Less Is More

Simpler & Better Medicine

Tactile Assessment of Fever in Children by Caregivers. — February 7, 2017
Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. — December 21, 2016

Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents.

Summary: For children between ages 5 and 18 years old who have experienced an acute concussion, early participation in physical activity within 7 days of the injury may be associated with a lower risk of persistent postconcussive symptoms (PPCS) at 28 days post-injury than an approach of having no physical activity within the first 7 days post-concussion.

Note – the authors of this study emphasize that 1) caution in the immediate post-injury period remains vital, 2) activities that entail a risk of repeat head injury should remain prohibited in the early post-concussion period, and 3) an adequate randomized controlled is needed to better understand the benefits of early physical activity following concussion.

https://www.ncbi.nlm.nih.gov/m/pubmed/27997652/

Strength of Recommendation = B

Amitriptyline, Topiramate, or Placebo for Pediatric Migraine — November 1, 2016

Amitriptyline, Topiramate, or Placebo for Pediatric Migraine

Summary: For children or adolescents (aged 8 to 17 years) with a history of age with migraine occurring at least 4 days monthly, an approach of giving neither amitriptyline nor topiramate for headache prevention may be associated with the same degree of reduction in headache frequency, headache-related disability, and headache days as an approach of using either amitriptyline or topiramate for headache prevention, but with a lower likelihood of side effects such as fatigue, dry mouth, paresthesia, and weight loss. (In other words, amitriptyline and placebo appear to work no better for prophylaxis of pediatric migraine than placebo, but both medications are associated with higher rates of adverse events.)

https://www.ncbi.nlm.nih.gov/m/pubmed/27788026/

Strength of Recommendation = B

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. — October 11, 2016

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Summary: For low birthweight (LBW) infants born in resource-limited settings, kangaroo maternal care (KMC)* appears to be associated with a lower risk of mortality, nosocomial infection, or hypothermia, and with improved gains in weight and head circumference compared to conventional neonatal care. Additionally, for relatively stable LBW infancts, early onset KMC appears to be associated with a shorter hospital stay compared to late-onset KMC.

* Generally defined as skin-to-skin contact between  mother and child, frequent and nearly exclusive breastfeeding, and early hospital discharge.

https://www.ncbi.nlm.nih.gov/m/pubmed/27552521/

Strength of Recommendation = A

Cancer risk in people exposed to computed tomography scans in childhood or adolescence. — July 12, 2016

Cancer risk in people exposed to computed tomography scans in childhood or adolescence.

Summary: Minimizing use of computed tomography (CT) scanning in children and adolescents appears to be associated with a slightly lower risk of developing a new cancer over the next (approximately) 9.5 years, and possibly with slightly lower lifetime risk of new cancer.

http://www.ncbi.nlm.nih.gov/m/pubmed/23694687/

Strength of Recommendation = B

Cost-Effectiveness of Obtaining Blood Cultures in Children Hospitalized for Community-Acquired Pneumonia. — June 24, 2016

Cost-Effectiveness of Obtaining Blood Cultures in Children Hospitalized for Community-Acquired Pneumonia.

Summary: For children hospitalized with pneumonia, obtaining blood cultures only from those children at high risk for bacteremia (compared to obtaining blood cultures from all children hospitalized with pneumonia) might lead to an annual savings of over $3000 per 100 patients.

http://www.ncbi.nlm.nih.gov/m/pubmed/26456740/

Strength of Recommendation = C

Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children — June 21, 2016

Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children

Summary: For children brought to emergency care for an acute asthma exacerbation, giving single-dose dexamethasone + an inhaled beta-agonist may lead to the same rates of treatment response and hospitalizations as treatment with a 3-day course of prednisolone + an inhaled beta-agonist (although patients given dexamethasone might have a slightly increased need for subsequent oral steroids within the following 2 weeks).

http://www.ncbi.nlm.nih.gov/m/pubmed/26460983/

Strength of Recommendation = B

Cardiovascular safety of methylphenidate among children and young people with ADHD — June 17, 2016

Cardiovascular safety of methylphenidate among children and young people with ADHD

Summary: While stimulant medications can be effective for reducing impulsiveness and hyperactivity in children, for patients with attention-deficit & hyperactivity disorder (especially those with congenital heart disease), avoidance of methylphenidate may be associated with a lower risk of arrhythmia compared to starting treatment with methylphenidate.

http://www.ncbi.nlm.nih.gov/m/pubmed/27245699/

Strength of Recommendation = B

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial) — May 20, 2016

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial)

Summary: For adult, pregnant women singleton pregnancies and rupture of membranes before labor between 34 and 37 weeks, with no signs of infection, expectant management may lead to the same rates of neonatal sepsis, morbidity and mortality as immediate delivery, but expectant management may be associated with lower rates of respiratory distress, need for mechanical ventilation, and need for intensive care compared to immediate delivery.

http://www.ncbi.nlm.nih.gov/m/pubmed/26564381/

Strength of Recommendation = B

Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis — May 13, 2016

Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis

Summary: For children aged 6 months to 5 years old with gastroenteritis and minimal dehydration, oral rehydration with apple juice diluted 1:1 with water (or the child’s preferred oral fluid intake) may be associated with a lower likelihood of treatment failure and a lower likelihood of needing intravenous rehydration, compared to rehydration with an electrolyte maintenance solution.

http://www.ncbi.nlm.nih.gov/m/pubmed/27131100/

Strength of Recommendation = B

Early versus Late Parenteral Nutrition in Critically Ill Children. — May 10, 2016

Early versus Late Parenteral Nutrition in Critically Ill Children.

Summary: For critically ill children, waiting at least one week before starting parenteral nutrition appears to be associated with a lower rate of new infections, a shorter ICU stay, a shorter duration of mechanical ventilation, a smaller risk of needing renal replacement therapy, and a shorter overall hospital stay compared to early initiation of parenteral nutrition (ie, starting parenteral nutrition within 24 hours of ICU admission).

http://www.ncbi.nlm.nih.gov/m/pubmed/26975590/

Strength of Recommendation = B

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. — March 10, 2016

Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis.

Summary: For infant feeding, use of standard infant formula appears to be associated with the same risk of subsequent eczema, type 1 diabetes mellitus, or food allergy or allergic sensitization as found with use of extensively hydrolyzed. (In other words, use of extensively hydrolyzed infant formula does not appear to convey any protection against subsequent allergy or auto-immune disease, compared to use of standard infant formula).

http://www.ncbi.nlm.nih.gov/m/pubmed/26956579/

Strength of Recommendation = A

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. — February 1, 2016

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports.

Summary: For children and adolescents, avoiding use of selective serotonin and serotonin-norepinephrine reuptake inhibitor antidepressants (specifically, duloxetine, fluoxetine, paroxetine, sertraline, or venlafaxine) may be associated with a lower risk of adverse outcomes (specifically, suicidality or aggression) compared to treatment with these antidepressants.

http://www.ncbi.nlm.nih.gov/m/pubmed/26819231/

Strength of Recommendation = A

Long-term appearance of lacerations repaired using a tissue adhesive. — January 8, 2016
Nasal Foreign Bodies: A Sweet Experiment. — December 11, 2015

Nasal Foreign Bodies: A Sweet Experiment.

Summary: When a child has placed a foreign body in the nose, if it can be confirmed from history that the foreign body is a candy (and not a potentially dangerous inorganic or corrosive object), then a “wait and see” approach may be reasonable, since most such candies will dissolve in less than an hour.

http://www.ncbi.nlm.nih.gov/m/pubmed/25639608/

Strength of Recommendation = C

A whole-of-population study of term and post-term gestational age at birth and children’s development. — November 6, 2015

A whole-of-population study of term and post-term gestational age at birth and children’s development.

Summary: Based on population-level data, it appears that for healthy pregnancies, a policy of nonintervention unless medically necessary up to 41 weeks’ gestation may be associated with a lower risk of the child having developmental vulnerability at school entry.

http://www.ncbi.nlm.nih.gov/m/pubmed/25754325/

Strength of Recommendation = C

When should the umbilical cord be clamped? — November 4, 2015
Home- or community-based programmes for treating malaria. — October 19, 2015

Home- or community-based programmes for treating malaria.

Summary: Training of basic-level health workers or mothers in the administration of anti-malarials, either presumptively based on the presence of a fever or based on the result of a rapid diagnostic test, may increase the number of people receive an appropriate antimalarial within 24 hours of evaluation and may reduce all-cause mortality, compared to standard medical evaluation and care.

http://www.ncbi.nlm.nih.gov/m/pubmed/23728693/

Strength of Recommendation = B

Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. — October 12, 2015

Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial.

Summary: In areas of sub-Saharan Africa with holoendemic malaria, training local mother coordinators to teach mothers to give under-5 children antimalarial drugs may reduce under-5 mortality by up to 40%, compared to a community-health-worker, facility-based approach to evaluation and treatment.

http://www.ncbi.nlm.nih.gov/m/pubmed/10950232/

Strength of Recommendation = B

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. — September 24, 2015

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

Summary: For women in labor, use of continuous cardiotocography (CTG) rather than intermittent auscultation may be associated with an increased likelihood of having a caesarean section or an instrumental vaginal birth, without reducing the likelihood of cerebral palsy or infant mortality (however, CTG may be associated with a reduced risk of neonatal seizures).

http://www.ncbi.nlm.nih.gov/m/pubmed/23728657/

Strength of Recommendation = A

Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. — September 17, 2015

Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence.

Summary: For adolescents with major depression, patients who do not take paroxetine and imipramine may do just as well with their depression as those to take either medication, without the increased risks of suicidal ideation and behaviour associated with paroxetine, or the increased risk of cardiovascular problems associated with imipramine. (In other words, in this re-analysis study, adolescents with depression treated with paroxetine or imipramine did not have any significant improvement in depression measures than those treated with placebo, but they did have an increased risk of side effects)

http://www.ncbi.nlm.nih.gov/m/pubmed/26376805/

Strength of Recommendation = B

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. — July 14, 2015
Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. — July 7, 2015

Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma.

Summary: For children with moderate to severe acute asthma, treatment with albuterol delivered by metered-dose inhaler (MDI) + spacer may lead to a greater reduction in wheezing and a lower likelihood of hospital admission than treatment with albuterol delivered by nebulizer. In this study, treatment with MDI + spacer was preferred over treatment with nebulizer by approximately 85% of children and parents, and the costs of treatment with MDI + spacer were approximately 65% of the costs of treatment with nebulizer.

http://www.ncbi.nlm.nih.gov/m/pubmed/10753248/

Strength of Recommendation = B

Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age. — July 3, 2015

Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age.

Summary: For children under age 2 seen in an emergency department with acute wheezing, giving albuterol (salbutamol) by metered-dose inhaler (MDI) with a spacer and facial mask may lead to faster clinical improvement than giving albuterol by nebulizer (the albuterol dosing in this study was 2 puffs at 100 microg/puff by MDI every 10 min for 5 doses, or 0.25 mg/kg every 13 min for 3 doses by nebulizer).

http://www.ncbi.nlm.nih.gov/m/pubmed/10738013/

Strength of Recommendation = B

Allergy in children in hand versus machine dishwashing. — July 2, 2015

Allergy in children in hand versus machine dishwashing.

Summary: For families with children, using hand dishwashing rather than machine dishwashing may be associated with a reduced risk of allergy development in the children, and using fermented food or food bought directly from farms may further decrease the risk of the children developing allergies.

http://www.ncbi.nlm.nih.gov/m/pubmed/25713281/

Strength of Recommendation = B

Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. — June 17, 2015

Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.

Summary: For children with night-time cough and difficulties sleeping due to an upper respiratory infection (URI), honey may be the preferred treatment. In a comparison of honey, dextromethorphan, or no treatment for children with URI, parents rated honey most favorably for improving cough, child sleep, and parent sleep.

http://www.ncbi.nlm.nih.gov/m/pubmed/18056558

Strength of Recommendation = B

Systematic review of randomized controlled trials examining written action plans in children: what is the plan? — June 16, 2015
Written action plans for asthma in children. —

Written action plans for asthma in children.

Summary: For children with asthma, use of an asthma-action plan (AAP) that is based on symptoms may lead to a lower risk of acute care visits than use of an (AAP) based on peak-flow (PF) measurements, and may be more acceptable to patients (although a PF based AAP may lead to a greater reduction in the number of symptomatic days per week).

http://www.ncbi.nlm.nih.gov/m/pubmed/16856090/

Strength of Recommendation = A

Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial. — May 11, 2015
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