Prematurely born infants commonly have abnormal metabolic screens.

Both gestational and chronological age influence metabolic profiles used to screen for inborn errors of metabolism. (Read the full article)

The definition of hypertension in children is complex because of the age-, gender-, and height-specific blood pressure algorithm. Blood pressure to height ratio was reported to easily identify hypertension in Chinese children living in a local area (Hebei Province).

Blood pressure to height ratio index is simple and accurate for screening for prehypertension and hypertension in Chinese children aged 6 to 17 years and can be used for early screening or treating Chinese children with hypertension. (Read the full article)

In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.

Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. (Read the full article)

Homicide is the third leading cause of mortality in general population youth aged 15 to 29 years. Groups at greatest risk for early violent death (racial/ethnic minorities, males, poor persons, and urban youth) are overrepresented in the juvenile justice system.

We examined rates of and risk factors for firearm homicide and other causes of death in delinquents 16 years after detention. Our study analyzes gender differences; compares Hispanics, African Americans, and non-Hispanic whites; and includes a representative sample of delinquents. (Read the full article)

Pneumonia is a leading cause of hospitalization among children, and readmissions after discharge are common.

Eight percent of children experience a readmission within 30 days after hospital discharge for pneumonia. Readmissions are most common among young children and those with chronic medical conditions, and are associated with substantial costs. (Read the full article)

Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.

Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families. (Read the full article)

Children born late and moderately preterm are at increased risk of developmental problems compared with term-born peers. Screening for developmental problems in the early years may thus aid in the early identification of children at risk for adverse outcomes.

The Parent Report of Children’s Abilities-Revised has good concurrent validity and 90% sensitivity and 76% specificity for identifying moderate/severe cognitive developmental delay in infants born late and moderately preterm. This parent questionnaire may be used as a clinical screening tool. (Read the full article)

Available bowel preparation solutions for colonoscopy continue to represent a challenge for children and their families due to poor taste, high volume, and dietary restrictions with subsequent poor compliance and need to place nasogastric tube for administration.

Low-volume polyethylene glycol (PEG) preparations and sodium picosulphate plus magnesium oxide and citric acid (NaPico+MgCit) are noninferior to PEG 4000 with simethicon for bowel preparation before colonoscopy in children. Given its higher tolerability and acceptability profile, NaPico+MgCit should be preferred in children. (Read the full article)

As the number of chronically ill children grows in the United States, end-of-life discussions and advance directives (AD) will become increasingly important. Although pediatric palliative care is gaining interest, little is known about parental preferences regarding ADs for chronically ill children.

Knowledge about ADs is limited among caregivers of children who have chronic illness. However, interest in creating ADs is high, suggesting an unmet need and opportunity for health care providers to improve the care of children who have chronic illness. (Read the full article)

The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.

AFIX consultations achieved short-term gains in coverage for 11- to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. (Read the full article)

Predicting high-risk populations in congenital diaphragmatic hernia (CDH) can help target care strategies. Prediction rules for infants with CDH often lack validation, are aimed at a prenatal population, and are of limited generalizability. We cannot currently discriminate the highest risk neonates during the crucial period shortly after birth.

This clinical prediction rule was developed and validated on an international database. It discriminates patients and high, intermediate, and low risk of mortality; is easy to apply; and is generalizable to most infants with CDH. (Read the full article)

Interventions based on principles of trauma-focused cognitive behavior therapy have been shown to reduce symptoms of trauma and depression in mothers of premature infants. It is not known whether these benefits are sustained at long-term follow-up.

A brief, cost-effective 6-session manualized intervention for parents of infants in the NICU was effective in reducing symptoms of parental trauma, anxiety, and depression at 6-month follow-up. There were no added benefits from a 9-session version of the treatment. (Read the full article)

Prenatal maternal smoking has been associated with attention-deficit/hyperactivity disorder in children, but the causal nature of this association is unclear. Controlling for the association with paternal smoking has been inconsistent.

Women who used nicotine replacement also had children with a higher risk of attention-deficit/hyperactivity disorder. Mother's smoking behavior appears more important than father's, suggesting a possible causal effect of nicotine exposure or factors related to maternal nicotine dependence. (Read the full article)

Newborn infants who are predominantly breastfed are much more likely to develop prolonged hyperbilirubinemia than those fed formula, but the prevalence of prolonged hyperbilirubinemia in a largely white, North American, breastfed population is unknown.

Practitioners can be reassured that it is normal for 20% to 30% of predominantly breastfed infants to be jaundiced at age 3 to 4 weeks and for 30% to 40% of these infants to have bilirubin levels ≥5 mg/dL. (Read the full article)

Supplemented mother’s own milk is the preferred nutrition for very low birth weight infants.

Through targeted encouragement and guidance, most mothers are able to provide milk to their very low birth weight infants, both for early and prolonged feeding, in an open-bay NICU. (Read the full article)

To date, studies of adaptive behavior in fragile X syndrome have focused on particular age points, either longitudinally or cross-sectionally across a broad age spectrum. Studies have shown variable patterns in adaptive behavior among people with fragile X syndrome.

This study fills a critical gap in knowledge about the profile of adaptive behavior across childhood, adolescence, and young adulthood in fragile X syndrome. This study is the first to incorporate longitudinal data from an age-matched typically developing group. (Read the full article)

Term MRI can assist in identifying the nature and extent of brain injury in preterm infants. However, brain injury detected by MRI does not fully account for neurodevelopmental impairments, particularly cognitive and behavioral impairments, common in preterm survivors.

In addition to brain injury, an assessment of brain growth by using one-dimensional measurements on MRI is helpful for predicting neurodevelopment. Two different patterns of impaired brain growth are observed that relate independently to early cognitive development in preterm infants. (Read the full article)

A substantial gap exists between what is recommended for effective primary care of children and what takes place. Patient-centered health information technologies have been used to gather information and counsel parents, however, have not been integrated directly with electronic health records nor been speech-based to improve decision-making at the point-of-care.

This study shows that a ubiquitous technology, the telephone, can be successfully used to automatically assess and counsel parents before pediatric primary care visits as well as inform their primary care clinicians in a way that is feasible and effective for multiple important issues. (Read the full article)

Children with cognitive delay have been shown to have more behavior problems than typically developing children; however, few studies have investigated this relationship over time or among very young children.

Our findings provide some of the first national, prospective evidence that having a cognitive delay may place children at risk for developing and maintaining behavior problems before school age. Early identification and intervention may improve outcomes for these children. (Read the full article)

Previous studies examining developmental outcomes associated with late preterm and early term birth have shown mixed results. Many of these studies did not fully take into account the role of the social environment in child development.

Social factors, not late preterm or early term birth, were the strongest predictors of poor developmental outcomes at 2 to 3 and 4 to 5 years. The influence of mild prematurity may lose strength beyond the neonatal period. (Read the full article)

Prescribing patterns in the US pediatric population are changing but not uniformly. A detailed examination of prescription variation is needed to better understand pharmacotherapy of children and to inform future exploration of the causes and consequences of diverse practices.

We examine pediatric pharmacotherapy and quantify payer type differences and small geographic area variation. Substantial payer-type differences and regional variations were found, likely reflecting local practice cultures. Variation was greatest for medications used in situations of diagnostic and therapeutic uncertainty. (Read the full article)

Children born very preterm (VPT) are at high risk of educational delay. School readiness has been identified as a potentially useful clinical framework for early detection of those at greatest risk. However, evidence to support its predictive validity is limited.

VPT preschoolers are at risk of impairment across the 5 American Academy of Pediatrics school readiness domains. The number of domains affected predicted likelihood of later learning problems, supporting the utility of schoolreadiness frameworks for identifying children needing surveillance and/or support. (Read the full article)

Cigarette smoking during adolescence causes significant health problems. Health care providers play an important role in promoting tobacco use abstinence among adolescents, but recent data on the prevalence of provider screening and advice to adolescents are lacking.

This study uses nationally representative surveillance data to provide current estimates of self-reported receipt of health professional screening and advice about tobacco use among US adolescents. Cessation behaviors and correlates of past-year quit attempts among smokers were also explored. (Read the full article)

Exposure to second-hand tobacco smoke during pregnancy and infancy has been linked to development of asthma, rhinitis, and eczema in young children. It is unclear whether these risks persist into adolescence.

Exposure to second-hand smoke in utero or during infancy influences the development of allergic disease up to adolescence. Excess risks for asthma and rhinitis were seen primarily in early childhood, whereas those for eczema occurred at later ages. (Read the full article)

Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS). Cerebral oxygenation and blood pressure are reduced in the prone sleeping position in healthy term infants. Preterm infants are at significantly increased risk of SIDS.

Preterm infants display reduced cerebral oxygenation compared with term infants, most prominently at 2 to 3 months corrected age in the prone position when blood pressure is concurrently reduced. This may contribute to the increased risk for SIDS among infants born preterm. (Read the full article)

Adolescent males from low-income communities are a group at increased risk of obesity and related health concerns. Obesity prevention interventions targeting adolescents have so far had mixed success. Targeted interventions, tailored for specific groups, may be more appealing and efficacious.

A multicomponent school-based intervention using smartphone technology can improve muscular fitness, movement skills, and key weight-related behaviors among low-income adolescent boys. (Read the full article)

Palliative care is an increasingly important element of pediatric care for children with noncurable, terminal conditions. Freestanding hospices represent one model of care provision; however, little research on this approach has been conducted.

This report documents the experience of North America’s first freestanding hospice over 15 years to better understand the characteristics of children and families enrolled and to establish baseline information for future studies and program planning. (Read the full article)

Overweight and peer victimization are common in childhood and negatively affect health and well-being. Overweight may predispose children to peer victimization, but whether adiposity also increases the risk of bullying perpetration is unclear.

A high BMI at school entry predicts bullying involvement, according to reports of teachers and children themselves. Although trends were visible across the whole BMI spectrum, particularly obese children were victimized and likely to be bully perpetrators. (Read the full article)

Pediatric primary care has undergone a cultural shift. Changes in electronic health records, certification requirements, and practice structure have left many physicians feeling too busy to participate in research. Practice-based research networks must adapt to fit the current climate.

Adding quality improvement activities that meet Maintenance of Certification Part 4 criteria to research study design adds value to a practice-based research protocol. This incentive meets the needs of busy physicians, and may help researchers meet study recruitment goals. (Read the full article)

Lung ultrasound outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. In the pediatric age, lung ultrasound has been also successfully applied to the fluid-to-air transition after birth and to rapid pneumonia diagnosis.

Nasal ventilation has dramatically decreased the need for invasive mechanical respiratory support. This study demonstrates that, after a short trial on nasal continuous positive airway pressure, lung ultrasonography reliably predicts the failure of noninvasive ventilation unlike the conventional chest radiogram. (Read the full article)

Adolescents and adults born early preterm have higher blood pressure and altered glucose metabolism compared with their term born peers. Evidence of an atherogenic lipid profile is inconsistent. Whether these risks apply to those born less preterm is not known.

In adolescence, girls have higher blood pressure and boys a more atherogenic lipid profile than their term born peers. Overall, our results are consistent with a dose-response relationship between shorter length of gestation and increasing levels of cardiovascular risk factors. (Read the full article)

Recent reviews suggest that children bullied by siblings are at increased risk of internalizing symptoms. It is not known whether being bullied by a sibling increases risk of psychiatric disorders such as depression, anxiety, and self-harm.

Using a large, community-based birth cohort, we found that being bullied by a sibling is prospectively associated with a doubling in the odds of both depression and self-harm at 18 years in young adults. (Read the full article)

Puberty suppression has rapidly become part of the standard clinical management protocols for transgender adolescents. To date, there is only limited evidence for the long-term effectiveness of this approach after gender reassignment (cross-sex hormones and surgery).

In young adulthood, gender dysphoria had resolved, psychological functioning had steadily improved, and well-being was comparable to same-age peers. The clinical protocol including puberty suppression had provided these formerly gender-dysphoric youth the opportunity to develop into well-functioning young adults. (Read the full article)

Many pediatric acute respiratory tract infections (ARTI) are viral and do not require antimicrobial treatment. Recent estimates of antimicrobial overprescribing for these infections, defined based on the published bacterial disease prevalence among all ARTI, are not available.

Based on the published bacterial prevalence rates for pediatric ARTI, antimicrobial agents are prescribed almost twice as often as expected to outpatients nationally, amounting to an estimated 11.4 million potentially preventable antimicrobial prescriptions annually. (Read the full article)

Despite child-resistant packaging requirements for most medications and safe storage education for all medicines, tens of thousands of young children are brought to emergency departments and thousands are hospitalized annually after ingesting prescription medications. Targeted prevention efforts may be needed.

Twelve medications were implicated in nearly half of hospitalizations for prescription medication ingestions. Buprenorphine and clonidine were most commonly implicated and had the highest hospitalization rates when accounting for outpatient use. Prevention efforts should focus on most commonly implicated medications. (Read the full article)

The single-family room (SFR) NICU is a major response to improve care and reduce developmental morbidity in preterm infants. However, no studies have examined how and why this model is associated with changes in medical and neurobehavioral outcome.

This study shows improved medical and neurodevelopmental outcome in infants hospitalized in the SFR model of care. More important, improvements occurred specifically in relation to increases in maternal involvement and developmental support afforded by the SFR environment. (Read the full article)

Infants who require positive pressure ventilation at birth are considered to be at risk for subsequent compromise and are recommended to receive postresuscitation care. The supportive evidence and details of this care have not been fully investigated.

We investigate the need for postresuscitation care in infants who require positive pressure ventilation at birth, review the aspects of care needed, and explore the important risk factors most predictive of it. (Read the full article)

The detection of critical congenital heart disease by fetal echocardiography or neonatal physical examination can have limitations. The addition of pulse oximetry screening in the newborn nursery increases the rate of diagnosis of these conditions before hospital discharge.

In a tertiary-care center with comprehensive fetal echocardiography, nearly all newborns with critical congenital heart disease are diagnosed prenatally. Pulse oximetry will identify more infants from settings with lower prenatal detection. Improving access to and training in fetal echocardiography should also improve detection of these conditions. (Read the full article)

Restrictive feeding by parents is associated with poorer eating self-regulation and increased child weight status. However, this association could be due to confounding home environmental or genetic factors that are challenging to control.

Differential maternal restrictive feeding is associated with differences in twins' caloric compensation and BMI z score. Controlling for the shared home environment and partially for genetics, these findings further support a true (ie, unconfounded) association between restriction and childhood obesity. (Read the full article)

Neonatal circumcision in the United States has been estimated to be performed in ~58% of all neonates, and varies by US geographic region.

This study estimates neonatal and postneonatal circumcision rates among commercially insured males aged 0 to 18 years that were performed in both inpatient and outpatient settings. This study also estimates indications and payments for the procedure. (Read the full article)

Phototherapy decreases bilirubin concentration in skin more rapidly than in blood. During and after phototherapy, transcutaneous bilirubin measurements are considered unreliable and therefore discouraged.

Transcutaneous bilirubin underestimates total serum bilirubin by 2.4 mg/dL (SD, 2.1 mg/dL) during the first 8 hours after phototherapy. This gives a safety margin of ~7 mg/dL below the treatment threshold to omit confirmatory blood sampling. (Read the full article)

Parental smoking cessation helps eliminate children’s exposure to tobacco smoke. A child’s visit to the doctor provides a teachable moment for parental smoking cessation. Effective strategies to help parents quit smoking are available for implementation.

Evidence-based outpatient intervention for parents who smoke can be delivered successfully after the initial implementation. Maximizing parental quit rates in the pediatric context will require more complete and sustained systems-level integration. (Read the full article)

Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group.

A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. (Read the full article)

Jaundiced newborns without additional risk factors rarely develop kernicterus if the total serum bilirubin is <25 mg/dL. Measuring the bilirubin/albumin ratio might improve risk assessment, but the relationships of both indicators to advancing stages of neurotoxicity are poorly documented.

Both total serum bilirubin and bilirubin/albumin ratio are strong predictors of advancing stages of acute and post-treatment auditory and neurologic impairment. However, bilirubin/albumin ratio, adjusted to the same sensitivity, does not improve prediction over total serum bilirubin alone. (Read the full article)

Prophylactic indomethacin in extremely low birth weight infants decreases severe intraventricular hemorrhage and patent ductus arteriosus but it is unknown whether concurrent enteral feeding and prophylactic indomethacin is associated with increased risk of spontaneous intestinal perforation.

The combination of prophylactic indomethacin and enteral feeding during the first 3 days after birth does not increase the risk of spontaneous intestinal perforation. (Read the full article)

Delivering competent oral case presentations is an important clinical communication skill, yet effective means of improving trainees’ presentations have not been identified.

Oral presentation feedback sessions facilitated by faculty by using an 18-item competency-based evaluation form early in pediatric clerkships improved medical students’ subsequent oral presentations. Medical schools should consider implementing this evidence-supported practice. (Read the full article)

Most studies of fetal alcohol syndrome and fetal alcohol spectrum disorders (FASD) prevalence in the general population of the United States have been carried out using passive methods (surveillance or clinic-based studies), which underestimate rates of FASD.

Using active case ascertainment methods among children in a representative middle class community, rates of fetal alcohol syndrome and total FASD are found to be substantially higher than most often cited estimates for the general US population. (Read the full article)

Previous studies have examined state regulations for child care facilities and found substantial variation among states. None of these studies examined regulations related to healthy sleep practices, which is an important and often overlooked intervention target for obesity prevention.

We reviewed state regulations related to healthy sleep in child care and compared them to recent national recommendations put forth by the Institute of Medicine. We found that many states lacked regulations, highlighting an important and timely opportunity for improvement. (Read the full article)

Pediatric Brain Injury Research Network investigators recently derived a highly sensitive clinical prediction rule for pediatric abusive head trauma (AHT).

The performance of this AHT screening tool has been validated. Four clinical variables, readily available at the time of admission, detect pediatric AHT with high sensitivity in intensive care settings. (Read the full article)

Lead is an ubiquitous environmental pollutant, and no safe threshold for blood lead level in children has been discovered yet. Prenatal lead exposure affects growth of children.

Low level of prenatal lead exposure of <5.0 μg/dL affects postnatal children’s growth, which was further intensified by low calcium intake. (Read the full article)