Authors’ conclusions: screening by clinical examination and pulse oximetry (SpO2) fulfills conditions for validity and feasibility to be established as a routine in a developing country like China.
Reviewers’ commentary: supplementing the screening of major and critical congenital heart defects with SpO2, before hospital discharge of newborns, is a feasible technique in developing countries, pending on a comprehensive economic evaluation. Benefits may be important for individuals only if this measure is inserted into a system of care and treatment very expensive and not always accessible in these countries.
de Lucas García N, Balaguer Santamaría A. Evid Pediatr. 2015;11:3
Authors’ conclusions: smoke-free legislation is associated with substantial reductions in preterm births, very small for gestational age newborns and with hospital attendance for asthma.
Reviewers’ commentary: this systematic review and meta-analysis shows benefit of smoke-free legislations on hospital attended child asthma and on very small for gestational age newborns. It also reduces the number of preterm births, although the effect size is smaller and there are some methodological limitations in the studies approaching this result.
de Lucas García N, Esparza Olcina MJ. Evid Pediatr. 2015;11:4
Authors´ conclusions: systematic review shows that many cases of tuberculosis and multidrug-resistant tuberculosis are not detected properly in children. The estimates could be much closer to reality if the epidemiological data would be more accurate and better availability of new diagnostic procedures.
Reviewers´ commentary: this systematic review on the incidence of multidrug-resistant tuberculosis in children reveals that this would be the case for a 3% of the newly diagnosed tuberculosis in children, although there is still a need for better epidemiological data and more accurate diagnostic tools worldwide.
García Vera C, Ruiz-Canela Cáceres J. Evid Pediatr. 2015;11:5
Authors' conclusion: treatment of young infants with macrolides is strongly associated with infantile hypertrophic pyloric stenosis and should therefore only be administered if potential treatment benefits outweigh the risk. Maternal use of macrolides during the first two weeks after birth was also associated with an increased risk of hypertrophic pyloric stenosis.
Reviewers' commentary: macrolides in newborn during the first two weeks after birth, is strogly associated with hypertrophic pyloric stenosis. Their use in mother on late pregnancy and during these first two weeks, also increases that risk, without clarifying the role of breastfeeding in the process.
Juanes de Toledo B, Cuestas Montañés EJ. Evid Pediatr. 2015;11:7
Authors' conclusions: gross motor (GM) impairment was found in children exposed prenatally to alcohol (i.e. balance, coordination and ball skills). Evaluation of GM proficiency should be part of standardized management of fetal alcoholic spectrum disorders.
Reviewers' commentary: although this study has methodological limitations, it shows an association between fetal alcohol spectrum disorders and gross motor deficits. These results justify the evaluation of gross motor proficiency in this group of patients.
Authors´ conclusions: the addition of a trivalent vaccine against group B streptococcus in pregnant women to the current gestational screening programs and intrapartum antibiotics could reduce the burden of disease with cost-effectiveness similar to other vaccines, which have been recently approved in the United States of America.
Reviewers´ commentary: the theoretical cost-effectiveness of a trivalent vaccine against group B streptococcus in pregnant women for the United States of Americais high ($ 91,321 per quality-adjusted life-year gained). However, any decision on the introduction of the vaccine should be subject to verification of their efficacy and safety in clinical trials. The frequency of the disease and the profile of related serotypes in our environment should be also evaluated, because, if there are differences, it would affect the estimates of cost-effectiveness.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2015;11:9
Author’s conclusions: practitioners can be reassured that it is normal for 20 to 30% of predominantly breastfed newborns to be jaundiced at age 3 to 4 weeks and for 30 to 40% of these infants to have bilirubin levels ≥ 5 mg/dl. The jaundice zone score does not provide an accurate assessment of the bilirubin level, but a score of zero (complete absence of jaundice) suggests that the level is unlikely to be > 12.9 mg/dl, whereas a score of ≥4 usually predicts a level of ≥10 mg/dl.
Reviewers’ commentary: this study reafirms that pediatricians should be aware that between 20 and 30% of normal white newborns present prolonged jaundice, especially breastfed infants. The score of Kramer, according to the study, is not predictive to establish levels of risk for encephalopathy. Close clinical control and TCB levels will be required to treat these patients appropriately.
Orejón de Luna G, Cuestas Montañés EJ. Evid Pediatr. 2015;11:11
Authors´ conclusions: the predictive model developed can identify with little error infants with fever without source and altered urinalysis with low risk of invasive bacterial infection. Outpatient treatment might be appropriate for one in four children diagnosed, with a significant improvement in resource utilization.
Reviewers´ commentary: we can assume that the risk of invasive bacterial infection is very low in children who meet the criteria of this predictive model. In our environment the hospitalization of infants under three months with urinary tract infection is recommended, because at this age there is an increased risk of invasive bacterial infection. To change this recommendation the benefits of this predictive model should be tested in an external validation sample, and also should be tested the safety of its implementation.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2015;11:12
Authors’ conclusions: children with abnormal ultrasonographic results or a combination of high fever and an organism other than E. coli have a higher risk for the development of renal scarring after a first urinary tract infection.
Reviewers’ commentary: with the survey data only three clinical variables are a reasonable screening procedure for renal scarring: ultrasound, presence of fever> 39° and a different seed to E. coli in the culture properly obtained. Although due to the limitations of the study it should be tested in a prospective design. Systematic VCUG, according to this study and the recommendations of the GPC should only be performed on a small subset of patients, when indicated.
Pérez-Moneo Agapito B, Ruiz-Canela Cáceres J. Evid Pediatr. 2015;11:13
Authors' conclusions:maternal prenatal use of vitamins and folic acid reduces the risk of both acute lymphoblastic and acute myeloid leukemia in children. This association varies by parental education, a surrogate for lifestyle and sociodemographic characteristics.
Reviewers' commentary: data heterogeneity and potential bias compromise the internal validity of the study. This and the limitations of its observational design make it advisable further studies with highest level of evidence in order to systematically recommend folic acid and vitamins supplementation to all women of childbearing age one year before and during pregnancy.
Ortega Páez E, Molina Arias M. Evid Pediatr. 2015;11:14