Authors' conclusion: success rates of labial adhesion with topical estrogens, in all three studies reviewed, was 46.7%, 66.6% and 79% respectively, having poorer results the in girls older than 3 years and in the cases with dense and fibrotic adhesions. The described adverse events are few and mild, reversing at discontinuation of treatment. The authors conclude that topical estrogens are a correct treatment for labial adherence, being the first step previous to manual or chirurgical separation.
Reviewers' commentary: topical estrogens seems an effective and safe treatment, mainly in symptomatic girls. However, because of the absence of well designed experimental studies, the possibility of spontaneous resolution as the girl grows up and the recurrence rates in the reviewed studies, there is not feasible to conclude that it is the best treatment for asymptomatic girls. It seems more logical the clinical follow up and decide the treatment as the symptoms appear.
Orejón de Luna G, Fernández Rodríguez MM. Evid Pediatr. 2009;5:70
Authors' conclusions: there is weak evidence due to the limited sample of the studies included for long-term interventions on the management of the fetal alcohol syndrome. However there is promising research under way, that is identified in the article.
Reviewers' commentary: there is no evidence as to the effectiveness of long term interventions on fetal alcohol syndrome.
Ruiz-Canela Cáceres J, Martín Muñoz P. Evid Pediatr. 2009;5:59
Authors' conclusions: Acute symptomatic seizures associated with stroke, traumatic brain injury or CNS infections carry a higher short-term mortality and a lower recurrence risk than unprovoked seizures associated with the same causes. In the authors' opinion, these findings support the exclusion of acute symptomatic seizures from the concept of epilepsy.
Reviewers' commentary: this is a well designed study that clearly shows the prognostic differences between acute symptomatic and unprovoked seizures. These differences have implications for the elaboration of concepts and definitions in the field of epilepsy.
Ramos Lizana J, Bonillo Perales A. Evid Pediatr. 2009;5:60
Author's conclusions: specific serotypes strongly and independently affect invasive peumococcal disease mortality (IPD).
Reviewer's commentary: in accordance with this Danish epidemiological study, the new developing pneumococcal conjugate vaccines will protect against the most common serotypes of IPD in < 5 years (although we do not have evidence enough for the serotypes which produce more deaths), but not in ≥ 5 years, in which they only protect against two of the nine most lethal serotypes (those with adjusted OR> 3 in relation to serotype 1).
Rivas Juesas C, González de Dios J. Evid Pediatr. 2009;5:61
Authors' conclusions: there is a significant association between sudden death and the use of stimulants in children and teenagers. This fact should be taken into account when weighing the risks and benefits of such drugs.
Reviewers' commentary: the methodological limitations of the appraised article do not allow drawing conclusions about the existence of a cause-effect relationship between central nervous system stimulants in the treatment of TDAH and sudden death.
Authors' conclusions: an 11-valent pneumococcal conjugate vaccine produces a 22.9% reduction of community-acquired radiologically confirmed pneumonia in children younger than 2 years of age; this fact suggests that at least one-fifth of these pneumonias are caused by pneumococcus.
Reviewers' commentary: an 11-valent pneumococcal conjugate vaccine does not prevent significantly the community-acquired radiologically confirmed pneumonia in children younger than 2 years of age. Although it is predictable, considering other studies, that this vaccine could prevent a percentage of pneumonias, its use will continue being based on the prevention of invasive pneumococcal disease, since it is risky to estimate the impact of the vaccine on other outcomes.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2009;5:63
Authors´ conclusion: interventions based on increasing physical activity in schools do not improve BMI, but have other health benefits.
Reviewers´ commentary: there is evidence that these programs do not improve BMI. The studies included do not evaluate adherence and most of them lack an objective measurement of the physical activity. The problem of childhood obesity can not be addressed without a multifactorial intervention.
Pérez Gaxiola G, Llerena Santa Cruz E. Evid Pediatr. 2009;5:64
Authors' conclusions: prenatal multi-micronutrient supplementation is associated to a reduction in the risk of low birth weight, and to a higher weight of the newborn compared to the current recommendation of iron-folic acid supplementation.
Reviewers' commentary: the studies' population and their possible biases, as well as the missing evaluation of the security in the administration of multi-micronutrients, doesn't advise to change the current recommendations.
García Vera C, Esparza Olcina MJ. Evid Pediatr. 2009;5:65
Authors' conclusions: public health measures to increase folic acid intake were followed by a decrease in the birth prevalence of severe congenital heart defects. These findings support the hypothesis that folic acid has a preventive effect on heart defects.
Reviewers' commentary: this population study shows that fortification of wheat flour and grain-products with folic acid, in Canada, was followed by a significant decrease in the prevalence of severe congenital heart diseases, supporting the hypothesis that an appropriate folic acid intake around the time of conception reduces the prevalence of severe congenital cardiopathies.
Olivares Grohnert M, Cuestas Montañés EJ. Evid Pediatr. 2009;5:66
Authors' conclusions: the four strongest predictors are easily available and clinically relevant. The risk score assigned to a child with influenza may provide a disposition tool for predicting hospitalization in children in seasonal influenza epidemics.
Reviewers' commentary: more research is needed to apply this clinical rule, mainly with a prospective cohort, improving predictive value of physical exam and further validation in different populations plus one impact analysis.
Chalco Orrego JP, Bada Mancilla CA. Evid Pediatr. 2009;5:67
Authors´ conclusion: one dose of live attenuated influenza vaccine (LAIV) provided clinically significant protection against influenza in young children previously unvaccinated against influenza, 2 doses provided additional protection. Protection after 2 doses in year 1 persisted through a second season without revaccination. LAIV excipients were no a major contributor to reactogenicity.
Reviewers´ commentary: influenza vaccines are administered as a 2-dose schedule for previously unvaccinated children aged younger than 9 years. In this randomized controlled trial with a score of three over five in the Jadad Scale, the efficacy of one doses of live attenuated influenza vaccine (LAIV) is higher than placebo, although the efficacy of two doses is higher than one. LAIV was showed not efficacy in preventing otitis media. With the available data it would be advisable to follow the vaccination with two doses
Authors' conclusions: Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.
Reviewers' commentary: Given the current recommendations of the clinical practice guidelines, the results of this study (number needed to treat [NNT] of 11, with a wide confidence interval), its methodological limitations and the potential side effects of treating infants with high doses of dexamethasone, it does not seem sensible to change our therapeutic approach to bronchiolitis.
Aizpurua Galdeano P, Ortega Páez E. Evid Pediatr. 2009;5:69
