Term MRI can assist in identifying the nature and extent of brain injury in preterm infants. However, brain injury detected by MRI does not fully account for neurodevelopmental impairments, particularly cognitive and behavioral impairments, common in preterm survivors.

In addition to brain injury, an assessment of brain growth by using one-dimensional measurements on MRI is helpful for predicting neurodevelopment. Two different patterns of impaired brain growth are observed that relate independently to early cognitive development in preterm infants. (Read the full article)

Delayed diagnosis of critical congenital heart defects (CCHDs) is associated with increased morbidity and mortality.

Despite increasing prenatal diagnosis rates, delayed diagnosis of CCHDs continues to occur, with rates highest among isolated cases and those delivered at nontertiary care hospitals. Better understanding of delayed diagnosis could help to improve screening efforts. (Read the full article)

Practitioners caring for critically ill infants need to acquire competence in insertion of chest tubes for pneumothorax. Ethical and logistic concerns inhibit the use of animals, and there are no realistic simulation models available for neonatal chest tube insertion training.

An inexpensive, nonanimal chest tube insertion model can be easily constructed and used effectively to train interns and residents to improve their knowledge, clinical skills, and comfort levels to perform the chest tube insertion procedure in infants. (Read the full article)

For newborn infants, extreme hyperbilirubinemia (≥24.5 mg/dL) is associated with risk for severe bilirubin encephalopathy. The causal factor of extreme hyperbilirubinemia is often not established. The genotype of Gilbert syndrome, the UGT1A1*28 allele, is considered a potential risk factor.

The UGT1A1*28 allele was not associated with risk for developing extreme hyperbilirubinemia. (Read the full article)

Vitamin K prophylaxis at birth is an effective intervention for preventing vitamin K deficiency bleeding.

Refusal of vitamin K is not common, but those who refuse are more likely to have a birth attended by a midwife, and deliver at home or in a birth center. They are also less likely to immunize their child. (Read the full article)

Hydroxyurea is a treatment option for young patients with sickle cell disease (SCD). Establishing the safety of hydroxyurea is of paramount importance. The effect of hydroxyurea on immune function and immunizations in SCD has not been studied previously.

Children with SCD receiving hydroxyurea have lower lymphocyte, CD4, and memory T-cell counts compared with those receiving placebo, but still in the range for healthy children. Despite slower response to measles vaccine, measles, mumps, and rubella and pneumococcal vaccines are effective. (Read the full article)

Lung ultrasound outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. In the pediatric age, lung ultrasound has been also successfully applied to the fluid-to-air transition after birth and to rapid pneumonia diagnosis.

Nasal ventilation has dramatically decreased the need for invasive mechanical respiratory support. This study demonstrates that, after a short trial on nasal continuous positive airway pressure, lung ultrasonography reliably predicts the failure of noninvasive ventilation unlike the conventional chest radiogram. (Read the full article)

Vaccinating youth is among the nation’s highest health care priorities. Despite proven health benefits, human papillomavirus vaccination rates remain low.

This is the first known study to test whether vaccination of high-risk adolescents is related to their or their parents’ previous knowledge levels. In the results presented, neither parental nor adolescent knowledge is related to subsequent adolescent vaccination. (Read the full article)

Continuously aerosolized albuterol been shown to be safe and effective for the treatment of severe status asthmaticus in the emergency department and ICU. Little evidence supports its use in the non–intensive care setting.

With the appropriate resources and support, continuous albuterol may be administered in the non–ICU setting with a low incidence of clinical deterioration and adverse effects. Certain clinical factors may help identify which patients may benefit from higher acuity care. (Read the full article)

Little is known about how pediatricians communicate with overweight Latino children and their parents regarding overweight and obesity.

Findings suggest that many overweight Latino children and their parents do not receive direct communication that the child is overweight, weight-management plans, culturally relevant dietary recommendations, or follow-up visits. (Read the full article)

Youth in foster care are at higher risk of health problems at entrance and during their stays in care. Little is known about this group’s risk of health problems in young adulthood, in comparison with other populations of young adults.

This is the first prospective study to our knowledge demonstrating that former foster youth are at higher risk of chronic health problems than economically secure and insecure general population young adults. (Read the full article)

Rhinoviruses are commonly detected in both acutely ill and asymptomatic infants and children. The finding may represent new infection or prolonged presence of rhinovirus RNA in the respiratory tract.

In young, otherwise healthy infants, shedding of RNA from the same rhinovirus strain rarely persisted longer than 30 days. (Read the full article)

IP-10 is a novel immunologic marker for tuberculosis (TB) infection. It has been suggested that IP-10 may perform better in children compared with the QuantiFERON test, but only a few studies have investigated IP-10 for diagnosing active TB in children.

This study is the first to investigate IP-10 and QuantiFERON for diagnosing TB in children by using consensus classifications. Both IP-10 and QuantiFERON exhibited poor performance in children from a high-burden setting, and performance was especially compromised in young children. (Read the full article)

Exclusively breastfed newborns lose weight daily in the first few days after birth. The amount of weight lost varies substantially between newborns, with higher amounts of weight loss increasing risk for morbidity.

This study presents nomograms demonstrating percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms have potential to be used for early identification of neonates on a trajectory for greater weight loss and related morbidities. (Read the full article)

Syndrome-specific standardized growth curves are not currently available for non–growth hormone–treated subjects with Prader-Willi syndrome and are required for monitoring growth and development in this rare obesity-related disorder.

Standardized growth curves were useful in monitoring growth and development in these subjects with Prader-Willi syndrome and for the management of growth hormone treatment of both genders, particularly those aged 3 to 18 years. (Read the full article)

Researchers speculate that children with fetal alcohol spectrum disorders often are not recognized or diagnosed correctly.

This is the first study to assess the rate of missed diagnoses and misdiagnosis in foster and adopted children with fetal alcohol spectrum disorders. (Read the full article)

Pediatric obstructive sleep apnea syndrome (OSAS) has been associated with decreased health-related quality of life (QoL). Observational studies suggest that adenotonsillectomy for pediatric OSAS improves QoL, but these studies did not use a randomized study design or a control group of children with OSAS managed nonsurgically.

A prospective, randomized controlled study of adenotonsillectomy for pediatric OSAS showed significantly greater QoL and symptom improvements in children undergoing adenotonsillectomy than in the nonsurgical control arm. The extent of improvement was not appreciably influenced by baseline OSAS severity or obesity. (Read the full article)

Previous research has established steep socioeconomic status gradients in children’s cognitive ability at kindergarten entry. Few studies have had comprehensive data to examine the contribution of a wide range of risk and protective factors across early childhood to these gradients.

Family background, health, home learning, parenting, and early care and education factors explain over half the gaps in reading and math ability between US children in the lowest versus highest socioeconomic status quintiles, suggesting a need for comprehensive early interventions. (Read the full article)

Previous trials reported no significant effect of triamcinolone acetonide aqueous nasal spray on growth velocity of children with perennial allergic rhinitis. However, they did not conform to Food and Drug Administration guidelines for evaluating effects of intranasal corticosteroids on growth.

This is the first published study consistent with the 2007 Food and Drug Administration–recommended study design evaluating growth velocity in children aged 3–9 years with perennial allergic rhinitis treated with triamcinolone acetonide or placebo for 12 months. (Read the full article)

Noninvasive ventilation (NIV) reduced the need of intubation in preterm infants with RDS. However, randomized studies comparing nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure are still lacking.

The present study shows no differences in short-term outcomes between 2 different NIV strategies, nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure, in preterm infants for the initial treatment of RDS. (Read the full article)

Exposure to oral erythromycin in the first few weeks of life has been associated with the development of pyloric stenosis. Although azithromycin has become an acceptable alternative, little is known on whether this medication increases the risk of pyloric stenosis.

Exposure to oral azithromycin in the newborn period increases the risk of developing pyloric stenosis. Although this risk is highest if the exposure occurred in the first 2 weeks of life, the risk extends out to 6 weeks of age. (Read the full article)

It is unclear whether developmental delays observed among infants with single-suture craniosynostosis (SSC) persist at school age. Few neurodevelopmental studies have examined children with SSC beyond age 3, with most having methodological limitations.

This study is the first to follow and test infants with SSC and a control group at school age. Infancy delays among children with SSC persisted at school age in some areas (IQ, math) but not others (reading, spelling). (Read the full article)

Although there is evidence regarding comorbidity of physical and mental disorders from clinical samples of specific disorders and treatment registries, there is limited evidence from systematic samples of youth with comprehensive information on the full range of mental and physical disorders.

This report is the first study to investigate the specificity of associations between a broad range of mental and physical conditions by using a large, systematically obtained pediatric sample with enriched information from electronic medical records and direct interviews. (Read the full article)

Myxovirus resistance protein A (MxA) is a protein induced during viral infections. A few small-scale studies have suggested that MxA could be used as a marker of viral infection in clinical routine practice.

This study involves the largest patient population thus far and confirms the usefulness of MxA for diagnosing viral infections in children consulting the emergency department in a clinical routine setting. (Read the full article)

Smoking has been found to increase the risk of some specific congenital anomalies; however, results remain inconsistent. Nicotine replacement therapy (NRT) is increasingly being used as for smoking cessation in pregnancy although little is known about its association with congenital anomalies.

Being prescribed NRT while pregnant was not associated with major congenital anomalies (MCA), except a small increase in respiratory anomalies (3/1000 births). This must be considered in context of the rarity of MCAs and higher morbidities in the NRT group. (Read the full article)

Otorrhea is common in children with tympanostomy tubes: annually, 2 of 3 children develop 1 or more episodes. Antibiotic-glucocorticoid eardrops are the most effective treatment in both the short- and long-term.

Treatment with antibiotic-glucocorticoid eardrops costs less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea. Non–health care costs constitute a substantial proportion of the total costs of this condition. (Read the full article)

Clinical trials of the quadrivalent human papillomavirus vaccine show it to be highly efficacious in preventing vaccine-type–specific cervical dysplasia and anogenital warts, but few studies have assessed its effects in the real world and none have done so at the program/population level.

This study provides strong evidence of the early benefits of quadrivalent human papillomavirus vaccination on reductions in cervical dysplasia and possible reductions in anogenital warts among girls aged 14 to 17 years, offering additional justification for not delaying vaccination until girls are older. (Read the full article)

Infants with an inconclusive diagnosis of cystic fibrosis after newborn screening may turn out to have cystic fibrosis. However, little is known about the incidence, characteristics (phenotype and genotype), and outcomes of these infants to guide investigations and follow-up.

In this prospective longitudinal study, a proportion (11%) of infants with an initial inconclusive diagnosis were subsequently diagnosed with cystic fibrosis. This finding underscores the need for follow-up of this population. (Read the full article)

Little is known about the prevalence or outcomes of infants with indeterminate diagnostic results after a positive cystic fibrosis (CF) newborn screen (CF transmembrane conductance regulator–related metabolic syndrome [CRMS]).

CRMS accounted for 15.7% of newborn screened diagnoses in the CF Patient Registry from 2010 to 2012 (CRMS:CF ratio = 5.0:1.0). Although most infants were healthy, some infants demonstrated clinical features concerning for CF. (Read the full article)

The sensitivity of the urinalysis (UA) traditionally has been considered suboptimal in young infants. Whether the finding of a negative UA and a positive urine culture represents a false-negative UA versus a false-positive urine culture remains unclear.

In infants <3 months with bacteremic urinary tract infection, a condition that represents true infection, the UA sensitivity is higher than previously reported for urinary tract infection in general, suggesting that the UA is reliable even in young infants. (Read the full article)

Dyslexia has a lifelong impact on learning. The consensus in the literature from clinical studies is that dyslexia is not caused by vision abnormalities. However, interventions and therapies directed at eye-related functions are still available.

In this cohort the majority of dyslexic children had normal results for all ophthalmic tests. These population-based data support the consensus that dyslexia is not primarily a vision problem and that vision-based therapies are not justified or likely to help. (Read the full article)

Treatment of idiopathic steroid-resistant nephrotic syndrome is challenging, and therapeutic options are limited. In spite of good initial response with rituximab, responders always remain prone to further relapse, necessitating either repeat course of rituximab or addition of another steroid-sparing immunosuppressant.

Mycophenolate mofetil may be an effective maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory steroid-resistant nephrotic syndrome. (Read the full article)

Prophylactic vaccination of young women 16 to 26 years of age with the 9-valent human papillomavirus (HPV)–like particle (9vHPV) vaccine prevents infection and disease with vaccine HPV types.

These data support bridging the efficacy findings with 9vHPV vaccine in young women 16 to 26 years of age to girls and boys 9 to 15 years of age and implementation of gender-neutral HPV vaccination programs in preadolescents and adolescents. (Read the full article)

Neonatal coarctation of the aorta (CoA) is a life-threatening cardiac defect, but because symptoms may be lacking initially, newborns with this defect are frequently discharged from the hospital undiagnosed. Delayed diagnosis of CoA is associated with increased morbidity and mortality.

This population-based study analyzes the contribution of prenatal ultrasound and postnatal pulse oximetry screening to the timely diagnosis of neonatal CoA. Both screening methods had low sensitivity for CoA. Nearly half of all newborns with isolated CoA were discharged undiagnosed. (Read the full article)

It is known that trisomy 21 decreases the risk of (nonocular) angiogenic-mediated disorders, such as solid tumors. It is not known whether trisomy 21 decreases the risk of ocular angiogenic-mediated disorders such as retinopathy of prematurity.

This study shows that trisomy 21 decreases the risk of retinopathy of prematurity (ROP), thus unmasking a potentially identifiable genetic component to ROP risk. This study paves the way for the future development of a laboratory-based ROP screening tool. (Read the full article)

Diabetic ketoacidosis (DKA) is a common and serious first manifestation of diabetes mellitus in children. During initial evaluation, the venous blood pH is frequently used to make the diagnosis and classify the severity of DKA.

This study demonstrates that the serum bicarbonate concentration is a simple and accurate predictor of DKA and its severity and can be used in lieu of venous pH measurement, especially in resource-poor settings where access to pH measurement is limited. (Read the full article)

Weak recommendations exist to guide emergent neuroimaging decisions in children with first, unprovoked seizures. The prevalence of and risk factors associated with clinically relevant abnormalities on neuroimaging have not been well defined in prospective studies.

Clinically relevant intracranial abnormalities on neuroimaging occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most of these children do not require emergent neuroimaging. Specific clinical findings identify patients at higher risk. (Read the full article)

Discharge from the NICU requires coordination and may be delayed for nonmedical reasons. Predicting when patients will be medically ready for discharge can avoid these delays and result in cost savings for the hospital.

We developed a supervised machine learning approach using real-time patient data from the daily neonatology progress note to predict when patients will be medically ready for discharge. (Read the full article)

Prenatal diagnosis may lead to benefits in outcomes for certain forms of critical congenital heart disease. Despite recognized benefits, single-center studies and focused regional efforts suggest that prenatal detection rates for congenital heart disease remain low in the United States.

We describe prenatal detection rates for a large cohort of neonates and infants undergoing heart surgery across a range of congenital heart defects. Additionally, this study adds new information by demonstrating geographic variability of prenatal detection rates across the United States. (Read the full article)

The routine childhood immunization schedule is crowded during the first 2 years, leading to deferred doses and limiting the addition of new vaccines. Combination vaccines can reduce the "shot burden" and improve coverage rates and timeliness.

Antibody response rates to antigens contained in an investigational hexavalent vaccine (DTaP5-IPV-Hib-HepB) were noninferior to licensed comparator vaccines when given as a 3-dose infant series. The safety profile was similar to control except for increased rates of mild-to-moderate, self-limited fever. (Read the full article)

In adults, there is significant increased length of stay, cost, and/or resource use associated with hospital-acquired conditions. Less is known about the epidemiology and impact of many hospital-acquired conditions in pediatric populations.

We find increased pediatric length of stay and costs due to venous thromboembolism and catheter-associated urinary tract infections. This is essential information for hospital administrators and safety departments who are planning interventions to reduce harm associated with these hospital-acquired conditions. (Read the full article)

Increasing percentages of youth are living with chronic medical conditions. Although adolescents face peak risks for onset and intensification of alcohol and marijuana use, we know little about these behaviors and their associations with treatment adherence among chronically ill youth.

This study quantifies alcohol and marijuana use behaviors among a heterogeneous sample of chronically ill youth in aggregate and by condition, and measures associations between alcohol use/binge drinking and knowledge about alcohol interactions with medications/laboratory tests and also treatment nonadherence. (Read the full article)

Choosing career paths can be a difficult decision for residents contemplating fellowship training. Limited resources are available to residents to help guide their choices.

This article provides additional descriptions and insight into actual lifestyle and workplace environments for pediatric residents who choose fellowship training compared with those who do not. (Read the full article)

Many studies have suggested that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly co-occuring neurodevelopmental conditions.

In children with co-occurring ASD and ADHD, an initial ADHD diagnosis may be associated with delayed ASD diagnosis and a higher likelihood of ASD diagnosis older than 6 years of age. Clinicians should consider ASD when evaluating young children presenting with ADHD symptoms. (Read the full article)

Sleep disturbances in infants associate with individual differences in temperament. However, little is known about interindividual differences and potential moderating factors, such as genotype.

The results suggest that the cumulative effect of total sleep duration during the first 3 years of life on temperament is moderated by child 5-HTTLPR genotype following a differential susceptibility model. (Read the full article)

The frequency of cardiac arrest is significantly lower in children than in adults, rendering the delivery of high-quality cardiopulmonary resuscitation more difficult. Metronome-based studies in adults showed improvement in adequate compression rate, with a detrimental effect on the depth of chest compressions.

This is the first pediatric study to confirm that the use of a metronome during cardiopulmonary resuscitation significantly improves the delivery of adequate rate without affecting the compression depth. This effect was more prominent among medical students and pediatric residents and fellows than nurses. (Read the full article)

Children with marked cerebral palsy (CP) are considered at greater risk of adverse events (AEs) after intramuscular injections of BoNT-A. To date there has been no randomized controlled trial examining safety of intramuscular BoNT-A injections in children with marked CP.

Children with nonambulatory CP had no greater risk of moderate or serious AEs after intramuscular injections of BoNT-A compared with a sham/control group. There was no greater risk of AEs for children receiving 2 compared with 1 episode of BoNT-A. (Read the full article)

Children with cystic fibrosis demonstrate gas exchange abnormalities and increased respiratory loads during sleep independent of lung function, age, and BMI. Assessment of breathing patterns during sleep provides an opportunity for detection of early lung disease progression.

Children with cystic fibrosis demonstrated increased respiratory loads and gas exchange abnormalities during sleep compared with controls. Based on these findings, sleep assessment in this patient population can identify markers for the early detection of lung disease progression. (Read the full article)

England, Switzerland, Sweden, Italy, Spain and Finland maintained their perfect records but European champions the Netherlands were held by the Republic of Ireland.

Experts say if you can afford to continue repaying your debts, resist the temptation to take a payment holiday, even if you qualify for the relief.