Authors’ conclusions: in thrombocytopenic preterm neonates, refraining from transfusing platelets prophylactically until their platelet counts reach levels below 25 000/mm3, decreases their risk of mortality or of serious bleeding.
Reviewers’ commentary: his unprecedented RCT – of excellent methodological quality – concludes that in clinical practice the threshold of prophylactic transfusions of platelets for preterm infants under 34 weeks, (currently fixed empirically at 50 000/mm3), should be reduced to figures below 25 000/mm3.
Conclusions of the authors of the study: the early introduction of solid foods before 5 months of age: increases the duration of the night sleep, decreases the number of night awakenings and decreases the number of important problems during the night sleep of the infants.
Reviewers' commentary: although this study shows that the early introduction of solids influences sleep, the effect size was small. While the lack of adherence to the protocol of early feeding could have decreased the difference between the groups, it can neither be ruled out the possible presence of other factors that could be related to the improvement of sleep. The results of this study are of no sufficient relevance to support a change in the current recommendations for the introduction of complementary feeding in breastfeeding infants in order to prevent sleep problems.
Fernández Rodríguez MM, Flores Villar S. Evid Pediatr. 2019;15:19
Authors’ conclusions: overnight oximetry processed via Bluetooth technology by a cloud-based machine learning-derived algorithm can reliably diagnose OSAS in children with clinical symptoms suggestive of the disease. This approach provides virtually limitless scalability and should alleviate the substantial difficulties in accessing pediatric sleep laboratories while markedly reducing the costs of OSAS diagnosis.
Reviewers’ commentary: overnight oximetry processed by means of this specific algorithm seems to be useful to confirm the diagnosis of moderate to severe sleep apnea-hypopnea syndrome, but not so much in mild cases. The negative results do not rule out the disease. The utility of the test could be improved
Gimeno Díaz de Atauri Á, García Vera C. Evid Pediatr. 2019;15:20
Authors’ conclusions: age-specific shock index cut-off values may identify children at high risk of early mortality in severe sepsis/septic shock and allow for better targeted management.
Reviewers’ commentary: shock index should be monitored in children with severe sepsis or septic shock, although the prognostic value as a predictor of mortality at 48 hours in each age group, in settings different from the one in the study, should be considered with caution, pending external validations. It is a simple and inexpensive tool for guiding the aggressiveness of the treatment and the transfer to specialized centers, thus improving the prognosis.
de Lucas García N, Rodríguez-Salinas Pérez E. Evid Pediatr. 2019;15:21
Authors’ conclusions: administration of bronchodilator therapy using a valved-holding chamber and mask in severe asthma exacerbation was associated with fewer hospital admissions and better oxygen saturation than using a nebulizer.
Reviewers’ commentary: children with severe asthma exacerbation who receive bronchodilator treatment by a valved holding chamber could have a better response in the first hours than those who receive it nebulized.
Albi Rodríguez MS, Aparicio Rodrigo M. Evid Pediatr. 2019;15:22
Authors’s conclusions: the parotitis component of the MMR vaccine appears to be significantly less immunogenic than that of measles, with a higher decrease in antibody levels. There is a significant increase in the T cell response to mumps and measles, although for parotitis, this increase is small. The biological relevance of this difference is not clear.
Reviewer’s commentary: the small sample size and the origin of the cohort raise questions about the representativeness of the sample, although it is highly likely that in our environment a similar phenomenon occurs, since it is now a very common occurrence the diagnosis of adolescents with mumps. Revaccination should therefore be considered to improve protection, at least in the case of epidemic outbreaks.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2019;15:23
Authors’ conclusions: the study reveals a strong association, and a dose-dependent response, between exposure to prenatal nicotine and the diagnosis of attention deficit hyperactivity disorder in the children of exposed mothers. Future studies that incorporate maternal smoking, environmental and epigenetic factors would be justified.
Reviewers’ commentary: according to the results seen above, the consumption of tobacco by women during pregnancy would be a risk factor for the development during childhood of attention deficit hyperactivity disorder in offspring. These results, although of modest magnitude, would be applicable to our environment, with the simple reinforcement of the recommendation to suppress tobacco during pregnancy. This would mean a theoretical 8.2% reduction in the number of diagnoses of attention deficit hyperactivity disorder. Although from this study we can not assume causality, the dose-effect relationship reinforces the existing evidence.
Martínez Rubio M.V, Ortega Páez E. Evid Pediatr. 2019;15:24
Authors’ conclusions: the quality of life of a school-age extremely preterm children without severe impairment was lower relative to a reference population from both the parents' and child's points of view. This evaluation should help to better understand the long-term morbidity and to provide better support for them and their families.
Reviewers’ commentary: the appraisal of quality of life perceived by the families of children with a history of extreme prematurity should complement the medical assessment in the long-term follow-up of these children to identify morbidity and evaluate the effectiveness of treatments.
Aizpurua Galdeano P, Pérez González E. Evid Pediatr. 2019;15:25
Authors’ conclusions: melatonin seems safe and effective in improving sleep in children with neurodevelopmental disorders. The quality of the evidence is limited due to the heterogeneity and inconsistency, so more studies are needed.
Reviewers’ commentary: although evidence is limited, melatonin may be a safe and effective therapeutic option to improve sleep disturbances in children with neurodevelopmental disorders.
Flores Villar S, Molina Arias M. Evid Pediatr. 2019;15:26