Although the natural course of bilirubin levels has been extensively studied in general neonatal populations, there is a paucity of data regarding bilirubin trends in neonates before the development of significant hyperbilirubinemia.

This study provides data on the natural course of transcutaneous bilirubin before the development of significant hyperbilirubinemia, and on the effect of different demographic and perinatal risk factors on the rate of bilirubin increase in neonates with borderline bilirubin values. (Read the full article)

The relationship between energy intake and obesity in children has yielded inconsistent results. Efforts to improve dietary intake as a means of improving weight status have largely yielded disappointing results.

Self-reported energy intake for younger, but not older, overweight/obese children is higher than healthy-weight peers. In early childhood, higher (or excessive) energy intake may lead to onset of obesity, but other mechanisms may be important to maintain obesity through adolescence. (Read the full article)

Changes in resident work hours are believed to have an impact on resident education and patient safety.

This study provides an understanding of the impact of changes in resident work hours on the staffing strategies of children’s hospitals. (Read the full article)

Pediatric osteoarticular infections can be treated with successful microbiologic and clinical outcomes with a transition from parenteral to oral therapy. The best way to determine the timing of this transition is neither well studied nor standardized.

A total of 193 (99.5%) of 194 pediatric patients with acute bacterial osteoarticular infections were successfully transitioned to oral therapy, determined by using a combination of clinical findings and C-reactive protein levels, representing the largest single-center data set analyzed. (Read the full article)

Severe neonatal hyperbilirubinemia can lead to acute bilirubin encephalopathy and, subsequently, chronic bilirubin encephalopathy (CBE). This condition is preventable through routine identification and proper treatment; therefore, it is rare for permanent neurologic complications to occur.

This article describes the incidence of CBE in Canada, which is higher than previously reported in the literature. Furthermore, it describes the underlying causes of CBE and the spectrum of neurologic disease. (Read the full article)

Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.

Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country. (Read the full article)

A 2001 survey of pediatric residency training directors indicated that few programs prepared residents to intervene on tobacco. A decade later, it is not known whether programs are doing more to prepare residents to intervene effectively with patients and parents.

Despite the need for pediatricians to play a leadership role in tobacco prevention and control, most pediatric residency training programs focus more on health effects of tobacco use and smoke exposure than on how to intervene with patients and parents. (Read the full article)

Fever phobia is a ubiquitous problem throughout the world. As a result, fever is pharmacologically overtreated, and medical attention is frequently sought by worried parents.

Most Canadian parents fear their child’s fever, resulting in aggressive surveillance and treatment. Parents expect information about fever etiology and how to care for their ill child. Few parents expect antibiotics and satisfaction with care is high. (Read the full article)

Iatrogenic medical errors are an important medical care issue in the United States. Errors may be particularly important in children with chronic health conditions, especially as the prevalence of chronic conditions is increasing in children.

In a nationally representative sample, we found that pediatric inpatients with chronic conditions were at a significantly higher risk for medical errors than inpatient children without chronic conditions, controlling for severity of illness, length of stay, and other potential confounders. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Few longitudinal studies from developing countries have assessed the relation between early maternal depressive symptoms and child growth beyond age 2. The results of these studies have been inconclusive.

Early maternal depressive symptoms were related to higher odds of deficits in stature but not to deficits in weight among preschool- and school-aged children. Well-child care provides opportunities to identify maternal depressive symptoms to prevent future child growth delays. (Read the full article)

Sending and receiving sexually explicit picture and text messages via cell phone (ie, "sexting") among adolescents is publicized as a societal and public health concern, yet it is unknown whether sexting is associated with physical sexual activity or sexual risk behavior.

This study is the first to examine sexting among a probability sample of adolescents and found that sexting is associated with sexual activity, sexual risk behavior, and knowing other person(s) who have sent a sext. (Read the full article)

Pediatric obesity is a prevalent public health issue that is associated with medical and physical consequences. Clinic-based interventions for pediatric obesity are effective, but they have limited reach and are costly.

This is the first examination of an empirically informed, scalable treatment of pediatric overweight and obesity delivered in YMCAs. The results indicate that a scalable, community-based pediatric obesity intervention can produce clinically meaningful changes in weight and quality of life. (Read the full article)

Findings from 3 studies suggest that the diagnosis of venous thromboembolism in hospitalized US children has increased in recent years.

This study provides additional evidence of an increasing trend in the rate of venous thromboembolism-associated hospitalization in US children, as well as a concurrent increase in the prevalence of venous catheter procedures. (Read the full article)

Overweight children are at risk for becoming obese adults, especially if they have an obese parent. Family-based behavioral interventions, largely implemented in specialized settings, have shown efficacy in weight control in youth aged ≥8 years.

This study demonstrates the efficacy of a family-based behavioral weight control program translated to be implemented in the primary care setting. The work underscores the importance of pediatricians intervening early and shifting their focus from the child to the family. (Read the full article)

Current human milk fortifiers fail to provide the higher protein intake that is now recommended for feeding human milk–fed infants. There is a desire to avoid the use of powdered products when feeding these infants.

A new ultraconcentrated liquid human milk fortifier that provides more protein than current powdered fortifiers is safe and supports better growth in human milk–fed infants than a powdered fortifier. (Read the full article)

The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure measurement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years. (Read the full article)

Expedited partner therapy (EPT) is an effective method of partner treatment of sexually transmitted infections but is not used frequently. There are limited data on provider knowledge, practices, and comfort with EPT use in adolescents.

California pediatric residents have knowledge gaps and discomfort providing EPT and presence of an adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Our findings support the need to improve EPT education in pediatric residencies. (Read the full article)

Electronic cigarettes are battery-powered devices that simulate tobacco cigarettes by vaporizing nicotine and other chemicals into an inhalable mist. They have gained popularity around the world, but little is known about their safety and addictive properties.

Among Polish youth, electronic cigarettes are the fourth most common source of nicotine after cigarettes, waterpipes, and snuff. For those aged between 15 and 24 years, ever use of an electronic cigarette was 20.9%, and 30-day use was 6.9%. (Read the full article)

High blood pressure in childhood predisposes people to hypertension in adulthood and is associated with early development of cardiovascular disease and risk for premature death. High sodium intake and overweight/obesity are recognized as risk factors for hypertension in children.

These results show that usual sodium intake was positively associated with systolic blood pressure and risk for pre-high blood pressure and high blood pressure among US children. The data indicate a synergistic interaction between sodium intake and weight status on risk for high blood pressure. (Read the full article)

Most studies on corticoid treatment of respiratory syncytial virus (RSV) respiratory diseases have revealed no beneficial effect. The mechanism by which RSV respiratory-infected patients are insensitive to the antiinflammatory effect of corticosteroids is unknown.

This study helps to understand how a respiratory syncytial viral infection may alter the normal antiinflammatory response to cortisol and the insensitivity to glucocorticoid treatment. The increase expression of β glucocorticoid receptor could be a marker of disease severity. (Read the full article)

Infants with hypoxic-ischemic encephalopathy suffer a high rate (>40%) of death or moderate to severe disability, even after therapeutic hypothermia. High-dose erythropoietin (Epo) reduces brain injury and improves neurologic function in animal models of neonatal hypoxic-ischemic brain injury.

Multiple doses of Epo (up to 2500 U/kg intravenously) given in conjunction with hypothermia are well tolerated in newborns with HIE. Epo doses of 1000 U/kg intravenously in cooled infants produce plasma concentrations that are neuroprotective in animal studies. (Read the full article)

Despite numerous preventive strategies including prophylaxis with 400 IU/day of vitamin D in recent years, the deficiency of vitamin D in infants is still a global health problem.

This study reveals that the risk of vitamin D deficiency is high in exclusively breastfed infants, especially in winter, despite vitamin D supplementation. Therefore, it is suggested that an adjustment of vitamin D dosage for seasonal variation might be necessary. (Read the full article)

Inflammatory bowel disease pathogenesis is incompletely understood. Previous pediatric studies suggested associations between antibiotic use and inflammatory bowel disease development but were limited by recall bias, lack of controls, incomplete antibiotic capture, or included exposures between symptom onset and diagnosis.

Our population-based cohort study suggests that certain childhood antibiotic exposures are associated with an increased risk of developing inflammatory bowel disease. Our findings have implications for understanding the condition’s pathogenesis and provide additional stimulus for reducing unnecessary childhood antibiotic use. (Read the full article)

Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care.

This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. (Read the full article)

Adult patients with neurocardiogenic syncope have shown high rates of depression. Patients with more severe depressive symptoms have higher rates of syncope recurrence. Psychiatric interventions improve quality of life and decrease syncope recurrence rates.

Children with neurocargiogenic syncope presented a 2.6-fold higher rate of clinically significant depressive symptoms compared to healthy controls. No recurrent syncope was noted during follow-up which along with improvement in family functioning predicted depressive symptoms improvement. (Read the full article)

National data from child protective services agencies have shown a 55% decrease in the incidence of substantiated cases of physical abuse from 1992 to 2009, but no study has tracked the occurrence of serious injuries due to physical abuse.

Using national data from hospitalized children, we found a statistically significant increase in the incidence of serious injuries due to physical abuse from 1997 to 2009. These results are in sharp contrast to data from child protective services. (Read the full article)

Children born late preterm (34–36 weeks’ gestation) are at increased risk of adverse early childhood outcomes compared with term-born children. The impact of the neonatal experience on longer-term outcomes of these infants has not yet been well considered.

This study provides information regarding the development of late preterm infants at 3 years. Late preterm infants who received neonatal intensive or high-dependency care had similar developmental outcomes to children born late preterm who did not receive this care. (Read the full article)

Exergaming offers a physical activity (PA) alternative for youth that may be attractive in our increasingly technophilic society. Exergaming increases PA and decreases sedentary time, but most exergame studies are clinically based and focus on measuring energy expenditure during exergaming.

One-quarter of adolescents exergamed at intensity levels that could help them achieve PA recommendations. Exergamers were more likely to be female, play nonactive video games, watch ≥2 hours of television per day, be stressed about weight, and be nonsmokers. (Read the full article)

Implementing expanded vaccination recommendations has challenged primary care providers, who administer the majority of vaccines in the United States. School-located vaccination has been proposed as a means of increasing vaccination rates while reducing the burden on primary care providers.

This study assesses physicians’ support for their patients’ receipt of vaccines in school. Additionally, it compares physicians’ support for adolescent versus influenza vaccination and compares support by insurance status of their patient. (Read the full article)

There are limited data regarding the current status of the pediatric clinical trial enterprise.

Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible. (Read the full article)

Exposure to background television (ie, times when the television is on but the child is attending to another activity) is negatively associated with children’s cognitive functioning and social play.

US children (8 months to 8 years) are exposed to nearly 4 hours of background television on a typical day. Younger children and African American children are exposed to more background television. Family behaviors associated with background television are offered. (Read the full article)

Some epidemiologic evidence suggests an inverse association between sleep duration and obesity in various age groups. However, in the case of adolescents, inconsistent results have been reported, which can be partly explained by methodologic options.

Our study supports an effect of sleep duration in adiposity during adolescence and found gender differences in this association. The results are consistent by using either the traditional longitudinal approach or cross-lagged modeling. (Read the full article)

Infant behavioral dysregulation is a common concern, involving irritability, excessive crying, and problems with feeding and sleep. Previous research into its behavioral outcomes has been limited by small cohorts and short follow-up, and findings have been contradictory.

Long-term follow-up of a large cohort showed that infant behavioral dysregulation was a risk factor for maternal-reported behavior concerns at 5 and 14 years, but was unrelated to young adult mental health outcomes. (Read the full article)

The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.

The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting. (Read the full article)

Understanding human disease genomics requires large population-based studies. There is lack of standardization, as well as social and ethical concerns surrounding the consent process for pediatric participation in a biorepository.

The study identifies specific barriers to pediatric participation in biorepositories relative to adults, and proposes strategies to improve ethical and responsible participation of pediatric-aged patients in large-scale genomics and biorepository-driven research without significantly increasing research burden for affected families. (Read the full article)

Discussing end-of-life (EoL) care with adolescents and young adults (AYAs) is difficult. Often, such conversations are delayed or avoided, but AYAs contemplate EoL issues and want to make decisions about their care. Few established resources exist to help this process.

Results support the use of a developmentally appropriate document that allows AYAs an opportunity to share their choices about EoL care and how they would like to be remembered in the future. (Read the full article)

Children investigated for alleged maltreatment have considerable physical, mental health (MH), developmental, and educational needs and often do not receive services to address these needs. The prevalence/correlates of MH services use in the current challenging financial environment is unknown.

This study demonstrates the importance of medical providers and schools for receipt of MH services for these children, but shows disparities in MH service use between white and nonwhite children. Unlike earlier findings, MH service use declined over the follow-up. (Read the full article)

Anecdotal accounts that suggest elopement behavior occurs in children with autism spectrum disorders (ASDs), that injuries and fatalities can result, and that associated family burden and stress are substantial. However, there has been little research characterizing the phenomenon or its frequency.

Nearly half of children with an ASD elope, and more than half of these "go missing." Elopement is associated with autism severity, and is often goal-directed. Addressing elopement behavior is an important aspect of intervention for many individuals with ASDs. (Read the full article)

Increased computed tomography (CT) use among adults and children presenting to emergency departments has spawned concern about associated radiation exposure. The risks and benefits of CT use for certain conditions, such as abdominal pain, among general pediatric populations remains unclear.

This study analyzes emergency department radiology trends between 1998 and 2008 among children with abdominal pain, highlighting a dramatic increase in CT use. Factors associated with CT ordering include older age, non-black race, and hospital admission. (Read the full article)

Retinal hemorrhages occur in accidental and inflicted traumatic brain injury (ITBI) and some medical encephalopathies. Large numbers and peripherally located retinal hemorrhages are frequently cited as distinguishing features of ITBI in infants, but the predictive value has not been established.

This prospective retinal imaging study found that a diagnosis of ITBI in infants and children can be distinguished from other traumatic and nontraumatic causes by the presence of >25 dot-blot (intraretinal layer) hemorrhages (positive predictive value = 93%). (Read the full article)

Invasive Cronobacter infection is a rare but devastating disease known to affect hospitalized premature or immunocompromised infants fed powdered infant formulas (PIFs). PIF labels imply that powdered formulas are safe for healthy, term infants if the label instructions are followed.

Cronobacter can also infect healthy, term infants in the first months of life, even if PIF label instructions are followed. Invasive Cronobacter infection is extremely rare in exclusively breastfed infants or those fed commercially sterile, ready-to-feed formulas. (Read the full article)

Significant variation in congenital hypothyroidism screening operations/performance has been observed in the United States. The origin of this variation remains unknown, in part because of a lack of evaluation. Accordingly, debates persist about optimal screening operations including laboratory testing methods.

Four distinct screening protocols applied to Michigan resident infants are compared in detecting congenital hypothyroidism overall and specific to cases characterized by high initial thyrotropin concentrations thought to have a more severe form of the disease. (Read the full article)

School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is a widely used universal prevention strategy currently implemented in >16 000 schools across the United States. Previous research has shown positive effects on school climate and school-level discipline problems.

This study reports multilevel results on data from a 4-year randomized controlled effectiveness trial of SWPBIS in 37 elementary schools. Results indicate significant impacts on children’s aggressive behavior problems, concentration problems, office discipline referrals, emotion regulation, and prosocial behavior. (Read the full article)

Healthy sleep is essential for supporting alertness and other key functional domains required for academic success. Research involving the impact of modest changes in sleep duration on children’s day-to-day behavior in school is limited.

This study shows that modest changes in sleep duration have significant impact on the behavior of typically developing children in school. Modest sleep extension resulted in detectable improvement in behavior, whereas modest sleep restriction had the opposite effect. (Read the full article)

Among middle-aged adults, genotype scores predict incident type 2 diabetes but do not improve prediction models based on clinical risk factors including family history and BMI. These clinical factors are more dynamic in adolescence, however.

A genotype score also predicts type 2 diabetes from adolescence over a mean 27 years of follow-up into adulthood but does not improve prediction models based on clinical risk factors assessed in adolescence. (Read the full article)

Most term and late preterm infants with neonatal encephalopathy have not had recognized asphyxial birth events. Several nonasphyxial risk factors for neonatal encephalopathy have been identified in previous studies.

In a large sample, we confirm the association of several nonasphyxial factors with neonatal encephalopathy, including markers of intrauterine exposure to infection or inflammation, intrauterine fetal growth restriction, and birth defects. We identify steps that would improve studies of neonatal encephalopathy. (Read the full article)

Brain maturation processes of very premature children are adversely affected by serious neonatal infections. Differences in brain development persist into childhood and adolescence, and underpin widespread neurocognitive and behavioral deficits in very preterm children.

We present evidence for long-term beneficial effects of early nutritional intervention with glutamine in very preterm infants on brain development at 8 years of age, mediated by a decrease in the number of serious neonatal infections. (Read the full article)

The use of metformin in pregnancy is increasing in the treatment of both gestational diabetes and polycystic ovary syndrome. Metformin crosses the placenta. Teratogenicity is not reported. Possible long-term effects are undetermined.

Intrauterine metformin exposure seems to have long-term effects on infant weight. At 1 year of age, infants born to women and exposed to metformin weigh more than those exposed to placebo in utero. (Read the full article)

Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.

Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article)