Authors’ conclusions: the reviewed studies show discrepancies on cranberry juice efficacy on urinary tract infections’ recurrence in children. One study finds no difference between cranberry juice and prophylactic antibiotics. No relevant adverse effects were found, although there were some drop outs due to its flavour.
Reviewers’ commentary: the best conducted study finds a slight efficacy of cranberry juice on reducing the overall number of urinary tract infections in the sample but not in the number of children with recurrences. The other two studies have methodological problems that rise doubts on the validity of their results. The product seems innocuous.
Authors´conclusion: overweight or obese children who were also obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who later became non obese by adulthood were similar to those among persons who were never obese.
Reviewers´commentary: obese children who were also obese as adults had an increase of cardiovascular risk factors. A decrease in adiposity, between childhood and adulthood is associated with reductions in these risks. This study has inherent limitations due to its observational design, nonetheless it can be hypothesize that reducing body mass index in children and adolescents who are overweight or obese could reduce their cardiovascular risk.
Authors' conclusions: There is no evidence to support the effectiveness of increased fluid intake, use of prebiotics, probiotics or behavioral therapy for the treatment of functional constipation. Only some evidence that shows some efficacy of dietary fiber.
Reviewers' commentary: This review contains a very small number of studies with great heterogeneity among them. These studies also are of small sample size. Therefore it is not possible to conclude from the results of this review, which treatment is more effective. Given the current state of knowledge on the subject, it seems prudent to recommend that the patient and their parents take preventive measures such as diets rich in fruits and vegetables and the acquisition of an appropriate intestinal habit. Should the patient require drug treatment, polyethylene glycol 3350 seems to be the best option.
Authors’ conclusions: symptoms and signs, either individually or combined into prediction rules, cannot be used to definitively diagnose or rule out streptococcal pharyngitis.
Reviewers’ commentary: the lack of accuracy of signs and symptoms of strep throat should be taken into account when prescribing antibiotics. We must change our previous behavior of widespread use of antibiotics to an individual aproach, in which using antibiotics is only justified in cases with microbiological confirmation. Symptomatic treatment without antibiotics or microbiological testing may be acceptable in cases with medium to low clinical risk.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2012;8:33
Authors' conclusion: bed sharing could increase the risk of sudden infant death syndrome and this risk is higher when the infant’s mother smokes and when the infant is less than 12 weeks of age.
Reviewers' commentary: although this review provides evidence of an association between bedsharing and sudden infant death syndrome, mainly in smoking mothers, the recommendation about bedsharing should be individualized according to patients values.
Pérez Gaxiola G, Cuello García CA. Evid Pediatr. 2012;8:34
Autors' conclussions: for outpatient treatment of seizures of more than 5 minutes duration, midazolamadministered intramuscularly is at least as effective and safe as intravenous lorazepam.
Reviewers' commentary: the main advantage of intramuscular midazolam is the ease of administration compared to intravenous route. The results of this study showed that this drug is not inferior to intravenous lorazepam. Therefore, intramuscular midazolam should be considered as an alternative of choice for treatment of prolonged seizures in the community setting.
Authors’ conclusions: heart rate characteristics’ monitoring can reduce mortality rates in very low birth weight neonates.
Reviewers' commentary: the benefits of heart rate characteristics’ monitoring (decreased mortality, mainly by late-onset sepsis) entail prior knowledge of the predictive values of this monitoring results, and must be assessed along with the risks (measures to be taken in case of "normal" or "abnormal" results) and cost-effectiveness (more diagnostic testing and/or treatments).
González de Dios J, Molina Arias M. Evid Pediatr. 2012;8:36
Authors’ conclusion: a 4CMenB vaccine is immunogenic against reference strains when administered with routine vaccines at 2, 4 and 6 or at 2, 3 and 4 months of age, producing minimal interference with the response to routine infant vaccinations.
Reviewers’ commentary: randomized controlled trial, to determine both the immunogenicity of a new multi-component serogroup B meningococcal vaccine, as tolerability after its administration with or without routine vaccines; as well as the relationship between adverse effects and the study vaccine. More than 99% of participants had a protector immune response against two of its four components, with mild immunologic interference with some of systematic vaccine antigens (pertussis and serotype 6b pneumococcal). Fever was seen in more than 75% cases, and serious adverse events in 10% of the participants. Its long-term protection and its real clinical effectiveness are unknown.
Juanes de Toledo B, Ruiz-Canela Cáceres J. Evid Pediatr. 2012;8:37
Authors’ conclusions: achieving asthma control is uncommon. Parents tend to overestimate the asthma control; therefore it leads to unsuccessful asthma treatment.
Reviewers’ commentary: patients and caregivers tend to underestimate symptoms related to uncontrolled asthma. It is necessary to carry out interventions to improve the knowledge of the patients and their families on the illness in order to optimize the treatment and to reduce the prevalence of poorly controlled asthma in children.
Gimeno Díaz de Atauri Á, Rivas Juesas C. Evid Pediatr. 2012;8:38
Authors' conclusions: proton pump inhibitors (PPI’s) should not be administrated to treat the symptoms of gastroesophageal reflux disease (GERD) in otherwise clinically healthy infants without the evidence of acid-induced disease.
Reviewers' commentary: although PPIs have been shown to increase gastric pH in these trials, there is currently no evidence of its efficacy in treating symptoms of gastroesophageal reflux in patients from one to twelve months old, consequently they are not recommended.
Cuestas Montañés EJ, Ortega Páez E. Evid Pediatr. 2012;8:39
Authors' conclusions: efficiencyof screening for congenital adrenal hyperplasia 21-hydroxylase deficiency was moderate in term infants and very low inpreterm infants. The authors recommend the discontinuation of screening as has been done so far, in premature infants.
Reviewers' commentary: performance of screening for congenital adrenal hyperplasia in infants born at term, it seems appropriate. Not so in preterm infants, where there is a high rate of false positives, which calls into question its inclusion within the neonatal screening. There are specific techniques but also more expensive, which could improve the effectiveness of screening. Should do more studies to rate this as well as economic studies that assess whether increase defficiency,offsets the increase in spending would the implementation of these screening techniques.
Fernández Rodríguez MM, Orejón de Luna G. Evid Pediatr. 2012;8:40
Authors’ conclusions: antenatal screening at gestational age of 12 weeks and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.
Reviewers' commentary: treatment of women with subclinical hypothyroidism in the late first trimester does not seem to improve their children's IQ at 3 years of age. These results support the current guideline recommendations against universal screening for hypothyroidism during pregnancy. However, it would be advisable to wait for the performance of the follow up expected at five and seven years of age.
Aizpurua Galdeano P, Aparicio Rodrigo M. Evid Pediatr. 2012;8:41
Authors’ conclusions: fluid restriction appears to be safe in late preterm and term neonates with uncomplicated transient tachypnea of the newborn. Fluid restriction may be of benefit in decreasing the duration of respiratory support and reducing hospitalization costs in the more severe cases.
Reviewers’ commentary: limitations in the existent evidence so far make them insufficient to recommend the restrictive use of liquids in the transient tachypnea of the newborn, necessitating further studies assessing this intervention.
Aparicio Sánchez JL, Carvajal Encina F. Evid Pediatr. 2012;8:42
