Antibiotics-induced rash in Epstein-Barr virus acute infectious mononucleosis, especially the aminopenicillins-induced type, was first described during the 1960s, with a reported incidence of 80% to 100%. This phenomenon was not further investigated but is well-established in pediatric textbooks.

The main observation of this study is that rash induced by amoxicillin in confirmed Epstein-Barr virus acute infectious mononucleosis was found at a rate of ~30%, which is much lower than previously reported. (Read the full article)

Cognitive and motor developmental test scores of preterm and late preterm infants increase with gestational age. Developmental test scores in full-term infants have not previously been considered to relate to gestational age.

In a cohort of healthy, full-term infants, 37 to 41 weeks, 12-month mental and psychomotor scores on the Bayley Scales of Infant Development increased with gestational age, suggesting that neurodevelopment is optimal in infants born at 39 to 41 weeks. (Read the full article)

Children are taking more medications than ever before. Medication errors in the hospital are common. Less is known about the medication errors that occur in children's homes, and there are no studies that examine the entire process.

We reviewed 963 medications in the homes of children with cancer at 3 sites. We found 3.6 errors with injury and 36 errors with potential for injury per 100 patients. Interventions should target common and dangerous errors at home. (Read the full article)

Juice consumption among 2- to 5-year-old children exceeds dietary recommendations. In 2007, the US Department of Agriculture revised the composition and quantities of prescribed foods in WIC food packages to align them with dietary guidelines. Juice allowances were reduced by approximately half.

WIC participants purchased about a quarter less juice volume after implementation of the revised WIC packages. Large reductions in WIC-provided juice were only partly compensated for by extra juice purchases with non-WIC funds. Little compensation occurred for other beverages. (Read the full article)

Extremely preterm infants who receive antihypotensive therapy have worse outcomes than untreated infants. The reasons for this are not clear. High-quality randomized trials have not been performed to date because of logistical challenges, thereby necessitating alternative methods of investigation.

Antihypotensive therapy administration was not associated with improved in-hospital outcomes for any of the 15 definitions of low blood pressure investigated. Alternative methods of deciding who to treat are needed to maximize patient benefit and minimize harm. (Read the full article)

Infants with a diverse gut microbial flora are less likely to develop eczema and allergy.

Parental sucking of their infant’s pacifier is associated with a reduced risk of allergy development and an altered oral flora in their child. Transfer of oral microbes from parent to infant via the pacifier might be used in primary prevention. (Read the full article)

Before the introduction of conjugate pneumococcal vaccines and routine penicillin prophylaxis, febrile patients with sickle cell disease were known to have a 3% to 5% risk of bacteremia. Consequently, hospitalization rates for febrile episodes are >70%.

We observed no mortality or morbidity among those managed completely as outpatients, and bacteremia occurred in <1%. Physicians should strongly consider outpatient management of febrile children with sickle cell disease if there are no other indications for admission. (Read the full article)

Cognitive behavioral therapy is an effective and safe treatment of chronic fatigue syndrome in children and adolescents. After 6 months, Internet-based cognitive behavioral therapy in the form of FITNET led to an 8 times higher chance of recovery compared with usual care.

The positive effects of FITNET were maintained at long-term follow-up (>2.5 years).Patients following usual-care treatment achieve similar recovery rates at long-term follow-up. (Read the full article)

Pharmacologic treatment with sapropterin dihydrochloride (6R-tetrahydrobiopterin; BH4) has been an effective option for some phenylketonuria patients since its approval by the US Food and Drug Administration in 2007 and the European Medicines Agency in 2008.

This retrospective multicenter study revealed the long-term effects of sapropterin on metabolic control, dietary tolerance, and the outcome of BH4-responsive phenylketonuria patients harboring specific phenotypes and genotypes. It also confirmed that the minor adverse events disappeared by lowering the dose. (Read the full article)

Abdominal pain is a frequent complaint in pediatric emergency departments, with a broad differential diagnosis. The impact of demographic and clinical characteristics of patients on the evaluation and management of these children is not well known.

The most common cause of abdominal pain is constipation, which rarely requires hospital admission. Demographic factors, in particular race, do not seem to affect evaluation and management. (Read the full article)

Cross-sectional studies in children and adults have reported a significant positive association between attention-deficit/hyperactivity disorder (ADHD) and obesity.

This controlled, prospective, follow-up study of boys with ADHD found significantly higher BMI and obesity rates in adulthood, compared with men without childhood ADHD, regardless of socioeconomic status and other lifetime mental disorders. (Read the full article)

Sleep patterns of adult monozygotic twins are more similar than those of dizygotic twins, showing moderate heritability and little effects of environmental influences. There have been very few genetically informative studies of sleep in preschool children and results appear inconsistent.

From previous studies, we investigated daytime and nighttime continuous sleep duration longitudinally. This is the first time that the etiologies of daytime and nighttime continuous sleep duration trajectories were studied in early childhood. (Read the full article)

There are ethnic differences in lung function, with white people generally having higher values of FVC and FEV₁ than people of South Asian origin, whereas differences in forced expiratory flows are absent or less marked. The underlying reasons are unknown.

Lung function differences were not explained by cultural, socioeconomic, or perinatal factors, nor by environmental exposures or wheezing illness. This suggests that genetic factors are responsible, and supports the use of ethnicity-specific prediction equations for children of South Asian origin. (Read the full article)

Obesity is a growing concern for Mexican-American adolescents, with both behavioral and cultural variables that are related to the increasing trend.

These results highlight a patient-centered view of the emotional and physical burden of obesity in female Mexican-American adolescents, the families’ personal struggles with weight-related conditions, and the challenge of balancing family needs with those specific to the adolescent. (Read the full article)

Infants born late-preterm and early-term are at higher risk of morbidity and mortality compared with term infants. Home care practices recommended for all infants include supine sleep position, no smoke exposure, and breastfeeding to optimize health outcomes.

Our study provides new findings on the timing of hospital discharge, outpatient follow-up, and home care of late-preterm and early-term infants compared with term infants in the United States. (Read the full article)

Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications.

Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, β-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. (Read the full article)

The remarkable improvement in the survival of extremely premature infants has been well documented. However, there have been few cohort studies large enough to determine the neurodevelopmental outcomes of survivors born at 22 or 23 weeks.

The proportions of unimpaired or minimally impaired were 12.0% at 22 weeks (n = 75) and 20.0% at 23 weeks (n = 245). The outcomes were inferior compared with those for infants born at 24 and 25 weeks, but were improved compared with those in previous studies. (Read the full article)

Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children >12 months of age.

The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up. (Read the full article)

Atherosclerotic cardiovascular diseases are rooted in childhood. Vascular intima-media thickness (IMT) and elasticity are early surrogate markers of atherosclerosis. In adults, cardiorespiratory fitness is associated with enhanced arterial elasticity and decreased IMT.

Fitness was favorably associated with aortic IMT and elasticity in adolescents. The association was independent of several cardiometabolic risk factors. In fit adolescents, the increase in IMT during the preceding 6 years was smaller compared with low-fit peers. (Read the full article)

Although concussion is increasingly being diagnosed in the pediatric population, little is known about what factors lead to prolonged postconcussive symptoms in children. In particular, the effect of previous history of concussion on recovery from a repeat injury is unclear.

Children with a history of previous concussion, particularly recent or multiple concussions, are at increased risk for prolonged symptoms after concussion. This suggests that repeat concussion, particularly within a vulnerable time window, may lead to longer duration of symptoms. (Read the full article)

About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.

In this large randomized controlled trial, anticipatory guidance on the "when, what, and how" of complementary feeding was associated with increased maternal "protective" feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance. (Read the full article)

Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.

Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. (Read the full article)

Popular press and research show that sibling aggression is common. Too often, however, it is dismissed as benign, and other forms of child aggression, such as peer aggression, are considered more serious. Peer aggression is linked to poorer mental health.

Using a national probability sample, we show that the nature and severity of sibling aggression have negative links to children’s and adolescents’ mental health. We demonstrate that sibling and peer aggression are comparable their links to symptoms of distress. (Read the full article)

Obesity is associated with cardiometabolic risk factors and chronic conditions, such as type 2 diabetes. However, a proportion of overweight and obese youth remain free from cardiometabolic risk factors and are considered metabolically healthy.

This study provides insight into the determinants of cardiometabolic risk factors and the concept in health promotion of "fitness versus fatness." Hepatic lipid accumulation and not fitness level appears to drive cardiometabolic risk factor clustering among overweight and obese youth. (Read the full article)

Young adult smokers frequently encounter the health care system as parents coming in for their child’s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents.

This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice. (Read the full article)

Infants born late preterm and early term are at increased risk for short-term morbidities compared with term infants. Longer-term morbidity and disability in this group of infants is not well established.

Massachusetts infants born late preterm and early term are at increased risk of early intervention program enrollment than term infants. Boys and children whose mothers were less educated, older, and with public insurance were most affected. (Read the full article)

Child maltreatment is a serious and prevalent public health problem in the United States. Responsible for substantial morbidity and mortality, maltreatment affects children's physical and mental health.

Although many health impacts of child maltreatment have been documented, no claims-based study has quantified the impact of maltreatment on health service utilization and costs. This study presents systematic claims-based estimates of maltreatment impacts on utilization and costs for the Medicaid population. (Read the full article)

Cornelia de Lange syndrome (CdLS) is a genetic syndrome with multisystem abnormalities. Infections are a significant cause of morbidity and mortality in affected patients and are typically attributed to anatomic abnormalities.

This study identified a high frequency of antibody immunodeficiency in CdLS subjects, indicating a critical need for screening and management of immunodeficiency in CdLS patients with a history of severe or recurrent infections. (Read the full article)

Violence involving firearms is a leading cause of death among US youth ages 14 to 24. The emergency department is the primary medical setting for care of assault-injured youth and an underused but important setting for violence-prevention programs.

Among assault-injured youth seeking emergency department care, firearm possession rates are high, most obtained outside of legal channels. Higher rates of negative retaliatory attitudes and substance use among those youth with firearms increases risk of future lethal violence. (Read the full article)

Children exposed to alcohol prenatally have increased risk of a range of developmental problems such as language delay, behavior problems, learning, and memory and cognitive deficits, all of which can have a negative impact on educational achievement.

The expression of learning problems varied with the dose, pattern, and timing of prenatal alcohol exposure. Test scores below national benchmarks for reading were associated with first trimester heavy alcohol exposure and for writing after late pregnancy occasional binge drinking. (Read the full article)

Obstacles to vaccine delivery, including poverty, reduced access to medical care, and incomplete understanding of vaccine safety and importance, result in suboptimal coverage rates in some populations, allowing for disease outbreaks. Multicomponent interventions are successful in increasing immunization coverage rates.

We show that collaboration with local resources, including the county health department and a large community-based organization, effectively increases immunization coverage rates in low-income, resource-poor children. (Read the full article)

Physical punishment is associated with a range of Axis I and II mental disorders in adulthood. More research is needed on the possible long-term relationship between physical punishment and physical health.

To our knowledge, this is the first nationally representative examination of harsh physical punishment and physical health. Harsh physical punishment in the absence of child maltreatment is associated with higher odds of cardiovascular disease (borderline significance), arthritis, and obesity. (Read the full article)

There is wide variation in testing and treatment of children hospitalized with pneumonia. Limited data are available on diagnostic testing patterns and the association of test utilization with disposition outcomes for children with pneumonia evaluated in the emergency department (ED).

Significant variation exists in testing for pediatric pneumonia. EDs that use more testing have higher hospitalization rates. However, ED revisit rates were not significantly different between high- and low-utilizing EDs, suggesting an opportunity to reduce testing without negatively affecting outcomes. (Read the full article)

Assessment of general movements (GM) in early infancy is predictive of adverse neurologic outcome, particularly cerebral palsy. There is limited evidence of the predictive value of GM for other domains of neurodevelopment such as language and cognitive impairment.

Abnormal GM in preterm infants in the first 3 months postterm are predictive of a range of neurodevelopmental outcomes in early childhood. GM at 3 months are more accurate at distinguishing later neurodevelopment impairment than those at 1 month. (Read the full article)

Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months.

This study assessed the respective effects of early- and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early- and late-onset sepsis were associated. (Read the full article)

Twin studies suggest that bronchopulmonary dysplasia (BPD) is heritable; however, only a small number of genetic loci have been associated with BPD and these explain only a limited amount of this heritability.

A genome-wide association study of singleton infants (899 BPD cases and 827 controls) of 25 to 30 weeks’ gestational age did not identify single-nucleotide polymorphisms associated with BPD at the genome-wide significance level but did identify polymorphisms warranting further study. (Read the full article)

Previous research on potential deleterious effects of typically developing children growing up in households with children with disability has produced mixed results. Research methods have been cited as a problem in many studies.

This is the largest known empirical study comparing functional impairment in siblings living with a child with disability and siblings residing with children who are typically developing. This study also follows the trajectory of functional impairment across 2 measurement periods. (Read the full article)

Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied.

Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. (Read the full article)

Data available before the 1990s in addition to small studies with clinical populations have shown that ocular growth and development differ between extremely preterm and term-born children.

Contemporary data on long-term visual outcomes indicate that adolescents born extremely low birth weight and/or extremely preterm exhibit more visual sensory and perceptual morbidity than adolescents born at term. (Read the full article)

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric has examined 30-day risk-adjusted outcomes in children’s surgery. Because of low event rates, initial efforts yielded valid models that did not meaningfully discriminate outcomes among over 20 participating institutions.

Programmatic growth, sampling algorithm refinement, and hierarchical modeling use have resulted in the ability to reliably discriminate performance among hospitals in multiple domains. We report the first actionable peer-reviewed risk-adjusted, multiinstitutional outcome data in children’s surgery. (Read the full article)

Respiratory outcomes of patients with bronchopulmonary dysplasia (BPD) range from no oxygen requirement to chronic respiratory failure. Outcomes of least severe types of BPD are well described. Limited data exist on outcomes of patients with BPD-related chronic ventilator dependency.

Along with a first estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were dependent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation. (Read the full article)

Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes.

This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. (Read the full article)

Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. Inhaled nitric oxide given to reduce morbidity in very preterm infants does not reduce the prevalence of bronchopulmonary dysplasia and has uncertain effects on long-term outcome.

Inhaled nitric oxide (5 ppm) given early in the course of respiratory illness in infants born before 29 weeks of gestation is not associated with changes in developmental or respiratory outcomes at 2 years of age corrected for prematurity. (Read the full article)

Tympanometry provides a measure of middle ear function. There has been no description of the relationship between measurements of middle ear function in the absence of gross anatomic defects and clinical outcome among children with acute nontraumatic coma.

This study reveals an unexpected association between abnormal middle ear function and death in childhood acute coma. These findings call for more investigations on the relationship between middle and inner ear anatomy and function and intracranial dynamics and clinical outcomes. (Read the full article)

Pulse oximetry screening at 24 hours of age improves detection of critical congenital heart disease in asymptomatic newborns.

This study describes an initial experience with pulse oximetry screening for critical congenital heart disease and provides a strategy for preparing for state implementation of recent federal newborn screening recommendations. (Read the full article)

Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates.

This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. (Read the full article)

The intestinal microbiome may play a role in immune system maturation, and it has been postulated that early-life probiotic administration may reduce the risk of allergies and asthma in childhood. To date, however, results from clinical trials have been inconsistent.

In this meta-analysis, administration of probiotics in early life may reduce total immunoglobulin E level and protect against atopic sensitization but do not seem to protect against asthma/wheezing. Future trials should carefully select probiotic strains and include longer follow-up. (Read the full article)

Effective implementation of Pediatric Emergency Care Applied Research Network head trauma rules depends on their early application. As the registered nurse (RN) is often the first to evaluate children with blunt head trauma, initial RN assessments will be an important component of this strategy.

We demonstrated fair to moderate agreement between RN and physician providers in the application of the Pediatric Emergency Care Applied Research Network head trauma rules. Effective implementation strategies may require physician verification of RN predictor assessments before computed tomography decision-making. (Read the full article)

The incidence of pediatric pneumococcal meningitis has declined after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). It is unknown whether the frequency of severe neurologic sequelae and adverse outcomes has changed in the era of widespread PCV7 use.

Pneumococcal meningitis continues to be associated with substantial mortality and long-term morbidity. Sixty-three percent of survivors had neurologic sequelae. More than one-half of the children who were eligible for PCV7 were unimmunized at the time that they developed pneumococcal meningitis. (Read the full article)

Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)