Abstract

Authors’ conclusions: the accuracy of clinical tools for predicting significant neonatal hyperbilirubinemia is comparable (although not better) to predischarge transcutaneous bilirubin measurement. Neonatal risk of developing significative hyperbilirrubinemia can be assessed simply and accurately by using a combination of predischarge transcutaneous bilirrubin determination and gestational age.

Reviewers’ commentary: present study results are framed in a global debate on the utility and effectiveness of neonatal hyperbilirubinemia screening. In primary care environments, by means of a combined screening approach, neonatal hyperbilirubinemia’s development risk can be estimated with acceptable accuracy in order to define course of action on a rational basis.

Abstract

Authors’ conclusions: increased risk of cancer is not observed among British children born after assisted reproduction during the 17 year follow-up. Although an absolute risk increase for hepatoblastoma and rhabdomyosarcoma was detected, it was small.

Reviewers’ commentary: according to these results there is no increase in the total number of cancers in children born after assisted reproduction, although it still persists the question of whether a high index of suspicion for the accompanying symptoms of hepatoblastoma and rhabdomyosarcoma is needed. It would be necessary to study larger cohorts to clarify the existence of this association.

Abstract

Authors’ conclusions: the implementation of the “low risk ankle rule” produces a significant reduction in order of radiographies without increasing the number of non-diagnosed relevant fractures or diminishing patient or physician’s satisfaction.

Reviewers’ commentary: albeit the weaknesses of this study (absence of randomization of participant hospitals and a high number of losses) it appears that the implementation of the “low risk ankle rule” could reduce the use of radiographs in the emergency setting, reducing the radiation to patients as well as the healthcare expenses.

Abstract

Authors' conclusions: children and teenagers have a wide range of morbidities at least three years before and after a diagnosis of obstructive sleep apnoea, and higher mortality at five years.

Reviewers' commentary: childhood obstructive sleep apnoea syndrome is associated with increased morbidity and mortality, although this excess risk may be largely due to diseases that predispose to it. Before planning an active search for undiagnosed cases, we should know if prognosis can be improved by providing respiratory support measures or treating associated diseases.

Abstract

Authors' conclusions: percentage predicted forced expiratory volume in one second (%FEV1) is decreased in preterm-born survivors, even those who do not develop bronchopulmonary dysplasia (BPD). %FEV1 of survivors of BPD₂₈ (supplemental oxygen dependency at 28 days) has improved over recent years. Future research should focus on evaluating the risk of developing chronic obstructive pulmonary disease (COPD).

Reviewers' commentary: prematurity produces a decline in lung function especially in those who develop BPD. Follow up programs are needed to prevent smoking, childhood pneumonias and asthma, because these factors could accelerate the process and increase the risk of COPD.

Abstract

Authors' conclusions: overweight and, especially, obese children are at increased risk of subsequent physician diagnosed asthma in comparison to normal weight children. The observed sex effects were inconsistent.

Reviewers' commentary: a possible association exists between obesity and asthma.

Abstract

Authors' conclusions: the factors, that are responsible for the differences in the prevalence between certain populations, also vary the specificity and sensitivity of their diagnostic tests.

Reviewers' commentary: with data from 23 different meta-analyses (grouping 416 studies) the authors prove that differences in the prevalence of diseases may lead to significant changes in the sensitivity and specificity of the tests that are used for their diagnostic.

Abstract

Authors' conclusions: restrictive red blood cell transfusion for patients with a non cyanotic congenital heart defect undergoing elective cardiac surgery, with a threshold of haemoglobin (Hb) 8,0 g/dl, leads to a shorter hospital stay without a higher incidence of adverse events or complications, also it's secure and less expensive.

Reviewers' commentary: restrictive red blood cell transfusion is not associated with a longer hospital stay or a higher incidence of perioperative complications in regard to liberal blood cell transfusion. Moreover, it's less expensive and reduces the theoretical risk of donor exposure. The line of research for future studies will be to find alternative parameter to Hb, able to identify the individualize transfusion threshold.

Abstract

Authors' conclusions: since obesity at the start of adolescence is associated with asthma symptom persistence, prevention and treatment of obesity may reduce avoidable healthcare costs and disease burden.

Reviewers' commentary: childhood asthma/wheeze and obesity, measured by body mass index, have been linked. In this study of an adolescent population, children who where obese at the age of 11 years have an increased incidence and prevalence of wheezing at the age of 15 years. Further studies will be necessary to understand whether asthma and obesity are causally associated, or if both are outcomes from a common exposure.

Abstract

Authors' conclusions: our results show the importance of adequate iodine status during early gestation and emphasize the risk that iodine deficiency can pose to the developing infant, even in a country classified as only mildly iodine deficient. Iodine deficiency in pregnant women in the UK should be treated as an important public health issue.

Reviewers' commentary: In this study, the children of women with mild to moderate iodine deficit in the first trimester of pregnancy have lower scores in verbal intelligence quotient (IQ) and reading performance at age 8-9 years. However, the strength of the association is weak and some factors that may have influenced the results have not been taken into account.

Abstract

Authors' conclusions: the Verigene Gram-Positive Blood Culture Test is useful for the early diagnosis of sepsis, with a high sensitivity and specificity.

Reviewers' conclusions: genetic tests are sophisticated tools that are very useful in the diagnosis of diseases. This has an impact on treatment and prognosis of disease since it is known that early and adequate antibiotic treatment for sepsis reduces morbidity and mortality.

Future studies need to determine the real impact of this test when applied to patients and morbimortality is evaluated. Nevertheless, blood culture continues to be mandatory in these cases. It is probable that the cost/benefit analysis proves favourable since reductions in morbimortality in a severe disease as is sepsis can have an important impact on costs for the health care system and for patients on the long run.

Abstract

Authors’ conclusions: although L. reuteri may be effective as a treatment strategy for crying in exclusively breastfed infants with colic, the evidence supporting probiotic use for the treatment of infant colic or crying in formula-fed infants remains unresolved. Results from larger rigorously designed studies will help draw more definitive conclusions.

Reviewers’ commentary: L reuteri is useful in reducing the time of infant crying. It reduces an average of 55 minutes per day, but only in mothers with exclusive breastfeeding and milk protein-free diet. It is still premature to generalize these results, and it is not known if this strain will work in different populations, or if it is cost-effective to give this treatment for 21 days.