EvidPediatr. Current Issue

[EDITORIAL] Sepsis in the neonatal period

Lopez Sastre J.B., Fernandez Colomer B, Coto Cotallo G.D., de la Rosa Fraile M — 2007-12-01

The sepsis is undoubtedly one of the big problems in the exercise of the neonatology. In Spain, the Group of Hospitals Castrillo places the incidence of vertically sepsis in 2,5 for 1.000 newborn and the nosocomial sepsis in 2,1 for 1000. Similar incidences have been referred in the United States.

[EDITORIAL] Role of pediatricians in tobacco control

Jimenez-Ruiz C.A. — 2007-12-01

The active and pasive smoking are two serious problems that affect to the chidren and adolescents. The profesional of pediatrics play a relevant role in the prevention and the treatment of these pathological processes. All the parents of children and adolescents qho come to the consultations must be asked over the consumption of tobacco and to inform about the need to leave it

[CAA] Some dietary therapies could alleviate symptoms of patients suffering from infantile colic

Gonzalez de Dios J, Perdikidis Olivieri L — 2007-12-01

Authors' conclusions: the exclusion of cow milk proteins in infants fed with adapted milk, a restrictive hypoallergenic diet in the mother and the use of several herbal therapeutic products have proven to be moderately effective for the treatment of infant colic.

Reviewers' commentary: this systematic review provides a rigorous approach to the process of decision making of a frequent and transitory problem, in which the stress of the parents and commercial pressures do not always allow a judicious use of the multiple alternatives that are available to the paediatrician.

[CAA] The importance of knowing and recognizing the spectrum of fetal alcohol syndrome

Gonzalez de Dios J, Rivas Juesas C — 2007-12-01

Authors' conclusions: this epidemiologic and prospective study, the first national data in the world, shows the complexity, severity and developmental impact of fetal alcohol syndrome. We need preventive approaches and early diagnosis.

Reviewers' commentary: fetal alcohol syndrome is a predictable disease. We need the to have the knowledge to suspect it and also to make an early diagnosis and be able to be able to recognize the broad spectrum of presentations of this disorder.

[CAA] A new intervention for the prevention and cessation of smoking in pediatric consults appears to be ineffective and costly

Ibañez Pradas V, Suwezda A — 2007-12-01

Authors' conclusions: a pediatric practice-based intervention delivered by pediatric providers and older peer counsellors proved feasible and effective in discouraging the initiation of smoking among non-smoking adolescents.

Reviewers' commentary: it isn’t still demonstrated what is the best pediatric-based intervention, delivered by pediatric providers, for discouraging the initiation of smoking among non-smoking adolescents, neither what intervention helps the smoking cessation. The trend indicates that the motivational interviewing could be effective in smoking control, but it only has been shown to be effective in small communities at a high cost, what makes doubtful its feasibility in other scenarios. Even though there isn’t a structured plan to deal with this problem, it is necessary to take profit of the opportunities to approach this topic with the adolescents in the pediatric primary care clinics.

[CAA] The programs for the prevention of perinatal invasive group B streptococcal disease are effective in reducing early neonatal mortality, but do not alter mortality at later age

Balaguer Santamaria A, Gonzalez de Dios J — 2007-12-01

Authors' conclusions: there is a decline in the U.S. incidence of invasive disease by group B streptococcal disease (GBS) between birth and 6 days of life in 2003-2005 with respect to 1999-2000. However, there was no change in the incidence of late neonatal disease and an increase of invasive disease by GBS was registered in adults during the study period.

Reviewers' commentary: prevention of invasive disease by GBS based on intrapartum antibiotics, with its advantages and disadvantages, seems to have reached its limit. Therefore research for a pentavalent vaccine should be a public health priority.

[CAA] One dose of ondansetron seems to reduce vomiting in patients with acute gastroenteritis attended in emergency departments

Ochoa Sangrador C, Orejon de Luna G — 2007-12-01

Authors' conclusions: ondansetron therapy decreases the risk of persistent vomiting, hospital admissions and the use of intravenous fluid, in children with vomiting due to gastroenteritis. Treatment guidelines should incorporate ondansetron for the therapy of selected childrens with gastroenteritis.

Reviewers' commentary: despite the fact that ondansetron appears to reduce the vomiting of patients with gastroenteritis, the information provided by this review does not clear up some doubts that question its widespread application in clinical practice. It would be necessary to conduct more studies that include a broader spectrum of patients and evaluating the benefit of treatment on the patient.

[CAA] Intranasal budesonide can not yet be recommended to treat symptoms of mild obstructive sleep apnea syndrome in children

Garcia Vera C, Esparza Olcina MJ — 2007-12-01

Authors' conclusions: intranasal budesonide may be an effective treatment, alternative to surgery, in children with mild obstructive sleep apnea syndrome.

Reviewers' commentary: some problems in design and methodology reduce validity to the results of this study, so that until new trials are conducted, it doesn’t seem appropriate to recommend this treatment in mild presentations of the syndrome in children six to twelve years old.

[CAA] The use of DNA microarrays for detection of viruses in respiratory tract infections is a promising technique, although it must be purified, cheapened and simplified before its introduction into clinical practice

Ochoa Sangrador C, Andres de Llano J — 2007-12-01

Authors' conclusions: considering its favorable profile with regard to sensibility, specificity and wide spectrum, the viral test based on microarrays promises to be an important diagnostic help for the clinical pediatrician in the detection of infections of the respiratory tract.

Reviewers' commentary: in spite of the advantages of these new technologies, they do not currently seem to be applicable in the welfare practice, in view of his high cost and complexity.
Lowering the price, simplification and automatization are necessary before they replace the technique nowadays in use. Likewise the time of delay for obtaining result will have to be shorter and the consistency, reproducibility and clinical profitability must be proved in new studies.

[CAA] Parents, compared with health care providers, tend to underestimate the weight of their children

Buñuel Alvarez JC, Olivares Grohnert M — 2007-12-01

Authors' conclusions: children tend to underestimate their weight. Parents and health professionals also have a tendency to underestimate the weight of the child.

Reviewers' commentary: this study provides limited evidence, due to its methodological limitations on the presence of an inadequate estimate of body self image of children (under-weight) and by their parents also. It is neccesary to develop validated scales of measurement that can confirm these results.

[CAA] Clinical assessment is not a good method for screening for significant neonatal jaundice

Fernandez Rodriguez M, Martin Muñoz P — 2007-12-01

Authors’ conclusions: clinical visual estimation of the level of bilirubin is unreliable as a screening method to rule out neonatal hyperbilirubinemia significantly before discharge.

Reviewers’ commentary: the results of this study are consistent with other authors on the limitations of exploration in the estimation of bilirubin level before the 5 days of life; as inputs highlights the best rating for the term of more than 60 hours and the characteristic of being screening conducted by two thirds by nursing staff.

[CAA] Self-completed questionnaires tend to produce an underestimation of tobacco consumption among adolescents

Buñuel Alvarez JC, Puebla Molina SF — 2007-12-01

Authors' conclusions: adolescents tend to underestimate their habit of smoking calculated through a self reported survey.

Reviewers' commentary: adolescents tend to underestimate (or even deny) their tobacco consumption, and this fact could be even greater in daily clinical practice, when they are asked directly about it. Simple tools, valid and applicable to clinical practice are needed, to accurately determine the status of smoking among adolescents.

[CAA] Can today be questioned the clinical utility of central venous pressure?

Buñuel Alvarez JC, Modesto i Alapont V, Cuestas Eduardo — 2007-12-01

Authors' conclusions: central venous pressure (CVP) should not be used to make clinical decisions regarding fluid management.

Reviewers' commentary: even though there is a poor relationship between CVP and both blood volume and the hemodynamic response to a fluid challenge, we suggest to keep considering the CVP an useful clinical parameter in fluid management.

[CAA] Is internet-based learning as effective as face-to-face learning?

Juanes de Toledo B, Ruiz-Canela Caceres J — 2007-12-01

Authors' conclusions: learning via the Internet is associated with a positive impact on knowledge and learning behavior for the remaining variables equally to traditional education.

Reviewers' commentary: the use of the Internet as a learning method is as effective as traditional methods, allows an almost unlimited accessibility and shows in some respects as in the acquisition of knowledge superior to traditional methods of teaching.

[CAA] Recurrent abdominal pain persists over time in 29% of children

Modesto i Alapont V, Aparicio Rodrigo M — 2007-12-01

Authors' conclusions: twenty-nine percent of children with the diagnosis of recurrent abdominal pain may still suffer from it after years of follow up. Additional diagnosis testing in absence of alarming symptoms does not influence their prognosis.

Reviewers' commentary: in around 30% of children with the diagnosis of recurrent abdominal pain, the pain may persist during years. Nevertheless, in absence of alarming symptoms there is not justification to make additional diagnosis testing, because it will not change the prognosis. Probably there is a multifactorial mechanism on the base of this persistence that needs further investigation.

[CAA] The use of salmeterol plus inhaled corticosteroids does not appear to increase the incidence of severe asthma related events

Gonzalez Rodriguez MP, Gimeno Diaz de Atauri A — 2007-12-01

Authors' conclusions: salmeterol combined with inhaled corticosteroids decreases the risk for severe exacerbations, does not seem to alter the risk for asthma-related hospitalizations, and may not alter the risk for asthma-related deaths or intubations compared with inhaled corticosteroids alone.

Reviewers' commentary: long acting beta-agonists (LABA) are recommended by clinical guidelines in association with inhaled corticosteroids as a third step for management of asthma. An increased risk of life-threatening and fatal asthma attacks has been described in relation with its use. In this study, despite their methodological limitations, no increase in the morbidity or mortality related to asthma has been found in people treated with LABA and inhaled corticosteroids. There are studies in course comparing the adverse events in asthmatic patients in treatment with salmeterol and inhaled corticosteroids versus patients only treated with inhaled corticosteroids. There will be interesting to provide information about the real relationship between the salmeterol and asthma-related serious adverse events.

[CAA] Physical therapy is superior to recommendations on postural habits to reduce the prevalence of severe deformational plagiocephaly in infants

Ibañez Pradas V, Suwezda A — 2007-12-01

Authors' conclusions: physical therapy reduces the prevalence of deformational plagiocephaly in children with positional preference.

Reviewers' commentary: this is the first randomized controlled trial on the effectiveness of physical therapy for children with deformational plagiocephaly, assessed through a new diagnostic method (plagiocephalometry). Although group assignment was not kept concealed properly, trial’s results show that, the implementation of a systematic program in experienced hands seems to be a more reliable method than the usual medical advice about positional habits.

[CAA] Adolescents who were preterm infants with intraventricular hemorrhage have more cognitive disorders

De la Rosa Morales V, Gonzalez Rodriguez MP — 2007-12-01

Authors' conclusions: the present study suggests that long-term difficulties are evident for general cognitive performance as well as for specific cognitive abilities in preterm subjects with intraventricular haemorhage in the newborn period. These data could explain the academic problems shown by these individuals

Reviewers' commentary: adolescents who were preterm have learning and behavior difficulties. The presence of intraventricular hemorrhage in the perinatal period has been associated with poor educational performance, although the results of this study do not allow to confirm this aspect. To find out what factors are associated with the prognosis in childhood and adolescence prospective follow-up studies from birth should be conducted.

[CAA] Extended prophylaxis with nevirapine or nevirapine plus zidovudine in breastfeeding infants born to HIV-1-infected mothers decreases postnatal HIV-1 infection

Bada Mancilla CA, Chalco Orrego JP — 2007-12-01

Authors' conclusions: extended prophylaxis with nevirapine or with nevirapine plus zidovudine significantly reduced postnatal HIV-1 infection in 9-month-old infants.

Reviewers' commentary: postnatal transmission of HIV-1 among breast-feeding children is a major concern mainly in sub-Saharan countries. Antiviral treatments like a single dose of nevirapine plus zidovudine for 1 to 4 have been used in newborns for its prevention. This trial concluded that an extended nevirapine prophylaxis is related to a decreased rate of infection at nine months although it fails in describe some related outcomes like a higher resistance rate mentioned by other authors. So, with the actual knowledge, it does not seem yet recommendable to change to extended nevirapine regimens.

[CAA] The risk of anaphylaxis following quadrivalent human papillomavirus vaccination is low

Carreazo Pariasca NY, Cuervo Valdes JJ — 2007-12-01

Authors' conclusions: based on the number of confirmed cases, the estimated rate of anaphylaxis following quadrivalent human papillomavirus vaccine was significantly higher than the identified in other comparable vaccines. However, overall rates were very low and all cases were managed appropriately with no serious sequelae.

Reviewers' commentary: even taking into account the methodological problems of this study, the quadrivalent human papillomavirus vaccine seems to be safe to be used in massive vaccine campaigns. The anaphylaxis rate should be confirmed in other populations.

[BASES OF EBM] Tools for the development and use of evidence-based practice guidelines

Ruiz-Canela Caceres J, Guerra de Hoyos J.A., Rivas Aguayo D — 2007-12-01

In this moment the process of capture of decisions in the clinical practice has become very complex, because the majority of the problems of health have more than one possible intervention. These can contribute benefits but also risks.

[ARTICLES TRANSLATED] oes this child have appendicitis?

Barroso Espadero D — 2007-12-01

Practice: The authors stated that clinical examination does not establish a diagnosis of appendicitis, but can be useful in determining which children require immediate surgical assesment and which require further diagnostic assessment. Research: The authors stated that future research, using prospective age-specific data from large cohorts of children with ndifferentiated abdominal pain, could incrase the usefulness of clinical examination

[ARTICLES TRANSLATED] Benefits of cognitive-behavioural therapy for children and youth with obsessive-compulsive disorder: re-examination of the evidence

Aizpurua Galdeano P — 2007-12-01

Practice: The authors suggested tha CBT should be regarded as an equivalent first-line treatment to anti-OCD medication. Research: The author stated that additional well-conducted studies using a range of outcomes, including measures of life functioning, are required to carify the benefits of CBT for paediatric OCD. In the interim, the author suggested further investigation of how CBT can be made more available as a treatment option