Authors' conclusions: in the randomized controlled trial, the intermittent rectal diazepam (RD) prophylaxis reduces to 45% the recurrence rates of febrile seizures in high risk patients (p = 0,005), 20% reduction in the intermediate-risk (p = 0,341) and only 13% in the low-risk children (p = 0,412). The side effects in the RD group were mild and transient and no long-term side effects during the 3-year follow-up. The clinical practice guideline reviewed the literature with the aim of addressing possible therapeutic interventions in the management of children with simple febrile seizures and concluded that although there is evidence that both continuous antiepileptic therapy and intermittent therapy with oral diazepam (OD) are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risk associated with simple febrile seizures. In situations of parental anxiety associated with febrile seizures, intermittent OD at the onset of febrile illness may be effective in preventing recurrence.
Reviewers' comantary: continuos antiepileptic therapy or intermittent therapy with diazepam, is no recommended because the risks outweigh the benefits. In situations with severe parental anxiety associated with febrile seizures intermittent OD or RD could be used at the onset of febrile illness. The first choice RD at a dose of 0,33 mg/kg with a total of three doses within the first 24 h from the onset of fever.
Authors' conclusions: montelukast did not improve respiratory symptoms of post-RSV bronchiolitis in children.
Reviewers' comantary: this clinical trial contradicts a previous pilot study with methodological limitations. Montelukast has not proven to be effective in respiratory symptoms post-RSV bronchiolitis and there are doubts about its efficacy in severe bronchiolitis with persistent symptoms in the first two weeks.
González de Dios J, Ochoa Sangrador C. Evid Pediatr. 2009;5:4
Authors' conclusions: current data suggest that 3% nebulized hypertonic saline solution can reduce hospital stay and improve the clinical severity score of infants with bronchiolitis.
Reviewers' comantary: this is a rigorous systematic review of four well-designed studies in which there is no notable heterogeneity, but it included few patients. The results show the effectiveness of nebulized hypertonic compared to normal saline solution to reduce the length of hospitalization (0.9 days) and respiratory clinical score.
Balaguer Santamaría A, Buñuel Álvarez JC, González de Dios J. Evid Pediatr. 2009;5:5
Authors' conclusions: montelukast was not effective in reducing the length of hospitalization in infants admitted for a first episode of acute bronchiolitis.
Reviewers' comantary: it is a clinical trial that, despite some limitations in the analysis of the results (lack of multivariate analysis of variables to correct imbalances between groups), offers good quality evidence about the absence of effectiveness of montelukast in reducing the length of hospitalization in children with a first episode of acute bronchiolitis.
Authors' conclusions: the RTS,S/AS02D malaria vaccine seems to be safe in infants, it doesn’t interfere with immunological response to other co administered vaccines and diminishes the incidence of malaria infection.
Reviewers' comantary: implications for the practice: the RTS,S/AS02D vaccine seems to be the first effective vaccine against malaria infection in children. Implication for the investigation: phase 3 studies are needed to confirm the effectiveness, safety profile and inmunogenicity of the vaccine in order to include it in immunization schedules, especially in endemic areas and in populations at risk.
Orejón de Luna G, Ramos Lizana J. Evid Pediatr. 2009;5:7
Authors' conclusions: repeated course of antenatal corticosteroids (every 14 days) is not recommended for a bad relationship between efficiency (no improvement neonatal morbi-mortality) and security (decrease the weight, height and head circumference at birth).
Reviewers' comantary: the reduction of foetal growth by use of repeated courses of corticosteroids, given the discrepancy results from short term effectiveness of this multicenter clinical trial quality (1.858 pregnant women) and the systematic review published previously (2.008 pregnant women from 5 clinical trials) make recommend a single cycle of steroids on the risk of premature birth, supported also by the limited information on current long-term effects of the use of steroids in the foetus.
González de Dios J, Balaguer Santamaría A. Evid Pediatr. 2009;5:8
Authors' conclusions: changes in brain activity in response to a painful stimulus is good related to the PIPP scores but we must be careful. It must be kept in mind that about 1 in 3 painful stimulus do not cause any behavior change.
Reviewers' comantary: clinical pain tools are useful in the assessment of the neonatal pain but their utility could be improved by combining them with other tools as Near Infrared Spectroscopy.
Aparicio Sánchez JL, Bernaola Aponte G. Evid Pediatr. 2009;5:9
Authors' conclusions: PEG3350 is effective in the short-term treatment of children with functional constipation. We recommend a starting dose of 0.4 g/kg per day.
Reviewers' comantary: PEG3350, along with behavior modification, is a good therapeutic option in the treatment of constipation in children.
Authors' conclusions: the administration of a fibre mixture in the diet causes comparable results to lactulose in the treatment of childhood constipation.
Reviewers' comantary: dietary fibre could be as effective as lactulose in the treatment of childhood constipation; however, bigger trials are needed to draw definitive conclusions.
Authors' conclusions: the physical exam cannot independently confirm or exclude nonacute sexual abuse in prepubertal girls. Vaginal discharge and/or posterior hymenal transections rise the suspicion of sexual abuse. The absence of hymenal transection is associated with low probability of sexual abuse.
Reviewers' comantary: there is no evidence of the diagnostic usefulness of the physical findings after the first 72 hours of a sexual assault. Vaginal discharge and/or hymenal transection are present in less than half of the cases, but their existence produce a high level of suspicion. Moreover, genital lesions are only one of the types of sexual abuse in childhood, and in 95% of prepurbertal girls that have suffered sexual abuse there are no findings in the physical exam.
Aparicio Rodrigo M, Juanes de Toledo B. Evid Pediatr. 2009;5:12
Authors' conclusions: The information that favors the conservative attitude in the treatment of acute otitis media must be reconsidered until studies of better quality are performed.
Reviewers' comantary: The limitations and the heterogeneity of the studies included in this review raise concerns both for and against the antibiotic treatment in acute otitis media. Further research is needed in this area with controlled clinical trials involving valid and representative samples of patients.
Ochoa Sangrador C, Andrés de Llano JM. Evid Pediatr. 2009;5:13
Authors' conclusions: changes in the age at diagnosis increase the prevalence of autism in the most recent cohorts compared to the oldest.
Reviewers' comantary: considering the Danish as reliable records, we may conclude that there is not an increase in the prevalence of autism, but an insufficient follow-up, and also a better understanding of the disease makes these prevalences appear higher.
Ruiz-Canela Cáceres J, Martín Muñoz P. Evid Pediatr. 2009;5:14
Authors' conclusions: this study describes six asthma phenotypes in childhood. Three of them, characterised by the onset of wheezing in children of more than 18 months of age, are strongly related to atopy. There seems to be environmental influences on the appearance of atopic wheezing during the first years of life on individuals genetically prone to develop asthma.
Reviewers' comantary: this study represents the most important population cohort study for understanding the heterogeneity of asthma since the publication of the Tucson study in 1995. It shows three new phenotypes in asthmatic patients. Besides, it is an outstanding study to improve our practice because it allows us to perform some allergic test in children with real risk of atopic asthma. Profundizando en el conocimiento de los fenotipos del asma infantil
Rivas Juesas C, González de Dios J. Evid Pediatr. 2009;5:15
Authors' conclusions: evidence suggests that interventions promoting breastfeeding are more effective than usual care in increasing its duration in the short and in the long term. Combined interventions, before and after birth, and with lay support could be the most beneficial.
Reviewers' comantary: subject to the acceptance of meta-analysis with excessive heterogeneity, the results on the initiation and duration of breastfeeding show that support to breastfeeding must continue, most importantly in the pre and postnatal period; there must improve the awareness of maternities on the importance of providing the means for a successful beginning of breastfeeding, increasing the number of hospitals adhering to the “Baby Friendly Hospital Initiative” and implementing lay support.
García Vera C, Esparza Olcina MJ. Evid Pediatr. 2009;5:16
Authors' conclusions: Bariatric surgery in pediatric and adolescent patients results in sustained and clinically significant weight loss, but it also has the potential for serious complications.
Reviewers' comantary: Bariatric surgery appears to be effective in adolescents, although it is not well known the real impact on the follow up in the medium and long term. The most convenient surgical technique and the age these interventions can be made are not determined yet. The methodological quality of future research and reviews should be more rigorous, assessing not only the reduction in body mass index, but also morbidity, mortality, quality of life and economic outcomes to draw appropriate conclusions.
Suwezda A, Ibáñez Pradas V. Evid Pediatr. 2009;5:17
Authors' conclusions: Compared to targeted programs in other provinces, the introduction of universal vaccination in Ontario (Canada) in 2000 was associated to a relative reduction in influenza-associated mortality and health care use. The results of this large-scale natural experiment suggest that universal vaccination could be an effective public health measure in order to reduce the annual burden of influenza.
Reviewers' comantary: This study has some limitations that could limit the generalization of its results. The bigger effectiveness of universal influenza immunization should be corroborated by experimental studies. On the other hand, it is necessary to know the cost-effectiveness of this strategy.
Olivares Grohnert M, Cuestas Montañés EJ. Evid Pediatr. 2009;5:18
Authors' conclusions: Intravenous dexamethasone reduces the risk of nausea and vomiting during the postoperative days after tonsillectomy (with or without adenoidectomy) in a dose-dependent way, but it is associated to an increased risk of postoperative bleeding in the following ten days.
Reviewers' comantary: The results of this study discourage the routine use of dexamethasone, particularly at doses of 0.5 mg / kg in patients undergoing adenoidectomy and / or tonsillectomy because the risk of bleeding within ten days implies an unfavorable risk-benefit profile.
Authors' conclusions: adolescents exhibit six patterns of smoking during adolescence. There is a relation between this habit and the presence of smokers in the adolescent environment as well as with the positive or negative perception that they have on several variables related to the tobacco habit.
Reviewers' comantary: despite its methodological limitations, this study supports the usefulness of some interventions in adolescent smoking prevention like sending messages against tobacco industry and promoting a smoking-free environment at home and in public places.
Authors' conclusions: a five days oral steroid treatment was no more effective to solve an acute crisis of asthma than a three days treatment in children older than two years.
Reviewers' comantary: oral prednisolone for three days may be sufficient to control the crisis in children with an exacerbation of asthma. In those cases showing an incomplete response on the third day, the duration of treatment can be extended with new clinic re-assessment two-three days later.
Authors' conclusions: the use of paracetamol in infancy can be a risk factor for asthma,rhynoconjuntivitis and eczema.
Reviewers' comantary: the most important limitations of this study are its retrospective nature, and the not corrected selection byass: the analysis adjusted for confusion factors was undertaken in 51% of the study population and no information was given whether this subgroup had differences with the population of origin. The study supports the conclusions of other authors about paracetamol as a possible risk factor although new studies are necessary to confirm or discard the rol of paracetamol in the development of allergic disease.
Perdikidis Olivieri L, Fernández Rodríguez MM. Evid Pediatr. 2009;5:22
Authors' conclusions: in newborns under mechanichal ventilation (SIMV, HFV), open and closed tracheal suction cause similar transitory reduction of the lung volume, heart rate and oxygen saturation. Closed suction only seems to be better than the open one in the lung volume recovery time, that is slightly smaller, but only in patients under HFV (not in those with SIMV).
Reviewers' comantary: the most severe infants were excluded from the study and this could be a limitation to its clinical applicatibility. New better designed studies are necessary in order to know if there is any difference between closed and open tracheal suction.
Aparicio Sánchez JL, Modesto i Alapont V. Evid Pediatr. 2009;5:23
Authors' conclusions: Caffeine intake during pregnancy > 200 mg / day increases the risk of low birthweight.
Reviewers' comantary: Observational cohort study of a large sample size, controlling confounding variables that may affect fetal growth and birth weight. It demonstrates an association between LBW and intake of caffeine from values as low as 30 mg / day. This association appears to exist throughout the pregnancy. It is highlighted the weakness of previous studies that consider caffeine intake linked only to coffee and cola drinks, which could underestimate the real impact of caffeine on fetal growth.
Puebla Molina SF, Bonillo Perales A. Evid Pediatr. 2009;5:24
Authors' conclusions: Compliance with gluten-free diet is an essential factor to obtain optimal quality of life. Psychosocial and educational support should be provided for patients having difficulties at strictly adhering to a gluten-free diet. Early coeliac disease’s onset and diagnosis is associated to a better physical health, less coeliac disease associated burden and fewer social problems, indicating the importance of the earliest possible coeliac disease’s diagnosis.
Reviewers' comantary: In adolescents with coeliac disease, to follow a strict adherence to a gluten-free diet allows to obtain an improvement in some aspects of quality of life, like family and social relations; nevertheless it would be desirable to conduct studies on quality of life using more specific questionnaires in relation to the coeliac disease to asses the real impact in the quality of life of these patients.
Authors' conclusions: Head covering is a major modifiable risk factor associated with sudden infant death syndrome and parental advice to avoid this situation should be emphasised.
Reviewers' comantary: There is enough evidence to support more specific measures to avoid head covering with bed clothes in infants under twelve months of age leading to decrease sudden infant death syndrome risk.
Chalco Orrego JP, Bada Mancilla CA. Evid Pediatr. 2009;5:26
