Authors´ conclusions: within a very low birth weight group with high variability in early growth, faster growth from birth to term is associated with better neurocognitive abilities in young adulthood. Neurocognitive outcomes were predictive, in particular, by early postnatal head growth.
Reviewers´ commentary: in adult ex-preterm infants, a larger body size in the first 12 months is associated with better intellectual performance. This new finding is in contrast to the current recommendation on the optimal way in which theseinfants should grow to prevent metabolic syndrome (slow and progressive).
Rivas Fernández MÁ, González de Dios J. Evid Pediatr. 2015;11:22
Authors’ conclusions: measles-mumps-rubella-varicella (MMRV) vaccine increases the risk of febrile seizures comparing to separated measles-mumps-rubella and varicella. Nevertheless the absolute risk is small, so that vaccination policy makers should take into consideration the risks and benefits of this formulation.
Reviewers’ commentary: in agreement with previous studies, it appears that the first shot of MMRV in the second year of life is related to a higher risk of febrile seizures than the separated MMR and varicella vaccines. In view of the fact that the absolute risk is one more febrile seizure every 2841 administered doses, it is mandatory to consider its pros and cons.
Esparza Olcina MJ, García Vera C. Evid Pediatr. 2015;11:23
Authors´ conclusions: there is a low risk of intussusception in the 3-7 days following vaccination with the first dose of the pentavalent rotavirus vaccine: RV5. Although this risk does not outweigh the benefits, family members should be advised of the alarm signs in order to proceed to early diagnosis.
Reviewers´ commentary: the RV5 vaccine postmarketing studies warn of a rare side effect: intussusception 3 to 14 days after the first dose. Each country should decide if the use of the vaccine is justified for your environment, having in mind the risk -no measurable, given the type of study design-, and the demonstrated benefits (the protective effect against severe gastroenteritis). This decision should be especially individualized in the subgroups most vulnerable to suffering adverse reactions (e.g.: ex-preterm infants), or in those less likely to develop severe forms of acute gastroenteritis (breast milk fed). In any case, the family should be informed of the risk they are assuming.
Authors’ conclusions: the rapid streptococci test is accurate and can be used to streamline pharyngitis treatment in primary care. Backup cultures for negative results may not be necessary in low incidence rheumatic fever settings. The new molecular tests have better sensitivity but are less rapid.
Reviewers’ commentary: rapid antigen detection streptococci tests are sensible and specific enough to be used in primary care pediatrics for deciding what pharyngitis could benefit of antibiotic treatment in children of higher group A streptococcus infections’ prevalence. Control cultures to confirm negative tests may be necessary only in areas with high incidence of rheumatic fever.
García Vera C, Esparza Olcina MJ. Evid Pediatr. 2015;11:25
Authors’ conclusions: in pediatric patients with acute asthma exacerbations practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone.
Reviewers’ commentary: changes in which corticosteroid should be used for asthma attacks are not yet justified. Well-designed clinical trials comparing acceptance, vomiting or other adverse effects should be carried out.Also adequate non-inferiority trials, focusing on clinical variables or costs, must be done with dexamethasone against standard treatment.
Authors´ conclusions: swimming is associated with an increased risk of trunk asymmetries and hyperkyphosis. Although swimming has been considered a complete sport and a treatment option for scoliosis, our data contradict that approach, and also show a higher prevalence of low back pain in females.
Reviewers´ commentary: based on the study data, competitive swimming is associated to a higher prevalence of spine pathology in adolescents who practice this sport. Given the study design and its methodological limitations, we should consider its conclusions as a hypothesis to be confirmed by high-quality prospective studies.
Author’s conclusions: azithromycin (AZT), when administered prophylactically, is associated with a decrease of bronchopulmonary dysplasia (BPD) and in the composite variable DBP / mortality in preterm infants (RNP). This effect disappeared by including other macrolides in the analysis. Because the pharmacokinetics of these drugs in RNP is not well known and because of its possible adverse effects, more studies are needed before recommending the routine use of AZT in RNP.
Reviewers’ comments: AZT, administered prophylactically, has a modest effectiveness in reducing the incidence of BPD. There are no available data on the safety of AZT in preterm or on what subset of RNP would benefit most from this intervention. In view of the currently available evidence it seems prudent not to use this drug systematically in RNP.
Authors´ conclusions: fecal calprotectin has high accuracy for diagnosis of inflammatory bowel disease (IBD) in tertiary referral centers. Both the concentration of calprotectin and the child's age are associated with the diagnosis of IBD.
Reviewers´ commentary: fecal calprotectin is a determination of high diagnostic performance in childhood inflammatory bowel disease. Its usefulness would be different according to the clinical stage. In clinical settings with a high prevalence of IBD, specific to specialized care, it would be most useful for the selection of those patients more appropriate to undergo endoscopy and confirm the diagnosis. However, in low prevalence settings, as in primary health care centers, it would be of greater service to detect the presence of the disease.
Ortega Páez E, Pérez-Moneo Agapito B. Evid Pediatr. 2015;11:30
Author’s conclusions: the CYD-TDV dengue vaccine was efficacious against VCD and severe VCD and led to fewer hospitalizations for VCD in five Latin American countries where dengue is endemic.
Reviewers’ commentary: data on immunologic correlates are still modest but appears to have a significant impact on severity and mortality. Long-term follow-up of vaccines will be essential to understand whether waning vaccine-elicited immunity predisposes recipients to more severe outcomes on subsequent natural infection. For now, pediatricians should remains optimistic that one day will be possible to prevent dengue.
