In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis.

Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events. (Read the full article)

Many children with blunt head trauma and isolated skull fractures are admitted to the hospital. Several small studies suggest that children with simple isolated skull fractures are at very low risk of clinical deterioration.

In this large cohort of children with isolated linear skull fractures after minor blunt head trauma, none developed significant intracranial hemorrhages resulting in neurosurgical interventions. These children may be considered for emergency department discharge if neurologically normal. (Read the full article)

Handheld echocardiography is a more portable and lower-cost alternative to standard echocardiography for rheumatic heart disease screening. Direct comparison of handheld echocardiography and auscultation for the detection of rheumatic heart disease has not been done previously.

Handheld echocardiography significantly improves detection of rheumatic heart disease compared with auscultation alone and may be a cost-effective screening strategy in developing countries. (Read the full article)

Topical corticosteroids are often used to treat atopic dermatitis (AD) in infants, although compliance is poor due to concerns over side effects. Pimecrolimus was shown to be a safe and effective noncorticosteroid treatment of AD in infants in short-term studies.

The Petite Study shows that long-term management of mild-to-moderate AD in infants with pimecrolimus or topical corticosteroids was safe without any effect on the developing immune system. Pimecrolimus had similar efficacy to topical corticosteroids and a marked steroid-sparing effect. (Read the full article)

Childhood obesity rates in the United States remain at historic highs. The pediatric primary care office represents an important, underutilized source of intervention. There is a need to test the efficacy of motivational interviewing for pediatric obesity in primary care.

This is among the first large-scale randomized trials to show significant reductions in BMI and that motivational interviewing, delivered by trained providers in the primary care setting, can be an important and feasible part of addressing childhood obesity. (Read the full article)

Smoking has been found to increase the risk of some specific congenital anomalies; however, results remain inconsistent. Nicotine replacement therapy (NRT) is increasingly being used as for smoking cessation in pregnancy although little is known about its association with congenital anomalies.

Being prescribed NRT while pregnant was not associated with major congenital anomalies (MCA), except a small increase in respiratory anomalies (3/1000 births). This must be considered in context of the rarity of MCAs and higher morbidities in the NRT group. (Read the full article)

Sharing human milk between those with an abundant supply and those seeking milk for their child is growing in popularity, including that facilitated by Web sites established to link buyers and sellers.

This study documents that human milk purchased via the Internet can be contaminated with cow’s milk, which poses a potential risk to infants with allergy or intolerance to cow’s milk. (Read the full article)

A program to support pediatric primary care providers in mental health care using point-of-care, telephone-based advice from specialists has been available since 2005 in Massachusetts. Other US states are implementing similar models. Little is known about how providers use this service.

There is wide variability in adoption and use of this program. Patterns are associated with panel size, enrollment timing, and assignment to the program team at the pilot site. Findings will help new programs establish expectations and design implementation interventions. (Read the full article)

Neonatal arterial ischemic stroke is associated with later cerebral palsy and cognitive impairment. Many studies on neonatal ischemic stroke are limited by modest sample sizes, and prospective studies that include outcomes assessments are scarce.

Results from this prospective, nationwide, population-based study provide information on the epidemiology, associated clinical variables, clinical manifestation, vascular distribution, and treatment of neonatal arterial ischemic stroke. The study also provides outcomes regarding motor function and cognition. (Read the full article)

Both obesity and developmental disabilities have increased in recent decades; however, the full long-term effects of prepregnancy obesity on a child’s psychosocial development remain unknown. Limited studies suggest associations between maternal prepregnancy obesity and child psychosocial development.

This study in 6-year-old children provides evidence that severe prepregnancy obesity is associated with adverse child psychosocial outcomes, including attention-deficit/hyperactivity disorder. These findings were not explained by many pregnancy and postpartum factors related to maternal obesity or child development. (Read the full article)

Clinical trials of the quadrivalent human papillomavirus vaccine show it to be highly efficacious in preventing vaccine-type–specific cervical dysplasia and anogenital warts, but few studies have assessed its effects in the real world and none have done so at the program/population level.

This study provides strong evidence of the early benefits of quadrivalent human papillomavirus vaccination on reductions in cervical dysplasia and possible reductions in anogenital warts among girls aged 14 to 17 years, offering additional justification for not delaying vaccination until girls are older. (Read the full article)

Disparities in asthma morbidity are exacerbated by underutilization of preventive controller medications. Community pharmacies are well positioned for an increased role in population health. The Asthma Medication Ratio, currently used at the patient-level, could be adapted for use at the pharmacy-level.

A newly developed Pharmacy-level Asthma Medication Ratio was associated with population-level childhood asthma morbidity. Collaborative relationships between physicians, community pharmacists, and patients (and families) have the potential to promote testable interventions aimed at reducing asthma morbidity and cross-community disparities. (Read the full article)

More than a quarter of child deaths in the United Kingdom are estimated to have identifiable failures in care. Although children account for 40% of the family practice workload, little is known about iatrogenic harm to children in this setting.

This is the first analysis of nationally collected pediatric safety incident reports from family practice. To mitigate harm to children, priority areas requiring improvement include medication provision, referral of unwell children, provision of evidence-based treatment, and adequate diagnosis and assessment. (Read the full article)

Newborn screening for critical congenital heart defects (CCHDs) has been implemented in many hospitals, yet there is uncertainty about the number of infants with CCHDs that might be detected through universal implementation of newborn CCHD screening in the United States.

We estimated that ~875 infants with CCHDs might be detected, and ~880 missed, annually through universal CCHD screening in the United States. Increases in prenatal diagnosis are unlikely to substantially impact the number of infants detected through CCHD screening. (Read the full article)

Early detection of scoliosis facilitates treatment. For detection, topographic features, such as truncal asymmetry or rib hump, are used.

We show a correlation between curve magnitude at presentation and BMI. Obesity may obscure physical examination findings. (Read the full article)

Insulin resistance plays a role in obesity. Recently it has been associated with increased risk of AD. Aβ42 and PSEN1 are molecules associated with increased risk of later AD. Patients affected by AD show elevated levels of plasma Aβ42.

Levels of Aβ42 and PSEN1 are significantly elevated in obese adolescents and correlated with the degree of both adiposity and systemic insulin resistance. (Read the full article)

Dyslexia has a lifelong impact on learning. The consensus in the literature from clinical studies is that dyslexia is not caused by vision abnormalities. However, interventions and therapies directed at eye-related functions are still available.

In this cohort the majority of dyslexic children had normal results for all ophthalmic tests. These population-based data support the consensus that dyslexia is not primarily a vision problem and that vision-based therapies are not justified or likely to help. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Associations have been reported between celiac disease (CD) and numerous autoimmune conditions in adults and children. However, current screening guidelines do not consider patients with rheumatic diseases to be at high risk for CD.

The prevalence of CD in children presenting for rheumatology evaluation was found to be 2% by routine serologic screening. The majority of screening-detected CD cases had no CD-associated symptoms. Gluten restriction was found to relieve some musculoskeletal complaints. (Read the full article)

Breastfeeding provides a protective effect against some malocclusions, and there is a strong inverse correlation between the duration of breastfeeding and the duration of pacifier use.

The protective effects of predominant and exclusive breastfeeding against malocclusion are distinct: exclusive breastfeeding reduces the risk of malocclusions regardless of pacifier use, whereas the effect of predominant breastfeeding depends on the duration of the pacifier use. (Read the full article)

Treatment of idiopathic steroid-resistant nephrotic syndrome is challenging, and therapeutic options are limited. In spite of good initial response with rituximab, responders always remain prone to further relapse, necessitating either repeat course of rituximab or addition of another steroid-sparing immunosuppressant.

Mycophenolate mofetil may be an effective maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory steroid-resistant nephrotic syndrome. (Read the full article)

Gastrostomy tube placement is a difficult decision for families of children with neurologic impairment. Better understanding the impact of these tubes on the lives of children and families will help improve decision-making and support from health care providers.

Gastrostomy tube placement has broad-reaching implications for children and their families. There are physical, emotional, and relational challenges and benefits for the child, the parents, and the family unit. Exploring potential outcomes with families may improve decision-making conversations and support. (Read the full article)

More than 200 million children <5 years are not reaching their developmental potential. Lack of stimulating caregiving is a major cause, and effective scalable interventions are needed. Integrating parenting with health services has been recommended, but there are few evaluations.

An innovative parenting intervention can be delivered at routine visits for primary health care, with benefits to child cognitive development and parenting knowledge. This approach using films, discussion, and practice has the potential for delivery at scale. (Read the full article)

Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown.

Results suggest that detection and disclosure of FMR1 newborn carrier status may not result in significant adverse events for mothers. (Read the full article)

Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric inpatient care quality remains unknown.

Most children are admitted to hospitals in which all-condition measures of inpatient quality are powered to show differences in performance from average, but most condition-specific measures are not. Policy on incentives for pediatric inpatient quality should take these findings into account. (Read the full article)

It is known that trisomy 21 decreases the risk of (nonocular) angiogenic-mediated disorders, such as solid tumors. It is not known whether trisomy 21 decreases the risk of ocular angiogenic-mediated disorders such as retinopathy of prematurity.

This study shows that trisomy 21 decreases the risk of retinopathy of prematurity (ROP), thus unmasking a potentially identifiable genetic component to ROP risk. This study paves the way for the future development of a laboratory-based ROP screening tool. (Read the full article)

Weak recommendations exist to guide emergent neuroimaging decisions in children with first, unprovoked seizures. The prevalence of and risk factors associated with clinically relevant abnormalities on neuroimaging have not been well defined in prospective studies.

Clinically relevant intracranial abnormalities on neuroimaging occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most of these children do not require emergent neuroimaging. Specific clinical findings identify patients at higher risk. (Read the full article)

Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appropriate advice from multiple sources such as family and physicians.

Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; the findings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention. (Read the full article)

Stevens-Johnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare.

We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non–Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate. (Read the full article)

A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising.

The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children <3 years old with intracranial injury plus ≥3 features, the estimated probability of abuse is >81.5%. (Read the full article)

Small-for-gestational-age neonates are at risk for thrombocytopenia during the first days and weeks after birth. However, the incidence, duration, severity, responsible mechanism, value of platelet transfusions, and risk of death from this variety of neonatal thrombocytopenia are unknown.

Ten percent of thrombocytopenic small-for-gestational-age neonates have a recognized cause for low platelets (aneuploidy, extracorporeal membrane oxygenation, disseminated intravascular coagulation); they have a high mortality rate (65%). Ninety percent have a moderate, transient (2 weeks), hyporegenerative thrombocytopenia with a low mortality rate (2%). (Read the full article)

Street youth demonstrate elevated mortality compared with the general adolescent and young adult population. Suicide is a leading cause of death among street youth. Many street youth have experienced childhood maltreatment, including abuse and neglect.

In this prospective cohort of street youth, self-reported attempted suicide and history of childhood maltreatment were common. Individuals who experienced childhood physical abuse, emotional abuse, or emotional neglect were at highest risk of attempting suicide. (Read the full article)

Attention is a prerequisite for neurocognitive and behavioral functioning, having a crucial role in academic and social child development. Children with traumatic brain injury have pronounced deficits in attention, but the nature and consequences of these deficits remain unclear.

Lapses of attention represent a core attention deficit after pediatric mild traumatic brain injury with risk factors for complicated traumatic brain injury, or moderate/severe traumatic brain injury. Importantly, lapses of attention explain the relation between intelligence and parent-rated attention problems. (Read the full article)

Previous studies have shown that concomitant administration of the quadrivalent human papillomavirus vaccine with MCV4 and Tdap was generally well tolerated and did not interfere with the immune responses to the respective vaccines.

Concomitant administration of the novel 9-valent human papillomavirus vaccine with MCV4 and Tdap, 2 vaccines that are currently recommended for routine vaccination of adolescents, did not compromise the safety, tolerability, and immunogenicity of the individual vaccines. (Read the full article)

The value of ultrasound imaging for the diagnosis, prognosis, and surgical planning of cryptorchidism is limited at best.

Ultrasound remains grossly overused by referring physicians throughout Ontario, Canada, which resulted in a 3-month delay to definitive surgery and unnecessary expenditures. (Read the full article)

Rudeness is routinely experienced by hospital-based medical teams. Individuals exposed to mildly rude behavior perform poorly on cognitive tasks, exhibit reduced creativity and flexibility, and are less helpful and prosocial.

Rudeness had adverse consequences on diagnostic and procedural performance of members of the NICU medical teams. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance. (Read the full article)

Concern of the risk of malignancy from ionizing radiation has prompted many to advocate for judicious use of computed tomography (CT) and as low as necessary radiation doses administered per scan. Recent analysis has shown a decline in CT utilization.

We identified decreases in CT utilization between 2004 and 2012 for the 10 most common diagnostic groups receiving CT. Decreases were typically associated with increases in alternate imaging modalities. We provide a possible reason for the decrease in CT utilization. (Read the full article)

Increasing percentages of youth are living with chronic medical conditions. Although adolescents face peak risks for onset and intensification of alcohol and marijuana use, we know little about these behaviors and their associations with treatment adherence among chronically ill youth.

This study quantifies alcohol and marijuana use behaviors among a heterogeneous sample of chronically ill youth in aggregate and by condition, and measures associations between alcohol use/binge drinking and knowledge about alcohol interactions with medications/laboratory tests and also treatment nonadherence. (Read the full article)

Adding second-stage automated auditory brainstem response (ABR) testing for infants who failed the initial OAE test in a two-stage neonatal hearing screening has been shown to reduce false referrals to the hearing clinic.

Infants with hearing loss may be missed by a 2-stage hearing screening because they pass the automated ABR test. In our study, a significant number of infants with hearing loss >45 decibel hearing level passed screening with automated ABR. (Read the full article)

The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth.

Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation. (Read the full article)

Maternal–child relationships among women raising children from sexual violence-related pregnancies (SVRPs) are not well understood. Limited case reports suggest widely varied and complex relationships. The determinants of these relationships are unknown.

With its large sample size, this article quantifies and analyzes maternal–child relationships among women raising children from SVRPs, and assesses the impact of stigma, acceptance, and maternal mental health on these relationships. (Read the full article)

Small for gestational age neonates (weight <10th percentile) are at risk for neutropenia during the first days after birth. However, the duration, responsible mechanism, and outcomes of this variety of neonatal neutropenia are not precisely known.

Six percent of small for gestational age neonates had neutrophils <1000/μL, with an average neutropenia duration of 7 days. Neutropenia was more closely linked with small for gestational age status than maternal hypertension. This neutropenia is associated with elevated nucleated red blood cell count and increased odds of necrotizing enterocolitis. (Read the full article)

Children with cystic fibrosis demonstrate gas exchange abnormalities and increased respiratory loads during sleep independent of lung function, age, and BMI. Assessment of breathing patterns during sleep provides an opportunity for detection of early lung disease progression.

Children with cystic fibrosis demonstrated increased respiratory loads and gas exchange abnormalities during sleep compared with controls. Based on these findings, sleep assessment in this patient population can identify markers for the early detection of lung disease progression. (Read the full article)

Maternal gestational weight gain is associated with childhood overweight. It is unknown whether gestational weight gain programs the child’s health or whether gestational weight gain is an indicator of postnatal behavioral factors.

We disentangled these influences by studying the effect of gestational weight gain simultaneously with postdelivery maternal weight change as an indicator for shared family lifestyle on child’s weight development and found that both had an independent effect. (Read the full article)

HPV is the most common sexually transmitted infection in the United States. More than 50% of sexually active men and women will acquire HPV infection in their lifetime. In 2011, HPV was recommended for routine use among male adolescents.

(Read the full article)

Given the efforts to decrease the use of ionizing radiation in pediatric patients, there is significant variability in head computed tomography (CT) scan use in pediatric emergency departments for minor head trauma.

This study characterized variability in CT scan rates for all body regions in emergency department, observation, and inpatient encounters across 30 tertiary pediatric hospitals. Two-fold variation remained after case-mix adjustment, with higher volume hospitals having lower rates of CT scanning. (Read the full article)

Apple is thought to be planning a merger of its app platforms, which means a developer can develop an app once and have it automatically run on iPhone, iPad, and Mac without any extra work. The initiative is called 'Marzipan.'

Lisa Dahlkvist's penalty won Sweden an Olympic shoot-out against favourites the United States, and Germany forged on, but France did not make it to the last four.

The Olympic women's football final will be an all-European affair after Sweden ousted hosts Brazil on penalties and Germany beat Canada in Tuesday's semi-finals.