Corticosteroids inhibit the expression of many proinflammatory cytokines released during the course of community-acquired pneumonia infection. Corticosteroids have been found in some studies to be associated with improved clinical outcomes in adults with pneumonia. No studies have investigated corticosteroid use in children with pneumonia.

Results showed that corticosteroid treatment in children with pneumonia is common and its use is highly variable across institutions. Although corticosteroid therapy may benefit children with acute wheezing treated with β-agonists, corticosteroid therapy may lead to worse outcomes for children without wheezing. (Read the full article)

Autism has been associated with pregnancy and birth complications that may indicate a suboptimal prenatal environment. Although the interpregnancy interval (IPI) may affect the prenatal environment, the association between the IPI and risk for autism is not known.

Using full-sibling pairs from a large population, the authors examined the association between autism and IPIs. Second-born children conceived after an IPI of <12 months had more than threefold increased odds of autism relative to those with IPIs of ≥36 months. (Read the full article)

The current standard of care includes informing women about prenatal testing and newborn screening for cystic fibrosis and providing genetic counseling to parents whose child is referred for sweat-testing. Despite counseling, early data identified some persistent confusion about residual risk.

Prenatal discussions about carrier testing and newborn screening for cystic fibrosis are not routine. Parental anxiety about abnormal results from a screen is decreased after speaking to a genetic counselor when scheduling the sweat test. Despite counseling, residual risk continues to be poorly understood. (Read the full article)

Optimism later in life is protective against a range of health problems. It has commonly been a focus in adolescent mental health promotion. Cross-sectional studies suggest a protective effect against adolescent health risks, but prospective studies have been lacking.

Optimism is somewhat protective against adolescent health risks; the strongest effect was seen against the onset of new depressive symptoms. Its protective effect against heavier substance use and antisocial behavior was modest and only for the highest categories compared to the lowest. Promoting optimism along with other positive aspects of psychological and emotional style has a role in mental health promotion that is likely to be enhanced if an intervention also addresses risk and protective factors in an adolescent's social context. (Read the full article)

Several qualitative studies have revealed that caregivers use infant fussing as a cue for beginning complementary feeding (CF). Despite a higher prevalence of early CF among black infants, few studies have quantitatively examined the role of maternal perception of infant fussiness.

Results of this study show that in a cohort of low-income, black, first-time mothers, early CF was highly prevalent and that maternal perception of infant temperament, breastfeeding, and maternal obesity and depression were important factors related to early CF. (Read the full article)

The associations between food insecurity and child well-being have been well studied on the basis of household levels of food insecurity, as reported by heads of households.

Household measures, however, may not capture gender biases in food insecurity and morbidity. This study assessed adolescents' own experience with food insecurity and how it was associated with morbidity and the effect of gender in this process. (Read the full article)

Few epidemiological studies, which included varied exposure assessment, have investigated the relation between drinking-water–disinfection byproducts such as trihalomethanes and hypospadias, and their results have been inconclusive.

Little evidence was found for an association between trihalomethanes and hypospadias, but a novel association between water consumption and hypospadias was found. Factors that influence maternal water consumption, or other contaminants in tap or bottled water, might explain this finding. (Read the full article)

Cardiovascular risk factors predict the development of premature atherosclerosis. As the number of risk factors increases, so does the extent of these lesions. Assessment of cardiovascular risk factors is an accepted practice in adults but is not used in pediatrics.

In this study, the authors discuss how the presence of ≥2 cardiovascular risk factors is associated with vascular changes in adolescents. The findings were compared with the Patholobiological Determinants of Atherosclerosis in Youth risk score to demonstrate that a simple method of clustering is a reliable tool to use in clinical practice. (Read the full article)

Several correlational studies documented that participants who would be classified as "pathological" video gamers demonstrate a pattern of correlations with other variables that are comorbid (eg, depression) or occur with (eg, poorer grades and increased hostility) other addictions.

Following a large sample across 2 years, this study provides needed data on risk factors for becoming a pathological gamer, how long pathological gaming lasts, outcomes, and whether it is a primary problem or is a symptom of comorbid problems. (Read the full article)

The use of steroids as a treatment for patients with Duchenne muscular dystrophy results in a slower progression in weakness. Bisphosphonates often are used in conjunction with steroid therapy to enhance bone health.

The combination of steroids and bisphosphonates seems to be associated with significantly improved survival rates compared with treatment with steroids alone. (Read the full article)

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

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

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

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

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

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

Many patient and family demographic characteristics are well-known risk factors for nonurgent emergency-department use. No previous study has examined the primary care physician perspective on parental decisions regarding specific nonurgent emergency-department visits by children.

When discussing specific instances when families in their practices sought nonurgent care for children in the emergency department, physicians believed that parents acted appropriately. Neither parents nor primary care physicians saw nonurgent emergency-department visits as a significant enough problem to warrant change. (Read the full article)

Combined auditory brainstem response/otoacoustic emission testing is used to screen for auditory neuropathy spectrum disorder (ANSD), which leads to failure to develop normal auditory behavior and oral language. Prevalence estimates have been obtained for infants in NICUs.

ANSD risk in well-infant nurseries has not been examined. This study contributes ANSD prevalence estimates for infants admitted to well-infant nurseries and compares the costs of 2 different 2-technology screening protocols. (Read the full article)

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

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

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

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

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

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

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

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

No studies have focused on the financial impact of fellowship training in pediatrics.

The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, the study may be valuable to policy makers who evaluate health care reform and pediatric workforce-allocation issues. (Read the full article)

Primary care providers (PCPs) identify patients with undescended testis (UDT) and refer them to surgical specialists. Referral beyond the recommended times for orchiopexy has been reported, and PCPs' accuracy in identifying and distinguishing UDTs from retractile testes has been questioned.

We describe 3 observations that are strongly correlated with UDT, that is, birth history of UDT, prematurity, and visible scrotal asymmetry. UDT diagnoses are best made by 8 months of age, to reduce confusion with testicular retraction and to facilitate timely orchiopexy. (Read the full article)

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

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

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

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

Chlamydia testing among adolescents and young women without symptoms is recommended by the US Preventive Services Task Force, but only approximately one-half of eligible young women presenting for health care are screened appropriately.

Our work indicates that providers screen young women for chlamydia differentially according to patient age, race/ethnicity, insurance status, and sexual health history. Biases in chlamydia screening may contribute to higher reported rates of chlamydia among minority and poor young women. (Read the full article)

For treatment of obesity in preadolescent children, approaches that focus on parents taking sole responsibility for implementing weight-management strategies may be most effective. However, the optimal content, intensity, and duration of programs for obese children remain unclear.

Targeting parents only, a 10% relative weight loss is achievable in moderately obese preadolescent children and can be maintained 2 years from baseline, which justifies an investment in treatment as a secondary obesity-prevention strategy. (Read the full article)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A delay in seeking medical care for children with significant injury often raises a concern about child abuse, but there are few data describing the range of responses children display after accidental fracture for providers to use in comparison.

This study presents the range of responses exhibited by children after accidental fractures and identifies factors associated with a delay in seeking medical care. No child was asymptomatic, although a minority did not manifest all expected responses after their injury. (Read the full article)

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

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

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

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

Pediatric weight gain is a critical aspect of the obesity epidemic. Chronic stress produces physiologic perturbations capable of altering brain mechanisms related to eating as well as those implicated in self-regulatory behaviors.

We show that early childhood risk exposures are associated with weight gain in adolescence, independent of childhood BMI. We also find that deficiencies in self-regulatory processes help explain the link between chronic stress and adiposity. (Read the full article)

Gallbladder disease in children is an evolving entity and studies suggest an increasing frequency of symptomatic pediatric gallbladder disease and resultant cholecystectomies.

Hispanic ethnicity and obesity are epidemiologically significant risk factors for symptomatic gallbladder disease in the pediatric population. (Read the full article)

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

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

Conduct problems, substance use, substance use problems, and depressive symptoms increase as black adolescents enter high school. Although family-centered prevention programs deter these problems during middle school, no such programs have been developed and evaluated for black high school students.

This study demonstrates that participation in a family-centered preventive intervention reduces conduct problems, substance use, and substance use problems among black adolescents by more than 30% compared with adolescents in an attention control condition across nearly 2 years. (Read the full article)

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

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

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a progressive, inherited neuromuscular disease manifesting with diaphragmatic paralysis in the first year of life. All patients need mechanical ventilation.

We describe the natural course of SMARD1, developed a scoring system, and defined prognostic values. The clinical outcome of the patients was heterogeneous, and residual enzymatic activity of the IGHMBP2 protein was associated with a more benign disease course. (Read the full article)

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

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

Children with sickle cell disease are at high risk of complications from influenza infection and have been recommended to receive annual influenza vaccine since the 1970s. Few safety studies, however, have examined the safety of influenza vaccine in this population.

This large cohort study did not find an association between influenza vaccination and hospitalization for sickle cell crises in children with sickle cell anemia. (Read the full article)

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

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

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

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

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

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

The medical home is associated with beneficial outcomes in children with special health care needs and in the entire pediatric population. It is unknown if it benefits the majority of the pediatric population (ie, children without special health care needs).

This study is the first to demonstrate an association between the medical home and beneficial health care utilization, child health, and health-promoting behavior outcomes in children without special health care needs. (Read the full article)

Very low birth weight (VLBW) male neonates appear to have increased mortality. VLBW female neonates appear to have better long-term outcomes.

VLBW male neonates have increased mortality and poorer neurological outcome. This gender difference appears to disappear at weeks' gestation. (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)