Martínez-Cañavate Burgos A, Álvaro M, Larramona H, Lucas Moreno JM, Mesa del Castillo M, Sancha J, Tabar Purroy A, Grupo de trabajo de Inmunoterapia de la SEICAP . Evid Pediatr. 2011;7:78
Authors’ conclusions: the authors didn’t find differences on the rate of cardiovascular events or death between children exposed and unexposed to stimulant medication. They don’t find appropriate to perform an electrocardiogram (EKG) or referral to cardiology of all children with attention deficit and hyperactivity disorder (ADHD) before starting stimulant medication. Cardiology referral should be considered only if cardiac risk factors are detected.
Reviewers’ commentary: at present there isn’t enough evidence to justify the performance of an EKG as screening previous to initiate medical stimulant medication in children with ADHD. It seems reasonable to perform a careful history and physical examination (blood pressure and cardiac frequency included) and referral to cardiology only when cardiac risk factors or cardiac diseases are detected.
Aparicio Rodrigo M, González de Dios J, Ramos Lizana J. Evid Pediatr. 2011;7:80
Authors’ conclusions: there is no evidence that current use of an attention-deficit hyperactivity disorder drug was associated with an increased risk of serious cardiovascular events.
Reviewers’ commentary: this new study, with a higher sample than the previous ones, continues to support their findings on the lack of cardiovascular effects of psychoactive drugs used for patients with attention-deficit/hyperactivity disorder.
Aparicio Rodrigo M, González de Dios J. Evid Pediatr. 2011;7:81
Authors' conclusions: results support the hypothesis that the first hours after birth are a sensitive period for the development of attachment behavior in very low birth weight preterm infants. When a mother is enabled to see her infant shortly after birth, the sensitive period right after birth may be used to help form an important basis for the secure attachment of the preterm infant.
Reviewers' commentary: study with adequate internal validity that supports the existence of a sensitive period in the period immediately following birth of a premature baby, which would favor the establishment of an appropriate mother-child attachment. The analysis showed a statistically significant association between visual contact early and secure attachment at 12 and 18 months of corrected age.
Authors' conclusions: Isoniazid (INH) reduces the risk of tuberculosis (TB) in children infected with HIV taking antiretroviral therapy (ART).
Reviewers' commentary: the study has the limitations inherent to cohort studies and some methodological weaknesses. However, given the importance of the results and the potential impact on public health, it seems advisable to use INH associated to ART for preventing TB in HIV patients living in areas of high prevalence of both diseases. More studies are needed to establish the most appropriate regimen and to assess potential adverse effects and the preventive effect in the longer term.
Gimeno Díaz de Atauri Á, Rivas Juesas C. Evid Pediatr. 2011;7:83
Authors’ conclusions: low arterial cord pH showed strong, consistent, and temporal association with clinically important neonatal outcomes that are biologically plausible. These data could justify the increased surveillance of infants born with a low cord pH.
Reviewers’ commentary: there is a clear relationship between fetal acidosis and perinatal asphyxia, this systematic review also shows that the association between low pHAU and neonatal morbidity and mortality is not limited to populations at risk. This finding reopens the debate on whether we should make cord pH at every birth. That depends on whether this test provides an appropriate balance of risks, costs and benefits. Considering that this test can be done safely during delivery at low price, the key question would be: do we need to make a close follow up of all infants with low pHAU even without perinatal asphyxia? In this case the main "cost" would be the effect of labelling and the false positives. In our opinion, the pHAU is a useful data if available at all births, but current studies suggest recommend only a close follow up at medium to long term of newborns with pHAU when it is associated with perinatal asphyxia.
González de Dios J, Balaguer Santamaría A. Evid Pediatr. 2011;7:84
Authors' conclusions: the new vaccine against tuberculosis, MVA85A, was safe and produced a high and durable T cell response in infants.
Reviewers' commentary: the study has methodological limitations that call into question the authors' conclusions. However it opens the door to developing a new vaccine against tuberculosis in children, requiring more studies to assess its immunogenicity, safety and effectiveness.
Orejón de Luna G, de Lucas García N. Evid Pediatr. 2011;7:85
Authors' conclusion: although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions.
Reviewers' commentary: existing studies and systematic reviews about complementary therapies are of low quality and have a high risk of bias. To recommend any of them, results must be reproduced in more rigorous clinical trials.
Pérez Gaxiola G, Cuello García CA. Evid Pediatr. 2011;7:86
Authors' conclusion: in pregnant women the administration of inactivated influenza vaccine was associated with a decreased incidence of prematurity and, in the peak period of virus circulation, with a decrease in low birth weight.
Reviewers' commentary: some methodological limitations of this study make it difficult to generalize the results. In any case, the administration of influenza vaccine is recommended for pregnant women because it decreases their morbidity and mortality. If the results of this study are confirmed, the reduction of the incidence of prematurity and low birth weight will be additional reasons to administer influenza vaccine in pregnant women.
Authors' conclusions: parent-reported symptoms are not reliable predictors of serious respiratory infection, and do not correlate well with nurse assessment. Nurse triage assessment of respiratory distress and some vital signs are important predictors.
Reviewers' commentary: the symptoms reported by parents do not seem reliable in diagnosing severe respiratory infections in childhood. Nevertheless, taking into account the limitations of this study, we cannot rule out that these symptoms can have some usefulness in predicting severity of any origin.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2011;7:88
Authors' conclusions: pulse oximetry is a safe and feasible method of screening that improves screening procedures currently available. It allows an early identification of congenital heart diseases and other diseases.
Reviewers' commentary: although neonatal pulse oximetry is acceptably valid, feasible to implement and a cheap method of screening, the expected diagnostic improvement will be low in children born after pregnancies submitted to well done ultrasound scans and properly explored in the early hours of life. Well-conducted cost-benefit studies are needed to assess its economic impact.
Authors' conclusion: in children with recurrent upper respiratory tract, adenoidectomy offers no benefit compared with the attitude of watchful waiting in reducing the incidence of new episodes.
Reviewers' commentary: the results of this study discourage the practice of adenoidectomy for the indication of reducing the incidence of upper respiratory tract infections. In this situation it's necessary to explain to parents that these infections are a normal immune development phase of any child.
Authors' conclusion: the meta-analyses suggest that children with previous problems with crying, sleeping and/or feeding in infancy have more behavioral problems than controls, particularly in multi-problem families.
Reviewers' commentary: the results of this study could have important clinical implications due to the frequency of problems with crying, sleeping and/or feeding in infancy and the burden that a child with behavioural problems / ADHD implies for the family, the society and the health care system. However, the results of this review should be interpreted with caution due to its methodological limitations and the fact that the children of multi-problem families (a recognized behavioural risk factor) had the worst outcomes.
Authors' conclusions: pleural fluid culture in blood culture bottles improves diagnostic yield when added to standard culture. This technique should be incorporated into clinical practice.
Reviewers' commentary: pleural fluid culture in blood culture bottles appears to improve diagnostic yield. This improvement justifies its incorporation into clinical practice, although its diagnostic impact on pediatric specimens is unclear and may be limited.
Rivas Juesas C, Ochoa Sangrador C. Evid Pediatr. 2011;7:92
Authors' conclusion: this clinical trial confirms previous findings on the safety and efficacy of oral propranolol treatment of infantile hemangiomas. Propranolol produces a significant decrease in volume, redness and elevation in all stages of the natural history of the tumour. These facts justify its use as a first choice drug in potentially disfiguring or complicated child hemangiomas.
Reviewers' commentary: the results of this study demonstrate that propranolol is effective in the treatment of infantile hemangiomas. However the optimal dose is unknown and larger trials are lacking to determine the incidence of any adverse effects. Since most of infantile hemangiomas produce only aesthetic consequences and the vast majority of them regress and disappear in the long term, currently the use of propranolol should be restricted to selected cases.
Authors’ conclusions: the existing referenceranges for heart rate and respiratory rate in children are inconsistent, and do not agree with centile charts derived from a systematic review of observational studies. This finding has potentially wide-ranging implications for clinical assessment of children, and for design of resuscitation guidelines, triage scores, and early warning systems.
Reviewers' commentary: the measure of cardiac and respiratory rate offers relevant information in children care decision making. This systematic review of quality concludes that the more used charts don’t agree in some values, carrying the risk of over or infra diagnosis of potential serious conditions. This study is based on multiple registers with heterogeneity of the population as well as of the registration process, what makes risky the extrapolation of the results. It seems important that big population studies were addressed in healthy children as well as in children with conditions such as fever or infections. In the meanwhile the clinician has to make decisions taking into account the existent variability and other examination data.
Authors' conclusion: in children with Helicobacter pylori infection sequential eradication therapy compared with standard triple therapy resulted in a higher eradication rate, although the difference was of borderline statistical significance.
Reviewers' commentary: sequential therapy versus triple therapy for the treatment of Helicobacter pylori infection in childhood shows a slight superiority in the limit of statistical significance. Although some treatment guidelines recommend sequential therapy as the first choice, further studies of quality are needed to consider it as such. Meanwhile, the sequential therapy could be considered a valid alternative to the triple one.
Ortega Páez E, Cuestas Montañés EJ. Evid Pediatr. 2011;7:95
Authors' conclusions: the evidence supporting the use of continuous positive airway pressure (CPAP) or CPAP-heliox to reduce partial pressure of carbon dioxide and respiratory distress in bronchiolitis is of low methodological quality, and there is no conclusive evidence that CPAP reduces the need for intubation.
Reviewers' commentary: although the quality of evidence is low, CPAP (alone or heliox) may be recommend as a first step of respiratory support in selected patients with bronchiolitis. Research using higher quality methodology, with higher sample sizes, longer period of monitoring and clinical variables of interest is needed to clarify the beneficial role of these interventions.
Orejón de Luna G, González de Dios J. Evid Pediatr. 2011;7:96
