Foreign-born children and adolescents in the United States experience higher tuberculosis (TB) morbidity rates than US-born children and adolescents. Pediatric risk assessment should account for country of birth, contact with a known TB case, or travel to TB-endemic countries.

Our study reports national data on parental/guardian countries of origin and international residence of pediatric patients with TB. Two-thirds of US-born children with TB have international family connections, and many have lived in countries with increased risk for TB acquisition. (Read the full article)

A previous study of inflatable bouncer–related fractures has shown that upper extremity fractures are most common, and many fractures are caused by collisions; however, no study has examined nonfracture injuries or used nationally representative data to investigate inflatable bouncer–related injuries.

This is the first study to use nationally representative data to calculate national injury rates, assess risk factors, and examine trends for pediatric inflatable bouncer–related injuries treated in US emergency departments over a 21-year period (1990–2010). (Read the full article)

Delayed meconium passage impairs gastrointestinal function in premature infants. No intervention has been identified that accelerates meconium passage sufficiently. Gastrografin is an osmotic contrast agent used for radiologic examination of the bowel or for conservative treatment of uncomplicated meconium ileus.

Gastrografin did not accelerate complete meconium evacuation but stimulated gastrointestinal motility in a randomized, placebo-controlled trial in premature infants. Application shortened the time to full enteral feedings and hospital stay but was associated with necrotizing enterocolitis as a possible adverse event. (Read the full article)

Medical imaging that uses ionizing radiation provides notable benefits in the clinical setting. Controversy regarding increased cancer risk, particularly in children, dictates that ordering practices and use of such medical imaging be evaluated to reduce unnecessary exposure to imaging-related radiation.

We evaluated the prevalence and characteristics of diagnostic imaging procedures in children. The proportion of higher radiation procedures is increasing, especially among children evaluated in the inpatient and emergency department settings and those with gastrointestinal and neurologic symptoms, and congenital anomalies. (Read the full article)

Very low birth weight (VLBW; <1500 g) subjects show lower scores in performance-based tests of executive functioning (EF) than control subjects up to young adulthood.

VLBW adults’ perceptions of their EF in everyday life are very similar to those of term-born adults. Parental evaluation of VLBW/small-for-gestational-age adults’ EF is more negative than adults’ self-reports. (Read the full article)

Gaining intravenous access in children can be difficult. Recently, several near-infrared devices have been introduced attempting to support intravenous cannulation by visualizing veins underneath skin. Only one of those devices has been evaluated systemically thus far and results are inconclusive.

Although it was possible to visualize veins with near-infrared in most patients, the VascuLuminator did not improve the success of cannulation. An explanation is that the main problem is probably not localization of the vein but insertion of the cannula. (Read the full article)

Cerebral edema (CE) occurs frequently during treatment of diabetic ketoacidosis (DKA) in children. Severe, life-threatening CE occurs rarely, but subclinical CE is common. Whether the rate of infusion of intravenous fluids influences the occurrence or severity of CE is unknown.

This study demonstrates that the rate of fluid infusion in children with DKA does not substantially affect MRI measures of CE. Studies assessing measures other than edema formation are necessary to determine whether fluid infusion rates influence DKA-related brain injury. (Read the full article)

Maternal obesity is an increasingly important public health concern and may adversely affect central nervous system development in offspring. However, few studies have explored the relationship between maternal prepregnancy BMI and neurodevelopmental outcomes in children, with conflicting results.

Using data from a large and contemporary UK birth cohort, we found that maternal prepregnancy BMI is negatively associated with children’s cognitive performance. The relationship appears to become stronger as children get older, although the overall effect size is modest. (Read the full article)

Low birth weight (LBW) infants (<2500 g) are at risk for cognitive and behavioral problems later in life. During infancy, they are also at risk for iron deficiency, which has been associated with impaired neurodevelopment in other high-risk groups.

Iron supplementation during the first 6 months of life to LBW infants reduces the risk of behavioral problems at 3.5 years. Mild iron deficiency in infancy may be an important, preventable contributor to behavioral problems in children born with LBW. (Read the full article)

Children with congenital heart disease (CHD) are at increased risk for poor growth. Several factors may play a role in poor growth, including feeding difficulties, increased caloric requirements, and the effects of cardiac lesions on growth regulation.

In children with CHD, impaired growth as measured by weight, length, and head circumference occurs simultaneously rather than sequentially, supporting the theory that altered growth regulation likely plays an important role in the poor growth of children with CHD. (Read the full article)

Developmental screening using standardized tools has been endorsed by professional groups to improve rates of identification and referral for young children who have developmental delays. Little is known about the effectiveness of these tools among a high-risk urban population.

Using a randomized design, we found that a program of developmental screening improved the percentage and time to identification of developmental delay, referral, and eligibility for early intervention among a poor, racially diverse urban population of young children. (Read the full article)

Although survival of children born with Down syndrome has improved, unexplained racial and ethnic disparities in survival persist in the United States.

This study used population-based data from 10 birth defects monitoring programs in the United States to examine survival trends among children born with Down syndrome and to evaluate the changing influence of survival predictors over the life course. (Read the full article)

When research involving children is determined to present greater than minimal risk but no potential for direct benefit, permission is required from both parents, unless one is not reasonably available. These requirements are variably understood and applied, and guidance is lacking.

In a study on newborn screening, a sizeable percentage of fathers were not reasonably available, reflecting complexities of parental status and family relations. Guidelines developed in this project may provide tools for researchers and institutions to apply in other contexts. (Read the full article)

A reduced nephron number is associated with glomerular hyperfiltration, resulting in renal injury such as hypertension, proteinuria, and chronic kidney disease. Patients with a solitary functioning kidney have an increased risk of dialysis in early adulthood.

This study demonstrates that a subset of children with a solitary functioning kidney progress toward renal injury during childhood. Risk factors for renal injury are ipsilateral anomalies of the kidney and urinary tract and small renal length. (Read the full article)

Heuristics are decision-making aids or shortcuts that ease the task of making a wide variety of decisions in diverse contexts. Little is known about the heuristics that parents of children with serious illness use when confronting difficult decisions.

Parents of children with life-threatening illnesses use several different types of heuristics, explicitly, in making sense of complex situations, making decisions, and communicating these decisions to others. Better understanding of these heuristics may improve communication and decision support. (Read the full article)

Children exposed to second-hand smoke have high rates of hospitalization for respiratory illness. These visits represent a "teachable moment" when parental smokers can be motivated to quit. However, pediatric health care practitioners receive little training in tobacco cessation.

The Web-Based Respiratory Education About Tobacco and Health online training program was effective at increasing the provision of an effective tobacco cessation intervention by pediatric hospital-based respiratory therapists, registered nurses, and nurse practitioners to adult smokers. (Read the full article)

Survival estimates for preterm infants are vital for counseling parents, informing care, and planning services. Widely use estimates of in-unit survival derived from a large UK population for infants born at <33 weeks’ gestational age have been available since 1999.

These survival charts have been updated and will be of use to clinicians, parents, and managers. An alternative method for graphical representation of survival probabilities is offered: contour survival plots. (Read the full article)

Birth asphyxia, or failure to initiate or sustain spontaneous breathing at birth, contributes to ~27% to 30% of neonatal deaths in resource-limited countries, including Tanzania. Without change, these countries will fail to meet Millennium Development Goal 4 targets by 2015.

The Helping Babies Breathe program was implemented in 8 hospitals in Tanzania in 2009. It has been associated with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years. (Read the full article)

A number of studies have shown that home-visiting interventions can improve outcomes for children being raised in families that face multiple adversities. It is less clear how well these benefits are sustained over long periods.

The current study shows that the Early Start program of home visitation has benefits in terms of reducing child abuse, increasing parental competence, and improving childhood behavioral adjustment for up to 9 years, suggesting long-term benefits of home visitation. (Read the full article)

Bilateral acute otitis media (AOM) is considered more severe than unilateral AOM, and several guidelines recommend more active management of bilateral AOM. However, severity of symptoms and otoscopic signs of bilateral and unilateral AOM have previously not been comprehensively studied.

Bilateral AOM seems to be clinically only a slightly more severe illness than unilateral AOM. When assessing AOM severity, bilaterality should not be used as a determining criterion; instead, the child’s symptoms together with otoscopic signs should also be acknowledged. (Read the full article)

Prevalence of hypertension in children increased significantly over the past few decades, tracks into adulthood, and is a major risk factor for cardiovascular disease. However, current prevalence estimates in children have largely been based on studies conducted in school environments.

The current study reports the prevalence of childhood hypertension in community pediatric practice, which provides a typical pediatric examination environment, unlike blood pressure measured in school. The results show a significantly lower prevalence than what has previously been reported. (Read the full article)

A policy of intubation, mechanical ventilation, and surfactant administration is commonly used for the treatment of respiratory distress syndrome worldwide; however subsequent development of bronchopulmonary dysplasia remains as risk with this standard approach.

Noninvasive surfactant administration technique during spontaneous breathing (Take Care) along with nasal continuous positive airway pressure support successfully reduces the need for further respiratory support and bronchopulmonary dysplasia rate in very low birth weight infants. (Read the full article)

Amblyopia affects 2% to 4% of the US population and is preventable In January 2011, the US Preventive Services Task Force concluded there is insufficient evidence to support vision screening in children younger than age 3 years.

Results of the Iowa photoscreening program in 210 695 children older than 11 years suggest photoscreening reliably detects amblyogenic risk factors in children 1 to 3 years of age, and we recommend photoscreening children starting at 1 year of age. (Read the full article)

Health care transition services assist youth with special health care needs (YSHCN) in transitioning to adult care without gaps in services or health insurance coverage. Less than half of YSHCN receive anticipatory assistance in this transition; receipt of these services for youth with autism spectrum disorder is unknown.

Youth with autism spectrum disorder receive transition services half as often as youth with special health care needs. Quality of health care is associated with increased receipt of health care transition services. Presence of comorbid conditions decreased receipt of transition services. (Read the full article)

Preterm born children have cognitive problems that include deficits in working memory. Computer-based working memory training has been reported to improve cognitive function in children.

A computer-based working memory training program designed for preschoolers seems effective in very low birth weight children, not only on working memory tasks, but also by having a generalizing effect regarding memory and learning. (Read the full article)

Bisphenol A (BPA) is an environmental endocrine disruptor that can leach from polycarbonate plastics and epoxy resins, leading to widespread exposure. Fetal and early postnatal periods are particularly vulnerable to exposure to BPA.

This study identified medical devices as a potential source of exposure to BPA among premature infants in the NICU, even when efforts to reduce polycarbonate plastics were taken. (Read the full article)

Most studies focus on health of foster children or local samples of young children. One previous study examined a national cohort longitudinally but did not address the full age group or range of conditions at the time of initial investigation.

Using 2 approaches to assess children (aged 0–17.5 years) who have chronic health conditions, we found that regardless of placement, investigated children had much higher rates of these conditions than the general population at the time of initial assessment. (Read the full article)

UV radiation exposure in tanning beds is associated with an increased risk of skin cancer. Because of the rising rate of melanoma, the World Health Organization recommends that persons <18 years of age not use tanning devices.

Despite scientific evidence to the contrary, tanning facilities in Missouri, a state without indoor-tanning regulations, often misinformed consumers regarding the risk of skin cancer and would allow children as young as 10 years old to use tanning devices. (Read the full article)

Pediatric training programs use simulation for procedural skills training. Research demonstrates student satisfaction with simulation training, improved confidence, and improved skills when retested on a simulator. Few studies, however, have investigated the clinical impact of simulation education.

This is the first multicenter, randomized trial to evaluate the impact of simulation-based mastery learning on clinical procedural performance in pediatrics. A single simulation-based training session was not sufficient to improve interns’ clinical procedural performance. (Read the full article)

Children with acute liver failure due to a single-dose acetaminophen exposure have a characteristic liver biochemistry profile of low conjugated bilirubin and high alanine aminotransferase, which is associated with a favorable clinical outcome when treated with N-acetylcysteine.

Children with acute liver failure associated with chronic acetaminophen exposure also have a similar liver biochemistry profile, but for unknown reasons, they have a poorer clinical outcome than patients with single-dose acetaminophen exposure. (Read the full article)

Despite high coverage with acellular pertussis vaccine (DTaP), rates of pertussis have increased substantially in 7- to 10-year-olds in recent years. Duration of protection with 5 doses of DTaP may wane earlier than expected and is currently not well described.

This evaluation reports increasing risk of pertussis in the 6 years after receipt of the fifth DTaP dose, suggesting that waning of vaccine-induced immunity is occurring before the recommended adolescent booster dose at 11 to 12 years of age. (Read the full article)

Expectations are high that electronic health record–based clinical decision support and performance feedback will improve adherence to guidelines by delivering relevant and actionable information to clinicians. Few studies have evaluated these assertions or examined the combined effects of decision support and feedback.

Clinical decision support customized to a patient’s history and presentation and performance feedback are both effective for improving adherence to guidelines for otitis media. However, the combination of the 2 interventions is no better than either delivered alone. (Read the full article)

Acquired widespread pain syndromes of youth are prevalent, disabling, usually unexplained, and untreatable. Small-fiber polyneuropathy causes widespread pain and multisystem complaints in older adults. Some causes are treatable. Neurodiagnostic skin biopsy, autonomic function testing, and nerve biopsy permit objective diagnosis.

It identifies definite (in 59%) and probable (in 17%) small-fiber polyneuropathy among 41 young patients with otherwise-unexplained, childhood-onset widespread pain. It characterizes this new disease’s clinical features, diagnostic, and treatment options. Some cases appeared immune mediated and responded to immunomodulatory therapies. (Read the full article)

Children with chronic illnesses are at risk for emotional and behavioral problems. Therefore, interventions that focus on coping with the negative consequences of the disease are needed. Evidence-based interventions are limited and often focus on a single diagnosis group.

This study demonstrates the efficacy of a cognitive-behavioral group intervention for children with various chronic illnesses. The findings indicate that the involvement of parents is important to achieve long-term results. (Read the full article)

The reasons why teens are not immunized are related to parental lack of knowledge and the need for provider recommendations.

The reasons for vaccine refusal for human papillomavirus vaccine differ from other teen vaccines, and concerns about its safety are increasing over time. (Read the full article)

In the era of widespread conjugate vaccine use, the prevalence of bacterial meningitis has declined. However, the impact of this decline on the rate of emergency department visits for viral meningitis and cost of caring for these children is unknown.

There was a decline in the rate of diagnosis of viral meningitis in US children’s hospitals between 2005 and 2011. Most children diagnosed with viral meningitis are treated with antibiotics and are hospitalized, accounting for considerable health care costs. (Read the full article)

Universal hepatitis B virus (HBV) vaccination is a cost-effective strategy to control HBV infection. Giving hepatitis B immunoglobulin to neonates of HBV carrier mothers additionally reduces transmission but is not widely used because of its expense and infrastructure requirements.

Maternal screening for hepatitis B surface antigen and hepatitis B immunoglobulin treatment of neonates of hepatitis B virus carrier mothers could be a cost-effective addition to universal vaccination in settings in which health infrastructure can support such an intervention. (Read the full article)

The etiology of congenital heart defects (CHDs) is largely unknown. A few studies have suggested that maternal emotional stress around the time of conception may be related to the occurrence of CHDs.

Using a large registry-based data source from Denmark, we found that prenatal exposure to maternal bereavement, as a marker of severe stress exposure, may increase the prevalence of CHDs in offspring. (Read the full article)

Among adolescents younger than 15, 18% have had sex and 16 000 pregnancies occur annually; among those aged 15 to 17, 30% have had sex and 252 000 get pregnant. Information on the youngest adolescents has not been previously published.

Sexual activity and pregnancy are rare among 10-, 11-, and 12-year-olds, and sex is more likely to be nonconsensual. This arguably represents a different public health issue than sex among older teens, who have a greater need for contraception. (Read the full article)

Infant and neonatal mortality rates in the United States decreased markedly during the twentieth century but have not decreased notably during recent years. There has been an increase in preterm and low birth weight births in recent years.

The lack of decrease in infant and neonatal mortality rates in recent years is due in large part to the increasing proportion of preterm and low birth weight infants, particularly infants <500 g. (Read the full article)

Clinically significant bleeding in pediatric immune thrombocytopenia (ITP) is rare. Evidence-based guidelines for the management of pediatric ITP recommend that patients with mild or no bleeding be followed with observation alone.

Many pediatric patients with newly diagnosed ITP continue to be managed in the inpatient setting. Bleeding events are rare in this setting. Although geographic variability exists, intravenous immunoglobulin is the most commonly used inpatient ITP treatment in the United States. (Read the full article)

Advances in the treatment of critically ill infants have increased survival of extremely low/very low birth weight and medically complex infants. Improved survival can result in prolonged mechanical ventilation and sometimes tracheostomy. Current tracheostomy rates for these infants are unknown.

This long-term review of infants discharged from a NICU with tracheostomies is the first to describe tracheostomy rates specifically in extremely low/very low birth weight infants. It focuses on long-term clinical outcomes and comorbidities rather than surgical complications. (Read the full article)

The incidence of childhood and adolescent melanoma has been significantly increasing up to 2004. Risk factors (fair skin, light-colored hair/eyes, female gender, presence of nevi, family history, increased number of sunburns, and exposure to UV radiation) are associated with melanoma.

This study describes incidence trends of melanoma diagnosed between the ages of 0 and 19 years and from 1973 through 2009 by gender, stage and age at diagnosis, primary site, and exposure to UV radiation. (Read the full article)

Electronic health record (EHR) uptake by US hospitals has been slow, including among children’s hospitals. The Health Information Technology for Economic and Clinical Health program, which began in 2011, offers incentives for adoption and meaningful use of EHRs.

Using an annual survey, we evaluated how children’s hospitals have progressed in EHR adoption from 2008 through the start of the Health Information Technology for Economic and Clinical Health program and assessed their ability to meaningfully use EHRs. (Read the full article)

Pulse oximetry testing in newborns can detect asymptomatic cases of critical congenital heart defects and has been added to the US Recommended Uniform Screening Panel. However, the impact that earlier diagnosis may have on survival in this population is unclear.

One-year survival for infants with critical congenital heart defects has been improving over time, yet mortality remains high. Survival has been greatest for those diagnosed after 1 day of age and may increase more with screening using pulse oximetry. (Read the full article)

Parents of children with chronic cough have poor quality of life and often seek multiple consultations. There are few randomized controlled trials on the management of cough or on the efficacy of management algorithms outside of inpatient settings.

In a multicenter, trial, we found that the management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes. Earlier application of the algorithm leads to earlier cough resolution and improved parental quality of life. (Read the full article)

Health care–associated infections cause considerable morbidity and mortality among hospitalized children. Simple barrier precautions such as universal gloving of health care workers’ hands may reduce transmission of infectious agents between patients.

Mandatory use of gloves during respiratory syncytial virus season in pediatric units prevented other health care–associated infections such as central line–associated bloodstream infections, particularly in intensive care settings. These secondary benefits suggest continuing mandatory gloving throughout the year. (Read the full article)

Prompt, high-quality diagnosis of acute pyelonephritis and later identification of children with scarring are important to prevent future complications. Examination by dimercaptosuccinic acid scan is the current clinical gold standard but is not routinely performed.

Procalcitonin demonstrated a more robust predictive ability, compared with C-reactive protein or white blood cell count, to selectively identify both children who had acute pyelonephritis during the early stage of urinary tract infections, as well as those with late scarring. (Read the full article)

Neuropsychiatric conditions comprise a substantial and growing disease burden among children. Pharmacotherapy represents an important treatment option for these conditions, although most drugs are not approved for use in children.

Very few drug trials studying neuropsychiatric conditions focus on children. Furthermore, these trials examine and provide pediatric evidence for only a fraction of all available drugs in the treatment of common neuropsychiatric conditions. (Read the full article)

Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.

Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. (Read the full article)