Intussusception is the most common cause of intestinal obstruction in young children. To date, there have been no prospective studies that have been able to develop a reliable clinical prediction model to determine which patients are at low risk for intussusception.

This study is the largest prospective cohort study to date to evaluate children with possible intussusception. It includes both univariate and multivariate analyses to develop clinical prediction models for patients at low risk for intussusception. (Read the full article)

The professionalism of physicians can have an impact on patient care and satisfaction and physician career success and is increasingly emphasized in residency training programs.

This study was an examination of the perspectives of families of pediatric patients and of pediatrics residents on the attributes of professionalism in physicians. Important overlaps were found between the attributes of professionalism prioritized by patient families and resident physicians. (Read the full article)

Internet use has rapidly become a commonplace activity, especially among adolescents. Poor mental health and several somatic health problems are associated with heavy Internet use by adolescents.

Results of this study provide evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. Heavy Internet users were also confirmed to be at increased risk for somatic health problems in this nationally representative sample of adolescents. (Read the full article)

It has been well documented that exposure to tobacco marketing is a risk factor for smoking initiation among youth. However, few studies have tested the specificity of this association.

This study extends findings from other studies and shows (from a longitudinal design) that exposure to cigarette advertising is significantly associated with youth smoking initiation, whereas exposure to advertising for other commercial products is not. (Read the full article)

Approximately 27% of children with rotavirus in the hospital acquire it while hospitalized for another condition. Pediatric rotavirus vaccination greatly decreased the number of children hospitalized with rotavirus from 2007 to 2008.

Routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Thus, community-based vaccination efforts should be encouraged as a strategy to decrease hospital-acquired rotavirus. (Read the full article)

The National Children's Study, a large-scale, longitudinal, birth cohort study of US children that endeavors to identify preventable and environmental origins of chronic diseases, has begun recruitment.

In a highly diverse, urban setting, pregnant women can be recruited to participate in the National Children's Study at rates similar to those obtained in clinic settings. Refinements to the pregnancy screener and other components are needed to optimize implementation. (Read the full article)

Adults born at very low birth weight (VLBW) (<1.5 kg) have higher blood pressure and higher fasting insulin levels than their peers born at term. However, they show no signs of endothelial dysfunction in childhood and in adolescence.

Adults born at a VLBW showed no endothelial dysfunction compared with term adults. They had, however, a thicker intima-media layer in relation to lumen size. More rapid growth during their first weeks of life was associated with better endothelial function. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) has been the initial respiratory support for many preterm infants with respiratory distress syndrome (RDS). Nasal intermittent positive-pressure ventilation (NIPPV) seems to increase the beneficial effects of NCPAP by combining it with ventilatory inflations.

This study suggests that NIPPV, as an intial respiratory support for preterm infants with RDS, is feasible and safe and may have beneficial effects, when compared with NCPAP. (Read the full article)

Although gastroenteritis guidelines describe the need to perform oral rehydration, it remains underused, resulting in excessive use of intravenous rehydration. Other interventions, such as antiemetic administration, vary according to location, often resulting in differences in cost and outcomes.

In this nationwide cohort, intravenous rehydration use varied dramatically. Use was associated with the institution providing care and an increase in the need for future health care provider visits. Use of ondansetron also varied significantly across Canada. (Read the full article)

The direct effects of prolactin on the nutritional and antimicrobial composition of breast milk have not been examined previously in women.

The study demonstrates that recombinant human prolactin increases milk volume, induces changes in milk composition consistent with those during normal lactogenesis, and increases antimicrobially active oligosaccharide concentrations. The data suggest that prolactin is an important mediator of normal lactogenesis. (Read the full article)

Associations between short sleep duration, obesity, and metabolic dysfunction have been proposed for children but have not been explored appropriately.

The main findings included a nonlinear trend between sleep duration and body weight and the finding that children's sleep averaged 8 hours per night regardless of body weight. Lower sleep duration values were strongly associated with increased metabolic risk. (Read the full article)

For mothers of children with chronic medical conditions or disabilities, such as epilepsy or cerebral palsy, a history of maternal unresolved grief regarding the child's diagnosis has been associated with insecure infant-mother attachment.

Unresolved grief related to a preterm birth is associated with the development of insecure infantmother attachment. Mothers with resolved grief after preterm birth are 2.9 times as likely to have securely attached infants, compared with mothers with unresolved grief. (Read the full article)

Neurocognitive testing is recommended for the assessment of sport-related concussions. Computerized neurocognitive tests are more sensitive and more efficient than traditional neuropsychological testing in assessing sport-related concussions.

We describe the current prevalence of computerized neurocognitive testing, the relative use of the various computerized programs, the types of clinicians interpreting test scores, and associations of computerized tests with timing of return-to-play and medical provider type managing the athlete. (Read the full article)

The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF).

Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury. (Read the full article)

The efficacy of intravenous immunoglobulin and corticosteroid pulse combination therapy for refractory Kawasaki disease has been established. The Egami score can be used to predict which patients are likely to have refractory Kawasaki disease.

As a new strategy for primary treatment, intravenous immunoglobulin and corticosteroid pulse combination therapy is safe and effective for patients predicted to have refractory Kawasaki disease based on the Egami score. (Read the full article)

Educators, public health authorities, and law enforcement are confronting an increasing number of cases in which youth made sexual images of themselves and other minors and transmitted them via cell phones and the Internet.

This study provides the first detailed and comprehensive national estimate of the percentage of youth who create and distribute various kinds of sexual images. (Read the full article)

Preventive asthma medications (PAMs) are a primary management strategy to control asthma morbidity. Little is known about changes over time in prevalence of PAM use among children and adolescents in the United States.

Our analysis demonstrates an increase in use of PAMs among children and adolescents with current asthma in the United States from 1988–1994 to 2005–2008, but racial and ethnic disparities in use of PAMs persist. (Read the full article)

Media reports suggest that adolescents are being charged with sex crimes and even placed on sex offender registries because of participating in the "sexting" of sexual images, but the nature and outcomes of such incidents have not been described empirically.

This is the first study to examine types of sexting cases handled by police. It informs clinicians by identifying characteristics of "aggravated" versus milder incidents and finding that most youth were not arrested. Sex offender registration was rare. (Read the full article)

Primary hypertension is a growing concern in adolescents due to its association with the obesity epidemic. Recent studies have examined underdetection and underdiagnosis of hypertension in adolescents but medical management of primary hypertension in adolescents is not well-described.

Our study describes patterns of antihypertensive prescribing for adolescents with primary hypertension including the use of monotherapy versus combination therapy by physicians of different specialties and factors associated with receipt of antihypertensive therapy over a multi-year period. (Read the full article)

Most childhood HIV is acquired through perinatal transmission, some of which is preventable. Practitioners need to understand what proportion of perinatally acquired HIV infections are attributable to missed prevention opportunities.

Missed prevention opportunities include lack of early HIV testing for pregnant women; suboptimal use of antiretroviral medications during pregnancy, labor, or delivery or for the neonate; breastfeeding; and vaginal delivery when maternal viral load was ≥1000 copies/mL. (Read the full article)

Aluminum is ubiquitous and exposure is unavoidable. Adverse health effects have been associated with large exposures in workers or those with chronic kidney disease. There are no established age-specific reference ranges or toxicity data for populations of healthy children.

We demonstrate the wide variability of aluminum reference ranges in biological samples and that the ranges are not based on studies including healthy children. Further research is necessary to establish clinically relevant reference ranges for healthy children. (Read the full article)

Two UK models predict the risk of mortality in very preterm Western infants (1) alive at onset of labor and (2) admitted for neonatal intensive care. Prognostic models need temporal and geographic validation to evaluate their performance.

The 2 models showed very good performance in a recent large cohort of very preterm infants born in another Western country. The accurate performance of both models suggests application in clinical practice (Read the full article)

The prevalence of asthma and smoking among adolescents in Jordan is high. Well-designed, school-based, peer-led education programs can have a positive impact on asthma self-management in adolescents. Student peer leaders can be useful and responsible partners in health promotion programs.

A peer-led asthma education program —Adolescent Asthma Action—for adolescents developed in Australia was adapted to suit non–English-speaking cultures in the Middle East. Peer-led education led to improved self-management of asthma and motivated students to avoid smoking. (Read the full article)

Blood pressure and heart rate are altered by sleep state and postnatal age in healthy term and preterm infants. Preterm infants have altered blood pressure responses to head-up tilting during sleep.

Preterm birth has marked effects on the maturation of baroreflex sensitivity during sleep, which may contribute to the greater vulnerability of preterm infants to sudden infant death syndrome. (Read the full article)

Chorioamnionitis is associated with preterm birth and an increased risk of common adverse outcomes of prematurity, including early-onset sepsis and neurodevelopmental impairment. The effect of chorioamnionitis on postnatal immune function and risk of late-onset infection is unknown.

Chorioamnionitis, which complicates many preterm births, is independently associated with a significantly reduced risk of late-onset sepsis in preterm infants. The findings suggest that chorioamnionitis may modulate the development of postnatal immunity in a clinically significant manner. (Read the full article)

Children with special health care needs (CSHCN) account for more than one-third of pediatric health care costs. Little is known regarding the impact of shared decision-making (SDM) over time on child health care expenditures and utilization.

In a national sample, we found that increasing SDM was associated with decreased health care costs and utilization for CSHCN. Results support prospective studies to determine if pediatric interventions to foster SDM reduce the financial burden of caring for CSHCN. (Read the full article)

Clinical trials in children with severe traumatic brain injury (TBI) are challenging. To date, no work has been published that permits clinical investigators to estimate the number and compositional features of sites from which to recruit children with severe TBI into clinical trials.

Children with severe TBI are infrequent. Less than 5% of all US hospitals discharged more than 78% of severe TBI cases. To maximize enrollment efficiency for future clinical trials, attention has to be paid to selecting appropriate hospital sites. (Read the full article)

Available clinical prediction rules to identify children with cerebrospinal fluid pleocytosis at low risk for Lyme meningitis include headache duration, cranial nerve palsy, and percent cerebrospinal fluid mononuclear cells. These rules require independent validation.

These clinical prediction rules accurately identify patients at low risk for Lyme meningitis in our large multicenter cohort. Children at low risk may be considered for outpatient management while awaiting Lyme serology. (Read the full article)

Prematurely born children have an increased prevalence of behavioral problems in the long term. Knowledge regarding the effects of early intervention programs is sparse, and more randomized controlled trials are warranted.

A modified version of the Mother-Infant Transaction Program showed beneficial effects on behavioral outcomes reported by both parents of preterm infants with birth weights of <2000 g at a corrected age of 5 years. (Read the full article)

Predischarge serum or transcutaneous bilirubinometry (TcB) measurements are recommended as appropriate screening options for identifying infants at risk for neonatal hyperbilirubinemia (NH). Visual inspection for jaundice is not reliable at identifying infants with NH in the community.

When compared with visual inspection alone, coordinated TcB screening for NH in acute-care and community settings is associated with significant improvements in laboratory utilization, patient care, convenience, and safety. (Read the full article)

Lactoferrin is a glycoprotein with anti-infective activities being part of the innate defensive network. Bovine and human lactoferrin share high homology. Bovine lactoferrin can prevent late-onset sepsis in preterm very low birth weight neonates.

In preterm very low birth weight infants, bovine lactoferrin is able to prevent not only late-onset sepsis but also systemic fungal infections. This protection is achieved independently from their colonization status. (Read the full article)

Although there is some older literature examining how arrest prevalence accumulates through adolescence and adulthood, there is no contemporary research examining the arrest histories of a representative sample of American youth.

Using a contemporary US sample of adolescents and young adults, we estimated the cumulative arrest prevalence through age 23. The results suggest a substantial increase in the cumulative prevalence of arrest since the 1960s. (Read the full article)

Overweight has been associated with an increased risk of asthma in children, although the published literature is contradictory. How change in overweight status during childhood affects asthma risk has not been well studied.

Among children whose weight has normalized, high BMI during the first 4 years of life does not increase the risk of asthma at school age. Current high BMI is associated with increased risk of asthma and sensitization to inhalant allergens. (Read the full article)

The quality of the relationship between mother and child affects the child’s neurodevelopment, emotion regulation, and stress response. Extreme or sustained stress responses are associated with dysregulation of physiologic systems involved in energy balance, which could lead to obesity.

The prevalence of obesity in adolescence was more than twice as high among those youth who in early childhood had poor-quality relationships with their mothers compared with those with better relationships. (Read the full article)

Upper respiratory tract infections (URIs) are very common in children. Currently, there are no effective preventive measures for URI. There are no studies on the effect of montelukast for prevention of URI.

In a randomized, double-blind, placebo-controlled study of preschool-aged children, 12-week prophylactic treatment with montelukast did not reduce the incidence of URI. (Read the full article)

Eating disorders are characterized by preoccupation with weight and shape, which is manifested by a refusal to maintain a normal weight. An exact determination of expected body weight (EBW) is critical for diagnosis and clinical management of these disorders.

The McLaren and Moore methods present with several limitations when calculating EBW for adolescents with eating disorders. A commonly agreed upon method for EBW calculation such as the BMI percentile method is recommended for clinical and research purposes. (Read the full article)

Studies on vaccine safety are crucial to the ongoing success of our national immunization program. ITP has a known association with MMR in young children, occurring in 1 in 40 000 doses. The risk after other childhood vaccines is unknown.

This study found no increased risk of ITP after vaccines other than MMR in young children, confirmed an association of ITP with MMR, and also found that ITP may occur after certain other vaccines in older children. (Read the full article)

Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume–outcome relationship.

A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. (Read the full article)

Recommendations in pediatrics call for general developmental screening of young children; however, research suggests social-emotional development, in particular, is important as an initial indicator of general well-being versus risk, and may warrant inclusion in screening protocols.

Via a social-emotional screening program, significant percentages of children can be identified as being at risk for social-emotional problems, and colocation of an early childhood psychologist promotes the ability to effectively address young children’s social-emotional development within their medical home. (Read the full article)

Over the past decade, drug oversight committees and professional organizations have debated the evidence regarding cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deficit/hyperactivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this controversy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deficit/hyperactivity disorder before prescribing stimulants. (Read the full article)

In the United States, drowning is the second leading cause of unintentional injury death among children (1–19), accounting for >1000 deaths per year. Total lifetime costs in 2000 were estimated to be $2.6 billion for children aged 0 to 14.

National trends in pediatric drowning hospitalizations by age and gender have not been reported. This study provides benchmarks that can be used for state and regional comparisons and monitoring of injury prevention efforts. (Read the full article)

Asthma is a common obstructive pulmonary disease experienced during pregnancy. Clinical guidelines recommend women with asthma maintain asthma medication use during pregnancy. Epidemiologic studies suggest an association between several types of defects and asthma or asthma medication use during pregnancy.

Data from a large, population-based, multicenter, case-control study was used. This provides the opportunity to study specific birth defects with minimal heterogeneity in case groups, as well as control for a variety of potential confounders. (Read the full article)

Traumatic brain injury in school-aged children is associated with intellectual, behavioral, and social deficits. Research into outcomes of children injured before 3 years of age is limited despite data suggesting a high incidence of injury in this age group.

Results show that a moderate to severe traumatic brain injury before 3 years of age is associated with lowered cognitive function. Furthermore, this study highlights the link between social disadvantage and poor outcomes after traumatic brain injury in early childhood. (Read the full article)

Hepatitis A infection causes severe disease among adolescents and adults. Hepatitis A vaccination (HepA) is recommended universally at 1 year, with vaccination through 18 years based on risk or desire for protection.

This is the first study to evaluate adolescent HepA coverage in the United States using provider-reported vaccination data. HepA coverage was low among adolescents, leaving a large population susceptible to hepatitis A infection maturing into adulthood. (Read the full article)

Mixed prevalence rates of co-occurring psychiatric and neurodevelopmental conditions have been reported in children diagnosed with an autism spectrum disorder (ASD). ASD diagnoses remain fairly stable within a continuum, but some do not meet criteria for an ASD diagnosis years after initial diagnosis.

Co-occurring neurodevelopmental and psychiatric conditions may explain, in part, why the diagnosis of an ASD may change with age. (Read the full article)

Necrotizing enterocolitis (NEC) can present within the first week of life in term infants. In preterm infants, NEC usually appears after commencement of feeds and can occur between 2 and 3 weeks of life.

Among infants <33 weeks’ gestation, NEC appears to occur at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower gestational age infants. (Read the full article)

Recent studies have called into question the benefit of perioperative corticosteroids in children undergoing heart surgery, but have been limited by small sample size, the lack of placebo control, and the grouping of various steroid regimens together in analysis.

We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates and found no mortality or length-of-stay benefit associated with any regimen, and a higher risk of infection in certain subgroups. (Read the full article)

Childhood UV light exposures, specifically sunburns, have been shown to be associated with melanoma development later in life.

To date, most studies in this age group have been cross sectional in nature. This is the first prospective study of sunburn and sun behaviors in this age group. (Read the full article)

Previous research has demonstrated that young children with traumatic brain injury are at elevated risk of poor outcomes, particularly following severe injuries. These deficits persist until at least 5 years postinsult. Factors predicting outcomes in this age group have not been established.

This study follows survivors of very early traumatic brain injury into adolescence. Results indicate that severe injury is associated with poorest outcome, but after 3 years, the gap between children with severe traumatic brain injury and peers stabilizes. (Read the full article)

Epilepsy/seizure disorder is known to be associated with a range of mental health and neurodevelopmental comorbidities, based on clinical studies, and on population studies largely conducted outside the United States.

In a nationally representative sample of US children, estimated prevalence of reported lifetime epilepsy/seizure disorder was 1%, and of current epilepsy/seizure disorder was 6.3/1000. Developmental, mental health, and physical comorbidities are common, warranting enhanced surveillance, and an integrated service approach. (Read the full article)