Authors’ conclusion: ultrasound strategies aimed at the diagnosis of the developmental dysplasia of the hip, have not demonstrated to improve the results, including late diagnosis of developmental dysplasia of the hip and surgery. However, the included studies are substantially underpowered to detect significant differences in these uncommon events.
Reviewers’ commentary: due to the low incidence of developmental dysplasia of the hip and its consequences (surgery, avascular necrosis of the femoral head, osteoarthritis...), currently there are no studies with sufficient sample size and methodological quality to answer the question. Recent studies, of low methodological quality, report benefit of universal screening to reduce the need for surgery, but do not rule out the possibility that this intervention will increase the need for treatments that in many cases are unnecessary (mild dysplasia resolves spontaneously between 6 weeks and 6 months in >90% of untreated hips) and are not without complications.
Flores Antón B, Ortega Páez E. Evid Pediatr. 2012;8:52
Authors’s conclusions: procalcitonin is an important serological marker of serious bacterial infections in infants aged 2 to 60 days. The predictive value of procalcitonin in combination with pyuria count may be clinically useful.
Reviewer’s commentary: procalcitonin improves the predictive capability of bacterial infection comparing with other clinical and laboratory parameters, although it is unclear the utility of its incorporation into clinical practice. It is necessary to evaluate its impact in clinically relevant outcomes.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2012;8:53
Authors’ conclusions: inhaled carbon dioxide (CO2) can not be considered as an alternative to oral theophylline for the treatment of apnea of prematurity.
Reviewers’ commentary: the decline intotal time of apnea was significantly higher in preterm infants treated with theophylline. The CO2 is not a therapeutic alternative to theophylline for the treatment of apnea of prematurity, so it should not be used.
Author's conclusions: addition of prednisolone to the standard treatment of immunoglobulin and aspirin improves coronary artery outcomes in patients with severe Kawasaki disease in Japan.
Reviewers' conclusiones: findings from this trial show that early use of prednisolone and its maintenance in patients with severe Kawasaki disease might effectively control inflammation and vasculitis before failure of standard treatment occurs.
Molina Arias M, González de Dios J. Evid Pediatr. 2012;8:55
Authors' conclusion: boys with a relative minor age were 30% more likely to receive a diagnosis of ADHD and 41% more likely to be given a prescription for a medication to treat it. In girls, the numbers were 70% and 77% respectively.
Reviewers' commentary: health care professionals, teachers and parents need to be aware of the effect of the relative age in school children diagnosed or suspected of having ADHD.
Cuello García CA, Pérez Gaxiola G. Evid Pediatr. 2012;8:56
Authors’ conclusions: a body mass index (BMI) above the 85th percentile (P 85) during the first four years of life were not associated with an increased risk of asthma if the BMI was normal at age 7. A BMI ≥ P 85 at 7 years was associated with an increased risk of asthma and allergen sensitization.
Reviewers’ commentary: the results of this study and others recommend interventions on overweight-obesity in early ages of life to reduce the risk of developing asthma. This action should be undertaken at a low cost in primary care.
Domenech Zarketa D, Castan Campanera A, Lojo Pons P. Evid Pediatr. 2012;8:57
Authors’ conclusions: among infants and children younger than 6 years with cystic fibrosis, the use of inhaled hypertonic saline compared with isotonic saline did not reduce the rate of pulmonary exacerbations over the course of 48 weeks of treatment.
Reviewers’ comment: regarding the results of this study, that shows no efficacy of inhaled hypertonic saline in the reduction of exacerbations amongst children younger than 6 years with cystic fibrosis, this therapy shouldn’t be used in these patients. More studies are necessary to assess the effect over other outcomes or disease progression.
Gimeno Díaz de Atauri Á, Rivas Juesas C. Evid Pediatr. 2012;8:59
Authors’ conclusions: being bullied increases self harm risk in early adolescence. The programmes to prevent self harm risk in adolescents should focus on high risk children to teach them how to handle stress properly.
Reviewers’ commentary: well conducted cohort study that shows how being bullied is an independent risk factor for self harming in early adolescence. The highest risk among bullied children is that of children also abused by an adult, children with psychotic or depressive symptoms and those having suffered a suicide in the family.
Esparza Olcina MJ, Aizpurua Galdeano P. Evid Pediatr. 2012;8:60
Author's conclusions: Insertion of tympanostomy tubes alone (adenoidectomy with or without tympanostomy) was effective in preventing recurrent AOM in children younger than 2 years.
Reviewers' commentary: Although surgery prevents episodes of AOM, it is necessary to be selective in its indication and to evaluate the risks and benefits. Further studies should focus on the long term outcomes of surgery.
Fernández Rodríguez MM, Orejón de Luna G. Evid Pediatr. 2012;8:61
Authors' conclusion: the findings of this study suggest a positive association between Helicobacter pylori infection (HP) and colorectal polyps in children, indicating that HP infection is a risk factor for the development of polyps.
Reviewers' commentary: with the methodological limitations of this study, it cannot be assured that HP infection is a risk factor for colorectal polyps in children. Studies with more powerful methodology to try to answer this question are needed.
Cuestas Montañés EJ, Ortega Páez E. Evid Pediatr. 2012;8:62
Authors´ conclusions: both strategies, inmunoreactive trypsinogen and pancreatitis-asociated protein or inmunoreactive trypsinogen and DNA mutation detection with sequencing if necessary, perform well as cystic fibrosis screening. The first one has more false positive results; the second needs DNA technology.The combination of both strategies could be the best option to reduce false positive results. Taking in account these aspects, local authorities must decide the best strategy.
Reviewers´ commentary: this study shows no extra benefits for inmunoreactive trypsinogen and pancreatitis-asociated protein, when compared to habitual screening strategies. Inmunoreactive trypsinogen and DNA mutation detection with sequencing if necessary, would allow to diminish the number of false positives but it would detect a greater number of carriers. The combination of both detects less number of carriers and equivocal diagnosis than the previous one. There is no data about economical cost. These two last tests would be two valid options to consider in screening programs of cystic fibrosis.
Aparicio Rodrigo M, Juanes de Toledo B. Evid Pediatr. 2012;8:63