Authors ́ conclusions: the clinical risk factors associated with having secondary arterial hypertension were: family history of secondary high blood pressure age of the child ≤6 years, weight ≤10th percentile and a high load on the ambulatory Holter monitor for 24 hours of blood pressure. In this meta-analysis there was no significant difference in the symptoms in children with primary versus secondary hypertension.
Reviewers ́ commentary: the presence of data associated with an increased risk of secondary hypertension may be of particular interest in primary care to select patients in whom further clinical evaluation may be indicated. Potential selection bias and lack of adjustment for other risk factors may limit applicability. Prospective studies with larger sample size and adjustment for other factors associated with hypertension would be necessary.
Fernández Rodríguez MM, Blanco Rodríguez C. Evid Pediatr. 2024;20:2
Authors´ conclusions: the study suggests that the results of objective laboratory tests have the potential to predict Kawasaki disease. Machine learning with XGBoost can help clinicians differentiate Kawasaki disease patients from other febrile patients in pediatric emergency departments with excellent sensitivity, specificity, and accuracy.
Reviewers´ commentary: although the model presented has power to identify patients at risk of Kawasaki disease, it must be externally validated in populations more similar to ours before its use can be recommended.
Molina Arias M, Ortega Páez E. Evid Pediatr. 2024;20:3
Authors´ conclusions: family treatment of overweight or obese children in primary care improves weight outcomes for children and their parents. Siblings who have not been treated directly also improve outcomes, so this family approach may offer a new approach to families with multiple children.
Reviewers´ commentary: an structured family-based treatment of children with obesity through trained staff stabilizes the weight gain in children and in the family environment (parents and siblings) with obesity compared to conventional treatment. The improvement with respect to baseline BMI is not maintained over time, but it does not worsen as occurs if the approach is individual.
Rivero Martín MJ, Fernández Rodríguez MM. Evid Pediatr. 2024;20:4
Authors’ conclusions: in children with systemic inflammatory syndrome associated with SARS-CoV-2 infection, the medium-term cardiac outcome (6 months) has been favorable with resolution of left ventricular systolic dysfunction, although with persistence in a subgroup of patients with coronary anomalies.
Reviewers’ commentary: the satisfactory cardiovascular evolution of pediatric patients affected by systemic inflammatory syndrome associated with SARS-CoV-2 is of high clinical importance and allows establishing a medium-term prognosis for these patients. Up to 5% of patients with coronary involvement may remain with these lesions, so multicenter studies must be carried out to detect patients at risk of persistent lesions and to establish the prognosis in this subgroup of patients.
Authors´conclusions: in this study, proton pump inhibitors use was associated with an increased risk of serious infections in young children. Proton pump inhibitors should not be used without a clear indication in this population.
Reviewers´commentary: proton pump inhibitors slightly increase the risk of serious infections in children when they are first taken and during treatment. This relationship seems less relevant when treatment has finished. Its use should be limited to patients with a clear indication.
Llerena Santa Cruz E, Pérez-Moneo Agapito B. Evid Pediatr. 2024;20:6
Authors´ conclusions: we found dolutegravir (DTG) to be highly effective and safe within our cohort of children and adolescents living with HIV (CALHIV) in low-and middle-income countries. These findings can empower clinicians to prescribe DTG confidently to eligible CALHIV.
Reviewers’ commentary: dolutegravir has a high rate of viral suppression with a few adverse effects, so it could be an option to consider in settings without access to antiretroviral therapy in children over 20 kg, either as first or second line treatment.
Martín Masot R, Llerena Santa Cruz E. Evid Pediatr. 2024;20:7
Authors´ conclusions: tacrolimus has a high initial response in biologic naïve UC children. It can be effectively used as a bridge to other therapies with a 1-year colectomy-free survival of 64%.
Reviewers´ commentary: methodological limitations of this study prevent us from drawing conclusions about the role of tacrolimus treatment in steroid refractory and dependent pediatric ulcerative colitis. We must continue to accept current international recommendations for the treatment of these patients.
Fraile Astorga G, Molina Arias M. Evid Pediatr. 2024;20:8
Authors´ conclusions: neonatal screening for the early detection of congenital heart disease in newborns through pre- and post-ductal pulse oximetry, and neonatal physical examination in maternity hospitals, complement the regulated prenatal ultrasound study carried out around week 18-20 of gestation. Even so, 10% of neonatal congenital heart diseases escape, with coarctation of the aorta being the most predominant among them.
Reviewers´ commentary: the sequential screening protocol for severe congenital heart diseases allows the early detection of 90% of these. The three steps of the screening process are important, as it is the physical examination, especially in the detection of aortic coarctation, which is the most frequent of them and which remains with detection levels well below these figures. It would be good, therefore, to find an additional screening method for this heart disease applicable in neonatal units before discharge.
Martínez Rubio M.V, Flores Villar S. Evid Pediatr. 2024;20:9
Authors´ conclusions: moderate/low certainty evidence suggests that breastfeeding or supplemental breast milk may reduce pain in neonates undergoing painful procedures compared to no intervention/positioning/holding or placebo or non-pharmacological interventions. The effectiveness of breast milk for painful procedures should be studied in the preterm population, as there are currently a limited number of studies that have assessed its effectiveness in this population.
Reviewers´ commentary: the results of this systematic revision indicate that breastfeeding can mitigate the pain felt by newborns undergoing painful procedures, so, except in cases where it is not possible, families should be informed, and its application encouraged. The data in premature infants are insufficient, so studies are needed in this population subgroup.
Conclusions of the study authors: Children who underwent surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who underwent surgery at 12 months of age.
Reviewer comments: in experienced centers and selected cases, Sommerlad surgery at 6 months of age could lead to a slightly lower incidence of velopharyngeal insufficiency than surgery at 12 months of age (difference of 6.1% at 5 years of age), although the results are not very consistent and precise, with differences between countries.
Gimeno Díaz de Atauri Á, Pérez González E. Evid Pediatr. 2024;20:11
Editorial
