Authors' conclusions: melatonin demonstrated efficacy (sleep parameters) in school aged children and adolescents with delayed sleep phase disorders: advancing sleep onset time, shortening latencies, and others. An earlier time of administration could increase the effect. The adverse events rates were low (none serious). Results in waking hours (cognition, general health, mood…): few improvements.
Reviewers' commentary: the results evidenced that melatonin did better than placebo. It could be used in selected cases of chronic sleep onset insomnia. Small benefit (doubtful clinical significance) that disappears after short-term treatment periods. Remain unproved: prolonged treatments (safety…); benefits in waking hours; recommendation of an earlier time of administration. Patients with longer times of delay: not specifically investigated.
Evidences coming from few studies of small sample sizes, most of them not from healthy children (high percentages of: ADHD, comorbidities and stimulants drugs).
Barroso Espadero D, Ugarte Libano R. Evid Pediatr. 2012;8:3
Authors' conclusion: in nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction.
Reviewers' commentary: limitations of the evidence of a cohort study to evaluate the effectiveness of an intervention and the fact that current evidence suggests an increased risk of instrumental delivery and caesarean section, further studies are needed to address this question.
Aparicio Sánchez JL, Carvajal Encina F. Evid Pediatr. 2012;8:4
Authors' conclusions: this study evaluates by means of a cohort study design, the impact of breastfeeding in the behaviour of children (evaluated with a validated scale) in the following years. The authors conclude that breastfeeding is associated with a lower incidence of behaviour disorders.
Reviewers' commentary: the results of this study, which evaluates a complex outcome (the possible association and long-term impact of breastfeeding on child behavior), are yet another reason to support initiatives that promote breastfeeding. In addition, breastfeeding has many positive effects on the present and future health of children. The results of this study provide another reason to insist on its promotion.
Perdikidis Olivieri L, Martín Muñoz P. Evid Pediatr. 2012;8:5
Author’s conclusion: therapy with intravenous immune-globulins had no effect on the outcomes of suspected or proven neonatal sepsis in preterm newborns.
Reviewer’s commentary: the results of this trial don’t support the routine administration of immune-globulins to decrease mortality or prevent major disabilities in preterm newborns with suspected or proven neonatal sepsis.
Molina Arias M, Aparicio Sánchez JL. Evid Pediatr. 2012;8:6
Authors' conclusions: this systematic review of observational studies found that the level of chocolate consumption may be associated with a significant reduction in the risk of various cardiometabolic diseases.
Reviewers' commentary: in children and adults, chocolate consumptionis usually made in combination withcarbohydrates andfatsof high energy content. This couldparadoxically increase the risk of obesity, metabolic syndrome and CVD,results that arepreciselythose who health professionals wish toavoid.Iffuture clinical trialsconducted bothin childrenand adults,confirm these beneficial results, chocolate shouldbe administeredin "low calorie forms", and not combinedwith fat orcarbohydrates. In the meantime, chocolate consumption should not be activelyrecommendedin itscurrentcommercialhypercaloric forms.
Buñuel Álvarez JC, Lojo Pons P. Evid Pediatr. 2012;8:7
Authors’ conclusions: supplementation of vitamin A is associated with a significant reduction in morbidity and vision problems in children under five years of age. These supplements should be administered to all children at risk of deficiency (particularly in countries with low income).
Reviewers’ commentary: in children aged six months to five years supplementation with vitamin A is effective in reducing mortality in countries with deficits of this vitamin. Vitamin A can be considered as a supplement with low cost and low side effects, with benefits exceeding potential risks. It remains to establish the dose and frequency of administration, an issue that has to be the subject of future studies designed for this purpose.
Guarch Ibáñez B, Llerena Santa Cruz E, Buñuel Álvarez JC. Evid Pediatr. 2012;8:8
Authors’ conclusion: on the basis of the current evidence, it is recommended that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Further research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the emergency department.
Reviewers’ commentary: it would be useful in clinical practice to find out an instrument used as a “quick screen” to detect alcohol and cannabis misuse in emergency departments.In additionit it should be validated in the population to be applied and it should detect other high risk consumptions.
González Rodríguez MP, Velarde Mayol C. Evid Pediatr. 2012;8:9
Authors’ conclusion: to vaccinate children up to 24 months of life, previously immunized with 7-valent pneumococcal conjugate vaccine, in a catch-up programme, with a catch-up 13-valent vaccine is justified from an economic point of view. The average cost per event avoided is 1674 Euros vaccinating children up to 24 months, and increases to 2522 Euros by vaccinating up to 60 months of age. The cost per year of life saved for different vaccination strategies is always acceptable (from 12,250 Euros to 22,093 Euros).
Reviewers’ commentary: if the cost-effectiveness estimates were similar in our sanitary system, a catch-up campaign with a 13-valent vaccine would be an intervention to consider, although, given its high price, in competition with others of similar cost-utility. However, it is needed to know the impact of changes in some assumptions of effectiveness, of which there is no direct evidence, which could have biased the cost-utility estimates.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2012;8:10
Authors' conclusion: Children receiving acyclovir therapy had a higher mean Bayley mental-development scores at 12 months, and less cutaneous recurrences than did infants on placebo.
Reviewers' commentary: Even though the present randomised trial demonstrates some benefit in neurodevelopmental outcomes in children who had neonatal herpes and received oral suppression therapy with acyclovir, this benefit is marginal, the study presents high possibility of attrition bias, and is underpowered for important outcomes; hence we can only recommend this therapy with caution until more evidence is available.
Cuello García CA, Pérez Gaxiola G. Evid Pediatr. 2012;8:11
Authors' conclusions: among infants born at 23 to 25 weeks´ gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.
Reviewers' commentary: lacking evidence from difficult to perform controlled benefit-risk-cost trials, current data could allow the use of a single course of therapy with antenatal corticosteroid for mothers of premature infants at 23 to 25 weeks’ gestation. This decision should take into consideration the availability of the rest of treatments who are needed by these infants around the limits of viability, as well as the ethical issues prevailing in clinical practice.
González de Dios J, Molina Arias M. Evid Pediatr. 2012;8:12
Authors’ conclusions: parents prefer (more frequently than professionals) a more aggressive treatment when their children’s illness cannot be cured, being hope and quality of life the main factors for their decision.
Reviewers' commentary: end-of-life care for children with cancer should take into consideration not only scientific criteria but also ethics and moral, with special care to the preferences of the parents and child when he or she can decide. Even though this study has the methodological problems inherent to surveys’ studies, this paper has great interest because it focuses on understanding the motivations of the family and may help in parents-professional communication.
Aizpurua Galdeano P, Esparza Olcina MJ. Evid Pediatr. 2012;8:13
Authors' conclusions: ivacaftor administration was associated with a significant and sustained improvement in lung function between the second and the 48 week of follow up in patients with cystic fibrosis (G551D mutation). A decrease in pulmonary exacerbations was also found, as well as improvement in patient-perceived symptoms and weight gain in patients who received ivacaftor.
Reviewers' commentary: the results of this study are encouraging but they should be confirmed by others that solved its methodological limitations (lack of randomisation sequence concealment and doubts about the proper masking). Variables such as safety or prolonged beneficial effects of ivacaftor beyond the week 48 should be assessed in well designed studies with larger sample sizes. It would be recommendable to use the pulmonary events rate or the number of hospital admissions as first outcomes.
Authors' conclusion: conducting a screening of sleep problems in school children is feasible and, followed by a brief behavioral intervention, appears to show significant benefits by improving sleep habits and psychosocial function at the beginning of schooling.
Reviewers' commentary: the results of this study do not recommend, for now, do& general screening programs to detect sleep problems because of uncertainty about the potential effectiveness of the behavioral intervention due to small sample size.
Authors' conclusions: this study does not support the recommendation for delayed introduction of allergenic foods after the age of 6 months for the prevention of eczema and wheezing
Reviewers' commentary: according to the results of this study the introduction of potentially allergenic food between the age of four to six months does not imply increased risk of atopic disease, including atopic dermatitis, eczema and wheezing.
Cuestas Montañés EJ, Ortega Páez E. Evid Pediatr. 2012;8:16
Authors' conclusions: the standard two-dose primary series in the first year of life with pneumococcal conjugate vaccine provides good protection in most children, except for serotypes 6B and 23F, in which protection could be reduced.
Reviewers' commentary: the use of two doses of pneumococcal conjugate vaccine produces similar levels of protection to the use of three doses with reduced costs. There should be an assessment of the impact of this practice in a national setting depending on the profile of serotypes involved, and the clinical efficacy should be monitored.
Fernández Rodríguez MM, Orejón de Luna G. Evid Pediatr. 2012;8:17
Authors' conclusions: there is little evidence for or against the use of the ibuprofen and paracetamol combination, compared to the isolated use of one of them to relieve fever and the discomfort associated with it. In this context, it is prudent not to recommend the use of the combination therapy with both drugs to treat this clinical sign and use, if necessary, only one of them.
Reviewers' commentary: the results of this systematic review, recommend us to avoid prescribing the combined use of antipyretics as there is no evidence of effectiveness or safety data supporting its use. In addition, the role of antipyretics is to treat a symptom which by itself causes no harm, and it is an ally to control the infection. In this context, when treatment is really necessary, it is now advisable to treat fever with a single drug.
Llerena Santa Cruz E, Guarch Ibáñez B, Buñuel Álvarez JC. Evid Pediatr. 2012;8:18
Authors' conclusions: this study provides evidence that adolescents in the UK and elsewhere who are exposed to smoking depictions in films are more likely to initiate smoking. Given the association between smoking and poor health outcomes, these data justify a review of film ratings.
Reviewers' commentary: there seems to be an association between smoking depictions in films and smoking behaviour in adolescents everywhere. Reviewing the film rating in order to avoid the exposure of vulnerable population to these depictions could be a reasonable recommendation.