Authors’ conclusions: Lactobacillus reuteri (L. reuteri), compared to simethicone or placebo, seems effective in reducing the hours of crying in children with infantile colic (IC).
Reviewers’ commentary: methodological limitations of the reviewed studies do not allow currently a strong recommendation on giving preparations of L. reuteri as a treatment for IC. It is recommended to provide information to parents on the IC in order to reassure them about their evolution. Appropriate advice provided by a health professional is effective in reducing infant clinical symptoms.
Buñuel Álvarez JC, Guarch Ibáñez B, Llerena Santa Cruz E. Evid Pediatr. 2011;7:3
Authors' conclusions: HPV vaccination programs provide substantial potential public health and economic benefits. Including boys and men 9-26 years of age would further reduce HPV-related morbidity and mortality and improve population's quality of life.
Reviewers' conclusions: these results do not appear to be consistent enough to broad the current HPV-vaccination recommendations to include men and boys. Although the inclusion of males would provide some benefits, these benefits could be obtained in greater amount and at lower economic cost by improving health care education and broadening the current vaccination coverture among girls and women.
Molina Arias M, González de Dios J. Evid Pediatr. 2011;7:4
Authors' conclusions: antiemetic medication and especially antagonists of 5-HT3 receptors are useful in preventing and treating nausea and vomiting associated with oncologic treatments. There is a lack of studies on the effect of treatment on anticipatory vomiting and nausea, but it is probable that they are not effective. Children with cancer and their families identify secondary effects caused by cancer treatment as the most disagreeable aspect of it.
Reviewers' commentary: this is a well designed and developed study that meets adequately the criteria for a systematic review. It reviews the studies on impact of vomiting and nausea in children with cancer, and the secondary effects of antiemetic medication (which are frequent and significant) and exposes the need for future research, especially on the impact on quality of life of these children.
Perdikidis Olivieri L, Bonillo Perales A. Evid Pediatr. 2011;7:5
Authors' conclusions: respiratory syncitial virus (RSV) is the most common cause of childhood Acute Lower Respiratory Infections (ALRI) and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b.
Reviewers' commentary: despite an uncertainty level in estimates we can´t deny the impact of RSV infections on hospitalizations and mortality in children. National or regional reliable data of incidence and mortality are required awaiting a safe and effective vaccine against RSV.
Chalco Orrego JP, Bernaola Aponte G. Evid Pediatr. 2011;7:6
Authors' conclusions: secondhand smoke may be associated with invasive meningococcal disease, although that should be confirmed by high quality studies. The possible risk detected and the increasing secondhand smoking in developing countries, where invasive disease is more frequent, make it necessary to favor interventions for reducing children exposure to tobacco.
Reviewers' commentary: passive smoking showed a significant association with meningococcal invasive disease and with the meningococcus and pneumococcus carrier state. However, it is not clear that this association is causal and it may reflect the effect of other environmental factors associated with lower socioeconomic status. Prospective studies are required with an appropriate adjustment for other risk factors to confirm this association.
Ochoa Sangrador C, Aparicio Rodrigo M. Evid Pediatr. 2011;7:7
Authors’ conclusions: participation of children in large-group child-care centres before two and a half years of age, although associated with increased infections at that time, seems to protect against infections during the elementary school years.
Reviewers’ commentary: with the methodological limitations of this study, we cannot conclude that the participation in large-group child-care centres before two and a half years protect against infections during the elementary school. Further studies should be designed with the frequency of infections, their severity and the influence in the child and family life. They should also take into account the economic costs.
Authors' conclusions: in developed countries, administration of zinc sulfate in children with acute gastroenteritis does not reduce duration of illness.
Reviewers' commentary: with the data currently available, in developed countries with low risk of malnutrition the prescription of zinc supplements for treatment of acute diarrhea in children is not indicated. However, we only have this clinical trial. It would be pertinent to conduct studies placed in primary care to examine whether zinc supplementation can decrease the percentage of admissions and consultations in hospital emergency departments. At the hospital level, future studies should aim to determine whether supplementation with zinc has any effect on length of hospital stay.
Authors' conclusions: the systematic use of alcohol-based sanitizers during the epidemic season could significantly reduce the incidence of gastroenteritis in primary school children.
Reviewers' commentary: although the use of antiseptic solutions in schools seems to be beneficial, this study does not offer estimations of their effect with respect to the use of a conventional hand washing protocol. Valid estimates of its effectiveness, its cost and its feasibility in the short and long term are necessary, before recommending its implementation in schools.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2011;7:10
Authors' conclusions: in countries where intravenous rehydration is often used, emergency department administration of oral ondansetron to children with dehydration and vomiting secondary to gastroenteritis results in significant monetary savings compared to non-ondansetron policy.
Reviewers' commentary: according to this well conducted economic analysis, ondansetron administration in the emergency department to children with vomiting and mild-moderate dehydration secondary to gastroenteritis, produces important savings, much higher in the United Statesthan in Canada, there remain some doubts about the drug’s effectivity because the data used in this study are based in a meta-analysis with important methodological limitations.
Esparza Olcina MJ, Perdikidis Olivieri L. Evid Pediatr. 2011;7:11
Authors’ conclusions: vaccination with PCV13 is likely to be a cost-effective or cost-saving health-care intervention under all scenarios examined, even as a serotype catch-up program.
Reviewers’ commentary: this study forecasts that vaccination with PCV13 would be currently cost-effective and cost-saving in USA. With similar background, PCV7 decreased its cost-effectiveness because of increases of disease caused by non-vaccine serotypes. Further studies with real data after the implementation of vaccination with PCV13 are needed, not only in USA but also in other countries with different epidemiological situations and vaccination programs.
Aizpurua Galdeano P, García Vera C. Evid Pediatr. 2011;7:12
Authors’ conclusions: the routine use of ultrasound for the calculation of gestational age during the second trimester increases the risk of perinatal pathology among girls classified as postterm.
Reviewers’ commentary: the results of the study recommended using the date of the final menstruation to improve the prediction of gestational age, advancing the time of ultrasound. It would be desirable to conduct studies that clearly establish the existence of significant differences in biparietal diameters of both sexes in each gestational age and, where appropriate, develop and use tables for prediction of gestational age differentiating by gender.
de Lucas García N, Ortega Páez E. Evid Pediatr. 2011;7:13
Author´s conclusion: a limited number of serotypes cause most of invasive pneumococcal disease (IPD) worldwide. The serotypes included in existing PCV formulations account for 49%-88% of deaths in Africa and Asia, where the morbimortality is the highest, but few children have access to these vaccines.
Reviewer´s commentary: although the study has some limitations, it looks like there is not great variability worldwide between serotypes causing IPD mortality and most of them are included in the coverage of the new 10- and 13-valent vaccines. More analysis are needed on the potential benefit of implementing universal vaccination in the most affected countries by this disease.
Gimeno Díaz de Atauri Á, Rivas Juesas C. Evid Pediatr. 2011;7:14
Authors' conclusions: emergency and elective cesarean delivery are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery.
Reviewers' commentary: we can say that there is sufficient evidence showing the negative effect of cesarean section on breastfeeding. Both pediatricians and neonatologists should discuss firmly with obstetricians the correct indications for cesarean section.
Authors’ conclusions: otoscopic findings are critical to accurate acute otitis media (AOM) diagnosis. AOM microbiology has changed with the use of heptavalent pneumococcal conjugate vaccine. Antibiotics are modestly more effective than no treatment but cause adverse effects in 4% to 10% of children. Most antibiotics have comparable clinical success.
Reviewers’ commentary: AOM is a common cause of consultation and diagnostic uncertainty. Until recently, the prescription of antibiotics was the norm. The possible changes in epidemiology after vaccination against pneumococcus are unknown. The recommendation on whether to begin treatment or not, which antibiotic use and the duration of treatment may change with these findings.
Authors’ conclusions: unnecessary use of medication is very common among hospital pediatricians in the treatment of acute bronchiolitis, and this seems related to the perception by the pediatrician of the child’s severity, and the associated feeling of "having to do something" because of parental pressure or legal protection.
Reviewers’ commentary: to reduce unwarranted variability in the managementof acute bronchiolitis and excessive use of ineffective drugs, it’snecessary to ensure that recommendations from evidence-based clinical practice guidelines based are applied. It’s necessary that guidelines are not perceived by theprofessional as an imposition by health institutions, but as a tool that improves the care of patients with acute bronchiolitis.
Authors' conclusion: validation of this two clinical decision rules shows that both reach 100% sensitivity, although the Bacterial Meningitis Score has better specificity.
Reviewers' commentary: despite the high sensitivity reported in both clinical decision rules, this retrospective validation study should not be considered enough evidence to begin implementing any of the rules in every health system and clinical scenarios. It is likely that future validation studies will provide the evidence and narrow confidence intervals for its universal application. Meanwhile, we suggest an individual approach and implementation of the rules in patients with the suspicion of bacterial meningitis.
Pérez Gaxiola G, Cuello García CA. Evid Pediatr. 2011;7:18
Authors’ conclusions: oseltamivir-zanamivir combination for seasonal influenza A mainly type H3N2 virus infection has lower efficiency than oseltamivir monotherapy, and no better than zanamivir monotherapy. Thus oseltamivir monotherapy should be the recommended for this type influenza disease.
Reviewers’ commentary: combination therapy with oseltamivir and zanamivir is not an option for the treatment of influenza in adults with no known role in the prevention of resistance.
Aparicio Rodrigo M, Juanes de Toledo B. Evid Pediatr. 2011;7:19