Authors' conclusions: pain was reduced when the DPTaPHib vaccine was administered before the PCV in infants undergoing routine vaccination. On the basis of these results, we recommend that the order of vaccines be the DPTaP-Hib vaccine followed by the PCV.
Reviewers' commentary: infant pain response during routine intramuscular inmunization was affected by the order of administration of the vaccines. When two vaccines are given together, the least painful should be administered first. This strategy is simple, effective, cost free, and easily incorporated into clinical practice.
Aparicio Rodrigo M, Juanes de Toledo B. Evid Pediatr. 2009;5:77
Authors' conclusions: neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications and on the current A/H1N1 influenza strain remain to be determined.
Reviewers' commentary: the studies suggest that the neuraminidase inhibitors shorten the duration of symptoms usually between 0.5 and 1.5 days, being smaller the effect among the cases of clinical flu. There exist doubts on the clinical importance of the effect. The studies show homogeneous results for prevention with a reduction of 8% in the transmission of the flu; being the number needed to treat of 13 to prevent one additional household case of symptomatic influenza. Although at the present day the effect of the antiviral agents in reducing the disease or in preventing the complications for the new pandemic flu is unknown, the current evidence suggests that the potential benefit is limited and it seems reasonable to apply a restricted use of the neuraminidase inhibitors, valuing individually for each patient the risk level, the severity of the condition and the likelihood of the diagnosis.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2009;5:78
Authors' conclusions: the early vaccination against the pandemic flu (H1N1) 2009 prevents more deaths and saves more costs. The population's total coverage is not necessary to reduce the viral reproduction rate to shorten the pandemia.
Reviewers' commentary: the vaccination against H1N1 virus seems more effective in the second half of October than in mid November. These results would be important, if confirmed, for the health authorities to plan the beginning of the vaccination campaign against the flu H1N1. More cost-effectivity and cost-utility analysis are needed to confirm these results.
Orejón de Luna G, Ortega Páez E. Evid Pediatr. 2009;5:79
Authors' conclusions: the children aged between 6 and 59 months who were vaccinated with the trivalent inactivated influenza vaccine had lower risk of influenza illness.
Reviewers' commentary: the trivalent inactivated influenza vaccine could be effective in children under five years, especially if the vaccination schedule has been completed, neverthelesss the present study does not use the most appropriate methodology to prove it.
González de Dios J, Rivas Juesas C. Evid Pediatr. 2009;5:80
Authors' conclusions: oseltamivir prescribed at influenza diagnosis reduces influenza complications and hospitalizations for children at high risk of influenza complications.
Reviewers' commentary: the effectiveness of oseltamivir for the prevention of complications of seasonal influenza in children with chronic medical conditions is limited. Oseltamivir did not reduce the percentage of admissions for pneumonia and other respiratory diseases other than pneumonia. There is an urgent need of clinical trials in children of risk groups with flu, to determine ithe effectiveness of oseltamivir int the prevention of complicantions.
Authors' conclusions: oseltamivir prescribed at influenza diagnosis reduces influenza complications and hospitalizations for children at high risk of influenza complications.
Reviewers' commentary: among health workers, the surgical mask does not offer less protection against influenza than the respirator N95.
Cuestas Montañés EJ, Olivares Grohnert M. Evid Pediatr. 2009;5:82
Authors' conclusions: physical measures to prevent the spread of influenza virus and other respiratory viruses, for example hand washing and the use of face masks are effective, and relatively cheap to implement. The adequate promotion of these measures is important, since children are a very important means of viral propagation due to their less established hygienic practices.
Reviewers' commentary: this is a well designed systematic review. The studies in which it is based have multiple design problems. Nevertheless the conclusions seem valid, but more welll designed studies are necessary.
Perdikidis Olivieri L, Bonillo Perales A. Evid Pediatr. 2009;5:83
Authors' conclusions: antibiotic prophylaxis with TS is associated with a decrease of recurrence in children with UTIs in predisposed children. The selective use of TS prophylaxis in children at high risk of recurrence is recommended.
Reviewers' commentary: there are doubts about the clinical impact of treatment: minimal reduction in the recurrence of UTI, no effect on renal damage and increased risk of UTI with resistant organisms. Studies are needed to determine the effectiveness of risk in homogeneous groups in order to establish recommendations in our geographical area.
Authors' conclusions: there are few published studies to support use of the current TB standardized retreatment regimen. Randomized trials on the treatment of persons with isoniazid mono-resistance and/or a history of previous TB treatment are urgently needed.
Reviewers' commentary: there is not enough evidence to support the WHO standard regimen for retreatment of TBC. The analisis of the different current treatments shows a very variable efficacy. The management of previously treated or isoniazid resistant TB patients requires multinational clinical trials.
Pérez Gaxiola G, Llerena Santa Cruz E. Evid Pediatr. 2009;5:85
Authors' conclusions: the recommendation of offering a pacifier at 15 days does not modify the prevalence and duration of breastfeeding.
Reviewers' commentary: despite the scarcity of well-designed clinical trials about the recommendation of pacifier use, it appears that it has not a tendency to influence on the prevalence and duration of breastfeeding. Therefore its advice to diminish the risk of cot death is applicable.
Chalco Orrego JP, Bada Mancilla CA. Evid Pediatr. 2009;5:86
Authors' conclusions: the pneumococcal conjugate vaccine produces a significant effect regarding prevention of invasive pneumococcal disease. Results on prevention of otitis or pneumonia have been less striking, but considering the high burden of these diseases in infants, even a low efficacy has the potential for a tremendous impact on the health of infants in developing and industrialized countries.
Reviewers' commentary: there is evidence of the preventive effect of pneumococcal conjugate vaccine on invasive pneumococcal disease caused by the included vaccine serotypes. It is necessary to evaluate our circulating Streptococcus pneumoniae serotypes in order to determine the adequacy of the vaccine inclusion within the vaccine chart .
Editorial
