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)

Several studies have focused on birth weight heritability, reporting results that range between 40% and 80%. Few studies have focused on the process of weight gain and were mainly based on heterogeneous samples of infants.

The present work looks at a uniform set of healthy preterm newborn twins. The resulting high heritability estimate could suggest using the inclusion criteria to identify genes that regulate postnatal weight gain or failure. (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)

Chronic wet cough is a common symptom well recognized by pediatricians. Protracted bacterial bronchitis is defined as more than 4 weeks of wet cough that responds to antibiotic treatment. Diagnosis of protracted bacterial bronchitis is not readily accepted by pediatricians

Children with chronic wet cough often have bronchitis, which is evident during bronchoscopy. Purulent bronchial secretions suggest the presence of bacterial infection. Children with chronic wet cough frequently have a bacterial infection of the lower airway. (Read the full article)

Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking.

Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time. (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)

Refugee children arriving in the United States have had higher rates of elevated blood lead levels than US-born children. The Centers for Disease Control and Prevention recommends blood lead screening of all refugee children within 3 months after their arrival in the United States.

This is the first investigation we are aware of to examine and identify risk factors for lead poisoning among US-bound refugee children living in camps overseas, before their arrival in the United States. (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)

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspecific clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been associated with pseudo-outbreaks.

Contamination of specimens with vaccine derived Bordetella pertussis DNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modifiable factors. (Read the full article)

Registries have been established in a number of countries to monitor the health of patients with cystic fibrosis. Few international comparisons have been made between registries. International data registry comparisons may be useful for informing best practice and benchmarking.

Registry comparisons are feasible but are limited by factors such as nonstandardization of data collection. Lung function was lower in Australian children with cystic fibrosis compared with their US counterparts after adjusting for the benefits of diagnosis after newborn screening. (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)

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)

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)

Although follow-up examinations are recommended for suspected victims of sexual abuse or assault, little is known about the potential benefits of a second examination with regard to diagnosing trauma or sexually transmitted infections.

In ~23% of pediatric patients evaluated for sexual abuse or assault, a second examination by a specialist changed the interpretation of trauma likelihood or results in the detection of a sexually transmitted infection. (Read the full article)

Candidate genes involved in thrombophilia, inflammation, and preterm birth have previously been associated with cerebral palsy. Most studies to date have included small cohorts, did not allow for multiple testing, and require replication.

This study of children with cerebral palsy and their mothers did not confirm previously reported candidate gene associations. Prothrombin gene mutation was associated with hemiplegia in children born at term to mothers with a reported infection during pregnancy. (Read the full article)

The standard initial management for infants and children with acute pyelonephritis is intravenous antibiotic treatment.

Our results support the use of an oral cefixime treatment of initial episodes of acute pyelonephritis involving a gram-negative bacteria strain in children aged 1 month to 3 years who are without urological abnormalities and without clinical hemodynamic impairment. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) is a noninvasive ventilatory support that may reduce the need for mechanical ventilation in preterm infants with respiratory distress syndrome. Heliox, a helium-oxygen mixture, has shown positive effects, especially in obstructive diseases.

NCPAP with heliox reduces the need for mechanical ventilation in preterm infants with respiratory distress syndrome in comparison with NCPAP with medical air. (Read the full article)

Booster seat use improves seat belt fit and reduces risk of injury for children <57 in tall. Booster seat use decreases between ages 4 and 8 years. Children observed riding with other children frequently do not use booster seats.

In this national survey of parents, we found that a majority of parents of 4- to 8-year-old children carpool, and when they carpool booster seat use is inconsistent. Social norms and self-efficacy appear to influence booster seat use when carpooling. (Read the full article)

Although it has been shown that cystic fibrosis newborn screening is beneficial, the strategies vary widely, and there has been uncertainty about the costs and consequences of different algorithms and whether screening methods/decisions should be based on assumed cost differences.

This study contributes by offering a comparison of both costs, assessed comprehensively, and the consequences associated with the 2 most popular screening methodologies, immunoreactive trypsinogen/immunoreactive trypsinogen and immunoreactive trypsinogen/DNA, by using a decision-tree framework allowing variation in the model parameters. (Read the full article)

Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever.

Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.5°F was associated with adverse neonatal outcomes, with the rate of adverse outcomes increasing directly with maximum maternal temperature. Without temperature elevation, epidural use was not associated with adverse neonatal outcomes. (Read the full article)

Secondhand smoke exposure poses a significant health risk to nonsmokers. With the proliferation of comprehensive smoke-free laws prohibiting smoking in worksites and public areas, private areas have become the primary source of secondhand smoke exposure for many individuals, particularly youth.

Secondhand smoke exposure in cars has steadily declined among middle and high school students. However, many remain exposed to secondhand smoke in this environment. Jurisdictions should expand existing comprehensive smoke-free policies to prohibit smoking in vehicles occupied by youth. (Read the full article)

There are a number of effective interventions designed to prevent childhood/adolescent depression. Such interventions tend to comprise screening and the subsequent provision of psychological therapy. However, the cost-effectiveness of routinely providing such interventions at a population level is not known.

By using economic modeling techniques, this study shows that the population cost-effectiveness of such preventive interventions for childhood/adolescent depression is very favorable, although implementation issues, particularly around the acceptability to providers, need to be addressed before widespread adoption. (Read the full article)

Children undergoing stem cell transplantation are thought to be at risk for increased distress, adjustment difficulties, and impaired health-related quality of life. Few interventions to improve adjustment and quality-of-life outcomes in this setting have been tested.

The excellent outcomes observed in all patient groups, including controls, may be a result of improvements in standard supportive care. Stem cell transplantation may not be as demanding as previously thought to be, and children undergoing this procedure appear resilient to the challenge. (Read the full article)

The evidence base for obesity prevention is extremely limited. Although minority youth are at higher risk of obesity, and early childhood is a critical period for prevention, only 1 program has demonstrated sustained effects on obesity in young minority children.

Among youth at high risk for obesity based on income, minority status, and child behavior problems, early intervention that promotes effective parenting led to meaningful differences in obesity in preadolescence. Early family intervention is an innovative and promising approach. (Read the full article)

The social and emotional burdens of ostracism are well known, but few studies have tested whether ostracism adversely alters physical activity behaviors that may result in maintenance of childhood obesity.

This is the first study to experimentally assess the effect of simulated ostracism, or social exclusion, on physical activity behavior in children. Ostracism reduced accelerometer counts by 22% and increased time allocated to sedentary behaviors by 41%. (Read the full article)

Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight infants and contributes to morbidity and mortality.

Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants and persists to discharge in most survivors. Routine screening of these infants with echocardiography at 4 weeks of age identifies only one-third of those affected. (Read the full article)

In the previous decade, graduating pediatric residents generally experienced success in finding desired jobs, but they also experienced increased debt and flat starting salaries.

This study highlights trends over the past several years (2003–2009) including high levels of satisfaction among graduating pediatric residents, increasing ease in obtaining postresidency positions, and a modest decline in interest in primary care practice. (Read the full article)

Clinic-based weight control treatments for youth have largely been designed for preadolescent children and their families by using family-based care, a strategy that may be less appealing to adolescents as they become increasingly motivated by peer acceptance rather than parental influence.

To our knowledge, this is the first study to demonstrate the efficacy of a primary care–based, multicomponent lifestyle intervention specifically tailored for overweight adolescent females and demonstrating a sustained effect (at 12 months) extending beyond the active 5-month intervention. (Read the full article)

Bronchiolitis is the most common cause for hospital admission in patients aged <1 year. Hypoxia is a common reason for admission. Despite a multitude of studies looking at various treatment strategies, no clear benefit has been found.

With oxygen therapy being the main therapeutic option, home oxygen offers a novel way to manage bronchiolitis. This study shows that home oxygen is a safe and effective way to decrease hospital admissions in a select group of patients. (Read the full article)

Although China has the largest birth population in the world and a number of multicenter studies of neonatal respiratory failure are reported, there is a paucity of data regarding outcome measurement of very premature neonates requiring respiratory care and surfactant therapy.

This study is the largest survey, to date, in a Chinese network of 55 NICUs that presents the incidence, morbidity, and mortality rates, with risk factors of neonatal respiratory failure, with special emphasis on surfactant-treated very immature infants. (Read the full article)

Nonconvulsive status epilepticus (NCSE) is the diagnosis for encephalopathy caused by continuous epileptic activity on EEG. It is a well-known cause of morbidity and mortality in critically ill adults and neonates. NCSE is increasingly reported in critically ill children.

We show that NCSE is common in all inpatient settings, not only in the critically ill. Key risk factors that should dramatically increase suspicion of NCSE in clinical practice include a history of convulsive seizure and acute imaging abnormalities. (Read the full article)

Atherosclerotic cardiovascular diseases have roots in childhood. Modification of dietary fat intake influences serum lipid and lipoprotein concentrations. Reduction of saturated fat intake is recommended to promote cardiovascular health.

Dietary counseling had a beneficial effect on saturated fat intake from ages 7 months to 19 years. The counseling reduced serum low-density lipoprotein cholesterol concentrations in both genders. It also decreased computationally estimated concentrations of intermediate-density lipoprotein cholesterol, very low-density lipoprotein–triglycerides and apolipoprotein B in boys. (Read the full article)

Among extremely premature infants, survival has improved, but the rate of cognitive impairment has not. Impaired cognition is the most frequent developmental problem identified in survivors. Several antenatal factors have been associated with cognitive impairment, mostly related to social disadvantage.

In addition to social disadvantage, antenatal characteristics associated with cognitive impairment include maternal obesity and thrombosis of fetal stem vessels. Prenatal infection and inflammation were not associated with impaired early cognitive function among extremely preterm infants. (Read the full article)

Recent studies report that overall computed tomography utilization in the emergency department has continued to rise. Increased computed tomography use is concerning because of the association with radiation exposure and the potential risk of radiation-induced malignancy, which is highest in children.

Our data showed no overall increase in computed tomography utilization through 2010. In areas where alternative non–radiation-based modalities were options, there were decreased trends in computed tomography use and increased use of potential alternative non–radiation-based modalities. (Read the full article)

Most states require driver education (DE) for novice drivers, and several recent substantial efforts have sought to realign DE with the aim of producing safer drivers. However, teen participation rates and how they differ among relevant subgroups remain unknown.

This study provides national estimates of teen driver participation in formal DE, a recognized gap in the literature, and identifies disparities in behind-the-wheel training among certain racial/ethnic, socioeconomic, and gender groups, particularly in jurisdictions without a DE requirement. (Read the full article)