Authors’ conclusions: prophylactic pharmacologic treatments have little evidence supporting efficacy in pediatric migraine.
Reviewers’ commentary: this network meta-analysis does not provide evidence to support the prophylactic pharmacological treatment of childhood migraine versus placebo. Acute treatment and counseling about lifestyle measures may be the most important aspect of migraine management in daily practice.
Juanes de Toledo B, De Manuel Gómez C. Evid Pediatr. 2020;16:42
Authors’ conclusions: newborn screening with direct or conjugated bilirrubin measurements detected all known infants with biliary atresia in the study population, although the 95% confidence interval around the sensitivity was wide and the study desing did not ensure complete ascertainment of false-negative results. Research is needed in larger population to obtain more precise estimates of diagnostic yield and to better understand the clinical outcomes and cost-effectiveness of this screening approach.
Reviewers’ commentary: the screening strategy proposed by the present study based on the measurement of direct bilirubin in two phases, reduces the days until a Kasai portoenterostomy can be perform in biliary atresia, however its implementation seems not feasible since it requires a complex infrastructure.
Llerena Santa Cruz E, Pérez-Moneo Agapito B. Evid Pediatr. 2020;16:43
Authors' conclusions: this systematic review provides information on the low risk of polyethylene glycol side effects in children younger than 24 months with functional constipation. However, there is no evidence to establish the appropriate dose.
Reviewers' commentary: polyethylene glycol dosing recommendations for functional constipation in infants are based on clinical practice, since there are hardly any experimental studies at this age. It seems sensible to start treatment with medium-low doses, resorting to higher doses according to the response and tolerance.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2020;16:44
Authors' conclusions: most children with neurofibromatosis type 1 and inoperable plexiform neurofibromas had durable tumor shrinkage and clinical benefit from selumetinib.
Reviewers ́ commentary: selumetinib could be effective in the treatment of plexiform neurofibromas of neurofibromatosis type 1 with complications, with a plateau in the evolution of the disease along with a decrease in the volume of neurofibromas of 20-30% in half of those treated and a mild-moderate clinical improvement of other symptoms such as pain or functional impotence. This is a medication to be considered in the future in the treatment of neurofibromatosis type 1 (NF1) since it is a disease with no other possible treatment and its symptoms have a significant impact on the quality of life of the patient.
Aparicio Rodrigo M, Aizpurua Galdeano P. Evid Pediatr. 2020;16:45
Authors’ conclusions: there were no statistically significant differences in return of spontaneous circulation, survival to 24 hours, survival to hospital discharge, and favourable neurological outcome between children receiving amiodarone or lidocaine for shock-refractory ventricular fibrillation and pulseless ventricular tachycardia. These findings support the current paediatric cardiac arrest guidelines.
Reviewers’ commentary: both the administration of amiodarone and lidocaine are equivalent options in terms of the outcome achieved in the treatment of ventricular rhythms in paediatric intrahospital cardiac arrest, which is why each one can choose between one or the other according to protocols, local habits or particularizations related to possible adverse effects for the patient.
de Lucas García N, Pérez-Moneo Agapito B. Evid Pediatr. 2020;16:46
Authors’ conclusions: palivizumab did not provide any discernible long-term protective effect. In adolescent survivors of extreme prematurity good clinical and physiological respiratory outcomes were shown, as well as improvement with respect to preschool age. The forced expiratory volume in the first second (FEV1) remained lower than in healthy subjects, although within the normal range.
Reviewers’ commentary: within its possible limitations, this study did not find any relevant clinical differences in adolescence between preterm infants who received palivizumab compared to those who did not. This data adds to the existing controversy regarding its use due to the high cost of the drug in relation to the benefits, which, according to the results of this study, do not seem to extend beyond school age.
De Manuel Gómez C, Gimeno Díaz de Atauri Á. Evid Pediatr. 2020;16:47
Authors’ conclusions: the age of thelarche has decreased an average of three months per decade from 1977 to 2013. A younger pubertal onset may change the clinical management of girls with disorders of the onset of puberty, since the current concept of precocious puberty may be obsolete.
Reviewers’ commentary: notwithstanding the methodological limitations of this systematic review, its results agree with those previously published and advise reviewing the threshold of puberty onset and the clinical management of girls with related disorders.
Molina Arias M, Rivero Martín MJ. Evid Pediatr. 2020;16:49
Authors’ conclusions: the “Meningitis Score for Emergencies” accurately distinguishes bacterial from aseptic meningitis in children with cerebrospinal fluid pleocytosis.
Reviewers’ commentary: the “Meningitis Score for Emergencies”, which adds C-reactive protein and procalcitonin to previous scores, rules out with high level of confidence bacterial meningitis in children with cerebrospinal fluid pleocytosis and without certain risk factors, (without) alarm data on physical examination and without recent antibiotherapy either. With the current prevalence in our environment, approximately one in 3 children with scores of one or higher on the scale would actually have bacterial meningitis.