The single-family room (SFR) NICU is a major response to improve care and reduce developmental morbidity in preterm infants. However, no studies have examined how and why this model is associated with changes in medical and neurobehavioral outcome.

This study shows improved medical and neurodevelopmental outcome in infants hospitalized in the SFR model of care. More important, improvements occurred specifically in relation to increases in maternal involvement and developmental support afforded by the SFR environment. (Read the full article)

More than 200 million children <5 years old in low- and middle-income countries are not reaching their potential in cognitive development because of factors associated with poverty.

Poverty affects children’s cognition as early as 7 months and continues to increase until 5 years of age. It is mainly mediated by parental education, birth weight, home stimulation throughout the 5 years, and growth in the first 24 months. (Read the full article)

Continuously aerosolized albuterol been shown to be safe and effective for the treatment of severe status asthmaticus in the emergency department and ICU. Little evidence supports its use in the non–intensive care setting.

With the appropriate resources and support, continuous albuterol may be administered in the non–ICU setting with a low incidence of clinical deterioration and adverse effects. Certain clinical factors may help identify which patients may benefit from higher acuity care. (Read the full article)

Children who have attention-deficit/hyperactivity disorder (ADHD) attending clinical services have poorer outcomes in adolescence on a range of measures. However, it is unknown how early in development these impairments appear, particularly for community-ascertained samples.

At age 6 to 8 years, children in the community with ADHD have significantly poorer mental health, academic performance and social function compared with control children. Children who have impairing ADHD symptoms should be referred early for assessment and intervention. (Read the full article)

Physical activity programs have been shown to have positive implications for children’s cognitive performance and brain structure and function. However, additional randomized controlled trials are needed to determine whether daily physical activity influences executive control and its neural underpinnings.

The randomized controlled trial, designed to meet daily physical activity recommendations, used behavioral and electrophysiological measures of brain function to demonstrate enhanced attentional inhibition and cognitive flexibility among prepubertal children. (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)

In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs). Since 2004, hyperglycemic and diabetes risk with SGAs has been stated in product labels, and published guidelines have recommended baseline metabolic screening.

Between 2006 and 2011, 11% of children 2 to 18 years starting an SGA had baseline glucose assessed. Youth at risk for diabetes may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia. (Read the full article)

Little is known about how pediatricians communicate with overweight Latino children and their parents regarding overweight and obesity.

Findings suggest that many overweight Latino children and their parents do not receive direct communication that the child is overweight, weight-management plans, culturally relevant dietary recommendations, or follow-up visits. (Read the full article)

Parental smoking cessation helps eliminate children’s exposure to tobacco smoke. A child’s visit to the doctor provides a teachable moment for parental smoking cessation. Effective strategies to help parents quit smoking are available for implementation.

Evidence-based outpatient intervention for parents who smoke can be delivered successfully after the initial implementation. Maximizing parental quit rates in the pediatric context will require more complete and sustained systems-level integration. (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)

Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. Telomere length and perceived facial age are 2 indicators of accelerated aging.

Perinatal complications predicted greater signs of accelerated aging "inside," as measured objectively by leukocyte telomere length, an indicator of cellular aging, and "outside," as measured subjectively by perceived age, an indicator of declining integrity of tissues. (Read the full article)

Delivering competent oral case presentations is an important clinical communication skill, yet effective means of improving trainees’ presentations have not been identified.

Oral presentation feedback sessions facilitated by faculty by using an 18-item competency-based evaluation form early in pediatric clerkships improved medical students’ subsequent oral presentations. Medical schools should consider implementing this evidence-supported practice. (Read the full article)

The population of youth with chronic medical conditions is growing and many attend college. Yet we know little about US colleges’ capacity to identify and care for these youth, nor how transition guidelines and financing models should incorporate college health.

This is the first study to find that although many colleges can provide some clinical care for youth with chronic conditions, few colleges have systems to identify and track these students, elucidating gaps that pediatricians and institutions need to address. (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)

In 2000/2001, the American Academy of Pediatrics published recommendations for attention-deficit/hyperactivity disorder (ADHD) care. According to pediatricians’ self-report of adoption of these guidelines, community-based ADHD care appears to be marginally adequate.

Using reviews of >1500 patient charts, this study demonstrates that community-based ADHD care is not consistent with evidence-based practice. Furthermore, variability in much of community-based ADHD care is unrelated to the provider, suggesting that innovative, system-wide interventions are needed to improve ADHD care. (Read the full article)

Neurodevelopment can be adversely affected by viral infections. Human herpesvirus-6 (HHV-6) is similar to cytomegalovirus and can cause central nervous system disease. Congenital HHV-6 infection occurs in ~1% of live births, with unknown neurodevelopmental consequences.

HHV-6 congenital infection is associated with lower scores on the Bayley Scales of Infant Development II Mental Development Index compared with control infants at 12 months of age and may have a detrimental effect on neurodevelopment. (Read the full article)

Youth in foster care are at higher risk of health problems at entrance and during their stays in care. Little is known about this group’s risk of health problems in young adulthood, in comparison with other populations of young adults.

This is the first prospective study to our knowledge demonstrating that former foster youth are at higher risk of chronic health problems than economically secure and insecure general population young adults. (Read the full article)

Studies have shown that reciprocal vocalizations between mother and infant have positive effects on language development. It has been shown that girls acquire vocabulary and language skills earlier than boys.

Mothers more readily respond to their infant’s vocal cues than fathers, and infants show a preferential vocal response to their mothers in the first months of life. Mothers respond preferentially to infant girls versus boys at birth and 44 weeks. (Read the full article)

Studies have shown that setbacks, such as receiving low school grades, lead children to experience negative self-feelings (eg, shame, insecurity, powerlessness). Psychological theory predicts that unconditional regard can buffer this adverse impact of setbacks. However, causal evidence is lacking.

This randomized field experiment shows that briefly reflecting on experiences of unconditional regard buffers children’s negative self-feelings after an academic setback 3 weeks later. Unconditional regard may thus be an important psychological lever to reduce negative self-feelings in youth. (Read the full article)

In developed countries, child health disparities across wealth gradients are commonly widening; at the same time, child mortality in low- and middle-income countries is declining. Whether these declines are associated with widening or narrowing disparities is unknown.

A systematic analysis of the evidence on child mortality gradients by wealth in less-developed countries shows that mortality is declining fastest among the poorest in most countries, leading to declining disparities in this important indicator of child health. (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)

There is variability in cerebral palsy prevalence estimates in low-resource countries, related to definitions, detection of milder cases, diagnosis age, and adequate training for clinicians. Thus, differences in prevalence and motor patterns between high- and low-resource countries remain unclear.

There were more children with dystonia and less with spasticity in Bangladesh compared with Australia (cerebral palsy diagnosis/motor classifications were consistent between settings). Differences in motor patterns between high- and low-resource countries have profound implications for early detection and appropriate interventions. (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)

Fathers’ attitude and support affects breastfeeding outcomes. Fathers are currently not targeted in breastfeeding support and care provided by health care professionals. Breastfeeding interventions delivered to fathers have been shown to increase breastfeeding exclusivity and duration.

A coparenting breastfeeding support intervention delivered to mothers and fathers in the postpartum period showed beneficial effects on breastfeeding duration, paternal breastfeeding confidence, breastfeeding help provided by fathers, and mothers’ satisfaction with fathers’ involvement with breastfeeding. (Read the full article)

White matter abnormality (WMA) on neuroimaging is considered a crucial link with adverse neurodevelopmental outcome in preterm infants. Brain MRI is more sensitive in detecting WMA than cranial ultrasound (CUS), but questions remain about timing and prognostic value of modalities.

Near-term CUS and MRI abnormalities were associated with adverse 18- to 22-month outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of later neuroimaging in this large, extremely preterm cohort surviving to near-term. (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)

Prenatal alcohol exposure can cause congenital neuropsychological and behavioral disabilities in later life. These usually lead to secondary disabilities (adverse outcome when the individual interacts with environmental settings), such as problems with school, the law, alcohol, or drugs.

This was a 30-year psychosocial register–based follow-up on adults with fetal alcohol syndrome and state care comparison group. The FAS-group had lower education and higher rates of unemployment, social welfare, and mental health problems than peers. Rates of criminality did not differ. (Read the full article)

American Public Health Association reported >3.2 million students in the United States are bullied each year; 160 000 students skip school every day for fear of bullying. Little is known about whether bullying affects health-related quality of life (HRQOL) among college students.

Different types of bullying experiences affected different domains of HRQOL. Precollege bullying had long-term effects on HRQOL. Verbal/relational bullying-victimization experiences, mediated via depression, affected psychological HRQOL. Findings inform preventive and clinical practice to ameliorate the impact of bullying. (Read the full article)

Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine.

Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness. (Read the full article)

In 2009, only 58% of pediatricians were using electronic health records (EHRs), most of which were lacking pediatric functionality. The American Recovery and Reinvestment Act (ARRA) of 2009 accelerated the implementation of EHRs in pediatric offices.

The effects of ARRA have remained largely unmeasured in pediatrics. This study provides information on the prevalence and functionalities of EHRs, as well as physicians’ perceptions. (Read the full article)

Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion.

Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1–2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. (Read the full article)

Measles-containing vaccines are associated with several types of adverse events. Because measles-mumps-rubella-varicella (MMRV) versus separate measles-mumps-rubella (MMR) and varicella (MMR + V) vaccine increases a toddler’s risk for febrile seizures, we investigated whether MMRV is riskier than MMR + V and whether either vaccine elevates risk for additional safety outcomes.

Comparing MMRV with MMR + V, no increased risk of immune thrombocytopenia purpura, anaphylaxis, ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease was detected. No new safety concerns were identified after either vaccine, and most outcomes studied were unlikely after either vaccine. (Read the full article)

Pediatric traumatic brain injury (TBI) contributes to impairments in functioning across multiple settings. Online family problem-solving therapy may be effective in reducing adolescent behavioral morbidity after TBI. However, less is known regarding maintenance of effects over time.

This large randomized clinical trial in adolescents with TBI is the only study to examine maintenance of treatment effects. Findings reveal that brief, online treatment may result in long-term improvements in child functioning, particularly among families of lower socioeconomic status. (Read the full article)

Poverty is prevalent among children in the United States, and it has a clear association with negative health outcomes. Smoking and passive smoke exposure are both more common among socioeconomically disadvantaged populations and are associated with asthma morbidity.

Reported family hardships were common among children admitted for asthma or wheezing, and most were associated with detectable tobacco smoke exposure. The cumulative number of hardships was also associated with greater odds of tobacco smoke exposure. (Read the full article)

Uptake of rotavirus vaccines has increased steadily since introduction. Despite their demonstrated impact, rotavirus vaccine coverage is lower than for other vaccines recommended in infancy and disease continues to occur.

We observed higher rotavirus detection rates among patients from provider locations with lower rotavirus vaccine coverage; providers who do not offer rotavirus vaccine to age-eligible children may create pockets of susceptible children that serve as reservoirs of ongoing disease transmission. (Read the full article)

Exclusive breastfeeding until 6 months of an infant’s age is described as the safest, most powerful and cost-effective intervention to reduce infant morbidity and mortality globally. In developing countries, only ~25% of infants are exclusively breastfed for 6 months.

We developed a psycho-educational intervention combining education with techniques of cognitive-behavioral therapy, integrated it into the routine work of community health workers, which increased the rate and duration of exclusive breastfeeding until 6 months of an infant’s age. (Read the full article)

Researchers speculate that children with fetal alcohol spectrum disorders often are not recognized or diagnosed correctly.

This is the first study to assess the rate of missed diagnoses and misdiagnosis in foster and adopted children with fetal alcohol spectrum disorders. (Read the full article)

Meningococcal disease is a serious but rare infectious disease. In 2012, the incidence of meningococcal disease was at a historic low in the United States; however, incidence remained highest among infants aged <1 year.

This report describes the epidemiology and burden of meningococcal disease in infants aged <1 year in the United States and potential risk factors for transmission to this vulnerable group. These data are key to informing future meningococcal disease vaccination strategies. (Read the full article)

Administration of repeat doses of antenatal glucocorticoids to women at risk for preterm birth after an initial course reduces neonatal morbidity, without affecting rates of neurologic disability in early childhood. However, data on long-term effects on cardiometabolic health are limited.

Exposure to repeat doses of antenatal betamethasone did not increase cardiovascular risk factors at early school age. Clinicians wishing to use repeat antenatal glucocorticoids can be reassured that the risk of future cardiometabolic disease from this therapy is low. (Read the full article)

Asthma is heterogeneous and 40% to 70% of patients fail to achieve control with current treatment strategies. To delineate relevant subphenotypes of asthma, identify key factors, and test novel interventions, comprehensive repositories linking clinical, environmental, and biologic data are required.

This is the first statewide repository for inpatient pediatric asthma. The data collected will better define asthma phenotypes, identify care practices associated with the best health outcomes, and inform personalized care plans to reduce reutilization and readmission for pediatric asthma. (Read the full article)

Previous research has established steep socioeconomic status gradients in children’s cognitive ability at kindergarten entry. Few studies have had comprehensive data to examine the contribution of a wide range of risk and protective factors across early childhood to these gradients.

Family background, health, home learning, parenting, and early care and education factors explain over half the gaps in reading and math ability between US children in the lowest versus highest socioeconomic status quintiles, suggesting a need for comprehensive early interventions. (Read the full article)

Application of antenatal corticosteroids to mothers before delivery is highly beneficial to very low birth weight infants. Yet despite widespread quality improvement efforts, many eligible infants fail to receive this therapy.

We demonstrate improvement in antenatal corticosteroid use during the study period. However, significant regional variation persists, which network-level quality improvement efforts might help eliminate. (Read the full article)

Immune-related bioactive proteins are highly concentrated in the colostrum of mothers who deliver preterm infants. Oropharyngeal administration was proposed as a safe and feasible alternative method of providing colostrum to immunocompromised premature infants.

Oropharyngeally administered colostrum during the first few days of life increased urinary secretory immunoglobulin A and lactoferrin, decreased urinary interleukin-1β, reduced salivary transforming growth factor-β1 and interleukin-8, and reduced the occurrence of clinical sepsis in extremely premature infants. (Read the full article)

Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse health outcomes in adolescence and into adulthood. In girls, externalizing behaviors are more strongly associated with earlier FSI than internalizing behaviors.

Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Internalizing behavior at ages 8 and 10 was associated with early FSI for boys but not girls. (Read the full article)

Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied.

Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits. (Read the full article)

US children consume excessive amounts of sodium and substantial amounts of added sugars. Early life exposures to salt and sugar can set taste preferences and health trajectories.

A substantial proportion of toddler meals and other commercial foods meant for children age ≥12 months are of potential concern because of their high sodium content or presence of ≥1 added sugar. (Read the full article)

Medical home transformation is led by practice-level assessment, but much of the evidence supporting the medical home derives from individual-level assessment based on parental perception. The association between these 2 levels of assessment is unknown.

Among Boston-area community health centers, there was no association between the individual- and practice-level assessments of the medical home. This highlights the need for studies supporting the child health benefits of medical home practice transformation. (Read the full article)

Little is known about the impact of tobacco smoke exposure on preterm children with bronchopulmonary dysplasia. It is essential to understand how environmental exposures, such as tobacco smoke, influence respiratory morbidities in this vulnerable population.

Chronic tobacco smoke exposure is common in children with bronchopulmonary dysplasia. In children who required home respiratory support, hair nicotine levels were a better predictor of hospitalization and activity limitation than caregiver self-report. (Read the full article)