Authors’ conclusions: emergency interventions can increase the detection of the number of suspected cases of abuse, but the methodology of the studies precludes drawing conclusions about their effectiveness. It cannot be confirmed that age, repeated attendance to the emergency department and type of injury identify children with suspected child abuse or neglect.
Rewiewers’ commentary: both systematic reviews have limitations due to the quality of the articles. For the moment, we do not have a clinical tool to be used in the emergency department to increase the suspicion of abuse; other factors such as age, type of injury and repeated visits to the emergencies should be used with caution in the index of suspicion because they have not been found to be related to child abuse.
Fernández Rodríguez MM, Martín Muñoz P. Evid Pediatr. 2010;6:28
Authors’ conclusions: acellular pertussis vaccine administered at birth and one month produces a detectable immune response at two months of age.
Reviewers’ commentary: the results of this pilot trial are encouraging because they demonstrate seroconversion when acellular vaccine against pertussis is administered at birth and at two months old. However, these results should be confirmed in a clinical trial to solve the methodological limitations of this study.This trial should determine whether the seroconversion is clinically protective and if the pattern of administration interferes with seroconversion against other vaccine antigens.
Buñuel Álvarez JC, Guarch Ibáñez B. Evid Pediatr. 2010;6:29
Authors’ conclusions: Ibuprofen is effective in closing a patent ductus arteriosus. Ibuprofen is as effective as indomethacin in closing a ductus and reduces the risk of necrotizing enterocolitis and transient renal insufficiency. Ibuprofen could be the drug of choice, although studies are needed to evaluate the effect of the Ibuprofen treatment compared to indomethacin on long-term outcomes.
Reviewers’ commentary: the use of ibuprofen seems to be safe and effective in closing a ductus with fewer side effects than indomethacin. Studies with more number of patients are needed to evaluate the effect on long-term outcomes.
Andrés de Llano JM, Ochoa Sangrador C. Evid Pediatr. 2010;6:30
Authors’s conclusions: we found no association between recurrent abdominal pain and Helicobacter pylori infection in children and conflicting evidence for an association between epigastric pain and H. pylori infection. We found evidence for an association between unspecified abdominal pain but could not confirm this finding in children seen in primary care.
Reviewer’s commentary: this review doesn't seem to support initial testing for H. pylori in children with recurrent abdominal pain who are attended in primary care. Nevertheless, it would be of interest to establish a clinical decision rule to establish in which specific situations H. pylori infection should be suspected in order to make a faster and more accurate diagnosis.
Title: Universal screening for hearing disability has only shown a small advantage in language development in childhood, based on studies with a low level of scientific evidence.
Authors’ conclusions: the early identification and treatment of severe bilateral hearing disability may be associated with some advantages in relation to language development, even though the studies on which this hypothesis is based have a low level of scientific evidence. There is a lack of studies of other result variables of interest, like educational development, social aspects and quality of life.
Reviewers’ commentary: the universal screening program for hearing impairment must be based on greater level of scientific evidence to establish the cost-benefit-harm relations. There is a lack of studies that pose a special emphasis on long term results that imply a better quality of life (the apparent improvement on early language development should imply better educational, occupational and social outcomes), as well as the potential damage of over diagnosis (false positive results, with wrong labelling and cascading consequences) and the screening bias (early diagnosis bias, duration of disease bias and participation bias).
González de Dios J, Ortega Páez E, Perdikidis Olivieri L, Esparza Olcina MJ. Evid Pediatr. 2010;6:32
Authors´ conclusions: therapeutic hypothermia in newborns with hypoxic-ischaemic encephalopathy reduces the risk of death and neurological impairment at 18 months. Continued follow-up of the children enrolled in the studies included in the meta-analysis is essential to determine whether these benefits are maintained in later childhood.
Reviewers´ commentary: moderate hypothermia could be an efficient treatment for perinatal hypoxic ischaemic and an urgent financial assessment should be made.
Puebla Molina SF, Aparicio Sánchez JL, Modesto i Alapont V. Evid Pediatr. 2010;6:33
Authors’ conclusions: after the introduction of a rotavirus vaccine, a significant decline in diarrhea-related deaths among Mexican children was observed, suggesting a potential benefit from rotavirus vaccination
Reviewers’ commentary: even if the data are not precise (come from ecological study that studies mortality from diarrhea of all causes) rotavirus vaccine could have decreased the mortality from diarrhea in Mexican pediatric population.
Aizpurua Galdeano P, García Vera C. Evid Pediatr. 2010;6:34
Authors’ conclusions: for localized/segmental spasticity that warrants treatment, botulism toxin type A should be offered as an effective and generally safe treatment. There are insufficient data to the use of phenol, alcohol or botulinum toxin type B. For generalized spasticity that warrants treatment, diazepam should be considered for short-term treatment, and tizanidine can be utilized. There are insufficient data to use dantrolene or baclofen (oral or intrathecal).
Reviewers’ commentary: apparently there is only evidence on efficacy and safety to use botulinum toxin type A in the treatment of localized or segmental spasticity in children with cerebral palsy.
Authors’ conclusions: current US breast feeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breast feeding duration and exclusivity may be cost-effective.
Reviewers’ commentary: breast feeding is associated with a reduced risk of many diseases in infants and mothers in developed countries. Breast feeding should be promoted by implementing supports to help more families follow medically recommended guidelines. This is a cost-effective activity for families and society and improves the health of children.
Juanes de Toledo B, Ruiz-Canela Cáceres J. Evid Pediatr. 2010;6:36
Authors’ conclusions: cognitive competence and social and behavioral competence can be protective factors for ASRH (adolescent sexual and reproductive health) outcomes.
Reviewers’ commentary: adolescents and young adults experience negative sexual and reproductive health outcomes, such as sexually transmitted diseases, and pregnancy. This systematic review of observational studies describes that cognitive competence and social and behavioral competence can be protective factors for ASRH outcomes (ever had sex, use of contraception and pregnancy/birth). However, some aspects such as the variability in clinical measures in the studies, the lack of description of the magnitude of the association, make it difficult to ascertain the association between competence and ASRH outcomes.
Orejón de Luna G, González Rodríguez MP. Evid Pediatr. 2010;6:37
Authors’ conclusions: among U.S. minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs show promising in the reduction of obesity in this group.
Reviewers’ commentary: study with serious methodological limitations, which does not allow to generalize its conclusions, but provide similar results to others studies that conclude that multifactorial approach is more effective in the treatment or prevention of obesity.
Carvajal Encina F, Bernaola Aponte G. Evid Pediatr. 2010;6:38
Authors’ conclusion: a shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout childhood and early adolescence.
Reviewers' commentary: this is the first long-term study that shows a relationship between longer breastfeeding and better development of mental health. However, this relationship may not be causal, there may still be some factors (genetics, parental character, etc.) that influence mental health of children and cannot be measured or controlled. There is evidence that other factors have influence on the psychological development of children and adolescents.
Llerena Santa Cruz E, Pérez Gaxiola G. Evid Pediatr. 2010;6:39