Authors' conclusions: hypertonic saline given to children with bronchiolitis in the emergency department decreases hospital admissions. We can detect no significant difference in Respiratory Distress Assessment Instrument score or length of stay between the patients receiving nebulized 3% hypertonic saline.
Reviewers' commentary: nebulized 3% hypertonic saline for mild-moderate bronchiolitis can decrease hospital admissions without adverse events. The effect on length of stay is still in doubt. In regard to this, the absence of effect found in this study could be due to methodological limitations.
Gimeno Díaz de Atauri Á, Aparicio Rodrigo M. Evid Pediatr. 2014;10:60
Authors' conclusions: the necrotizing enterocolitis risk index GutCheckNEC gets an acceptable performance for surgical cases which need surgery or those who die but the accuracy is not so good for other cases.
Reviewers' commentary: this predictive scale can help to quantify the risk of necrotizing enterocolitis in our patients, although the important weight in the scale of the level of risk of the participating centers may limit its applicability. The scale has been validated but its clinical usefulness has not been assessed. Checking the protective role of breast milk and probiotics has practical interest; current evidence does not justify ignoring these interventions in our NICUs.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2014;10:61
Authors' conclusions: an elevated procalcitonin is useful to predict bacterial coinfection in infants with severe acute bronchiolitis. Its study can prevent the use of unnecessary antibiotics with associated cost savings.
Reviewers' commentary: procalcitonin in infants with severe acute bronchiolitis can predict diagnosis of bacterial infection and may prevent unnecessary empiric antibiotic therapy.
Pérez-Moneo Agapito B, Molina Arias M. Evid Pediatr. 2014;10:62
Authors' conclusions: the introduction of gluten later than 6 months of age is associated with an increased risk of celiac disease (CD). This study also reports an association between breastfeeding prolonged beyond 12 months' age and an increased risk for CD.
Reviewers' commentary: the aim of the study is to determine the existence of a “window period” for gluten introduction and also to know if breastfeeding at the time of gluten introduction is associated with a lower risk of CD. Given the design, the small effect size and the borderline significance of the main results, it is reassuring to follow current recommendations to maintain exclusive breastfeeding for the first six months (180 days) and to introduce gluten before seven months.
González Rodríguez MP, Flores Antón B. Evid Pediatr. 2014;10:63
Authors' conclusions: tubes and adenoidectomy improve hearing in the short-term time. Additional research is needed in subpopulations with coexisting conditions and there is also a need to evaluate the risk/benefit of long-term interventions.
Reviewers' commentary: tubes improve hearing in the first year. Adenoidectomy decreases the number of children with otitis media with effusion in the short term relative to expectant management, but at least 4 patients need to be treated to improve one at six months. Although hearing losing OME seems not to be associated with later language disorders.
Díaz Cirujano AI, Ruiz-Canela Cáceres J. Evid Pediatr. 2014;10:64
Authors' conclusions: compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with Community Acquired Pneumonia.
Reviewers' commentary: the use of broad spectrum antibiotics is not related to benefits in the hospital admission for community- acquired pneumonia. However, the longer hospital stay observed in these patients could be due to no adjusted basal risk differences. Although the recommendation for using narrow spectrum antibiotics is more rational in the beginning, only the development of an experimental study would let estimate its impact.
Francisco González L, Ochoa Sangrador C. Evid Pediatr. 2014;10:65
Authors' conclusion: extending the initial prednisolone treatment from 3 to 6 months does not have a significant effect in the rate of relapses, frequent relapses, use of steroid saving agents, or remission at one year of follow up.
Reviewers' commentary: a prolonged course of 6 months of prednisolone did not reduce relapses. In a post hoc subgroup analysis by age, children under 3 years old were found to have more remission time until their first relapse. This requires further study.
Corrales Cambero IM, Pérez Gaxiola G. Evid Pediatr. 2014;10:66
Authors' conclusions: a specific association is found between in utero exposure to zidovudine and heart defects. The association between efavirenz and neurological defects must be interpreted with caution. For the other drugs not associated with birth defects, the results were reassuring. The impact that antiretroviral drugs might have on the apparition of congenital defects has to be overcome by the main treatment goal, to avoid HIV transmission.
Reviewers' commentary: in utero exposure to zidovudine has been associated with the occurrence of cardiac defects in the newborn. It also described the relationship of efavirenz with neurological defects, but results have been inconclusive. No birth defects were found associated with other antiretrovirals. However, we must continue to monitor the occurrence of adverse effects and further studies are needed to assess the safety of such treatment
Jullien S, Orejón de Luna G. Evid Pediatr. 2014;10:67
Authors' conclusions: the introduction of small quantities of gluten between fourth and sixth months of age doesn’t reduce the risk of celiac disease at three years of age.
Reviewers' commentary: there is a lack of solid evidence to give recommendations about the age of gluten introduction, although it seems reasonable not to introduce it before the fourth month and not to delay it after the sixth month of age. Whenever possible it should be desirable to maintain breastfeeding.
Molina Arias M, Ortega Páez E. Evid Pediatr. 2014;10:68
Authors’ conclusions: infants with bronchiolitis treated with nebulized hypertonic saline had less improvement compared with those who received normal saline.
Reviewers’ commentary: despite the methodological quality of this study, due to the small sample size and the ethnical differences between the sample and our population, it doesn´t seem appropriate to generalize the results in our setting.
Rivas Juesas C, Ruiz-Canela Cáceres J. Evid Pediatr. 2014;10:69
Authors' conclusions: the Rome III criteria for abdominal pain are not specific enough to rule out organic causes. Alarm symptoms do not differentiate between organic and functional abdominal pain.
Reviewers' commentary: the absence of rigorous criteria to establish the gold standard diagnostic test invalidate the results and prevent us from drawing conclusions based on them.
Francisco González L, Molina Arias M. Evid Pediatr. 2014;10:70
Authors’ conclusions: this preliminary assessment did not find an increased risk of adverse events among women who received Tdap vaccine during pregnancy or their infants. For secondary outcomes, maternal immunization with Tdap resulted in high concentrations of pertussis antibodies in infants during the first two months of life and did not substantially alter infant responses to DTaP.
Reviewers’ commentary: this study is the first clinical trial that confirms the safety of Tdap vaccine in pregnant women and their children. Its results corroborate those of previously published retrospective studies. However, further research is needed to assess definitely whether this strategy to protect the newborn by vaccinating the mother is easy to implement and is safe and effective.
Llerena Santa Cruz E, Aizpurua Galdeano P. Evid Pediatr. 2014;10:73
Authors’ conclusions: in the absence of alcohol or tobacco consumption, and sleeping on a sofa, no significant increase of sudden infant death associated to bed-sharing was found.
Reviewers’ commentary: with the available evidence and the methodological limitations of this study there isn’t enough reasoning to change the previous recommendations.This study proves once more the importance of avoiding added risk factors to infant bed-sharing, nevertheless more recent and powerful enough studies are needed to prove the risks and benefits of sharing the bed in breastfed infants, excluding risk factors.
Ruiz-Canela Cáceres J, Esparza Olcina MJ. Evid Pediatr. 2014;10:74
Editorial
