Authors’s conclusions: The first review analyzes the early use of eritropoyetin (EPO) in preterm infants of less than seven days concluding that, although confirming a significative reduction in blood transfusions, the effect is of little clinical relevance and a bigger incidence of retinopathy of prematurity (RP) newborn appears. The second review studies the late use of EPO (more than eight days newborns), concluding that it doesn’t have adverse effects in the short term, and reduce blood transfusions significantly. The last review compares both procedures, concluding that the early use doesn’t have benefit compared with the late use and it is associated to a higher incidence of RP.
Reviewer’s commentary: In infants more than 1,000 g. the late clamping of the umbilical cord, the reduction of blood samples and a correct nutritional support must be enough to minimize the anaemia of prematurity. In infants of less than 1,000 g., a late administration of EPO is proposed added to the previous measures.
Melgar Bonis A, Bergón Sendín E, Vázquez Román S, López Maestro M. Evid Pediatr. 2008;4:62
Authors’s conclusions: Adherence to the mediterranean diet is associated with a lower risk of diabetes mellitus type 2.
Reviewer’s commentary: Some studies have shown that a Mediterranean diet is associated with a reduction of chronic diseases. The results of this study are consistent with other publications demonstrating the beneficial effect of this diet on glucose metabolism. Health education activities aimed to promote Mediterranean diet should be part of of pediatricians and general practitioners clinical practice. It would be useful to have studies that support the benefits of Mediterranean diet in less selected populations.
Olivares Grohnert M, Buñuel Álvarez JC. Evid Pediatr. 2008;4:48
Authors’s conclusions: height screening in childhood is useful for diagnosis and treatment of underlying diseases, with an acceptable cost-effectiveness.
Reviewer’s commentary: the limitations of the studies included in the systematic review and peculiar assumptions (regarding QALY) in the economic assessment, require further research in this field (with controlled clinical trials) to define the real value of height screening to improve health in childhood.
González de Dios J, Rivas Juesas C. Evid Pediatr. 2008;4:49
Authors’s conclusions: vitamina D supplementation in early childhood may offer protection against the development of type 1 diabetes.
Reviewer’s commentary: a reduction of 29 % in the risk of having type 1 diabetes in persons who had received vitamin D supplements in the first year of life compared with that of those who had not has an important health impact as observed in this systematic review of observational studies (four case control studies and one cohort study) and merits confirmation by means of experimental studies (clinical essays of sufficient quality).
González de Dios J, Perdikidis Olivieri L. Evid Pediatr. 2008;4:50
Authors’s conclusions: Vomiting for weight control may affect regularity of menses in adolescents, especially if their goal is weight loss.
Reviewer’s commentary: This is a cross-sectional study with a high risk of selection bias. In adolescents who consult for menstrual disorders, it may be useful, in selected cases, to investigate, by means of history taking and study of the family environment, the presence of signs and symptoms of a possible eating disorder.
Authors’s conclusions: health advisories and warnings issued by regulatory bodies may have unintended consequences on the provision of care, delivery of health services and clinical outcomes.
Reviewer’s commentary: paediatricians and mental health professionals must do the greatest possible effort to make a correct diagnosis of major depression in children and adolescents. The pharmacological treatment of such disease probably exceeds its possible harm.
Esparza Olcina MJ, Aizpurua Galdeano P. Evid Pediatr. 2008;4:52
Authors’s conclusions: the interventions for prevention, diagnosis, treatment and control of tuberculosis in children are not very effective. This ineffectiveness is higher in the immigrant population.
Reviewer’s commentary: this is a well-designed cross-sectional study, which analyzes the problem in the U.S. There are no studies that evaluate the effectiveness of interventions tested in other countries. Paediatricians must make efforts to diagnose the disease, study the contacts of the index case, establish the treatment and follow the compliance. The creation of state records to monitor disease control must be a priority objective of the health departments of all countries in the world.
Buñuel Álvarez JC, De la Rosa Morales V. Evid Pediatr. 2008;4:53
Authors’s conclusions: The prevalence of urinary tract infection varied with age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of urinary tract infection.
Reviewer’s commentary: Implications for practice: to know the estimation of the risk of urinary tract infection in childhood, according to different variables, may be useful to perform a diagnostic hypothesis and a more appropriate diagnostic and therapeutic management, particularly in primary care. Implications for research: further studies of prevalence, methodologically appropriate, are needed, primarily in older children and primary care patients.
Orejón de Luna G, Ochoa Sangrador C. Evid Pediatr. 2008;4:54
Authors’s conclusions: preventive administration of Lactobacillus GG during pregnancy and early infancy did not decrease the incidence of atopic dermatitis and could increase wheezing.
Reviewer’s commentary: even though first investigations looked promising we cannot generally recommend the use of probiotics in the prevention of AD in risk families with actual information. This study has not been able to detect a protective effect of Lactobacillus GG in the prevention of AD but has some limitations. New, well-designed studies are necessary in order to assess the real efficacy of probiotics and prebiotics in the prevention of children’s atopic disease.
Aizpurua Galdeano P, García Vera C. Evid Pediatr. 2008;4:55
Authors’s conclusions: In children with severe traumatic brain injury, hypothermia therapy started within eight hours after injury and continued for 24 hours does not improve neurological outcome six months later, and also may increase mortality.
Reviewer’s commentary: Traumatic brain injury is a frequent cause of death and brain damage in Childhood. The efficacy of hypothermia for the treatment of hypoxic-ischemic encephalopathy both in adult and neonates, has suggested that it could be useful for traumatic brain injury. This study shows that the early application of this procedure doesn't prevent brain damage and could be harmful. Therefore its use in the paediatric intensive care units is discouraged in these cases.
Modesto i Alapont V, Aparicio Rodrigo M. Evid Pediatr. 2008;4:56
Authors’s conclusions: doctors should require information about sleep problems (SP) during development and must know that not all of them have the same clinical significance.
Reviewer’s commentary: this study is a wake-up call about the consequences in adulthood of sleep disorders of childhood. The children with sleep problems who sleep fewer hours have a higher risk of experiencing development and emotional disorders in adult life. More studies with fewer losses during follow up are needed.
Juanes de Toledo B, Ruiz-Canela Cáceres J. Evid Pediatr. 2008;4:57
Authors’s conclusions: The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight.
Reviewer’s commentary: Accurately estimation of the extreme premature’s outcome is very important in order to make easier some decisions as not beginning or stopping their intensive care. The article analized could help in this issue.
Aparicio Sánchez JL, Puebla Molina SF. Evid Pediatr. 2008;4:58
Authors’s conclusions: daily sleep duration of less than 12 hours in the first two years of life is associated with a higher degree of adiposity and overweight at the age of three.
Reviewer’s commentary: the findings described in the research provide a recommendation easy to implement and of low cost: infants must sleep more than 12 hours to diminish their probability of overweight at the age of 3. Though limitations to its extrapolation exist, related to the characteristics of the population included in the study; the results coincide with reviews conducted later and it is posible that they provide the same results if appliyng the same design of study in other population.
Authors’s conclusions: attenuated influenza vaccine administration in children aged 1.5-18 years with history of intermittent wheezing was not associated with increased risk for acute respiratory illnesses, nor acute asthma exacerbation.
Reviewer’s commentary: intranasal, attenuated vaccines seem to be as efficacious as inactivated influenza vaccine; however, some papers suggest an increased risk for reactive airway disease especially in children younger than 5 years. The study results showed that intranasal, attenuated vaccines were not associated with increased risk for neither acute respiratory illnesses nor asthma exacerbation in children with history of intermittent wheezing. However, higher quality studies are needed before stating recommendations for this vaccine in this group of children.