Recent guidelines for the management of childhood pneumonia recommend narrow-spectrum antimicrobial agents (eg, ampicillin) for most children; however, few studies have directly compared the effectiveness of narrow-spectrum agents to the broader spectrum third-generation cephalosporins commonly used among children hospitalized with pneumonia.

By using data from 43 children’s hospitals in the United States, we demonstrate equivalent outcomes and costs for children hospitalized with pneumonia and treated empirically with either narrow- (ampicillin/penicillin) or broad-spectrum (ceftriaxone/cefotaxime) antimicrobial therapy. (Read the full article)

It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child’s risk for specific adverse health outcomes.

By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors. (Read the full article)

Over the past 10 years, children’s hospitals increasingly have established pediatric palliative care programs, but little is known about the prevalence of these programs or their geographic distribution, range of services offered, staff composition, or funding.

Among the 162 hospitals that responded to this survey (71.7% response rate), 69% have a pediatric palliative care program, with substantial variation across programs in terms of how they are staffed and funded and what services they provide. (Read the full article)

Levels of daily physical activity in children are decreasing worldwide. This implies risk factors for cardiovascular and metabolic diseases.

Strength training makes children not only stronger but significantly increases their daily spontaneous physical activity outside the training intervention. (Read the full article)

Children with chronic illnesses tend to be sicker during infections than previously healthy children but are triaged in the same way, even though the validity of triage systems has not yet been evaluated in these chronically sick children.

The performance of the Manchester Triage System was lower for children with a chronic illness than for previously healthy children. Children with cardiovascular illnesses, respiratory illnesses, gastrointestinal illnesses, or other congenital or genetic defects were especially at risk of being undertriaged. (Read the full article)

Peripherally inserted central catheters (PICCs) are essential to deliver life-saving treatment to neonates. Longer PICC dwell times may increase the risk of central line–associated bloodstream infections (CLABSIs) in neonates, but previous studies have yielded inconsistent results, likely due to different study designs, analytic methods, and small sample sizes.

The risk of CLABSIs increases during the 2 weeks after PICC insertion and remains elevated for the catheter duration. These data support daily review of PICC necessity, optimization of catheter maintenance practices, and consideration of novel strategies to prevent CLABSIs. (Read the full article)

In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.

Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention. (Read the full article)

Stable health insurance coverage facilitates access to health care. Despite expanded coverage options for children, parents report barriers to accessing insurance programs for their children, including uncertainty about a child’s coverage status and eligibility.

Electronic health records can be used as an emerging data source for conducting health insurance surveillance to track trends in patients’ insurance coverage status, and to identify patients who may benefit from outreach and support to obtain and maintain coverage. (Read the full article)

Late-onset sepsis is a frequent complication of prematurity, contributing to morbidity and mortality. Although evidence is accumulating that administration of probiotics to very preterm infants reduces necrotizing enterocolitis (NEC) and all-cause mortality, the effect on late-onset sepsis is less clear.

The probiotic combination Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis reduced NEC in very preterm infants, but not mortality or late-onset sepsis. Probiotics may be of greatest global value in neonatal settings with high rates of NEC. (Read the full article)

Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.

In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development. (Read the full article)

Although community engagement is considered an important professional role of physicians, there has been declining involvement of pediatricians in community child health activities. Whether enhanced training is associated with increased involvement is unclear.

This study reveals a continued decline in pediatricians’ involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians’ community involvement. (Read the full article)

Few data on treating children hospitalized for influenza with neuraminidase inhibitors are available, contributing to uncertainty regarding the benefits of treatment.

This study of nearly 800 critically ill children suggests that treatment with neuraminidase inhibitors improves survival from influenza. This message needs additional emphasis, given that in the past 2 seasons over one-third of cases did not receive antiviral treatment. (Read the full article)

Socioeconomic status is known to influence health and health care utilization, but few studies have explored the relationship between community-level income and inpatient resource utilization for children.

In a large sample of pediatric hospitalizations, lower community-level household income is associated with higher inpatient costs of care for common conditions. These findings highlight the need to consider socioeconomic status in health care system design and reimbursement. (Read the full article)

Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease, resulting in morbidity. Magnesium is a vasodilator and has been shown to improve red blood cell hydration. Previous small studies have suggested that treatment with magnesium may decrease VOEs.

Intravenous magnesium sulfate is well tolerated in relatively high doses but had no effect on the length of stay in hospital, pain scores, or cumulative analgesia used in children admitted with painful VOEs in sickle cell disease. (Read the full article)

Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time.

This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available. (Read the full article)

Pediatric surgery is performed in a variety of hospital types. General surgeons as well as fellowship-trained pediatric surgeons and surgical subspecialists perform inpatient operative procedures on infants and children. The distribution of procedures between specialists is not well characterized.

This study describes the demographics of pediatric surgery: the hospital type, the surgical procedures, and the quantity of inpatient pediatric surgery in the U.S. today. By implication, the data has much to inform health care about hospital and practitioner workforce. (Read the full article)

Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors.

The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. (Read the full article)

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health condition diagnosed in childhood, is highly heritable, and more common in boys. Although studies have identified perinatal risk factors, no one has investigated perinatal risk factors separately in boys and girls.

Contrary to other studies, low birth weight, postterm pregnancy, low Apgar scores, and fetal distress were not risk factors for ADHD irrespective of gender. Early term deliveries increased the risk of ADHD, and oxytocin augmentation in girls may be protective. (Read the full article)

Use of behavioral health (BH) screens in pediatrics have increased identification of children with BH issues. Screening rates increased in Massachusetts after it was mandated, as did the volume of some mental health services.

This is the first study of children after Massachusetts mandated behavioral screening began. Almost 40% of children who screened positive were newly identified. Being male, having a BH history, and being in foster care predicted a positive screen. (Read the full article)

Increasing numbers of hospitals are instituting 24/7 in-hospital pediatric intensivist coverage. Data regarding patient outcomes are mixed and the impact on housestaff education remains unknown.

This study quantifies the perceived impact of in-hospital attending coverage on pediatric resident and critical care fellow education and also investigates the growing concern that increasing supervision may contribute to housestaff being less well prepared for independent clinical practice. (Read the full article)

Broad-spectrum antibiotics are frequently used to empirically treat children hospitalized with community-acquired pneumonia despite recent national recommendations to use narrow-spectrum antibiotics.

Narrow-spectrum antibiotics are similar to broad-spectrum antibiotics for the treatment of children hospitalized with community-acquired pneumonia in terms of clinical outcomes and resource utilization. This study provides scientific evidence to support national consensus guidelines. (Read the full article)

The emergency department (ED) is a critical contact location for youth violence interventions. Information on the characteristics of youth, motivations for fights leading to the injury, as well as previous health service utilization of assault-injured youth seeking care is lacking.

Assault-injured youth are characterized in a systematic sample demonstrating frequent ED use and the need to address substance use and lethal means of force in interventions; context and motivations for the fight are novel and will inform intervention efforts. (Read the full article)

Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders.

Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. (Read the full article)

Inconsistent results have been reported on the association between sleep duration and blood pressure (BP) in children, likely as a result of inadequate adjustment for confounders and the use of different time frames in assessing sleep duration.

Short sleep duration and poor sleep quality are associated with higher BP in normal-weight adolescents. One night of adequate sleep may partially ameliorate the risk of high BP but cannot completely reverse the effect of chronic sleep insufficiency. (Read the full article)

Hypertonic saline (3% and 5%), has been shown to improve clinical severity scores and reduce inpatient length of stay, and was associated with a trend toward lower admission rate in acute bronchiolitis.

We are not aware of any previous data using 7% hypertonic saline in bronchiolitis. Our results suggest that 7% saline does not lower clinical severity of illness, admission rate, or length of stay, when compared with normal saline. (Read the full article)

Fewer clinical trials are performed in children compared with other patient populations. It is unknown how well existing pediatric clinical trials are aligned with the needs of children, both in high-income countries and globally.

There is only moderate correlation between clinical trial activity and pediatric burden of disease, with certain conditions substantially underrepresented in the current research portfolio. Our findings provide a benchmark for prioritizing conditions for study, analyzing gaps, and identifying funding priorities. (Read the full article)

The management of term and near-term newborns suspected of early-onset sepsis, particularly when they are not clearly symptomatic, remains controversial. Methods for quantifying risk that combine maternal factors with a newborn's evolving clinical examination have been lacking.

This study provides a method for predicting risk of early-onset sepsis. It combines maternal risk factors with objective measures of a newborn's clinical examination and places newborns into 3 risk groups (treat empirically, observe and evaluate, and continued observation). (Read the full article)

Early adiposity rebound is associated with future obesity and an increased risk of development of type 2 diabetes and coronary heart disease in adult life.

This study shows that early adiposity rebound is associated with future obesity and metabolic consequences of higher triglycerides, atherogenic index, apolipoprotein B, and blood pressure and lower high-density lipoprotein cholesterol at 12 years of age. (Read the full article)

Studies have shown dysfunction in the baroreflex mechanism and the autonomic nervous system, particularly in the sympathetic nervous system, in the pathophysiology of chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and syncope.

Vitamin B₁₂ deficiency is associated with postural orthostatic tachycardia syndrome in adolescence. (Read the full article)

Payment arrangements that blend global budgets with pay-for-performance are proliferating. However, little is known about how these contracts affect pediatric health care quality and spending for children with and without special health care needs receiving care from large provider organizations.

A prototypical global budget contract significantly improved preventive care quality measures tied to pay-for-performance, especially for children with special health care needs. It did not alter trends for spending or for quality measures that were not tied to pay-for-performance. (Read the full article)

Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.

We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years’ corrected age. (Read the full article)

Systematic health disparities in adults with systemic lupus erythematosus are well documented and are likely driven by biologic as well as modifiable factors. Sociodemographic factors and health care delivery characteristics have been associated with poor outcomes.

In hospitalized children with systemic lupus erythematosus, race and ethnicity were associated with increased risk for ICU admissions, end-stage renal disease, and death. Identification of sociodemographic factors associated with outcomes is important to address the needs of these vulnerable patients. (Read the full article)

Although appendicitis is the most common surgical cause of abdominal pain in pediatrics, its diagnosis remains elusive. When evaluated independently, clinical scoring systems and ultrasonography have been shown to have low to moderate sensitivity in the diagnosis of appendicitis.

Our study evaluated the accuracy of a clinical practice guideline combining the Samuel’s pediatric appendicitis score and selective ultrasonography as the primary imaging modality for children with suspected appendicitis. Our clinical pathway demonstrated high sensitivity and specificity. (Read the full article)

Due to reports of unintentional overdoses, in 2011 the US Food and Drug Administration finalized voluntary recommendations for dosing devices included with over-the-counter (OTC) liquid medications. The Consumer Healthcare Products Association previously endorsed similar recommendations for devices and dosing directions.

This study assessed dosing directions and devices for national brand name OTC liquid medications, available after a voluntary FDA guidance, and found high levels of adherence to most recommendations. Further improvement efforts should prioritize recommendations directly addressing potential dosing errors. (Read the full article)

Self-medication with over-the-counter (OTC) analgesics, particularly paracetamol (PCM), among children is widespread and increasing. Parents often administer the medicine. The health care system has little knowledge or possibility to regulate OTC medication, and use of PCM for children may be partly unjustified.

Maternal frequent self-medication with OTC analgesics is associated with frequent use of OTC analgesics, particularly PCM, among 6- to 11-year-old schoolchildren, even when the child’s frequency of pain is accounted for. (Read the full article)

Warnings of increased risk for suicidality have been placed on antidepressant medications. Because antidepressants differ in their characteristics, including effects on neurotransmitters, it is possible that the risk of suicidal behavior for individual medications may differ.

In a cohort of 36 842 children with review of medical records for confirmation of suicide attempts, we found no difference for risk of suicide attempts among individual medications compared with fluoxetine, the currently recommended antidepressant for treatment of depression. (Read the full article)

There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients.

Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. (Read the full article)

The effects of previous school-based physical activity promotion interventions have been modest, and none have demonstrated significant or meaningful increases in children’s physical activity outside of school, a period characterized by disproportionally low levels of physical activity in youth.

This study adds to the evidence-base for the effectiveness of comprehensive school health programs by demonstrating that such novel interventions lead to statistically significant, meaningful increases in the amount of physical activity children achieved on weekends and after school hours. (Read the full article)

Biomarkers such as C-reactive protein (CRP) and procalcitonin are elevated in children with severe bacterial infections. Children with severe malnutrition are at increased risk of bacterial infections and early markers for the diagnosis of infection in these children are needed.

Despite elevated values in severely malnourished children with invasive bacterial infection or infectious diarrhea, CRP and procalcitonin have limited diagnostic value. CRP could predict death in these children with a good negative predictive value. (Read the full article)

Recommended management of febrile neonates (≤28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments.

There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations. (Read the full article)

The Centers for Disease Control and FITNESSGRAM BMI percentile thresholds are commonly used for obesity screening in youth. It is assumed that these thresholds are predictive of metabolic health risk, but little diagnostic data are available.

Both thresholds are predictive of metabolic syndrome, more so for boys than for girls, although with differing sensitivity and specificity. The diagnostic details of the thresholds can inform clinicians and practitioners about how these standards perform in practice. (Read the full article)

In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past.

A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control. (Read the full article)

Anabolic-androgenic steroid misuse is not uncommon among adolescent boys, and initial use in adolescence is associated with a host of maladaptive outcomes, including cardiovascular, endocrine, and psychiatric complications.

This is the first known study to examine prevalence rates of anabolic-androgenic steroid misuse as a function of sexual orientation. A dramatic disparity was found, in that sexual minority boys reported misuse at a much higher rate than heterosexual boys. (Read the full article)

Fetal growth restriction, particularly in preterm children, is associated with delayed development and poor growth. Knowledge about the consequences of fetal growth restriction if classified by symmetry is lacking, especially in preterm children.

In preterm children, symmetric and asymmetric growth restriction at birth results in poorer growth later in life. Both groups are at considerable risk of developmental delay because their long-term development is independent of their head circumference at birth. (Read the full article)

Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents.

Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible. (Read the full article)

It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.

This is the first study to provide evidence that preterm infants’ exposure to adult words in the NICU before the mother’s due date are associated with better cognitive and language outcomes at 7 and 18 months’ corrected age. (Read the full article)

A growing body of research suggests that the food environment affects children’s weight. Specifically, living in areas with higher-priced fast foods and soda is associated with lower weight and BMI, whereas higher fruit and vegetable prices demonstrate the opposite association.

Using longitudinal data on lower-income young children, this study finds that higher-priced fruits and vegetables are associated with higher child BMI, but not food insecurity, and that this relationship is driven by the prices of fresh fruits and vegetables. (Read the full article)

Previous analyses have documented increased health care costs for children with autism spectrum disorders but have not provided comprehensive estimates of the total economic burden.

There are substantial additional costs associated with caring for children with autism spectrum disorders, amounting to >$17 000 per child annually. Costs accrued outside of the health care system account for the majority of the financial burden. (Read the full article)

Research indicates that bullying, a type of peer victimization, is related to worse mental and physical health. Most previous studies have been cross-sectional and have not examined effects of bullying over time.

This analysis examined longitudinal effects of bullying on mental and physical health from middle school to high school. Experiencing chronic bullying, especially in both the past and present, was associated with worse psychological and physical health. (Read the full article)

In children with congenital toxoplasmosis, ocular lesions can be detected and may relapse after birth despite pre- and postnatal treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.

Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment. (Read the full article)