Arthropod-borne viruses are important causes of neurologic infections among children in the United States. The epidemiology of these diseases is complex and relates to multiple factors, including vector biology, animal reservoirs, weather, and human behavior.

National surveillance data from 2003 to 2012 will improve understanding of the geographic, temporal, and clinical trends in pediatric neuroinvasive arboviral disease, and will inform decision-making for clinicians, public health authorities, and the general public. (Read the full article)

Recent concussion research has examined the role of impact location (ie, the area on the head to which impact occurred); however, no studies exist regarding impact location’s association with concussion outcomes (eg, symptomatology, symptom resolution time, return to play).

This study is the first to examine the association of impact location and concussion outcomes in young athletes. Our findings suggest that impact location, as assessed by sideline observers/player report, is likely of little use in predicting clinical outcomes. (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)

The prevalence of disability in childhood has been on the rise for the past several decades. Children living in poverty are more likely to have chronic health conditions and experience disabilities.

The percentage of children with disabilities rose 16% between 2001 and 2011. Economically disadvantaged children had the highest rates of disability, but economically advantaged children experienced greater increases in disability. Disability due to neurodevelopmental or mental health conditions rose substantially. (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)

With the publication of evidence-based guidelines for asthma, bronchiolitis, and pneumonia, numerous efforts have been made to standardize and improve the quality of care. However, despite these guidelines, variation in care exists.

This study establishes clinically achievable benchmarks of care for asthma, bronchiolitis, and pneumonia. Using a published method for achievable benchmarks of care, we calculated average utilization among the high-performers, which can serve as achievable goals for local quality improvement. (Read the full article)

Rates of human papillomavirus (HPV) vaccination lag behind other adolescent vaccines. Research indicates that provider recommendation is the key to improving HPV vaccination rates and that most adolescents who are unvaccinated received other vaccines, indicating missed opportunities for HPV vaccination.

This study explores in-depth the content of provider–patient conversations that either create or prevent opportunities for HPV vaccination. Effective and ineffective conversations are presented with the goal of providing practical tools to improve communication regarding HPV vaccines. (Read the full article)

Urinary tract infection is the most common serious bacterial illness among febrile infants and young children. Automated urine cytometry may supplant traditional urinalysis, but diagnostic performance at unique pediatric cutpoints has not been described for this labor-saving technique.

We describe new, clinically useful cutpoints for automated leukocyte and bacterial counts. The sensitivity and specificity of bacterial counts ≥250 cells/μL exceed those of other methods. However, point-of-care dipstick tests for leukocyte esterase or nitrite have acceptable performance. (Read the full article)

It is thought that vaccination coverage increases during and immediately after an infectious disease epidemic; however, little evidence exists to support this phenomenon.

The 2011 to 2012 pertussis epidemic did not significantly change the proportion of infants in Washington State who were up to date for pertussis-containing vaccines. This finding may challenge conventional wisdom that vaccine acceptance uniformly increases when risk of disease is high. (Read the full article)

Recent case reports have described acute life-threatening complications in adolescents who present to health services having lost large amounts of weight but who are not underweight. Little is known about the frequency of life-threatening complications in these adolescents.

Over 6 years, we found more than a fivefold increase in the incidence of hospitalized adolescents who, apart from not being underweight, have diagnostic features of anorexia nervosa. This group experienced a similar profile of acute complications of anorexia nervosa. (Read the full article)

Cardiovascular risk begins in childhood. New clinical guidelines established a care strategy for lowering risks. Incorporation of guidelines into routine practice lags due to barriers related to knowledge and attitudes about guidelines, as well as behaviors of practitioners, patients, and clinical systems.

This study demonstrated that a multifaceted approach including tools, education, and support for changes in practice systems can accelerate the adoption of guidelines during routine pediatric well-child visits, compared with dissemination of the guidelines alone. (Read the full article)

Growth impairment in sickle disease has been a consistent finding in published reports. Hydroxyurea (HU) decreases vasoocclusive events and increases hemoglobin levels, which may improve growth. However, HU may adversely affect growth in young children by its effect on DNA synthesis.

Height, weight, and head circumference were normal in HU-treated children in the study as compared with the World Health Organization standards. Height, weight, and BMI z scores were similar in placebo and treatment groups. There were no harmful effects of HU on growth. (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)

Asymptomatic neonatal subdural hemorrhage (SDH) is common, resolves within 4 weeks, and is typically infratentorial or posterior when supratentorial. Subdural hemorrhages may occur after cardiac surgery in infancy. Some hypothesize a causal relationship between hypoxia and SDH in infancy.

Asymptomatic neonatal SDH is often supratentorial and over the convexities. Small infratentorial SDHs may persist for ≤90 days. In young infants with congenital heart disease, an association between hypoxia and SDH could not be demonstrated. (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)

Although frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives across the United States, little is known about the health services these patients receive in the ED.

Eight percent of children account for 24% of ED visits and 31% of all costs. Frequent utilizers of pediatric EDs, especially infants without a chronic condition, are least likely to need medications, testing, and hospital admission during their ED visits. (Read the full article)

Parental reduced antigen diphtheria-tetanus-acellular pertussis (Tdap) vaccination is difficult to implement, and empirical data on its impact is limited to a single hospital-based study in Texas, which found no reduction in infant pertussis hospitalization.

In New South Wales, Australia, a case-control study found both parents receiving Tdap ≥4 weeks before disease onset was associated with a significant reduction in risk of early infant pertussis and suggestive of persistent protection in subsequent pregnancies. (Read the full article)

Influenza leads to respiratory deteriorations in cystic fibrosis (CF) patients. In children, live attenuated influenza virus vaccine (LAIV) is more efficacious than inactivated influenza vaccines, which could be beneficial for CF. Data on the safety of LAIV in this population are scarce.

This study assesses LAIV’s safety in patients with CF and is necessary to determine whether the anticipated benefits associated with LAIV will outweigh potential risks. This can potentially lead to a recommendation for preferential LAIV use in this population. (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)

Childhood immunization might contribute to an increase in asthma prevalence. Previous studies have been contradictory, and many lack sufficiently large control groups of nonimmunized children.

Pertussis immunization in infancy does not increase the risk of asthma medication in adolescents. Our study presents convincing evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma. (Read the full article)

Sleep disorders are common in children and adolescents and have a substantial negative impact on daily life and school performance. Long-term evaluations of the efficacy and safety of pharmacologic treatment options for sleep disorders are lacking in pediatric patients.

These 2 studies provide the first evaluation of the effectiveness and safety of eszopiclone in children and adolescents with insomnia associated with ADHD. Data presented here encompass longer-term (up to 1 year) pediatric exposure to eszopiclone. (Read the full article)

Admissions to the ICU during off-hours (nights and weekends) have been variably associated with increased mortality in both adults and children. Changes in staffing patterns, patient characteristics, or other factors may have influenced this relationship over time.

This study demonstrates in a large, current, multicenter database sample that off-hours admissions to PICUs are not associated with increased risk-adjusted mortality. Admissions in the morning from 6:00 am to 10:59 am are associated with increased mortality and warrant further attention. (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)

The built environment may affect weight status by presenting opportunities or barriers for exercise and nutritious eating. Although there is substantial cross-sectional evidence linking neighborhood factors and childhood obesity, causal uncertainty remains, owing to conceptual and methodological challenges.

This prospective study examined neighborhood influences on obesity during the transition to adolescence, a sensitive period for excess weight gain. Girls living in neighborhoods characterized by physical disorder or increased access to food and service retailers exhibited higher obesity risk. (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)

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)

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)

Preterm birth and faster infant growth have been identified as independent risk factors for autism-spectrum disorders (ASD). However, associations between prematurity and ASD-related traits as a continuum and effects of infant growth among those born preterm are still little studied.

VLBW young adults reported higher levels of ASD-related traits, particularly traits related to poorer social skills. Within the VLBW group, faster growth in weight, height, and head circumference from birth to term was associated with lower levels of ASD-related traits. (Read the full article)

Despite growing interest around clinical screening for health-related social and environmental risk factors, little evidence exists regarding screening formats that maximize disclosure of psychosocial information.

This study compares psychosocial and socioeconomic adversity disclosure rates in face-to-face interviews versus electronic formats in a large, urban pediatric emergency department. (Read the full article)

Randomized controlled trials (RCTs) of intensive clinician-implemented interventions have demonstrated significant improvements in outcomes of toddlers and preschool children with autism spectrum disorder. RCTs of parent-implemented interventions have demonstrated improvements in parent skills, but generally they have not demonstrated effects on children’s outcomes.

This RCT found significantly greater improvements with individual home coaching on child outcome measures of social communication, adaptive behavior, and developmental level. These findings support the efficacy of a parent-implemented intervention using little professional time, which increases potential community viability. (Read the full article)

National adolescent vaccination coverage estimates in 2013 among 13- to 17-year-olds are 86% for Tdap vaccine and 78% for MCV4. Comparatively, coverage with ≥3 doses of HPV vaccine is 38% among girls and 14% among boys.

One-fourth of 11-year-olds had HPV vaccine co-administered with Tdap vaccine, compared with two-thirds who had MCV4 co-administered. Whereas by age 17 years, >92% received Tdap vaccine and MCV4, only half of girls and one-fifth of boys completed HPV vaccination. (Read the full article)

Pneumococcal conjugated vaccines (PCVs) are known to decrease invasive pneumococcal disease in children, but their effect on pneumonia necessitating hospitalization is more variable across study sites, and effects on hospitalization for sinusitis have not been shown previously.

There was a significant decrease in hospitalizations for sinusitis in children <2 years of age, and hospitalization for pneumonia decreased in children aged <5 years after sequential introduction of PCV7 and PCV13. (Read the full article)

A previous study suggested that physicians in 1 practice network were less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for OM for black versus nonblack children.

Nationally, black children with OM are more likely to receive guideline-recommended, narrow-spectrum antibiotics than nonblack children. These findings may reflect inappropriate treatment of OM with the use of broad-spectrum antibiotics in a majority of US children. (Read the full article)

Children who suffer abusive head trauma (AHT) have lasting health and development problems. AHT can reduce life expectancy dramatically. AHT’s contribution to the burden of disease has been estimated only as part of a broad category of intentional injury.

The DALY burden of a severe AHT case averages 80% of the burden of death, with most survivors dying before age 21 years. Even mild AHT is extremely serious, with lasting sequelae that exceed the DALY burden of a severe burn. (Read the full article)

Primary ciliary dyskinesia presents in infancy with unexplained neonatal respiratory distress, yet diagnosis is often delayed until late childhood. Earlier diagnosis facilitates earlier onset of therapy, which may help to reduce long-term pulmonary morbidity and mortality.

A diagnostic workup for primary ciliary dyskinesia should be considered in a term infant presenting with unexplained respiratory distress and either lobar collapse, situs inversus, or a prolonged oxygen therapy requirement (>2 days). (Read the full article)

IP-10 is a novel immunologic marker for tuberculosis (TB) infection. It has been suggested that IP-10 may perform better in children compared with the QuantiFERON test, but only a few studies have investigated IP-10 for diagnosing active TB in children.

This study is the first to investigate IP-10 and QuantiFERON for diagnosing TB in children by using consensus classifications. Both IP-10 and QuantiFERON exhibited poor performance in children from a high-burden setting, and performance was especially compromised in young children. (Read the full article)

Younger age has been identified as an independent risk factor for all-terrain vehicle (ATV)-related injuries. Since the mid-1980s, one-third of ATV-related deaths have involved children younger than 18 years of age.

Using national data, we found both similarities and differences between pediatric age groups in the contribution of known risk factors to ATV-related deaths. The observed differences suggest the importance of targeting injury prevention approaches to specific age ranges. (Read the full article)

Cesarean delivery has previously been associated with increased risk of specific immune diseases in children. The mechanism remains unknown.

In 1 large population-based cohort, we demonstrate cesarean delivery as a shared risk factor for several immune-related diseases. Such common risk factor suggests early life commonality in the origins of these chronic immune disorders. (Read the full article)

Influenza represents a leading cause of morbidity and a rare cause of death in children. Annual influenza vaccination was gradually expanded to include all children ≥6 months in 2008. The impact of these recommendations on disease burden is unclear.

We assessed the burden of influenza-related health care encounters in children aged 6 to 59 months from 2000 to 2011. In this ecologic exploration, influenza vaccination and influenza-related emergency department visits increased over time, whereas hospitalizations decreased. Influenza-related health care encounters were greater when A(H3N2) circulated. (Read the full article)

There is a debate about whether e-cigarettes will benefit public health. However, there is little knowledge about how e-cigarette users and dual users (those using both e-cigarettes and tobacco cigarettes) differ from other adolescents on a range of variables.

Teenagers who only used e-cigarettes were intermediate in levels of risk and protective factors between nonusers and those who used both cigarettes and e-cigarettes. This raises a question about whether e-cigarettes recruit low-risk youth to tobacco product use. (Read the full article)

Necrotizing enterocolitis is associated with high mortality and morbidity in premature infants. Anaerobic antimicrobial therapy has been associated with increased risk of intestinal strictures in a small randomized trial. Optimal antimicrobial therapy for necrotizing enterocolitis is unknown.

Anaerobic antimicrobial therapy was associated with increased risk of stricture formation. Infants with surgical necrotizing enterocolitis treated with anaerobic antimicrobial therapy had lower mortality. For infants with medical necrotizing enterocolitis, there was no added benefit associated with anaerobic antimicrobial therapy. (Read the full article)

Early diagnosis of LOS in preterm infants may be challenging because of the questionable accuracy of blood culture and the common markers of infections, such as C-reactive protein and procalcitonin.

Our study demonstrated for the first time that P-SEP is an accurate biomarker for the diagnosis of LOS in preterm infants and might contribute to the monitoring of infant response to therapeutic interventions. (Read the full article)

Children and adolescents with attention-deficit/hyperactivity disorder are prone to sustaining trauma that requires emergency department (ED) admission. Methylphenidate can reduce attention-deficit/hyperactivity disorder symptoms and thus theoretically may reduce the risk of trauma-related ED admission, but previous studies did not provide a clear association.

For patients treated with methylphenidate, on-medication periods were associated with lower rates of trauma-related ED admission compared with off-medication periods. A similar protective association was found in both genders. Potential treatment benefit was greater for age ≥16 years. (Read the full article)

Maternal depression has been associated with adolescent engagement in risky behaviors such as substance use. However, there is a lack of longitudinal research examining timing-specific effects in this relationship.

The results of this study indicate that youth exposed to increasing levels of maternal depressive symptoms in middle childhood are more likely to engage in substance use and delinquent behaviors and have an earlier debut age of these behaviors. (Read the full article)

Frequency of influenza vaccination is low, partially because of missed opportunities to vaccinate. Barriers to implementing successful influenza vaccination reminders in the electronic health record include alert fatigue and incomplete vaccination information due to scattered records.

A noninterruptive, immunization information system–linked influenza vaccination reminder can increase vaccination late in the winter when fewer vaccine doses are usually administered. Tailoring the reminder to clinicians’ needs can increase its use. (Read the full article)

Retrospective studies have shown that the majority of parents, independent of their country of origin, prefer a shared approach over a paternalistic approach or an informed approach when an end-of-life decision must be made for their children.

In actual conversations parents act in line with their preference for a shared approach. This behavior contrasts with the "some sharing" approach of physicians who carefully prepare parents for an end-of-life decision already being made by the medical team. (Read the full article)

Although pediatric professional guidelines emphasize addressing a child’s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families’ receipt of community-based resources.

This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families. (Read the full article)

Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks’ gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated.

Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks’ gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. (Read the full article)

Behavioral observations influence a clinician’s decision to diagnose or refer, and may even override formal screening results. In the case of autism spectrum disorder, an expected rate of atypical behavior during the span of a medical visit is unknown.

We are the first to quantify the high base rates of typical behavior in young children who have autism and language delay. When observation times are brief, the preponderance of typical behaviors may negatively impact referral decision accuracy. (Read the full article)