It is not known whether birth at a pediatric cardiac specialty center or at a hospital with a higher neonatal level of care affects mortality for infants with ductal-dependent congenital heart disease.

For infants with ductal-dependent congenital heart disease, there is no difference in 90-day mortality for those born at specialty centers versus other centers in the state of Washington. (Read the full article)

Febrile neutropenia is a common complication in children with cancer. Traditionally, even low-risk episodes have been managed entirely in an inpatient setting, and discharge of the patients has been delayed until resolution of fever and sustainable hematopoietic recovery.

The results of this decision-analytic model evaluating low-risk febrile neutropenia episodes suggest that the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences. Uncertainty remains whether intravenous or oral treatment might be the preferable route of drug administration in an ambulatory setting. (Read the full article)

Optimism later in life is protective against a range of health problems. It has commonly been a focus in adolescent mental health promotion. Cross-sectional studies suggest a protective effect against adolescent health risks, but prospective studies have been lacking.

Optimism is somewhat protective against adolescent health risks; the strongest effect was seen against the onset of new depressive symptoms. Its protective effect against heavier substance use and antisocial behavior was modest and only for the highest categories compared to the lowest. Promoting optimism along with other positive aspects of psychological and emotional style has a role in mental health promotion that is likely to be enhanced if an intervention also addresses risk and protective factors in an adolescent's social context. (Read the full article)

Several qualitative studies have revealed that caregivers use infant fussing as a cue for beginning complementary feeding (CF). Despite a higher prevalence of early CF among black infants, few studies have quantitatively examined the role of maternal perception of infant fussiness.

Results of this study show that in a cohort of low-income, black, first-time mothers, early CF was highly prevalent and that maternal perception of infant temperament, breastfeeding, and maternal obesity and depression were important factors related to early CF. (Read the full article)

The professionalism of physicians can have an impact on patient care and satisfaction and physician career success and is increasingly emphasized in residency training programs.

This study was an examination of the perspectives of families of pediatric patients and of pediatrics residents on the attributes of professionalism in physicians. Important overlaps were found between the attributes of professionalism prioritized by patient families and resident physicians. (Read the full article)

Internet use has rapidly become a commonplace activity, especially among adolescents. Poor mental health and several somatic health problems are associated with heavy Internet use by adolescents.

Results of this study provide evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. Heavy Internet users were also confirmed to be at increased risk for somatic health problems in this nationally representative sample of adolescents. (Read the full article)

Many patient and family demographic characteristics are well-known risk factors for nonurgent emergency-department use. No previous study has examined the primary care physician perspective on parental decisions regarding specific nonurgent emergency-department visits by children.

When discussing specific instances when families in their practices sought nonurgent care for children in the emergency department, physicians believed that parents acted appropriately. Neither parents nor primary care physicians saw nonurgent emergency-department visits as a significant enough problem to warrant change. (Read the full article)

The National Children's Study, a large-scale, longitudinal, birth cohort study of US children that endeavors to identify preventable and environmental origins of chronic diseases, has begun recruitment.

In a highly diverse, urban setting, pregnant women can be recruited to participate in the National Children's Study at rates similar to those obtained in clinic settings. Refinements to the pregnancy screener and other components are needed to optimize implementation. (Read the full article)

No studies have focused on the financial impact of fellowship training in pediatrics.

The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, the study may be valuable to policy makers who evaluate health care reform and pediatric workforce-allocation issues. (Read the full article)

Although gastroenteritis guidelines describe the need to perform oral rehydration, it remains underused, resulting in excessive use of intravenous rehydration. Other interventions, such as antiemetic administration, vary according to location, often resulting in differences in cost and outcomes.

In this nationwide cohort, intravenous rehydration use varied dramatically. Use was associated with the institution providing care and an increase in the need for future health care provider visits. Use of ondansetron also varied significantly across Canada. (Read the full article)

For treatment of obesity in preadolescent children, approaches that focus on parents taking sole responsibility for implementing weight-management strategies may be most effective. However, the optimal content, intensity, and duration of programs for obese children remain unclear.

Targeting parents only, a 10% relative weight loss is achievable in moderately obese preadolescent children and can be maintained 2 years from baseline, which justifies an investment in treatment as a secondary obesity-prevention strategy. (Read the full article)

The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF).

Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury. (Read the full article)

Over 500 000 children in the United States sustain a traumatic brain injury (TBI) each year. Headaches are commonly reported after TBI in adults, but little is known about the epidemiology of headache after pediatric TBI.

Headaches are more common 3 months after pediatric TBI than after arm injury. The frequency of headache after TBI is related to patient gender, age, and injury severity. Headaches after mild TBI were most common among girls and teenagers. (Read the full article)

Primary hypertension is a growing concern in adolescents due to its association with the obesity epidemic. Recent studies have examined underdetection and underdiagnosis of hypertension in adolescents but medical management of primary hypertension in adolescents is not well-described.

Our study describes patterns of antihypertensive prescribing for adolescents with primary hypertension including the use of monotherapy versus combination therapy by physicians of different specialties and factors associated with receipt of antihypertensive therapy over a multi-year period. (Read the full article)

Gallbladder disease in children is an evolving entity and studies suggest an increasing frequency of symptomatic pediatric gallbladder disease and resultant cholecystectomies.

Hispanic ethnicity and obesity are epidemiologically significant risk factors for symptomatic gallbladder disease in the pediatric population. (Read the full article)

The prevalence of asthma and smoking among adolescents in Jordan is high. Well-designed, school-based, peer-led education programs can have a positive impact on asthma self-management in adolescents. Student peer leaders can be useful and responsible partners in health promotion programs.

A peer-led asthma education program —Adolescent Asthma Action—for adolescents developed in Australia was adapted to suit non–English-speaking cultures in the Middle East. Peer-led education led to improved self-management of asthma and motivated students to avoid smoking. (Read the full article)

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a progressive, inherited neuromuscular disease manifesting with diaphragmatic paralysis in the first year of life. All patients need mechanical ventilation.

We describe the natural course of SMARD1, developed a scoring system, and defined prognostic values. The clinical outcome of the patients was heterogeneous, and residual enzymatic activity of the IGHMBP2 protein was associated with a more benign disease course. (Read the full article)

Children with special health care needs (CSHCN) account for more than one-third of pediatric health care costs. Little is known regarding the impact of shared decision-making (SDM) over time on child health care expenditures and utilization.

In a national sample, we found that increasing SDM was associated with decreased health care costs and utilization for CSHCN. Results support prospective studies to determine if pediatric interventions to foster SDM reduce the financial burden of caring for CSHCN. (Read the full article)

The medical home is associated with beneficial outcomes in children with special health care needs and in the entire pediatric population. It is unknown if it benefits the majority of the pediatric population (ie, children without special health care needs).

This study is the first to demonstrate an association between the medical home and beneficial health care utilization, child health, and health-promoting behavior outcomes in children without special health care needs. (Read the full article)

Predischarge serum or transcutaneous bilirubinometry (TcB) measurements are recommended as appropriate screening options for identifying infants at risk for neonatal hyperbilirubinemia (NH). Visual inspection for jaundice is not reliable at identifying infants with NH in the community.

When compared with visual inspection alone, coordinated TcB screening for NH in acute-care and community settings is associated with significant improvements in laboratory utilization, patient care, convenience, and safety. (Read the full article)

Extreme preterm birth is associated with developmental shortcomings that may reduce exercise capacity and participation in physical activities in later life. The number of studies addressing these issues in adolescent populations is limited, test methods differ, and results are diverging.

Exercise capacity after preterm birth was in the same range as in term-born control subjects. Participation in physical activity was lower in preterm subjects compared with control subjects; however, the response to exercise in terms of increased aerobic capacity was similar. (Read the full article)

Sleep problems are common during childhood, but screening for sleep problems in the clinic setting is often cursory. Moreover, there are few longitudinal studies examining the prevalence and persistence of sleep problems in young children.

Patterns of sleep problems vary across early development, but sleep problems arising in infancy persist in 21% of children through 36 months of age. Parent response to a nonspecific query about sleep problems may overlook relevant sleep symptoms and behaviors. (Read the full article)

Upper respiratory tract infections (URIs) are very common in children. Currently, there are no effective preventive measures for URI. There are no studies on the effect of montelukast for prevention of URI.

In a randomized, double-blind, placebo-controlled study of preschool-aged children, 12-week prophylactic treatment with montelukast did not reduce the incidence of URI. (Read the full article)

Eating disorders are characterized by preoccupation with weight and shape, which is manifested by a refusal to maintain a normal weight. An exact determination of expected body weight (EBW) is critical for diagnosis and clinical management of these disorders.

The McLaren and Moore methods present with several limitations when calculating EBW for adolescents with eating disorders. A commonly agreed upon method for EBW calculation such as the BMI percentile method is recommended for clinical and research purposes. (Read the full article)

Studies on vaccine safety are crucial to the ongoing success of our national immunization program. ITP has a known association with MMR in young children, occurring in 1 in 40 000 doses. The risk after other childhood vaccines is unknown.

This study found no increased risk of ITP after vaccines other than MMR in young children, confirmed an association of ITP with MMR, and also found that ITP may occur after certain other vaccines in older children. (Read the full article)

Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume–outcome relationship.

A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. (Read the full article)

Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking.

Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time. (Read the full article)

Over the past decade, drug oversight committees and professional organizations have debated the evidence regarding cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deficit/hyperactivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this controversy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deficit/hyperactivity disorder before prescribing stimulants. (Read the full article)

The retention and use of residual bloodspots is a practice of many state newborn screening programs. This practice has become controversial, and little is known about public attitudes on the retention and research use of newborn residual bloodspots.

This study offers a detailed analysis of public attitudes regarding bloodspot retention and use for biomedical research. The results also offer insights on how education regarding this practice influences support for newborn screening and residual bloodspot use. (Read the full article)

In the United States, drowning is the second leading cause of unintentional injury death among children (1–19), accounting for >1000 deaths per year. Total lifetime costs in 2000 were estimated to be $2.6 billion for children aged 0 to 14.

National trends in pediatric drowning hospitalizations by age and gender have not been reported. This study provides benchmarks that can be used for state and regional comparisons and monitoring of injury prevention efforts. (Read the full article)

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspecific clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been associated with pseudo-outbreaks.

Contamination of specimens with vaccine derived Bordetella pertussis DNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modifiable factors. (Read the full article)

Mixed prevalence rates of co-occurring psychiatric and neurodevelopmental conditions have been reported in children diagnosed with an autism spectrum disorder (ASD). ASD diagnoses remain fairly stable within a continuum, but some do not meet criteria for an ASD diagnosis years after initial diagnosis.

Co-occurring neurodevelopmental and psychiatric conditions may explain, in part, why the diagnosis of an ASD may change with age. (Read the full article)

Recent studies have called into question the benefit of perioperative corticosteroids in children undergoing heart surgery, but have been limited by small sample size, the lack of placebo control, and the grouping of various steroid regimens together in analysis.

We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates and found no mortality or length-of-stay benefit associated with any regimen, and a higher risk of infection in certain subgroups. (Read the full article)

Childhood UV light exposures, specifically sunburns, have been shown to be associated with melanoma development later in life.

To date, most studies in this age group have been cross sectional in nature. This is the first prospective study of sunburn and sun behaviors in this age group. (Read the full article)

Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever.

Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.5°F was associated with adverse neonatal outcomes, with the rate of adverse outcomes increasing directly with maximum maternal temperature. Without temperature elevation, epidural use was not associated with adverse neonatal outcomes. (Read the full article)

Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight infants and contributes to morbidity and mortality.

Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants and persists to discharge in most survivors. Routine screening of these infants with echocardiography at 4 weeks of age identifies only one-third of those affected. (Read the full article)

In the previous decade, graduating pediatric residents generally experienced success in finding desired jobs, but they also experienced increased debt and flat starting salaries.

This study highlights trends over the past several years (2003–2009) including high levels of satisfaction among graduating pediatric residents, increasing ease in obtaining postresidency positions, and a modest decline in interest in primary care practice. (Read the full article)

There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.

This study combined systematic literature review and the Rand/University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care. (Read the full article)

Nonconvulsive status epilepticus (NCSE) is the diagnosis for encephalopathy caused by continuous epileptic activity on EEG. It is a well-known cause of morbidity and mortality in critically ill adults and neonates. NCSE is increasingly reported in critically ill children.

We show that NCSE is common in all inpatient settings, not only in the critically ill. Key risk factors that should dramatically increase suspicion of NCSE in clinical practice include a history of convulsive seizure and acute imaging abnormalities. (Read the full article)

Atherosclerotic cardiovascular diseases have roots in childhood. Modification of dietary fat intake influences serum lipid and lipoprotein concentrations. Reduction of saturated fat intake is recommended to promote cardiovascular health.

Dietary counseling had a beneficial effect on saturated fat intake from ages 7 months to 19 years. The counseling reduced serum low-density lipoprotein cholesterol concentrations in both genders. It also decreased computationally estimated concentrations of intermediate-density lipoprotein cholesterol, very low-density lipoprotein–triglycerides and apolipoprotein B in boys. (Read the full article)

Recent studies report that overall computed tomography utilization in the emergency department has continued to rise. Increased computed tomography use is concerning because of the association with radiation exposure and the potential risk of radiation-induced malignancy, which is highest in children.

Our data showed no overall increase in computed tomography utilization through 2010. In areas where alternative non–radiation-based modalities were options, there were decreased trends in computed tomography use and increased use of potential alternative non–radiation-based modalities. (Read the full article)

The number of individuals diagnosed with autism spectrum disorders (ASDs) continues to increase in the United States and other developed countries. Most prevalence estimates indicate that ASD is diagnosed less commonly in Hispanic individuals compared with non-Hispanic (NH) white populations.

Prevalence of ASD in Arizona’s population-based cohort is higher than reported previously. Prevalence in the Hispanic population and NH white population increased significantly over time, with a significant decrease in the gap between Hispanic and NH white prevalence. (Read the full article)

Studies in the Netherlands show that pubertal blockade at Tanner 2/3 prevents unwanted sex characteristics and improves psychological functioning. Endocrine Society guidelines (2009) recommend pubertal suppression for adolescents with gender identity disorder until approximately age 16.

This is the first study of a US cohort of children and adolescents with gender identity disorder. Patients were referred for medical treatment to a pediatric center that supports a multidisciplinary Gender Management Service. (Read the full article)

Active termination of life in newborns with myelomeningocele because of assumed suffering in these newborns has been extensively discussed. However, the level of discomfort and pain in these newborns has never been substantially assessed.

This is the first study presenting quantitative data on discomfort and pain in newborns with myelomeningocele. Therefore, it can be of guidance in the choice of treatment: either active treatment or palliative care in the context of end-of-life decisions. (Read the full article)

Children with special health care needs present clinically with varied functional difficulties across an array of health conditions. Little attention has been given to the interaction of these descriptors at a population level, thereby not addressing the complexity of functional difficulties and their impact on the health of CSHCN.

The data demonstrate the relationships among functional difficulties and health conditions, which then improve our understanding of CSHCN and their needs. Functional difficulties contribute significantly to outcomes, such as emergency room visits, parental work patterns, and limitations in daily activities, and have implications for practice, training, policy, and research. (Read the full article)

Few studies have examined the reliability of clinical findings in pediatric appendicitis. Clinical prediction rules are most useful if the included variables are reliable across practice settings and practitioners.

Among children who present with possible appendicitis, the interrater reliability varied considerably for patient history and physical examination variables. Those variables with the highest degree of reliability may be best suited for inclusion in appendicitis clinical prediction rules. (Read the full article)

Strategies to assist patients in achieving optimal chronic disease self-management are critical. The complex family and regimen issues surrounding pediatric type 1 diabetes management suggest the need to integrate such strategies into routine clinical care.

This study demonstrates the efficacy of a practical, low-intensity behavioral intervention delivered during routine care for improving glycemic outcomes. Findings indicate that the approach may offer a potential model for integrating medical and behavioral sciences to improve health care. (Read the full article)

Some studies reveal an association between exposure to alcohol consumption in movies and youth drinking, but the evidence is sparse.

Exposure to alcohol consumption in movies is associated with youth binge drinking, is little influenced by cultural differences between countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland), and is specific to movie alcohol, not movie smoking, depictions. (Read the full article)

Changes in BMI category appear to be common in young children and are associated with cardiometabolic risk in cross-sectional studies. However, there are few longitudinal studies and little information from multiethnic samples of US middle school children.

Findings demonstrate that shifts in BMI category are common in middle-school-aged children and associated with clinically meaningful changes in cardiometabolic risk factors. Programs to promote decreases in BMI, prevent increases, and moderate risk are indicated. (Read the full article)

Infantile hypertrophic pyloric stenosis incidence varies over different regions and time periods. Recently, a decline was reported in the United States, Sweden (concurrent with a decline in sudden infant death syndrome), Scotland, and Denmark. The etiology remains unclear; therefore, epidemiologic data are valuable.

A decline in the incidence of infantile hypertrophic pyloric stenosis in Germany from 2000 to 2008 was noted but with wide regional variations. The regional distribution of infantile hypertrophic pyloric stenosis was different from that of sudden infant death syndrome. (Read the full article)