Cognitive and motor developmental test scores of preterm and late preterm infants increase with gestational age. Developmental test scores in full-term infants have not previously been considered to relate to gestational age.

In a cohort of healthy, full-term infants, 37 to 41 weeks, 12-month mental and psychomotor scores on the Bayley Scales of Infant Development increased with gestational age, suggesting that neurodevelopment is optimal in infants born at 39 to 41 weeks. (Read the full article)

Infants with a diverse gut microbial flora are less likely to develop eczema and allergy.

Parental sucking of their infant’s pacifier is associated with a reduced risk of allergy development and an altered oral flora in their child. Transfer of oral microbes from parent to infant via the pacifier might be used in primary prevention. (Read the full article)

The American Academy of Pediatrics recommends that all preterm infants receive human milk; however, little is known about the use of human milk in US advanced care neonatal units.

Routine use of human milk and use of donor milk in neonatal advanced care units increased from 2007 to 2011, particularly among units providing intensive care. There is geographic variation in the use of human milk in these units. (Read the full article)

Blood lead levels well below 10 µg/dL are now recognized as causing adverse cognitive effects, including lower scores on standardized reading and math tests.

This is the first study to show that reading readiness early in kindergarten is independently associated with blood lead levels well below 10 µg/dL. Results suggest that lead exposure may have a larger impact on urban education than national estimates suggest. (Read the full article)

Child welfare data show declines in child physical abuse since the early 1990s, but analysis of national data from hospitalized children in the Kids’ Inpatient Database showed an increased incidence of serious physical abuse in children from 1997 to 2009.

We found no significant change in hospitalization rates for injury from abuse in young children and increases in injury severity using the National Inpatient Sample from 1997 to 2009. This data helps provide a more complete perspective of the problem. (Read the full article)

Early preventive pediatric dental visits are widely recommended. However, the effectiveness of pediatric preventive dental visits in reducing the need for subsequent, more expensive oral health treatment has not been well established.

Using an econometric method that accounts for time-invariant differences between children, and thus helps mitigate selection bias, we found a positive impact of preventive dental visits on oral health. However, there is less evidence regarding the cost-effectiveness of preventive visits. (Read the full article)

Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.

This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. (Read the full article)

Infants with birth defects are more likely to be born preterm or with low birth weight and are at higher risk of death.

This study describes the prevalence of birth defects in a cohort of very low birth weight infants and evaluates in-hospital surgical procedures, morbidity, and mortality. (Read the full article)

Preterm neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in infants in developed countries.

For preterm infants born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. (Read the full article)

Elevated blood pressure (BP) has long-term influence on the atherosclerotic process. The relative predictive ability of the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions has not been studied.

Simplified pediatric BP tables predict risk of high adult arterial stiffness as well as the complex table does. These simple screening tools could be used for identifying pediatric subjects at risk and for intervening to improve adult cardiovascular outcomes. (Read the full article)

About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.

In this large randomized controlled trial, anticipatory guidance on the "when, what, and how" of complementary feeding was associated with increased maternal "protective" feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance. (Read the full article)

Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.

Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. (Read the full article)

Screening for hypertension in asymptomatic children and adolescents occurs during routine care. For those with elevated blood pressure, a repeat measurement within 1 to 2 weeks is recommended. However, little is known about patterns of care after an incident elevated blood pressure.

In a population of 72 625 children and adolescents, 6108 (8.4%) had an incident elevated blood pressure. Among these, 1275 (20.9%) had their blood pressure measurement repeated within 1 month. However, few individuals with an incident elevated blood pressure subsequently developed hypertension. (Read the full article)

Children exposed to alcohol prenatally have increased risk of a range of developmental problems such as language delay, behavior problems, learning, and memory and cognitive deficits, all of which can have a negative impact on educational achievement.

The expression of learning problems varied with the dose, pattern, and timing of prenatal alcohol exposure. Test scores below national benchmarks for reading were associated with first trimester heavy alcohol exposure and for writing after late pregnancy occasional binge drinking. (Read the full article)

Many children exceed the American Academy of Pediatrics' recommendation to limit non-educational screen media to < 2 hours per day. The household media environment shapes children's television viewing (TVV), and heavy screen time is associated with poor health outcomes.

Parent TVV is a stronger predictor of child TVV than traditional media "access" and "rules" variables regardless of child age. This research highlights an important factor of child TVV that has been underemphasized in most studies and outreach efforts. (Read the full article)

Assessment of general movements (GM) in early infancy is predictive of adverse neurologic outcome, particularly cerebral palsy. There is limited evidence of the predictive value of GM for other domains of neurodevelopment such as language and cognitive impairment.

Abnormal GM in preterm infants in the first 3 months postterm are predictive of a range of neurodevelopmental outcomes in early childhood. GM at 3 months are more accurate at distinguishing later neurodevelopment impairment than those at 1 month. (Read the full article)

The evaluation of blunt head trauma in children who undergo cranial computed tomography will occasionally reveal incidental findings. These findings may require further evaluation or intervention. The prevalence of incidental findings has previously been described using small cohorts, limiting generalizability.

This study is the largest pediatric multicenter description of the prevalence of incidental findings on cranial computed tomography. Incidental findings are categorized by urgency to describe the spectrum of abnormalities, providing a context for clinicians faced with these unexpected results. (Read the full article)

Previous research has demonstrated that pediatric injuries associated with television (TV) tip-overs are increasing, children aged ≤4 years are at highest risk for injury, and the head and neck are most commonly injured.

We analyzed a nationally representative sample comprising 22 years of data. On average, 17 313 children receive emergency treatment of a TV-related injury annually in the United States. The rate of injury attributable to falling TVs increased by 95% over 22 years. (Read the full article)

Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months.

This study assessed the respective effects of early- and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early- and late-onset sepsis were associated. (Read the full article)

Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied.

Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. (Read the full article)

Sugar-sweetened beverage (SSB) consumption in school-age children and adolescents is linked to heavier weight, and decreased SSB consumption results in less weight gain. Reports regarding these associations among children aged 2 to 5 years have been mixed.

Preschool-aged and kindergarten children drinking SSB compared with infrequent/nondrinkers had higher BMI z scores. SSB consumption is also associated with higher weight status among children aged 2 to 5 years. (Read the full article)

Blood cultures are a common investigation in children admitted to the hospital with skin and soft tissue infections. The yield of blood cultures in this condition is unknown.

Blood cultures are not useful in children admitted to the hospital with uncomplicated skin and soft tissue infections, and they may be associated with increased length of hospital stay. (Read the full article)

Respiratory outcomes of patients with bronchopulmonary dysplasia (BPD) range from no oxygen requirement to chronic respiratory failure. Outcomes of least severe types of BPD are well described. Limited data exist on outcomes of patients with BPD-related chronic ventilator dependency.

Along with a first estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were dependent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation. (Read the full article)

Evaluating for elevations in alanine aminotransferase (ALT) is a common screening test for the presence of nonalcoholic fatty liver disease (NAFLD). NAFLD is less common among non-Hispanic blacks. Better predictors of NAFLD are needed to identify individuals in most need of screening.

Relative to other ethnicities, metabolic syndrome and insulin resistance performed poorly at identifying non-Hispanic black adolescents with ALT elevations. The presence of metabolic syndrome may therefore not be an adequate trigger for NAFLD screening. Triglyceride elevations performed similarly between groups in identifying ALT elevations. (Read the full article)

Term neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants.

For term neonates born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. (Read the full article)

Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high- or low-performers.

Only a few hospitals that care for children are high- or low-performers when their condition-specific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. (Read the full article)

Parents of premature infants are susceptible to developing trauma symptoms related to their NICU experience. There are no current well-established interventions that simultaneously address both parental trauma as well as redefinition of the parenting experience.

A brief, cost-effective, and feasible manualized intervention for NICU parents was effective in reducing both parental trauma and depression. Implementation of this intervention in the NICU setting has the potential to improve maternal well-being and infant outcomes. (Read the full article)

Rehabilitation of people with cerebral palsy aims to achieve and maintain optimal performance in mobility and daily activities. Although insight into the developmental trajectories of activities from childhood into adulthood is important, little is known about long-term development.

The gross motor function of children with cerebral palsy determines the developmental trajectories of mobility performance but not of daily activities, where intellectual disability was shown to be the determining factor. (Read the full article)

Unintentional injuries lead to a significant number of children suffering from long-lasting posttraumatic stress symptoms. Therefore, early identification of individuals at risk is crucial to provide preventative interventions. However, currently, no early screener has been evaluated in preschool-aged children.

Good sensitivity (85%) and acceptable specificity (63%) were found for an early screening measure for preschool-aged children after accidental injury. Hence, the 21-item Pediatric Emotional Distress Scale–Early Screener, a reliable and valid early screening instrument, is suggested for use within a stepped-care model. (Read the full article)

Stress affects health of children, potentially persisting as a trajectory into adulthood. Earlier biological markers assess only momentary stress, making it difficult to investigate stress over longer periods of time. Cortisol in hair is a new biomarker of prolonged stress.

Mother and child hair cortisol association suggests a heritable part or maternal calibration. Cortisol output gradually stabilizes, has a stable trait, and is positively correlated to birth weight. Hair cortisol is a promising noninvasive biomarker of prolonged stress, especially applicable for children. (Read the full article)

Pneumonia is the leading cause of death in young children worldwide. Anemia, widely prevalent globally, is not routinely assessed when treating pneumonia. The effect of anemia and high altitude on outcome of pneumonia is not well described.

Anemia at high altitude increases the risk of poor outcome with severe pneumonia. Children with severe pneumonia at high altitude present with more severe hypoxemia and have a longer time to recovery than children at low altitude. (Read the full article)

A large and growing literature has demonstrated significant associations between the use of spanking and later child aggression, but we know less about paternal spanking, effects of spanking on cognitive development, and longer-term effects.

Accounting for a broad array of risk factors, spanking predicts both aggression and receptive vocabulary across the first decade of life. Importantly, we include paternal spanking, cognitive outcomes, and a longitudinal span longer than that of much of the literature. (Read the full article)

Several studies have documented earlier onset of pubertal maturation in girls, with several potential factors attributed to the earlier onset.

This study demonstrates earlier maturation in white non-Hispanic girls, with greater BMI linked as a major factor. The entire distribution of pubertal timing has shifted to a younger age, suggesting redefinition of ages for both early and late maturation. (Read the full article)

Preterm infants are born with low serum levels and low body stores of tocopherol. Serum levels ≥0.5 mg/dL are required for protection against lipid peroxidation. Previous studies have shown good intestinal absorption of vitamin E given intragastrically to preterm infants.

Serum α-tocopherol increases after a single 50-IU/kg dose of vitamin E as dl-α-tocopheryl acetate given intragastrically to very preterm infants soon after birth; however, 30% of infants still have serum α-tocopherol level <0.5 mg/dL 24 hours after dosing. (Read the full article)

In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.

Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention. (Read the full article)

Global health is of increasing interest and relevance to North American pediatric trainees. Opportunities for resident global health training and exposure are most often limited to electives or trainees in dedicated global health tracks.

A series of short, structured, participatory global child health modules improved knowledge and were well received and integrated within academic programs. Such modules enable global health learning for all residents, including those who never intend to practice overseas. (Read the full article)

Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined.

Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk. (Read the full article)

Prenatal and postnatal organophosphate (cholinesterase inhibitor) pesticide exposure has been associated with delays in attention, memory, intelligence, and inhibitory control. Two recent studies reported decreased attention and working memory with greater exposure to organophosphates in boys but not in girls.

This is the first study to report associations between decreased acetylcholinesterase activity, a stable marker of cholinesterase inhibitor pesticide exposure, and lower overall neurodevelopment, attention, inhibitory control, and memory. These associations were present in boys but not in girls. (Read the full article)

Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.

In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development. (Read the full article)

The incidence of pertussis has significantly increased, and infection can result in severe disease among young children. This highly contagious disease may frequently be transmitted in pediatric health care settings, necessitating effective infection control practices to reduce exposure risk.

Despite institutional guidelines, pediatric health care workers (HCWs) are frequently exposed to pertussis because of delayed or incomplete adherence to infection control practices. Inconsistent reporting may also result in missed HCW exposures, increasing the risk of subsequent transmission to patients. (Read the full article)

Although immunoglobulin replacement is recognized as effective in children with primary immunodeficiency, pneumococcal infection may occur. There is no available prospective clinical study evaluating levels of protective serospecific antibodies in patients and products.

Protective (0.2 µg/mL) antibody levels for the most frequent pneumococcal serotypes were measured in children treated for primary immunodeficiencies. A linear relationship was demonstrated between peak and trough levels of serospecific antipneumococcal antibodies in patients and infused immunoglobulins. (Read the full article)

Early adiposity rebound is associated with future obesity and an increased risk of development of type 2 diabetes and coronary heart disease in adult life.

This study shows that early adiposity rebound is associated with future obesity and metabolic consequences of higher triglycerides, atherogenic index, apolipoprotein B, and blood pressure and lower high-density lipoprotein cholesterol at 12 years of age. (Read the full article)

Screening for autism spectrum disorders (ASDs) using the Modified Checklist for Autism in Toddlers (M-CHAT) improves early detection and long-term prognosis of ASD. Reducing the false-positive rate may increase implementation of screening for ASDs.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), simplifies wording of the original M-CHAT. The current validation study indicates that the M-CHAT-R/F improves the ability to detect autism spectrum disorders in toddlers screened during well-child care visits. (Read the full article)

Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.

We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years’ corrected age. (Read the full article)

Although appendicitis is the most common surgical cause of abdominal pain in pediatrics, its diagnosis remains elusive. When evaluated independently, clinical scoring systems and ultrasonography have been shown to have low to moderate sensitivity in the diagnosis of appendicitis.

Our study evaluated the accuracy of a clinical practice guideline combining the Samuel’s pediatric appendicitis score and selective ultrasonography as the primary imaging modality for children with suspected appendicitis. Our clinical pathway demonstrated high sensitivity and specificity. (Read the full article)

Xylitol given as a gum or syrup 5 times daily has been shown to reduce the incidence of acute otitis media in children, but this dosing schedule is unlikely to be feasible for many families.

A regimen of viscous xylitol syrup in a dose of 5 g 3 times daily was ineffective in preventing recurrences of acute otitis media in otitis-prone children. (Read the full article)

Due to reports of unintentional overdoses, in 2011 the US Food and Drug Administration finalized voluntary recommendations for dosing devices included with over-the-counter (OTC) liquid medications. The Consumer Healthcare Products Association previously endorsed similar recommendations for devices and dosing directions.

This study assessed dosing directions and devices for national brand name OTC liquid medications, available after a voluntary FDA guidance, and found high levels of adherence to most recommendations. Further improvement efforts should prioritize recommendations directly addressing potential dosing errors. (Read the full article)

Cognitive rest is recommended for the management of sport-related concussions. There are limited data to support this recommendation.

This study adds empirical data supporting the recommendation for cognitive rest after a sport-related concussion. (Read the full article)

Infant postexposure prophylaxis prevents perinatal hepatitis B (HepB) virus transmission and mortality and morbidity caused by chronic HepB virus infection. The US Perinatal Hepatitis B Prevention Program (PHBPP) identifies and manages infants born to HepB surface antigen–positive women.

It presents the first estimates of the long-term costs and outcomes of postexposure prophylaxis with the PHBPP. It analyzes the effects of the PHBPP, and alternative immunization scenarios, on health and economic outcomes for the 2009 US birth cohort. (Read the full article)

Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated.

A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems. (Read the full article)