Authors' conclusions: vitamin D hypovitaminosis is common in children with recurrent acute otitis media and is associated with an increase in its incidence when serum 25(OH)D levels are <30 ng/ml. The administration of vitamin D in a dosage of 1000 IU/d restores serum values in most cases and is associated with a significant reduction in the risk of uncomplicated otitis.
Reviewers' commentary: supplementation with vitamin D could reduce the recurrence of otitis. It would be desirable to have more studies that verify these results. If we consider that the evaluated intervention aims to correct deficient levels of vitamin D, it seems justified to check vitamin D levels in patients with recurrent otitis and to supplement those showing low levels.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2014;10:22
Authors’ conclusions: according to this study, Shock Index (SI) is a clinically relevant and easy to calculate predictor of mortality in children with septic shock.
Reviewers’ commentary: no conclusion can be drawn about the clinical usefulness of the SI with the analysis performed in this study. Other indexes have shown much better accuracy in predicting progression to death with a Bayes’ Theorem based analysis.
Ruiz-Canela Cáceres J, Modesto i Alapont V. Evid Pediatr. 2014;10:23
Authors' conclusions: lactose-free diet in children less than five-year-old with acute gastroenteritis, that are not being predominantly breastfed, may reduce the duration of diarrhea and the incidence of therapeutic failure. Reducing the intake of lactose may be beneficial but still further trials are needed, especially in low-income countries where mortality for diarrhea is higher.
Reviewers' commentary: although exclusion or reduction of lactose intake in infants with acute diarrhea may reduce its duration and treatment failure, due to the poor clinical impact of these results and the low level of evidence of the trials it seems advisable to maintain the current recommendation of not to restrict lactose consumption systematically in infants with acute gastroenteritis.
Molina Arias M, Ortega Páez E. Evid Pediatr. 2014;10:24
Authors’ conclusions: this combination of probiotics significantly reduced NEC of Bell stage ≥2 in very preterm infants, but not late-onset sepsis or mortality.
Reviewers’ commentary: this clinical trial did not confirmed that probiotics reduce late sepsis in very preterm infants, but we can say that probiotics do not increase the incidence of sepsis. So, this study supports that probiotic supplementation of enteral feeding in very preterm infants presents a favorable balance of benefits (less severe necrotizing enterocolitis and/or mortality), risks (safe even for the potential risk of infection) and costs.
González de Dios J, González Muñoz M. Evid Pediatr. 2014;10:25
Authors' conclusions: oral risedronate increases the bone mineral density and reduces the risk of fractures in children with osteogenesis imperfecta, with good tolerance.
Reviewers' conclusions: oral risedronate could reduce the number of non-vertebral fractures in mild osteogenesis imperfecta, without the high impact in the quality of life and costs of the intravenous treatment. Long term studies are necessary to evaluate the efficacy and safety.
Authors’ conclusions: packed red cells transfusion in very low birth-weight newborns is an independent risk factor for necrotizing enterocolitis.
Reviewers’ commentary: this study joins the current literature warning about a link between red cell transfusion and necrotizing enterocolitis. In spite of its design, a case-control study, results are similar to previous studies with larger samples, increasing the likelihood of this connection. Neither this study nor previous ones clarify whether there is a causal relation between both events or if it is just a manifestation of other factors causing enterocolitis.
Carvajal Encina F, Ibáñez Pradas V. Evid Pediatr. 2014;10:27
Authors' conclusions: the durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.
Reviewers’ commentary: for the moment we suggest continuing to use the criteria for duration of symptoms according to current guidance, patient's clinical characteristics and expertise of the attending physician.
Cuestas Montañés EJ, Suwezda A. Evid Pediatr. 2014;10:28
Authors' conclusions: Lactobacillus reuteri DSM 17938 did not benefit a community sample of breastfed infants and formula fed infants with colic. These findings differ from previous smaller trials of selected populations and do not support a general recommendation for the use of probiotics to treat colic in infants.
Reviewers' commentary: the results of this study question the efficacy of Lactobacillus reuteri in the treatment of infants with colic. For now and until more conclusive data, it seems reasonable not to include probiotics in our recommendations for the management of infantile colic.
Aparicio Rodrigo M, González de Dios J. Evid Pediatr. 2014;10:29
Authors’ conclusions: among children with perinatal hypoxic-ischemic encephalopathy enrolled, 10 min Apgar scores were significantly associated with school-age outcomes. A fifth of all infants with a 10 min Apgar score of 0 survived without disability to school age, suggesting the need for caution in limiting resuscitation to a specified duration.
Reviewers’ commentary: classical guidelines recommended 10 minutes as the time to stop resuscitation if heartbeat was not achieved. Based on this study (and others), the International Liaison Committee on Resuscitation and Neonatal Resuscitation currently states that the decision of the time to stop resuscitation may be influenced by the etiology of asphyxia, gestational age, start-up time of resuscitative measures, the current role of therapeutic hypothermia and the opinion of parents.
González de Dios J, Balaguer Santamaría A. Evid Pediatr. 2014;10:30
Authors' conclusions: severe varicella infections decreased since routine varicella vaccination in Spain (2006). This decrease was significantly higher in regions including the vaccine at 15–18 months of age compared with those vaccinating only susceptible adolescents. The hospitalization rate related to herpes zoster slightly increased (mainly in the >84 age group). No significant differences in herpes zoster hospitalization rates were found regarding the differences in varicella vaccination strategies among regions.
Reviewers' commentary: the incidence of severe varicella is reduced with varicella vaccination of susceptible adolescents. This benefit doubles vaccinating children at 15-18 months of age. The incidence of severe zoster is steadily growing, especially in the elderly. Although there is no evidence of a causal link with the vaccine, this issue is essential to establish the varicella vaccination social cost-effectiveness.
Gimeno Díaz de Atauri Á, Modesto i Alapont V. Evid Pediatr. 2014;10:31
Authors' conclusions: live attenuated influenza vaccine (LAIV) in children under two years is more effective than placebo and as effective as inactivated influenza vaccine. The safety profile of LAIV is reasonable although evidence is scarce. LAIV may be considered as an option in this age group.
Reviewers' commentary: according to the available evidence, live attenuated virus influenza vaccines could be an alternative to inactivated vaccines, as they are at least as effective as these. Doubts about the safety of these vaccines (risk of episodes of wheezing), have limited the making of clinical trials, so that the available information is scarce, but not more scarce than that available about inactivated vaccines.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2014;10:32