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)

Limited data exist about the frequency and incidence of serious injuries due to physical abuse of children. Data from Child Protective Services, which are published yearly, do not have information about severity.

This is the first study to provide US estimates on the occurrence of serious injuries due to physical abuse. The incidence was highest in infants on Medicaid. Such data can be used to track changes due to prevention. (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)

Prior to the Affordable Care Act of 2010, 34 states enacted laws extending eligibility for parents’ health insurance to adult children. Few studies have examined their impact; a single study found no change in insurance 1 year after enactment.

States that expanded parents’ insurance eligibility to young adults were associated with higher rates of insurance coverage, identification of a personal clinician, physical exams, and lower forgone care due to cost. The Affordable Care Act may similarly improve access to care. (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)

There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.

This study combined systematic literature review and the Rand/University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care. (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)

Delayed umbilical cord clamping in premature infants has been associated with decreased rates of intraventricular hemorrhage; however, the mechanisms that explain this finding have not been described.

Premature infants with delayed umbilical cord clamping have improved superior vena cava blood flow over the first days of life. This may provide one of the mechanism(s) by which this technique reduces the incidence in intraventricular hemorrhage in this at-risk population. (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)

Vitamin D levels in the general population have decreased considerably over the past decade. The implications of maternal vitamin D insufficiency during pregnancy for offspring neurocognitive development remain unclear.

Studying a large sample and using a prospective longitudinal design, this study demonstrates a link between maternal vitamin D insufficiency during pregnancy and offspring language impairment. There was no association with childhood behavioral or emotional problems. (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)

Adolescence is a time of risk taking, with poor inner-city youth at greater risk than the general population for drug use, school failure, adjudication, and teen parenthood. Little is known regarding these youths’ perceptions and intentions in early childhood.

Poor inner-city children were surprisingly idealistic regarding their future. Despite this, by late adolescence most experienced 1 or more trajectory-altering events. Early childhood experiences, exposure to violence and poor home environment, were factors most strongly associated with these outcomes. (Read the full article)

Childhood gender nonconformity has been associated with poorer relationships with parents, but it is unknown if childhood gender nonconformity is associated with childhood abuse or with posttraumatic stress disorder.

We identify gender nonconformity before age 11 years as a risk indicator for physical, sexual, and psychological abuse in childhood and lifetime probable posttraumatic stress disorder in youth. (Read the full article)

Community-acquired pneumonia (CAP) is a common pediatric illness caused by Streptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.

This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Furthermore, change in therapy did not lead to increased adverse outcomes. (Read the full article)

There is evidence of an impaired respiratory regulation in SIDS, in which serotonergic and noradrenergic neurons are involved. Monoamine oxidase A is the enzyme that degrades both neurotransmitters, and genetic variation of this gene might contribute to SIDS.

Alleles with weak effect on the monoamine oxidase A gene activity (*2/*3) appear to be associated with sudden infant death syndrome in boys. This association is strongest in infants who died at the age with the highest SIDS prevalence. (Read the full article)

Infantile colic affects almost 10% of all infants and is characterized by crying and fussing in an otherwise healthy and well-fed infant. Prenatal exposure to tobacco smoking is a risk factor, but it is unclear whether nicotine causes the association.

Infants exposed to nicotine replacement therapy during pregnancy had elevated infantile colic risk of the same magnitude as infants exposed to tobacco smoking. Intrauterine exposure to nicotine may play a causal role in the pathogenesis of infantile colic. (Read the full article)

Studies in the Netherlands show that pubertal blockade at Tanner 2/3 prevents unwanted sex characteristics and improves psychological functioning. Endocrine Society guidelines (2009) recommend pubertal suppression for adolescents with gender identity disorder until approximately age 16.

This is the first study of a US cohort of children and adolescents with gender identity disorder. Patients were referred for medical treatment to a pediatric center that supports a multidisciplinary Gender Management Service. (Read the full article)

Comprehensive home visits conducted by Community Health Workers including environmental remediation and office-based nurse case management improve asthma outcomes.

Implementation of a comprehensive quality improvement program as part of enhanced care of pediatric asthma patients with a history of hospitalizations or emergency department visits can improve health outcomes and be cost-effective as well as reduce health disparities. (Read the full article)

The demographics of trials that use antenatal consent may not be representative of the populations that they are intended to study.

This study analyzes the difference in clinical outcomes between the enrolled and eligible but not enrolled populations of a trial that required antenatal consent. (Read the full article)

Active termination of life in newborns with myelomeningocele because of assumed suffering in these newborns has been extensively discussed. However, the level of discomfort and pain in these newborns has never been substantially assessed.

This is the first study presenting quantitative data on discomfort and pain in newborns with myelomeningocele. Therefore, it can be of guidance in the choice of treatment: either active treatment or palliative care in the context of end-of-life decisions. (Read the full article)

Approximately 1.1% to 5.9% of febrile infants aged <90 days have bacteremia, but the incidence of bacteremia in this age is unknown. Escherichia coli, group B Streptococcus, and Staphylococcus aureus are the leading causes of bacteremia.

Bacteremia occurs in 2.2% of infants who have a blood culture drawn. The incidence rate of true bacteremia was 0.57 in 1000 full-term births. The most common pathogens were Escherichia coli (56%), group B Streptococcus (21%), and Staphylococcus aureus (8%). (Read the full article)

Rare diseases in childhood can be debilitating and require lifelong care. Since 1983, the Orphan Drug Act incentives have stimulated the development and significantly improved the availability of treatment products for patients with rare diseases.

We report an increasing pediatric orphan product designations and approvals from 2000 to 2009. The trend indicates that the Orphan Drug Act has continued to address this important unmet need. (Read the full article)

Very preterm children are at risk for developmental problems and, therefore, a systematic follow-up is important. However, the relevance of early follow-up of cognitive development has been questioned because of the divergent data on the prognostic value of early measures.

Good stability of cognitive development was found between the ages of 2 and 5 years. Well-conducted assessment of cognitive development in infancy is both reliable to anticipate later development and clinically valuable to identify those children who need developmental support. (Read the full article)

Active video games can enable children under laboratory conditions to participate in moderate, and even vigorous, physical activity. There are inconsistencies in the literature, however, about whether active video games enable children to increase physical activity under more naturalistic circumstances.

This study tests whether children receiving a new active video game spontaneously engaged in more physical activity, and whether commercially available active video games have a public health benefit. No additional physical activity was detected, suggesting no public health benefit. (Read the full article)

Few studies have examined the reliability of clinical findings in pediatric appendicitis. Clinical prediction rules are most useful if the included variables are reliable across practice settings and practitioners.

Among children who present with possible appendicitis, the interrater reliability varied considerably for patient history and physical examination variables. Those variables with the highest degree of reliability may be best suited for inclusion in appendicitis clinical prediction rules. (Read the full article)

Strategies to assist patients in achieving optimal chronic disease self-management are critical. The complex family and regimen issues surrounding pediatric type 1 diabetes management suggest the need to integrate such strategies into routine clinical care.

This study demonstrates the efficacy of a practical, low-intensity behavioral intervention delivered during routine care for improving glycemic outcomes. Findings indicate that the approach may offer a potential model for integrating medical and behavioral sciences to improve health care. (Read the full article)

Sleep-disordered breathing is associated with neurobehavioral morbidity in children. Prior related research has generally been cross-sectional or short (ie, 1–2 years) follow-up studies of a single symptom (ie, snoring, obstructive sleep apnea, mouth breathing), with limited control for confounders.

Sleep-disordered breathing was assessed as a trajectory of combined symptoms from 6 months to 69 months, in more than 11 000 children. Sleep-disordered breathing was associated with 40% and 60% more behavioral difficulties at 4 and 7 years, respectively. (Read the full article)

The availability of rapid response systems to assist deteriorating patients is the standard of care in children’s hospitals. Metrics for evaluating their effectiveness include cardiac and respiratory arrest rates, rare events that require years of data to show significant improvements.

A proximate outcome for in-hospital mortality among patients receiving rapid response system assistance was developed. This "critical deterioration" metric was eightfold more common than arrests and demonstrated criterion and construct validity, facilitating meaningful evaluation over shorter periods of time. (Read the full article)

Numerous late preterm infants undergo repetitive heel lancing procedures during their first hours of life to evaluate glycemic control. Heel lances are painful and 25% glucose solution is effective on reducing procedural neonatal pain scores and crying behavior.

This noninferiority randomized controlled trial demonstrated that compared with breast milk, 25% glucose provided lower pain scores and reduced duration of cry. Further research is necessary to clarify breast milk’s mechanisms and efficacy on neonatal pain relief. (Read the full article)

Pneumonia is still a significant problem in young children from developing countries where zinc deficiency is prevalent. Although zinc supplementation reduces the risk of childhood pneumonia, the effect of adjunct zinc on severe pneumonia is unclear with conflicting results.

The overall effect, if any, of zinc as adjuvant therapy for World Health Organization–defined severe pneumonia in young children is small. (Read the full article)

Preterm infants are at increased risk of behavioral problems, which has been associated with maternal distress. Paternal psychological well-being is less studied. Parents’ concerns may affect their perceptions or attitudes and have negative effects on the behavior of the child.

Parents report more behavior problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence. Also, the paternal psychological well-being contributes to the behavioral development of a preterm child. (Read the full article)

Stairs are a common source of injury to children. Most injuries are minor soft tissue injuries, with the head and neck region being injured most commonly.

This is the first nationally representative study of stair-related injuries to young children in the United States. A child aged <5 years is treated in a US emergency department, on average, every 6 minutes for a stair-related injury. (Read the full article)

Several studies have analyzed fatal or nonfatal youth injury incidence in US agricultural settings, but none have combined those estimates to form an overall picture. The only detailed study of costs related to such injuries is restricted to nonfatal injury.

This study provides a comprehensive analysis of the annual incidence and cost of agricultural youth injuries in the United States. It analyzes them from different perspectives: fatal versus nonfatal, at work versus not at work, and requiring hospitalization versus not requiring hospitalization. (Read the full article)

There is a perception among clinicians that methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and/or meningitis result in a greater burden of disease than invasive infections attributed to methicillin-susceptible Staphylococcus aureus (MSSA) among very low birth weight (VLBW) infants.

VLBW infants with MRSA and MSSA bacteremia and/or meningitis have equivalent morbidity and mortality. These findings suggest that allocation of resources for prevention and treatment of both MRSA and MSSA infections among VLBW infants should be comparable. (Read the full article)

Previous research on the cost of childhood autism has been restricted primarily to studying direct costs (money outlays) incurred by publicly and privately funded service systems.

This study estimates the economic impact on the family and examines indirect costs to families in the form of parental labor market productivity losses. (Read the full article)

Changes in BMI category appear to be common in young children and are associated with cardiometabolic risk in cross-sectional studies. However, there are few longitudinal studies and little information from multiethnic samples of US middle school children.

Findings demonstrate that shifts in BMI category are common in middle-school-aged children and associated with clinically meaningful changes in cardiometabolic risk factors. Programs to promote decreases in BMI, prevent increases, and moderate risk are indicated. (Read the full article)

Infantile hypertrophic pyloric stenosis incidence varies over different regions and time periods. Recently, a decline was reported in the United States, Sweden (concurrent with a decline in sudden infant death syndrome), Scotland, and Denmark. The etiology remains unclear; therefore, epidemiologic data are valuable.

A decline in the incidence of infantile hypertrophic pyloric stenosis in Germany from 2000 to 2008 was noted but with wide regional variations. The regional distribution of infantile hypertrophic pyloric stenosis was different from that of sudden infant death syndrome. (Read the full article)

Early administration of oral corticosteroids is essential for children presenting to emergency departments with moderate to severe acute asthma exacerbations, because subsequent admission need is directly related to time to receipt of systemic steroids, yet delays to administration remain long.

A medical directive allowing nurse initiation of oral corticosteroids before physician assessment was associated with improved quality and efficiency of care provided in the pediatric emergency department by ensuring implementation of evidence-based practice. (Read the full article)

Insulin is commonly used to treat neonatal hyperglycemia, but there are few data to support its use. Tight glycemic control with insulin improves outcome in diabetic patients, but it is not known whether it is effective in hyperglycemic preterm infants.

Tight glycemic control with insulin in hyperglycemic preterm neonates decreases the rate of linear growth despite increased weight and occipitofrontal head circumference gain and increases the risk of hypoglycemia. Insulin may not be a safe and effective treatment in hyperglycemic preterm neonates. (Read the full article)

Prenatal methamphetamine exposure has been related to deficits in fetal growth, changes in infant neurobehavior, and fine motor deficits, but little is known about its developmental effects on behavior problems in early childhood.

This is the first prospective study to identify behavior problems associated with prenatal methamphetamine exposure. Mood difficulties and acting-out behavior are increased in exposed children by age 3 years. Early identification and intervention may prevent escalation into delinquency and psychopathology. (Read the full article)