A program to support pediatric primary care providers in mental health care using point-of-care, telephone-based advice from specialists has been available since 2005 in Massachusetts. Other US states are implementing similar models. Little is known about how providers use this service.

There is wide variability in adoption and use of this program. Patterns are associated with panel size, enrollment timing, and assignment to the program team at the pilot site. Findings will help new programs establish expectations and design implementation interventions. (Read the full article)

Neonatal arterial ischemic stroke is associated with later cerebral palsy and cognitive impairment. Many studies on neonatal ischemic stroke are limited by modest sample sizes, and prospective studies that include outcomes assessments are scarce.

Results from this prospective, nationwide, population-based study provide information on the epidemiology, associated clinical variables, clinical manifestation, vascular distribution, and treatment of neonatal arterial ischemic stroke. The study also provides outcomes regarding motor function and cognition. (Read the full article)

Both obesity and developmental disabilities have increased in recent decades; however, the full long-term effects of prepregnancy obesity on a child’s psychosocial development remain unknown. Limited studies suggest associations between maternal prepregnancy obesity and child psychosocial development.

This study in 6-year-old children provides evidence that severe prepregnancy obesity is associated with adverse child psychosocial outcomes, including attention-deficit/hyperactivity disorder. These findings were not explained by many pregnancy and postpartum factors related to maternal obesity or child development. (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)

Outbreaks of serogroup B meningococcal disease occur at universities and other organizations. Until October 2014, options for control of serogroup B outbreaks were limited by the absence of a licensed vaccine for serogroup B meningococcal disease in the United States.

We describe a serogroup B outbreak at a university in 2013 and the campaign with investigational serogroup B vaccine held in response. This was the first use of a serogroup B vaccine as an outbreak response in the United States. (Read the full article)

More than a quarter of child deaths in the United Kingdom are estimated to have identifiable failures in care. Although children account for 40% of the family practice workload, little is known about iatrogenic harm to children in this setting.

This is the first analysis of nationally collected pediatric safety incident reports from family practice. To mitigate harm to children, priority areas requiring improvement include medication provision, referral of unwell children, provision of evidence-based treatment, and adequate diagnosis and assessment. (Read the full article)

Few studies have established the protective efficacy of 1 to 3 primary doses of diphtheria-tetanus-whole-cell pertussis (DTwP)/diphtheria-tetanus-acellular pertussis (DTaP) vaccines against pertussis, hospitalization, or pertussis complications in infants. However, vaccine effectiveness against infant pertussis death has not been previously reported.

This is the first study to report the protective role of ≥1 DTwP/DTaP doses among vaccine-eligible infants aged ≥6 weeks against death, hospitalization, and complications from pertussis. It describes risk markers for death among vaccine-ineligible infants aged <6 weeks. (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)

Infants born extremely premature and infants born to adolescent mothers are at risk for adverse developmental and behavior outcomes. There is limited research on the dual risk imparted to infants born extremely premature to adolescent mothers.

Extremely premature infants of adolescent mothers have significantly increased rates of behavior problems. Nonwhite race and living in ≥3 places by 18 to 22 months of age are risk factors for adverse behavior outcomes among infants of adolescent mothers. (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)

Newborn screening for critical congenital heart defects (CCHDs) has been implemented in many hospitals, yet there is uncertainty about the number of infants with CCHDs that might be detected through universal implementation of newborn CCHD screening in the United States.

We estimated that ~875 infants with CCHDs might be detected, and ~880 missed, annually through universal CCHD screening in the United States. Increases in prenatal diagnosis are unlikely to substantially impact the number of infants detected through CCHD screening. (Read the full article)

Concussion produces a range of symptoms that may impede academic functioning. The need for empirical validation exists, despite growing consensus on the importance of a guided return-to-school process for students recovering from concussion.

This study provides initial evidence of a concussion’s adverse effects on academic learning and performance across all grades, including heightened levels of school-related concern and amplified postinjury academic difficulties experienced by symptomatic students relative to their recovered peers. (Read the full article)

Early detection of scoliosis facilitates treatment. For detection, topographic features, such as truncal asymmetry or rib hump, are used.

We show a correlation between curve magnitude at presentation and BMI. Obesity may obscure physical examination findings. (Read the full article)

Insulin resistance plays a role in obesity. Recently it has been associated with increased risk of AD. Aβ42 and PSEN1 are molecules associated with increased risk of later AD. Patients affected by AD show elevated levels of plasma Aβ42.

Levels of Aβ42 and PSEN1 are significantly elevated in obese adolescents and correlated with the degree of both adiposity and systemic insulin resistance. (Read the full article)

The Respiratory Distress Assessment Instrument (RDAI) and the Respiratory Assessment Change Score (RACS) are the most frequently used measurement instruments in bronchiolitis clinical trials. Evidence is scarce regarding their measurement properties and their suitability for use as evaluative instruments in clinical trials.

The RDAI is an incomplete measure of respiratory distress in bronchiolitis, with poor to moderate construct validity. It has adequate discriminative properties but considerable test-retest measurement error. The RDAI and RACS were moderately responsive, but methodologic issues limit the interpretation of this finding. (Read the full article)

Distribution of infant formula discharge packs to breastfeeding mothers is common practice in maternity care facilities in the United States. Receiving discharge packs is associated with shortened exclusive breastfeeding duration. Many efforts have been made to discourage this practice.

From 2007 to 2013, there has been a marked reduction in distribution of discharge packs containing infant formula to breastfeeding mothers in hospitals and birth centers in the United States. (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)

Fifteen percent of tuberculosis cases globally are resistant to the drug isoniazid. Isoniazid resistance puts patients with tuberculosis at risk for poor treatment outcomes and threatens the effectiveness of isoniazid preventive therapy in people with latent tuberculosis infection.

We present the first global and regional estimates of the proportion of children with tuberculosis who have isoniazid-resistant disease, showing large geographic variations in risk of resistance. We estimate the number of annual incident cases of isoniazid-resistant tuberculosis in children. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Pediatric patients suffer higher mortality due to the shortage of transplantable organs. Factors influencing families’ donation decisions are similar for pediatric and adult patients. However, the general perception that families of pediatric patients are less willing to donate persists.

Communication emerged as a critical factor of family authorization, reinforcing its importance in the organ donation process. Patient age (ie, adult versus pediatric) was not predictive of family authorization. (Read the full article)

Studies on the consequences of abnormal prenatal hemoglobin (Hb) concentration have focused on maternal morbidities and adverse birth outcomes. To date, very little is known about the association between prenatal Hb concentration and infant cognitive and motor functions.

There is an inverted U-shaped relationship between maternal Hb concentration and infant gross motor function. Hb concentration between 90 and 110 g/L appears to be optimal for early gross motor function of children. (Read the full article)

Firearms are among the 10 leading causes of injury-related death for youth and continues throughout the life span. Annually youth homicides and assault-related injuries result in an estimated $16 million in combined medical and work loss costs.

Findings add to the field’s broadening conceptualization of youth victimization highlighting the potentially highly consequential risk factor of firearm and other weapon exposure as a component of victimization experiences on the mental health of youth. (Read the full article)

Low case volume has traditionally been associated with poor outcomes in complex surgical procedures, including pediatric liver transplantation.

This retrospective analysis supports the association between low case volume and poorer outcomes in pediatric liver transplantation, and, in addition, shows that candidates listed in low-volume centers have severely limited access to transplantation. (Read the full article)

Breastfeeding provides a protective effect against some malocclusions, and there is a strong inverse correlation between the duration of breastfeeding and the duration of pacifier use.

The protective effects of predominant and exclusive breastfeeding against malocclusion are distinct: exclusive breastfeeding reduces the risk of malocclusions regardless of pacifier use, whereas the effect of predominant breastfeeding depends on the duration of the pacifier use. (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)

Tonsillectomy guidelines make evidence-based recommendations for the perioperative use of dexamethasone, no routine use of antibiotics, and discharge education of families and for surgeons to monitor bleeding complication rates. The impact of the guidelines on processes and outcomes is unknown.

The guidelines were associated with improvement in perioperative care processes but no improvement in outcomes. Perioperative dexamethasone use increased slightly, and antibiotic use decreased substantially. Bleeding rates were stable, but revisit rates for complications increased because of revisits for pain. (Read the full article)

Previous research has described important variability in the medical evaluation of suspected child physical abuse. This variability may contribute to bias and reduce reliability in the medical diagnosis of abuse.

A panel of child abuse pediatricians participated in a Delphi Process, defining critical elements for the medical evaluation of suspected physical abuse in children. Results can be used to reduce practice variability that may contribute to potential bias in evaluation. (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)

The US Preventive Services Task Force recommends primary care clinicians apply fluoride varnish to the teeth of all young children, but no studies have examined the effect of comprehensive preventive oral health services on children’s clinical oral health status.

Comprehensive preventive oral health services delivered by primary care clinicians can help improve the oral health of Medicaid-enrolled children, but more work is needed to link medical and dental offices to ensure the continuity of dental care for these children. (Read the full article)

Infant screening is valued by members of the lay public, but how different benefits are independently valued, and whether harms are disvalued, is not known. Public expectations of screening can inform decisions about what diseases to screen for.

The public values clinical benefits of screening and disvalues harms, with tolerance for harm proportional to clinical benefit. These findings support newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms. (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)

Because there can be no delay in providing newborns with identification wristbands, some hospitals assign newborns temporary first names such as Babyboy or Babygirl. These nondistinct naming conventions result in a large number of patients with similar identifiers in NICUs.

We performed an intervention study to determine if assigning distinct first names at birth would result in a reduction in wrong-patient errors. We used the Retract-and-Reorder tool, an established, automated tool to detect the outcome measure of wrong-patient electronic orders. (Read the full article)

Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown.

Results suggest that detection and disclosure of FMR1 newborn carrier status may not result in significant adverse events for mothers. (Read the full article)

Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.

It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources. (Read the full article)

Studies on the risk of mortality and morbidities of extremely preterm infants of multiple gestation births have shown inconsistent results. Perinatal antecedents, admission status and severity of illness after birth can adversely affect outcomes of the extremely premature infants.

Preterm multiple gestation infants have increased risk of mortality but similar risk of major morbidities compared with singletons. Outcomes improved over time and all adverse outcomes, including mortality, were comparable between multiples and singletons in the most recent 5-year epoch. (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)

Attitudes and knowledge about appropriate management of common childhood illnesses may lead parents to mistakenly believe antibiotics are needed. Differences existed in antibiotic knowledge and attitudes between parents of Medicaid- and commercially insured children and according to other sociodemographic variables.

Despite efforts to decrease unnecessary antibiotic use, misconceptions about antibiotic use persist and continue to be more prevalent among parents of Medicaid-insured children. Tailored efforts for socioeconomically disadvantaged populations remain warranted to decrease parental drivers of unnecessary antibiotic prescribing. (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)

Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appropriate advice from multiple sources such as family and physicians.

Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; the findings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention. (Read the full article)

Stevens-Johnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare.

We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non–Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate. (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)

A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising.

The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children <3 years old with intracranial injury plus ≥3 features, the estimated probability of abuse is >81.5%. (Read the full article)

There has been increasing legislative and regulatory focus on the relationships of pediatric prescribers and industry. Pediatric professional medical association (PMA) and industry relationships, however, are relatively unstudied and lack a systematic method of assessment.

This cross-sectional study used a new quantitative scale, the industry relationship index, to systematically rate 9 pediatric PMAs with respect to best practice guidelines on interactions with the biomedical industry, revealing significant variation in PMA practices. (Read the full article)

Previous studies have shown that concomitant administration of the quadrivalent human papillomavirus vaccine with MCV4 and Tdap was generally well tolerated and did not interfere with the immune responses to the respective vaccines.

Concomitant administration of the novel 9-valent human papillomavirus vaccine with MCV4 and Tdap, 2 vaccines that are currently recommended for routine vaccination of adolescents, did not compromise the safety, tolerability, and immunogenicity of the individual vaccines. (Read the full article)

The value of ultrasound imaging for the diagnosis, prognosis, and surgical planning of cryptorchidism is limited at best.

Ultrasound remains grossly overused by referring physicians throughout Ontario, Canada, which resulted in a 3-month delay to definitive surgery and unnecessary expenditures. (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)

Rudeness is routinely experienced by hospital-based medical teams. Individuals exposed to mildly rude behavior perform poorly on cognitive tasks, exhibit reduced creativity and flexibility, and are less helpful and prosocial.

Rudeness had adverse consequences on diagnostic and procedural performance of members of the NICU medical teams. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance. (Read the full article)

Poor neurocognitive outcomes are associated with some types of congenital heart defects (CHDs). Guidelines for developmental screening for children with CHDs have been published. Population-based information on special education services needed among children with CHDs is limited.

Children in metropolitan Atlanta with congenital heart defects (CHDs) received special education services more often than children without birth defects. These findings highlight the need for special education services and the importance of developmental screening for all children with CHDs. (Read the full article)