Authors' conclusion: the clinical decision rule identified 90% of fractures and would reduce the number of imaging studies by 60%.
Reviewers' commentary: this simple clinical decision rule, which includes two easy to identify factors in children with mild head trauma, could reduce imaging studies, but its clinical impact should be first researched.
Authors' conclusions: the technique of fetal DNA for prenatal screening for trisomy 21 has a higher sensitivity, a smaller proportion of false positive and positive predictive value greater than the standard screening.
Reviewers' commentary: cell-free DNA test improves the non-invasive diagnosis of Down syndrome and, to a lesser extent of trisomies 13 and 18, although amniocentesis is still recommended to confirm a positive result. Doubts about the cost-effectiveness of the test in the low-risk obstetric population limit its use in the general population.
Aizpurua Galdeano P, Orejón de Luna G. Evid Pediatr. 2015;11:57
Authors’ conclusions: low Apgar scores at 5 minutes were most strongly associated with death during the first year of life (especially during the neonatal period), so this index is still useful today.
Reviewers' commentary: a low Apgar score at 5 minutes is still a factor of poor prognosis associated to an increase in early neonatal and, to a lesser extent, to late neonatal and infant mortality. While a relationship with specific causes of death was detected, this result is affected by some limitations of the study.
Fernández Rodríguez M, Modesto i Alapont V. Evid Pediatr. 2015;11:58
Authors’ conclusions: reductions in government health care spending are associated with significant increases in child mortality, with the largest increases occurring in low-income countries.
Reviewers’ commentary: reduction in health care spending is associated with increases in mortality in four child mortality measures and remains after controlling for economic, infrastructure, infectious disease, out-of-pocket expenditure and private health spending indicators.The reason this happens is not explained though the association is very robust. Countries must stablish ways to protect childhood.
Authors´ conclusions: the findings of lung ultrasound show good correlation with clinical assessment of children admitted with bronchiolitis and allow the identification of those who need supplemental oxygen with high specificity.
Reviewers´ commentary: in children hospitalized for bronchiolitis performing chest ultrasound may be useful to establish, together with the clinical findings, the severity of the disease and to evaluate serially its evolution over time, a feature in which ultrasound exceeds radiography.
Buñuel Álvarez JC, Llerena Santa Cruz E. Evid Pediatr. 2015;11:61
Authors' conclusions: promoting breast feeding for 6 months or more may help lower childhood leukemia incidence, in addition to its other health benefits for the children and mothers.
Reviewers' commentary: the available evidence at this time supports a probable protective effect of breastfeeding against leukemia on children. The health authorities and health professionals should take into account these results and take more effective measures to promote breastfeeding.
Díaz Cirujano AI, Aparicio Rodrigo M. Evid Pediatr. 2015;11:62
Authors' conclusions: therapeutic hypothermia in comatose children who survived an out-of-hospital cardiac arrest – compared with normothermia – didn´t confer a significant benefit in terms of survival with good neurological outcome at 12 months.
Reviewers' commentary:there were no statistic differences between therapeutic hypothermia or normothermia in any outcome, but it's clinically relevant that 1 of 13 patients in the hypothermia group has a positive outcome, without any of the adverse effects seen in the other 12. There are issues for future research, as if active control of fever could be the principal protector factor, or if hypothermia should be administered in some other way (with cool caps as in newborns, for example).
Authors' conclusions: all extremely low birth weight infants in the neonatal intensive care units have an increased incidence of sepsis evaluations and of increased respiratory support and intubation after routine immunization. These findings don't suggest that physicians should not use vaccines in extremely low birth weight infants.
Reviewers' commentary: vaccination of extremely low birth weight infants in the neonatal intensive care units can increase studies to rule out sepsis, with no real increase in this disease, respiratory support and intubation without a clear clinical meaning. These results do not contraindicate vaccination in these patients, as the benefits outweigh the risks. The use of combined vaccines does not increase the incidence of adverse effects.
Aparicio Rodrigo M, Martínez Rubio M.V. Evid Pediatr. 2015;11:64
Authors' conclusions: the vaccine anti-influenza A/H1N1 has a weak association with the development of Guillain-Barré syndrome.
Reviewers' commentary:despite the limitations of the present study, the results should be considered in adopting an individual decision on vaccination. However, the risk of Guillain-Barré syndrome after vaccination must be weighed against the proven benefits of the vaccination and the resulting reduction in influenza-related complications.
Ruiz-Canela Cáceres J, Fernández Rodríguez M. Evid Pediatr. 2015;11:65