Authors´ conclusions: in this randomized clinical trial of an immersive virtual reality intervention for pediatric patients undergoing venipuncture, pain, anxiety, procedure duration, and staff satisfaction with procedures were significantly improved after the immersive virtual reality intervention.
Reviewers´ commentary: use of virtual reality as a distraction in painful procedures can work as a complement to the usual non-pharmacological measures to reduce pain in children between 4 and 12 years of age, in this case applied to venipuncture.
Authors´ conclusions: exposure to a single CT scan was not associated with an increased risk of leukemia, lymphoma, or intracranial tumour. It was observed that from the fourth exposure or more, and especially in children with younger ages, an increased risk of cancer. As a conclusion of the study, the prudently need to indicate CT scans in the pediatric population is highlighted.
Reviewers´ commentary: children are more susceptible to damage induced by ionizing radiation than adults, but there are few studies on cancer risk after radiation exposure in children. In this case-control study on younger than 25 years, more incidence of intracranial tumours, leukemia and lymphoma were observed after exposition to more than one CT scan before 18 years.
Esparza Olcina MJ, Flores Villar S. Evid Pediatr. 2023;19:39
Authors´ conclusions: prefusion F protein vaccine against respiratory syncytial virus administered to pregnant women in the last trimester of pregnancy prevents this virus severe respiratory infections in their infants, without important adverse effects.
Reviewers´ commentary: the vaccine appears effective and safe, although its efficacy estimates are imprecise. It constitutes an alternative preventive option to the administration of nirsevimab in the newborn, with comparable impact expectations.
Ochoa Sangrador C, Rodríguez-Salinas Pérez E. Evid Pediatr. 2023;19:40
Authors´ conclusions: this study found that all dietary therapies are effective in the short term. However, modified Atkins diet had better tolerability, higher probability for 50% or higher seizure reduction, and comparable probability for 90% or higher seizure reduction and may be a sounder option than ketogenic diet. Direct head-to-head comparison studies are needed to confirm these findings.
Reviewers´ commentary: ketogenic diet, modified Atkins diet and the low-glycemic diet are effective for short term management of non-surgical refractory seizures. Modified Atkins diet had better tolerability and a greater probability of reducing seizures.
Oltra Benavent M, Cuestas Montañés EJ. Evid Pediatr. 2023;19:41
Authors´ conclusions: the introduction of the rapid diagnostic test (Biofire FilmArray® Meningitis/Encephalitis) of cerebrospinal fluid samples in encephalitis and meningitis in infants under three months can reduce the duration of the prescription of antivirals, but not the total time of antibiotic use, nor the days of hospitalization. This laboratory test should be supported by protocols discussed and agreed upon by the different medical societies involved to optimize their use.
Reviewers´ commentary: the evidence on the clinical impact of the use of multiple genetic detection tests in pediatric meningoencephalitis is of low quality, due to imprecision and methodological limitations. Before assuming their systematic use, we must evaluate their clinical performance, ideally with protocols that direct decision-making based on the positive or negative results of each component of the diagnostic panel.
Flores Villar S, Ochoa Sangrador C. Evid Pediatr. 2023;19:42
Authors´ conclusions: complete vaccination with 4CMenB was shown to be effective in preventing invasive disease due to serogroup B and non–serogroup B meningococci in Spanish children younger than 5 years of age. This evidence may be useful for the inclusion of this vaccine in the immunization program of countries where invasive meningococcal disease in children is problematic and its prevention a priority.
Reviewers´ commentary: this is a well-designed study that collects all cases of meningococcal B infection compared with matched controls (4 per case). The authors have minimized the risk of bias by controlling confounding factors and effect modifiers and conclude on its good efficacy.
Autors´conclusions: an easy-to-use ultrasound scoring scale has been developed that allows the diagnosis of moderate-severe inflammatory activity in pediatric Crohn's disease.
Reviewers´ commentary: the prediction rule presented shows a moderate capacity to differentiate between patients in remission and with moderate-severe activity, and an even lower capacity to distinguish between intermediate degrees of inflammatory activity. No external validation of the scale is carried out.
Pérez González E, Molina Arias M. Evid Pediatr. 2023;19:44
Authors´ conclusions: respiratory syncytial virus, human metapneumovirus and mycoplasma pneumoniae were most strongly related to pediatric community-acquired pneumonia and accounted for half of all cases. There were positive trends between increasing viral genomic loads of respiratory syncytial virus and human metapneumovirus, and higher odds for pediatric community-acquired pneumonia.
Reviewers´ commentary: in the nasopharyngeal aspirate of children with community-acquired pneumonia, there is an increased frequency of some viruses (respiratory syncytial virus and human metapneumovirus, primarily) and Mycoplasma pneumoniae. There is uncertainty about their causal involvement. Therefore, it is not possible to change the current recommendations on management of community-acquired pneumonia in children.
Gimeno Díaz de Atauri Á, Aparicio Rodrigo M. Evid Pediatr. 2023;19:45
Authors´ conclusions: the study confirms the efficacy of proton pump inhibitors (PPI) in a large cohort of children with eosinophilic esophagitis (EEo) with sustained histological remission by gradually reducing the drug dose.
Reviewers´ commentary: after long-term treatment with PPI dose reduction in patients with EEo, histological remission is maintained in most cases both at 7 and 16 months.
Authors´ conclusions: the evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, they likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference in the incidence of hyponatremia.
Reviewers´ commentary: the use of balanced solutions compared to 0.9% saline solution seems to slightly reduce the time in the hospital, as well as achieve higher pH and bicarbonate levels, without showing differences in terms of mortality or the appearance of renal failure in severe dehydration due to acute diarrhea. In our setting, balance solutions are available, so their use should be assessed; in low-income countries, their availability should be taken into account when recommending them.