in childood cancer survivors, the mortality for second primary tumors, circulatory diseases and respiratory diseases is increased beyond 25 years from diagnosis, which suggest a substantial increase in premature deaths.
Reviewers´ commentary: childhood cancer survivors have a lower life expectancy in adulthood, even after 25 years of diagnosis. Nevertheless, it is not possible to establish with this study the risk attributable to the initial disease and its associated treatment.
Olivares Grohnert M, Cuestas Montañés EJ. Evid Pediatr. 2010;6:85
Authors´ conclusions: in children with familial hypercholesterolemia there is no firm evidence regarding when to start statins treatment or what target low-density lipoprotein (LDL-c) cholesterol level should be attained.
Reviewers´ commentary: hypercholesterolemia is one of the main cardiovascular risk factors in adults, that often begins during chilhood. However, there is no clear association between lipid levels in children and its consequences in adulthood. In children, in short term studies, therapy with statins reduces total cholesterol and LDL-c, with no action on other risk parameters. Because it is not defined the age to initiate the therapy, nor the duration, nor the levels to achieve, and without knowing the long-term adverse effects, statin therapy in children should be prescribed with caution. Interventions should be aimed to dietary modifications, weight control, physical inactivity and smoking prevention.
Authors' conclusions: aluminum content of some infant formulas is high, particularly in preterm infant formulas and soy milk designed for children with cow's milk allergy or intolerance. Children can be very vulnerable to early exposure to aluminum. Therefore it has to be highlighted the urgent need to reduce to the minimum possible the content of this product in the formulas.
Reviewers' commentary: presence of aluminum in infant formulas is shown in several studies. The formulas with the highest concentrations were the preparations in powder, the soy-based ones and the designed for preterm infants. The toxic effects of aluminum on the metabolism of both bone and neurodevelopment are shown in infants undergoing parenteral nutrition. Pediatricians and health professionals in charge of child health must ensure, whenever possible, that infants receive breast feeding, especially if they are premature.
Llerena Santa Cruz E, Buñuel Álvarez JC. Evid Pediatr. 2010;6:87
Authors' conclusions: inhaled nitric oxide at 5 parts per million, started within the first 24 hours after birth and continued for a median of three weeks, does not improve survival without bronchopulmonary dysplasia or brain injury in very preterm neonates with mild to moderate respiratory distress syndrome.
Reviewers' commentary: this study addresses a relevant topic in the search for prevention strategies of bronchopulmonary dysplasia. It has a good methodological design. The results differ from those found previously, where low-dose inhaled nitric oxide did reduce the overall incidence of bronchopulmonary dysplasia in newborns with a birth weight of more than 1000 g.
Carvajal Encina F, Puebla Molina SF. Evid Pediatr. 2010;6:88
Authors´ conclusion: childhood bacterial pneumonia and empyema admission rates were increasing prior to 2006 in England. They have observed a 19% and 22% decrease respectively between 2006 and 2008, following the introduction of the VCN7 pneumococcal conjugate vaccination to the national childhood immunisation programme.
Reviewers´ comentary: the study has methodological limitations, so the results should be interpreted with caution. Prospective studies, with proper microbiological confirmation and serotyping are needed to evaluate the vaccine efficacy in the prevention of pneumonia and parapneumonic effusion, as well as cost-effectiveness studies in areas with universal vaccination.
Authors´ conclusions: RTS,S/ASO1E, malaria candidate vacccine integrated in the expanded program of immunization (EPI), showed a favorable safety and immnogenicity evaluation.
Reviewers´ commentary: RTS,S/ASO1E, malaria candidate vacccine does not compromise the immunogenicity of other systematic vaccines and it does not show significant adverse events. It is necessary to determine its efectiveness and its medium-term protection.
Fernández Rodríguez MM, Orejón de Luna G. Evid Pediatr. 2010;6:90
