Authors' conclusions: there is at present insufficient evidence that immunotherapy in any administration form has a positive effect on symptoms or medication use in children and adolescents with allergic rhino conjunctivitis. In allergic asthma, the subcutaneous immunotherapy appears to reduce symptoms and use of medication but the evidence is limited concerning the size of benefit. It is not free of side effects. High doses sublingual inmmunotherapy produce symptomatic improvement and medication use in children with asthma and allergies to grass pollen.
Reviewers' commentary: the prevalence of allergic diseases is increasing, and its burden is substantial. The efficacy of the treatment with allergen-specific immunotherapy has not been demonstrated; although the improvement has statistically significance, the clinical relevance is poor, with an increased risk of adverse reactions. Due to that, the use of immunotherapy should no be generalised, reserving it for cases thoroughly evaluated.
Authors' conclusions: we found no benefit or adverse effect on health related quality of life in young adult women with Turner syndrome either from receiving or not receiving growth hormone injections. The results of this study in young adult women with Turner syndrome suggest that they adjust well to their challenges in life.
Reviewers' commentary: many girls with Turner syndrome receive growth hormone to improve their final height. Although this trial has some limitations, the perception of quality of life is not associated with their height. We must take into account other aspects of their life that could require support and treatment.
González Rodríguez MP, Velarde Mayol C. Evid Pediatr. 2011;7:54
Authors' conclusions: growth hormone therapy in children with idiopathic short stature seems to be effective in partially reducing the deficit in height as adults, increasing adult height by about 4 cm, although the magnitude of effectiveness is on average less than that achieved in other conditions for which growth hormone is licensed. The individual response to therapy is highly variable, and additional studies are needed to identify the responders.
Reviewers' commentary: children with idiopathic short stature constitute a fixed proportion of the population, with about 2-3% of children 2 SD below the mean and 0.1% 3 SD below the mean. This high quality systematic review concludes that the administration of growth hormone in these children increases adult height by about 4 cm. Adding the cost of the therapy, the potential adverse effects (metabolic diseases and increased risk of malignancy into adult life) and difficulties for adequate adherence to the treatment, growth hormone therapy in short otherwise normal children, should be implemented with caution.
González de Dios J, González Rodríguez MP. Evid Pediatr. 2011;7:55
Authors' conclusions: we demostrated that is possible to perform a powerful, simple, well accepted and sensitive celiac disease (CD) screening using saliva.
Reviewers' commentary: this study describes the possibility to perform a simple, safe and apparently specific screening test for detecting CD in saliva at early age. This could contribute to reduce morbidity and mortality associated with CD. Further studies will be neccessary to confirm these results.
Cuestas Montañés EJ, Ortega Páez E. Evid Pediatr. 2011;7:56
Authors' conclusions: oral creatine improves muscle strength in muscular dystrophies but this effect could not be demonstrated in metabolic myopathies. No adverse effects were detected except inMcArdle's disease.
Reviewers' commentary: creatine may have a role in the treatment of muscular dystrophy. It is necessary to know in which stages of the disease it would be indicated, the long-term effect and the possible combination with other treatments.
Fernández Rodríguez MM, Orejón de Luna G. Evid Pediatr. 2011;7:57
Authors' conclusion: enteral supplementation of probiotics prevents severe necrotizing enterocolitis and all cause mortality in preterm infants. Our updated review of available evidence supports a change in practice. More studies are needed to assess efficacy in extremely low birth weight infants and assess the most effective formulation and dose to be utilized.
Reviewers' commentary: this systematic review provides high quality evidence with low possibility of future change regarding the strong recommendation for routinely providing probiotics to the premature infants in the neonatal intensive care units for diminishing the risk of severe necrotizing enterocolitis. In any neonatal intensive care unit with a 10% prevalence of necrotizing enterocolitis, 16 premature infants would have to be treated to prevent one death, and 17 to prevent one necrotizing enterocolitis stage II or III. More studies are needed to ascertain specific doses, formulation and effects in those extremely low birth weight infants, as well as economic analyses to determine its cost-effectiveness in different health systems. With current evidence, it should be strongly considered to routinely provide probiotics to premature babies.
Cuello García CA, González de Dios J. Evid Pediatr. 2011;7:58
Authors' conclusion: students 16 to 18 years old have a strong association between bullying and suicidal thoughts (item: "life is not worth living"). When the harassment was frequent, suicidal thoughts were eight times more frequent than when the harassment was absent. Furthermore, this association was independent of previous psychiatric morbidity.
Reviewers' commentary: bullying is associated with suicidal ideation, regardless of psychiatric disorders. Although this cross-sectional study does not allow determining the casual association, it supports a strong association between suicidal ideation and bullying. These findings provide further evidence that bullying must be taken seriously. Therefore, its prevention, early detection and support for victims are of paramount importance.
Authors' conclusions: malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant´s health and survival.
Reviewers' commentary: children of women with malaria during pregnancy, acute placental infection and cord infection have a higher infant mortality and an increased risk of malaria infection during the first year of life. Thus, it seems appropriate to initiate preventive measures against malaria during pregnancy, but further studies are needed to identify the most effective.
Bonillo Perales A, Perdikidis Olivieri L. Evid Pediatr. 2011;7:60
Authors' conclusions: breastfeeding protects against sudden infant death syndrome (SIDS). This effect is greater when breastfeeding is exclusive. The recommendation to breastfeed should be included in the messages to reduce the risk of SIDS.
Reviewers' commentary: despite some methodological limitations of the study evaluated, breastfeeding should be recommended in both maternity and pediatric primary care offices due to its many advantages, including its possible protective effect on sudden infant death syndrome. Among the tips for its prevention (back sleeping position, pacifier use when breastfeeding is well established), breastfeeding should be recommended as another protective factor.
Authors' conclusions: cranial osteopathy for children with cerebral palsy does not lead to significant improvement in motor function, pain, sleep or quality of life in children, nor in quality of life of their carers.
Reviewers' conclusions: parents of children with cerebral palsy frequently try various complementary and alternative medicine therapies, many of them without evidence-based efficacy. The present study is one of the few who evaluate one of these therapies, cranial osteopathy, being unable to find any significant improvement in health or quality of life of children with cerebral palsy, nor in quality of life of their carers.
Molina Arias M, González de Dios J. Evid Pediatr. 2011;7:62
Authors' conclusion: there does not seem to bean increased risk of orofacial clefts associated with the use of corticosteroids during pregnancy. The association between cleft lip with / without cleft palate and dermatological use of corticosteroids during pregnancy may be due to chance, as the result of multiple statistical comparisons, without implying a causal relationship.
Reviewers' commentary: the resultsof this study may permit the use of steroids in those pregnant women, in whom the treatment of certain diseases makes absolutely essential their use. The presence of other potential adverse effects of corticosteroids during pregnancy (e.g. fetal growth retardation, low birth weight) recommends extreme caution with the use of these drugs.
Llerena Santa Cruz E, Guarch Ibáñez B, Buñuel Álvarez JC. Evid Pediatr. 2011;7:63
Authors' conclusions: oral ibuprofen is more effective than intravenous ibuprofen for the closure of patent ductus arteriosus in premature newborns with very low birth weight. Patients with boderline renal function should be closely monitored.
Reviewers' commentary: this clinical trial makes plausible to implement the use of oral ibuprofen for the closure of patent ductus arteriosus in premature newborns, what is a great improvement in the cost-effectiveness. We need more clinical trials that replicate these results to recommend oral ibuprofen as an effective and safe intervention.
González de Dios J, Rivas Fernández MÁ. Evid Pediatr. 2011;7:64
Authors' conclusions: the detection of Helicobacter pylori antigen in stools with ELISA monoclonal antibodies is a noninvasive accurate test for the diagnosis of infection in children. One-step tests showed low accuracy and more studies are needed to obtain a useful office-based screening test. The available molecular tests are still unreliable.
Reviewers' commentary: the screening of antigens of Helicobacter pylori in stools, especially those based on ELISA with monoclonal antibodies, are accurate enough, but enough information about its usefulness in young children is lacking. These tests will be useful as an adjunct in the diagnosis and control of the eradication of the infection; although currently they cannot replace the endoscopy in the diagnosis and treatment of peptic disease by H. pylori.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2011;7:65
Authors’ conclusions: this study aims to call for attention on the readers of free medical journals about the fact that pharmaceutical industry’s advertising, that finances these journals, may influence drug recommendations.
Reviewers’ commentary: readers of medical literature should apply critical appraisal skills, especially when reading free medical journals.
Aizpurua Galdeano P, Esparza Olcina MJ. Evid Pediatr. 2011;7:66
Authors' conclusion: breastfeeding is associated with a lower risk for epilepsy in infancy. Infants breastfed for 3 to 5, 6 to 8, 9 to 12, and more than 13 months had 26, 39, 50 y 59% lower risk for epilepsy respectively compared to those breasted for less than a month.
Reviewers' commentary: risk of epilepsy in infancy decreased with the duration of breastfeeding and this relationship was even more notorious when breastfeeding was exclusive. Although an observational study in inherently at risk of bias, the null costs and risks of breastfeeding are surpassed by the benefits.
Pérez Gaxiola G, Cuello García CA. Evid Pediatr. 2011;7:67
Authors' conclusion: the risk of attention deficit hyperactivity disorder (ADHD) tends to increase with decreasing Apgar test score at 5 minutes (AT5).
Reviewers' commentary: The results of this study recommend close monitoring of children with AT5 scores less than 7 due to an increased risk of neurological morbidity in the short, medium and long-term (the higher incidence of ADHD would be one of the negative outcomes). It is also advisable, when performing the diagnostic process of ADHD, to take into account the perinatal history, and very specifically AT5. Although not a diagnostic criterion for ADHD, AT5 may be a clue to guide the clinician responsible for the child’s care.
Authors’s conclusions: the addition of zinc and prebiotics to oral rehydration salts decreases diarrhea duration in children.
Reviewer’s commentary: the addition of zinc and prebiotics to a hypotonic oral rehydration solution may be useful in children with gastroenteritis in developed countries.
Carreazo Pariasca NY, Bernaola Aponte G. Evid Pediatr. 2011;7:69
Authors' conclusion: although this study did not find an increased risk of intussusception after administration of vaccines against rotavirus, there was some evidence of increased risk after the first dose of both vaccines. Larger population studies are needed to provide more definite evidence.
Reviewers' commentary: At the moment there is insufficient evidence to suggest that rotavirus vaccines are unsafe, but close monitoring should continue to determine if there is a possible association with intussusception.
Ortega Páez E, Cuestas Montañés EJ. Evid Pediatr. 2011;7:70
Authors conclusions: children who do not get enough sleep are at increased risk of overweight, mainly due to an increased deposition of fat mass, rather than accumulation of fat free mass.
Reviewers' commentary: this study suggests a causal relationship between sleep duration (SD) and body mass index (BMI) at the expense of fat mass accumulation. After adjustment for major determinants of overweight such as dietary intake and physical activity, the relationship loses strength.
Juanes de Toledo B, Ruiz-Canela Cáceres J. Evid Pediatr. 2011;7:71
