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)

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

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

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)

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

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

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)

Neglect cases in Child Protective Services often receive home-based interventions, but their success in preventing maltreatment recidivism has been elusive. Structured, behavioral skills models, such as SafeCare, are promising but have not been tested in full-scale implementation trials.

This cluster trial experiment demonstrates significant maltreatment recidivism reduction due to implementing the SafeCare model in a fully scaled-up statewide system. The findings support adopting the SafeCare model for these types of services. (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)

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)

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)

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)

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)

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)

Inhaled nitric oxide for premature infants has been evaluated in multiple studies; however, these trials differed in treatment initiation, duration of therapy, and inclusion criteria. Furthermore, these trials reached differing conclusions regarding the benefit of inhaled nitric oxide.

We used a large sample of infants from children’s hospitals and found that the use of inhaled nitric oxide in premature infants was variable even when controlling for demographic characteristics and disease. (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)

Nearly one-third of all US children are overweight or obese, with even higher prevalence among Mexican American children. Overweight and obesity increase systemic inflammation, contributing to increased risk for chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease.

Obese Mexican American children had concurrent alterations in both inflammatory markers and traditional disease risk markers, relative to healthy weight children. Our results provide evidence partially explaining the health disparity for disease in Mexican American children who are overweight/obese. (Read the full article)

Although all residents progressively assume responsibility for clinical skills under the teaching and supervision of attending physicians, senior residents also assume responsibility for teaching and supervising. This leads to a dynamic negotiation of responsibilities, particularly on clinical work rounds.

A better understanding of how attending physicians and senior residents negotiate shared responsibilities for teaching and supervising, and the context in which this negotiation occurs, may clarify assumptions and set expectations for resident training. (Read the full article)

In utero exposure to glucocorticoids in animal models influences vascular development. Studies in young adults have shown that exposure to antenatal glucocorticoids alters glucose metabolism, but it is not known whether there are any cardiovascular effects.

Glucocorticoid exposure is associated with a localized increase in aortic arch stiffness, similar in magnitude to term-born individuals a decade older. The change in stiffness does not relate to changes in glucose metabolism that were also evident in this cohort. (Read the full article)

As a result of safety and environmental concerns about mercury, aneroid sphygmomanometers have replaced mercury-filled devices for blood pressure measurements. Despite this change, few studies have compared the 2 devices.

Little clinical variation exists between blood pressure measurements obtained from an aneroid or mercury device, suggesting that either device could be used in a research or clinical setting. (Read the full article)

Disparities are known to exist in the prescription of opioid analgesics among racial and ethnic groups in the management of postoperative, cancer, and emergency department pain in patients across all ages, including children.

Race is associated with an unequal burden of perioperative pain and opioid adverse effects in children. Relatively, African American children had higher postoperative pain, and Caucasian children had higher incidences of opioid related adverse effects. (Read the full article)

Although several randomized trials have examined the efficacy of serotonin receptor inhibitors in the treatment of repetitive behaviors, there still remains clinical uncertainty as to whether these agents are effective in treating such behaviors in children and adults with autism spectrum disorders.

The goal of this meta-analysis was to examine randomized trials of serotonin receptor inhibitors for treating repetitive behaviors in autism spectrum disorders. Although a small but significant effect of these agents was observed, this effect is likely due to the selective publication of trial results. (Read the full article)

Kindergarten entry vaccination requirements are associated with higher coverage for early childhood vaccines.

Middle school entry vaccination requirements may also be associated with higher coverage for adolescent vaccines, whereas education-only requirements appear not to have an impact at this time. (Read the full article)

Assessing for adequacy of supervision in the clinical setting is challenging and may result in significant variability in care. Clinicians must quickly decide if a child and family necessitate direct counseling, further intervention, or require reporting to state agencies.

This study identified the most important characteristics for the evaluation of the adequacy of supervision of a young child. A standardized scale using these characteristics may result in an efficient means to reduce variability in care. (Read the full article)

Conflicting results exist concerning long-term outcome in healthy infants with metabolic acidosis at birth.

Neonates who appear well after perinatal metabolic acidosis do not have an increased risk of neurologic or behavioral problems in need of referral actions or pedagogic arrangements at the age of 6.5 years. (Read the full article)

More than one-tenth pediatric patients use complementary and alternative medicines (CAM) for their medial conditions in the United States. Traditional Chinese medicine (TCM) is the most commonly used CAM in East Asia but large-scale epidemiologic studies are lacking.

In comparing TCM and non-TCM users among children in Taiwan, children’s age and parental TCM use were strongly associated with TCM use. Additionally, dyspepsia and allergic rhinitis were positively related to increasing TCM use. (Read the full article)

Omega-3 fatty acids (O3FA) are commonly used as complementary treatments in pediatric psychiatric disorders, including Tourette’s disorder (TD), and are well known to have anti-inflammatory properties. However, no studies to date have examined the effects of O3FA on pediatric TD.

This is the first double-blind, placebo-controlled clinical trial of O3FA in pediatric TD. The results indicate that O3FA supplementation may be beneficial in the reduction of tic-related impairment for some children and adolescents with TD, but not tics per se. (Read the full article)

Some researchers have suggested that individuals with Down syndrome (DS) are protected from atherosclerotic disease; however, recent data from 2 large cohort studies of individuals with DS are significant for increased mortality from ischemic heart disease and cerebrovascular disease.

This study compares lipid profiles among children with DS and their siblings, highlighting the presence of a less favorable lipid profile in this high-risk population. (Read the full article)

Isolated methylmalonic acidemia, one of the most common inborn errors of organic acid metabolism, is known to be associated with variably impaired intellectual functioning and severe biochemical and clinical abnormalities. However, the neurocognitive outcomes have yet to be fully described.

This research defines the neurocognitive phenotype of isolated methylmalonic acidemia and identifies processing speed as a specific impairment. Clinical, biochemical, and molecular genetic covariates were explored. A history of hyperammonemia at diagnosis was found to correlate with poorer cognitive outcomes. (Read the full article)

Infants weighing 501 to 1500 g are at high risk for mortality and for neonatal morbidities associated with both short- and long-term adverse consequences.

Mortality and major neonatal morbidity in survivors decreased for infants 501 to 1500 g between 2000 and 2009. However, in 2009, a high proportion of these infants still either died or survived after experiencing ≥1 major neonatal morbidity. (Read the full article)

The hypothesis that maternal prenatal folic acid lowers risk for childhood malignancy in offspring is supported by experimental and epidemiologic evidence, including 2 Canadian ecologic studies that showed inverse associations for some cancer types in the very young.

Examining Surveillance Epidemiology and End Results Program data, a decrease in the incidence of some childhood cancers (Wilms tumor, primitive neuroectodermal tumors) was observed in those <5 years after mandatory US folic acid fortification, with stronger effects detected in infants. (Read the full article)

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

In 2011, the Accreditation Council on Graduate Medical Education increased restrictions on resident duty-hours. Further changes have been considered, including greater work-hour restrictions and lengthening residency. Residents’ views about these policies are unclear.

This is the first systematic, national inquiry into resident opinions on reduced work-hours and longer residency. More pediatric residents support than oppose reduced hours, and a minority would add a year to residency to achieve them. (Read the full article)

Adherence to guidelines has generally been shown to improve patient care and reduce the cost of care. Current understanding of the varying reasons why clinicians deviate from guidelines is based on surveys and retrospective reviews.

We examined clinician deviations from guidelines in a prospective fashion and attempted to categorize those deviations. Better elucidation of clinician reasoning behind deviations may inform care improvement and help define strategies to eliminate unjustifiable deviations. (Read the full article)

Preterm children born between 29 and 36 gestational weeks are at higher risk of developmental delay. The Ages and Stages Questionnaires (ASQ) have been recommended as a developmental screening tool.

At 12 months’ corrected age (CA), the ASQ was insufficient in identifying delays on both mental and psychomotor scales of the Bayley Scales of Infant Development but was accurate in detecting mental delay at CA of 24 months. (Read the full article)

Known rates of nonsuicidal self-injury, hurting oneself without the intent to die, are between ~7% and 24% in samples of early adolescents and older adolescents, yet research has not reported rates for youth younger than 11 years old.

Children as young as 7 years old report engaging in nonsuicidal self-injury. There is a grade by gender interaction for nonsuicidal self-injury, such that ninth-grade girls report the greatest rates of engagement and do so by cutting themselves. (Read the full article)

Providers who speak Spanish, regardless of their proficiency level, may use Spanish for clinical care without seeking professional interpretation. Failure to use professional interpretation increases the risk for miscommunication and can lead to patient harm.

Providing residents with objective feedback on Spanish language proficiency decreased willingness to use Spanish in straightforward clinical scenarios. Language proficiency testing, coupled with institutional policies requiring professional interpretation, may improve care for patients with limited English proficiency. (Read the full article)

Early speech and language delays are risk factors for later developmental and social difficulties. It is easier to identify them retrospectively than prospectively. Population characteristics and prevalence rates make screening problematic.

Using data from a birth cohort, this study identifies predictors of language performance at 5 years and 4 patterns of change between 3 and 5 years, comparing those who change with those whose profile remains low across time points. (Read the full article)

Literature about polymorphic expression of an apparent life-threatening event (ALTE), particularly that concerning discrimination between ALTE with evident cause and idiopathic ALTE, is scarce. Relationships between SIDS and ALTEs have been supposed but data are still controversial and no genetic data are available.

Genetic analysis (5HTT and MAOA) on ALTEs and idiopathic ALTEs discriminated the 2 syndromes and found a link between the idiopathic form and SIDS. Consequently, we hypothesized that the 2 latter syndromes could be different phenotype expressions of a common genetic base. (Read the full article)

Children with a single kidney are often counseled to avoid contact/collision sports based on the concern of injury to the kidney; however, the incidence of kidney injury during sport is not well understood.

Based on this multiyear, prospective injury surveillance system of varsity-level high school athletes, sport-related kidney injury is rare. Reevaluation of American Academy of Pediatrics recommendations regarding sport participation by children with a single kidney is indicated. (Read the full article)

Emphasis on preventing central line-associated bloodstream infections (CLABSIs) in US health care facilities and prophylactic antifungal medication use in neonates may impact incidence of Candida spp. CLABSIs. However, data on trends in incidence of neonatal Candida spp. CLABSIs are lacking.

Data from a large sample of US NICUs was analyzed to assess trends in incidence over time. This analysis provides a description of the epidemiology of Candida spp. CLABSIs in a national health care-associated infections surveillance system. (Read the full article)

There is no literature on the concentrations of vitamin B₆ vitamers in cerebrospinal fluid of preterm and term newborn infants. This knowledge, however, is highly important, because vitamin B₆ plays a pivotal role in brain development and functioning.

In cerebrospinal fluid of newborn infants, B₆ vitamer concentrations are strongly dependent on postmenstrual age, indicating that vitamin B₆ homeostasis in brain differs between preterm and term newborns. This has implications for the evaluation of epilepsy and vitamin B₆ deficiency. (Read the full article)

Adherence to Pediatric Advanced Life Support resuscitation guidelines for children with sepsis is low; however, few studies have been conducted in the tertiary care emergency department setting.

Adherence to septic shock guidelines in a tertiary care pediatric emergency department is low. Adherence to fluid guidelines and the entire PALS algorithm was associated with a shorter hospital length of stay. (Read the full article)

Moderately preterm-born children (32–35^6/7 weeks’ gestation) are at risk for both neonatal morbidities after birth and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the developmental delays of this particular group.

Of all neonatal morbidities commonly seen in moderately preterm-born children, only hypoglycemia increased the risk of developmental delay after moderately preterm birth. A concerted effort to prevent hypoglycemia after birth might enhance developmental outcome in this group. (Read the full article)

Clinical trials have demonstrated that prophylactic human papillomavirus (HPV) vaccines are highly effective in preventing HPV infection, but the impact of vaccination on HPV prevalence rates in real-world, community settings is uncertain.

This study provides evidence of a substantial decrease in the prevalence of vaccine-type HPV among young women and evidence of herd protection in a community only 4 years after the quadrivalent HPV vaccine was licensed. (Read the full article)

Children without any underlying medical condition who walk on their toes are referred to as idiopathic toe-walkers. The prevalence and early course of idiopathic toe-walking are unknown.

This study establishes the prevalence and early spontaneous course of idiopathic toe-walking in a large, well-defined cohort of 5.5-year-old children. (Read the full article)

The American Academy of Pediatrics prioritized detection of mental illness in children presenting to emergency departments (ED) by using standardized clinical tools. Only a minority of ED physicians indicate that they use evidence-based screening methods to assess mental health concerns.

This study presents the psychometrics of the HEADS ED (home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources), a brief, standardized screening tool for pediatric EDs. This tool ensures key information is obtained for decision-making, determining acuity level, and areas of need. (Read the full article)

To date, 4 small to moderate sized studies have revealed conflicting results on the clinically important question whether thrombocytopenia contributes to persistent patent ductus arteriosus (PDA) in very immature, preterm infants.

Thrombocytopenia in the first 24 hours after birth was not associated with the incidence of PDA at postnatal day of life 4 to 5 in a large cohort of preterm infants with <1500 g birth weight. Platelet dysfunction, rather than platelet number, might play a role in ductus arteriosus patency. (Read the full article)

Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.

This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)

Computerized provider order entry (CPOE) has been recognized to enhance the efficiency, safety, and quality of medical work. Yet vendors and organizations have not determined best practices for customizations, resulting in systems that have poor usability and unintended consequences of use.

This study demonstrated that systematically developed order sets reduce cognitive workload and order variation in the context of improved system usability and guideline adherence. The concept of cognitive workload reduction is novel in the setting of computer order entry. (Read the full article)

Skills learned in standardized courses are estimated to last only a few months. Neonatal Resuscitation Program certification is mandatory for all pediatric residents and is valid for 2 years. Exact timing of when proficiency is lost is unknown.

Neonatal Resuscitation Program skills deteriorate immediately after certification, whereas knowledge is better retained. Significant skill deficits were seen at baseline raising concerns regarding the efficacy of the current course structure. Discrepancies in knowledge and skill retention may impact caregiver performance. (Read the full article)

Childhood obesity is a public health concern. Although determinants of childhood overweight have been identified and their effect sizes have been calculated, prevention as well as treatment have had limited success.

We have calculated the population-based relevance of determinants of childhood overweight by using attributable risks, which can be interpreted as maximum success rates of preventive measures. New concepts were applied to estimate the relative contribution of each risk factor. (Read the full article)