La administración prolongada de probióticos podría disminuir la frecuencia de infecciones respiratorias / Prolonged administration of probiotics may decrease the frequency of respiratory infections

Los probióticos pueden reducir la cantidad de niños diagnosticados con al menos una infección respiratoria de vías superiores (IVRS) en aproximadamente un 21%; probablemente, pueden reducir el número de niños diagnosticados con al menos tres IVRS en alrededor del 38%; pueden reducir la tasa de incidencia (número de casos nuevos durante un periodo de tiempo específico) de IVRS en alrededor del 18%; probablemente, pueden reducir el número de niños que usaron antibióticos para las IVRS en aproximadamente un 22%; y es posible que no aumenten la cantidad de personas que experimentaron efectos secundarios (cualquier daño). La evidencia que muestra una disminución en el número de niños que faltan a la guardería o a la escuela debido a las IVRS agudas con probióticos es muy incierta (AU)

Probiotics can reduce the number of children diagnosed with at least one upper respiratory infection (URTI) by approximately 21%; they can probably reduce the number of children diagnosed with at least three IVRS by about 38%; they can reduce the incidence rate (number of new cases during a specified period of time) of URTIs by about 18%; they can probably reduce the number of children using antibiotics for URTIs by about 22%; and the number of people experiencing side effects (any harm) may not increase. The evidence showing a decrease in the number of children missing daycare or school due to acute URTIs with probiotics is very uncertain. (AU)

Gas Embolism in Pediatric Minimally Invasive Surgery: Should It Be a Concern?

Introduction: Gas embolism can occur during minimally invasive surgical procedures. Its incidence and implications in infants and children are not clear. The objective of this study is to identify gas embolism with transthoracic echocardiography and its consequences in pediatric laparoscopic appendectomy. Materials and Methods: This is a descriptive observational study including children undergoing laparoscopic appendectomy. We performed transthoracic echocardiography during surgery and collected data on intraoperative hemodynamic and respiratory parameters. Results: To date, we have included 10 patients in whom intraoperative transthoracic echocardiography revealed a 50% incidence of gas embolism. All episodes of embolism were grade I or II, and the patients remained asymptomatic. The hemodynamic and respiratory parameters varied slightly during the pneumoperitoneum. Conclusions: Episodes of gas embolism in pediatric laparoscopic appendectomy appeared in up to 50% of patients. Although they were subclinical, we should be aware of the risk of serious events and take measures to maximize safety in pediatric minimally invasive surgery.

Alergia al cacahuete en niños: probable ventana de oportunidad para la desensibilización / Peanut allergy in children: probable window of opportunity for desensitization

Conclusiones de los autores del estudio: los niños menores de 4 años de edad alérgicos al cacahuete, que recibieron inmunoterapia oral al alérgeno, presentaron una mayor desensibilización y remisión frente al mismo. Por tanto, parece existir una ventana de oportunidad de desensibilizarse al cacahuete en esta franja etaria.Comentario de los revisores: la inmunoterapia se mostró eficaz para conseguir la desensibilización y remisión en niños alérgicos al cacahuete entre 1 y 4 años. Este efecto fue más evidente en el grupo de menor edad y con niveles más bajos de marcadores inmunológicos. (AU)

Authors’ conclusions: children under 4 years of age allergic to peanuts who received oral allergen immunotherapy exhibited greater desensitization and achieved remission more frequently. Thus, there seems to be a window of opportunity for desensitization to desensitized to peanuts in this age range.Reviewers’ commentary: immunotherapy proved effective in achieving desensitization and remission in children allergic to peanuts aged 1 to 4 years. This effect was more evident in the younger children and in children with lower levels of immunological markers. (AU)

Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría» / Main changes in the «COVID-19 in paediatrics» clinical practice guideline

Presentamos el resumen de las principales modificaciones surgidas en la guía de práctica clínica «COVID-19 en Pediatría» entre su versión inicial publicada en el año 2021 y la publicada en el año 2022. El documento se ha elaborado siguiendo los pasos estructurados de la medicina basada en la evidencia e incorporando el sistema GRADE para realizar síntesis de la evidencia, con valoración de su calidad y, cuando se consideró apropiado, emitir recomendaciones jerarquizadas (en función de la calidad de la evidencia, los valores y preferencias, el balance entre beneficios, riesgos y costes, la equidad y la factibilidad). En esta actualización se incluyen también los cambios recomendados por los revisores externos. Se sintetizan las principales modificaciones en los siguientes apartados: epidemiología, clínica, diagnóstico, prevención, tratamiento y vacunas. En el conjunto del conocimiento alcanzado a lo largo del primer año de pandemia, las publicaciones durante el segundo año añaden nuevos datos, sin que en muchas de las áreas se produzcan modificaciones sustanciales. Los principales cambios acaecen en el campo de investigación de las vacunas. Esta actualización finaliza en diciembre de 2021, coincidiendo con el aumento de la infección por ómicron, por lo que será necesario una futura actualización del documento.(AU)

We present a summary of the main modifications to the «COVID-19 in Paediatrics» clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future. (AU)

Main changes in the "COVID-19 in paediatrics" clinical practice guideline.

We present a summary of the main modifications to the "COVID-19 in Paediatrics" clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers. We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

[Main changes in the «COVID-19 in paediatrics¼ clinical practice guideline]. / Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría¼.

We present a summary of the main modifications to the «COVID-19 in Paediatrics¼ clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

A mayor pobreza infantil, peor salud física y mental / The greater the child poverty, the worse physical and mental health

CONCLUSIONES DE LOS AUTORES DEL ESTUDIO: la situación de pobreza crónica en la infancia afecta a 1 de cada 5 niños del Reino Unido. La exposición a la pobreza en edades tempranas se relaciona con una peor situación de salud física y mental. COMENTARIO DE LOS AUTORES DE LA REVISIÓN: en una cohorte de 10 652 niños de menos de 14 años de Reino Unido denominado Millenium Cohort Study (MCS) reclutados entre los años 2000 y 2002 los niños expuestos a pobreza mostraban un mayor riesgo de problemas de salud mental, obesidad y enfermedades crónicas

AUTHORS' CONCLUSIONS: the situation of chronic poverty in childhood affects 1 in 5 children in the United Kingdom. Exposure to poverty at an early age is related to a worse physical and mental health situation. REVIEWERS' CONCLUSIONS: in a cohort of 10 652 children under the age of 14 recruited between 2000 and 2022 in the United Kingdom, called the Millennium Cohort Study (MCS), those exposed to poverty showed a higher risk of mental health problems, obesity and chronic diseases

¿La introducción temprana de alimentación sólida mejora el sueño de los lactantes? / Does the early introduction of a solid diet improve the sleep of infants?

Conclusiones de los autores del estudio: la introducción temprana de alimentos sólidos antes de los 5 meses de edad aumenta el tiempo de sueño nocturno, disminuye el número de despertares y disminuye el número de problemas importantes durante el sueño nocturno de los lactantes. Comentario de los revisores: aunque este estudio demuestra que la introducción precoz de los sólidos influye en el sueño, el tamaño del efecto fue pequeño. Si bien la falta de adherencia al protocolo de alimentación precoz pudo disminuir la diferencia entre los grupos, no se puede descartar la presencia de otros factores que pudieron estar relacionados con la mejoría del sueño. Los resultados de este estudio no son lo suficientemente relevantes para cambiar las recomendaciones actuales de introducción de la alimentación complementaria en lactantes con lactancia materna con el fin de prevenir los problemas del sueño

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