Rapid and reliable tools for the diagnosis of neonatal sepsis are still unavailable. No single biomarker studied has yielded conclusive results. Genome-wide expression profiles (GWEPs) have been successfully determined for the diagnosis of sepsis in pediatric and adult populations.

GWEPs are described for the first time in very low birth weight infants with proven bacterial sepsis. Our results suggest that GWEPs could be used for early discrimination of septic newborn versus nonseptic infants. (Read the full article)

One in 4 children with cerebral palsy (CP) have a behavioral disorder. Parenting interventions are an efficacious approach to treating behavioral disorders. There is a paucity of research on parenting interventions with families of children with CP.

This is the first study to demonstrate the efficacy of a parenting intervention in targeting behavioral problems in children with CP. Further, results suggest that Acceptance and Commitment Therapy delivers additive benefits above and beyond established parenting interventions. (Read the full article)

Young children have multiple upper respiratory infections (URI) annually. Limited health literacy regarding URI can place families at risk for emergency department (ED) visits, inappropriate use of over-the-counter medications, and medication measurement errors.

Few educational interventions for URI have targeted groups with limited health literacy. Integrating an educational intervention into Early Head Start is a novel approach to increasing parental health literacy regarding URI and decreasing ED visits, with potential for wide dissemination. (Read the full article)

The use of electronic health record systems to measure adolescent health care quality requires an operational definition of sexual activity for measuring recommended health promotion activities such as Chlamydia screening and others related to reproductive health.

This study is the first to compare operational definitions of sexual activity by using information electronically abstracted from electronic health records of adolescent females. Our research supports the use of broader operational definitions of sexual activity for health quality measurement. (Read the full article)

There is growing understanding of the detrimental effect of paternal depression on children. The transition to fatherhood is a unique time for men. Identifying which fathers are at-risk and when will inform effective methods to help men and their families.

Nonresident fathers have the highest depression symptom scores, peaking before entering fatherhood. Although resident fathers’ scores decrease preceding entry into fatherhood, there is a significant increase from 0 to 5 years of their child’s life when key parent–infant attachment occurs. (Read the full article)

Injuries in children and young adults commonly cause morbidity and mortality. Epilepsy is common among children. Injury risk may be greater among those with epilepsy, but there are few large, population-based studies, making it difficult to estimate risk.

Children and young adults with epilepsy are at a greater risk of medicinal poisonings, thermal injuries, and fractures than those without epilepsy. Young adults with epilepsy are at particularly high risk of medicinal poisonings. (Read the full article)

Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like selective serotonin reuptake inhibitors (SSRIs). Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear.

This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays. However, underlying depression and its genetic underpinnings may be a confounder. (Read the full article)

Many young children are at risk for caries, which is the most common chronic disease of childhood. As primary teeth begin to develop in utero, prenatal influences are believed to affect the integrity of enamel and subsequent resistance to decay.

This study shows, for the first time, that maternal prenatal 25-hydroxyvitamin D levels may have an influence on the primary dentition and the development of early childhood caries. Specifically, lower levels are associated with increased risk of caries in infants. (Read the full article)

A national probability study based on time diaries for 2 days indicated that black and white adolescents get close to the recommended amount of sleep. Sleep should be measured by using multiple methods to get an accurate picture of adolescent sleep.

Based on actigraphy and daily diary assessments, healthy adolescents from a lower socioeconomic community got less than the recommended amount of sleep; black male students were likely to have short, fragmented sleep, which may play a role in their health risks. (Read the full article)

Home oxygen has been safely incorporated into emergency department management of bronchiolitis in certain populations. After discharge, a small proportion of patients (2.7%–6%) require subsequent admission. For patients managed successfully as outpatients, pediatricians report variable practice styles and comfort levels.

Our results define the clinical course and outpatient burden associated with discharge on home oxygen. By using an integrated health care system, we captured slightly higher rates (9.4%) of subsequent admission and found fever to be associated with this outcome. (Read the full article)

Previous studies that reported learning deficits among children with oral clefts mostly used small, clinic-based samples prone to ascertainment bias. No previous studies in the United States have used a population-based sample and direct testing of academic achievement.

Using a large population-based sample from the United States and standardized school tests for achievement, we found that children with oral clefts scored significantly lower than their classmates on all evaluated domains of achievement and had higher rates of learning disability. (Read the full article)

Children with attention-deficit/hyperactivity disorder (ADHD) have poorer academic and social functioning and more language problems than typically developing peers. However, it is unknown how language problems impact the academic and social functioning of these children.

Language problems are common in children with ADHD and are associated with markedly poorer academic functioning independent of ADHD symptom severity and comorbidities. There was little evidence that language problems were associated with poorer social functioning for children with ADHD. (Read the full article)

Up to 50% of children with attention-deficit/hyperactivity disorder (ADHD) meet criteria for a comorbid anxiety disorder. Despite the high prevalence of anxiety in these children, the impact of anxiety on the lives of children with ADHD has been largely overlooked.

Presence of ≥2 anxiety comorbidities in children with ADHD was associated with poorer child quality of life, daily functioning, and behavior. Multiple anxiety comorbidities were associated with poorer functioning for children with both ADHD-Inattentive and ADHD-Combined presentation. (Read the full article)

The widely disseminated National Institute on Alcohol Abuse and Alcoholism screening tool for adolescent alcohol use was developed based on epidemiologic data. It has not been validated in a clinical sample and does not screen for tobacco or drug use.

This study found that a measure that expanded the National Institute on Alcohol Abuse and Alcoholism adolescent alcohol use tool to include tobacco and drugs was sensitive and specific for identifying substance use disorders in a pediatric clinic patient population. (Read the full article)

Noonan syndrome is associated with a bleeding diathesis and abnormal coagulation tests.

Bleeding diathesis in Noonan syndrome was evaluated by using a validated bleeding score. For the first time, platelet function was fully investigated, and a significant prevalence of platelet abnormalities likely to contribute to the bleeding diathesis was found. (Read the full article)

Congenital pulmonary malformations are mostly identified prenatally. At birth, some children develop respiratory distress, which may be sufficiently severe to require mechanical ventilation and immediate surgery. The factors predictive of neonatal respiratory distress are not well defined.

Malformation volume and prenatal signs of intrathoracic compression are significant risk factors for respiratory complications at birth in fetuses with pulmonary malformations. In such situations, the delivery should take place in a tertiary care center. (Read the full article)

Population-based references of birth weight for gestational age are useful indices of birth size in clinical and research settings.

This article uses 2009–2010 US natality data and corrects for likely errors in gestational age dating to yield an up-to-date birth weight for gestational age reference. (Read the full article)

Hypothermia treatment of neonatal encephalopathy reduces death and disability from 66% to 50%; additional neuroprotective therapies are needed. We previously found in animal models that adding 50% xenon to the breathing gas during cooling doubled neuroprotection.

This clinical feasibility study used 50% xenon for 3 to 18 hours in 14 cooled infants with cardiovascular, respiratory, and amplitude-integrated EEG monitoring. This depressed seizures, with no blood pressure reduction. Xenon is ready for randomized clinical trials in newborns. (Read the full article)

Early preventive dental care is cost-effective and can reduce subsequent restorative or emergency visits. Little is known about the factors distinguishing families who receive dental care in early childhood and those who do not.

Our results suggest that among healthy children seen by primary care providers, those most in need of dental care are least likely to receive it. This highlights the importance of promoting early preventive dental care in the primary care setting. (Read the full article)

Chorioamnionitis (CAM) is a major risk factor for early-onset neonatal sepsis. The Committee on the Fetus and Newborn recommends extending the duration of antimicrobial therapy in neonates exposed to CAM and intrapartum antibiotics if laboratory data are abnormal, even if culture results are sterile.

When managed by using a strategy similar to recent Committee on the Fetus and Newborn guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy, subjected to additional invasive procedures, and had prolonged hospitalization. (Read the full article)

There is wide variation in pediatric subspecialty supply in the United States. The impact of this variation in supply on utilization and child and family disease burden is not known.

Among children with special health care needs, living in a county with lower subspecialty supply was associated with lower perceived need for subspecialty care, lower subspecialty utilization, and no meaningful differences in examined measures of child and family disease burden. (Read the full article)

Several experimental and observational studies reveal an association between exposure to alcohol consumption in movies and youth drinking, but little is known about the effect of such exposure on drinking onset among low-risk adolescents.

In a longitudinal study, exposure to alcohol consumption in movies was associated with drinking initiation in a sample of adolescents from 6 European countries who had never drunk alcohol and were attitudinally nonsusceptible to future use at the time of exposure. (Read the full article)

Previous studies have shown that food advertisements influence caloric intake among children. However, individual susceptibility to food advertisements has not been examined thoroughly.

This study examines the role of impulsivity in the effect of food advertisements. An advergame promoting snacks overruled refraining from eating, especially among impulsive children. The findings suggest that impulsivity plays an important role in susceptibility to food advertisements. (Read the full article)

Children receive only half of recommended health care; disadvantaged children have higher risk of unmet needs. Practice coaching combined with quality improvement using rapid-cycle feedback has potential to help practices meet quality standards and improve pediatric health care delivery.

The Practice-tailored Facilitation Intervention led to large and sustained improvements in preventive service delivery, including substantial numbers of disadvantaged children, and in multiple simultaneous health care domains. Practice-tailored facilitation holds promise as a method to advance pediatric preventive care delivery. (Read the full article)

Although a number of randomized controlled trials of erythropoietin administration to preterm infants have been performed, few studies have reported 2-year or longer neurodevelopmental outcomes, and no studies have evaluated neurodevelopmental outcomes of infants randomized to receive Darbepoetin.

This is the first prospectively designed study to evaluate the neurocognitive outcomes of preterm infants randomized to receive Darbepoetin or erythropoietin compared with placebo. Infants in the ESA groups had significantly higher cognitive scores compared with the placebo group. (Read the full article)

Quality measures developed by the Pediatric Quality Measures Program are required to assess disparities in performance according to special health care need status. Methods are needed to identify children according to level of medical complexity in administrative data.

The Pediatric Medical Complexity Algorithm is a new, publicly available algorithm that identifies the small proportion of children with complex chronic disease in Medicaid claims and hospital discharge data with good sensitivity and good to excellent specificity. (Read the full article)

Duration of protection among children and adolescents who have received the recombinant hepatitis B (HB) vaccination series is known to be long. Less is known about duration of protection of the vaccination series after being administered during infancy.

A robust response to a challenge dose of HB vaccine among adolescents indicates prolonged duration of protection against disease; the addition of a booster dose of HB vaccine to the routine immunization schedule for adolescents appears unnecessary. (Read the full article)

Curtailed sleep in children has been found to be associated with increased cardiovascular disease risk factors, including obesity. Few existing studies have examined measures of adiposity beyond BMI or have examined the effects of being chronically sleep curtailed.

In this cohort of children who had research-level measures of sleep, BMI, total fat mass, and fat mass distribution, we found that chronic sleep curtailment from infancy to age 7 years was associated with higher overall and central adiposity in mid-childhood. (Read the full article)

Adolescents with chronic disease are a diverse population with common needs for transition. Disease-specific interventions have shown promise at improving patient outcomes but with substantial personnel and resource costs. Whether a generic approach across diseases may be useful is unknown.

This study is among the first to evaluate a generic (across disease) approach to transition of adolescents to adult care. The approach demonstrated promise and cost savings due to reduced personnel requirement and use of low-cost technology dissemination methods. (Read the full article)

Children who experience outpatient adverse drug events represent 0.5% of pediatric emergency department visits. The subset of children with complex chronic conditions often take multiple medications, but the incidence and severity of adverse drug events in these children is unknown.

Children with complex chronic conditions have a higher risk of emergency department visits related to adverse drug events, compared with other children. The implicated drugs with the highest rates include psychotropic agents, antimicrobial agents, anticonvulsants, hormones/steroids, and analgesics. (Read the full article)

Food insecurity is best measured by comprehensive assessments. However, rapid assessments can be useful in certain circumstances, but their validity is not characterized.

Rapid assessment of food insecurity is feasible among Inuit adults and children. (Read the full article)

Children who have syndromic craniosynostosis are at risk for developing intellectual disability, behavioral and emotional problems. Study results were often based on small samples and wide age-based variation, using non-validated instruments and describing no clear inclusion and exclusion criteria.

Intellectual, behavioral, and emotional functioning is described in a national sample (N = 82) of school-aged children with syndromic craniosynostosis. Using standardized instruments, this study indicates higher risks for intellectual disability and behavioral problems mainly in children having Apert and Muenke syndromes. (Read the full article)

In addition to seizures, school-aged children with epilepsy can have coexisting cognitive and behavioral difficulties, but the spectrum and prevalence of such difficulties are uncertain.

This study provides population-based data on the prevalence of common comorbid cognitive impairments and factors associated with such diagnoses in school-aged children with "active" epilepsy. (Read the full article)

Parents of children with special health care needs and low-income children report more unmet specialty care needs. Care coordination is associated with increased and decreased referrals to specialty care, but whether care coordination is related to unmet needs is unknown.

Among children with special health care needs, care coordination is associated with lower odds of unmet specialty care needs regardless of whether care coordination was received within a medical home. This association was independent of household income. (Read the full article)

Administrative health insurance claims have limitations when measuring care quality.

Children’s care quality measures assessed using administrative claims alone may not accurately reflect care quality. Use of electronic health record data in combination with administrative claims data provides an opportunity for more complete measurement. (Read the full article)

The US health care system transition to the ICD-10-CM will occur in October 2015. The logistical and financial impact of the transition for billing codes frequently used by pediatricians has not been studied.

The findings of this study evaluate the government-provided mappings from ICD-9-CM to ICD-10-CM for accuracy and provide the diagnostic codes used by pediatricians, which may be adversely affected by the transition to ICD-10-CM. (Read the full article)

The traditional process-focused approach to quality improvement has not remedied NICUs’ inconsistency in quality of care delivery across clinically important measures. Global measurement of quality may induce broad, systems-based improvement, but must be formally studied.

We present a systematically developed and robust composite indicator, the Baby-MONITOR, to assess the quality of care delivered to very low birth weight infants in the NICU setting. (Read the full article)

Animal studies document dose-dependent and duration-of-therapy-dependent fluoroquinolone cartilage toxicity in weight-bearing joints. Preliminary pediatric data collected after fluoroquinolone treatment and up to 1 year posttreatment in blinded and unblinded studies suggest the possibility of cartilage toxicity in children.

These are the first prospectively collected data on fluoroquinolone musculoskeletal safety collected posttherapy from randomized, comparative studies of respiratory tract infections and analyzed at 5 years. Long-term musculoskeletal adverse events occurred with equal frequency in both levofloxacin and comparator groups. (Read the full article)

Parents in disadvantaged households are less likely to book share with their children during early childhood. These children are more likely to enter school with delays in emergent literacy and language skills, apparent as early as the age of 3.

This study examines the effect of parental immigrant status as a predictor of reading and sharing books with children. This research disentangles immigrant status from other variables thought to explain disparities in familial practices related to emergent literacy. (Read the full article)

Since the introduction of rotavirus vaccines, diarrhea-associated health care utilization among US children has decreased substantially. Moreover, indirect benefits from rotavirus vaccination have been observed in unvaccinated children and in adults.

With increasing rotavirus vaccine coverage during 2009–2011, we observed continued reductions in diarrhea-associated health care utilization and cost. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life. (Read the full article)

Previous analyses have documented that the prevalence of children with chronic conditions is growing and is responsible for increased growth in hospital charges; however, such utilization trends have not been documented in Medicaid and the Children’s Health Insurance Program.

From 2007 through 2010 in Illinois, children with chronic conditions became Medicaid and Children’s Health Insurance Program recipients at a higher rate than healthy children. In contrast to studies of hospital data, this analysis found per-member spending decreases in most chronic condition groups. (Read the full article)

In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.

Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. (Read the full article)

Children with shaken-baby syndrome, or abusive head trauma (AHT), have lasting health and development problems. The long-term medical cost of AHT is unknown.

Patients with AHT had higher inpatient, outpatient, and drug costs compared with other children for 4 years after their abuse diagnosis, amounting to tens of thousands of dollars in excess and preventable medical care per patient with AHT. (Read the full article)

Poor health in children is associated with exposure to family violence and disruption. Telomere length has been hypothesized to be a lasting biological indicator of exposure to early adversity and potentially predictive of negative health outcomes throughout the life course.

Telomere length reflects exposure to family violence and disruption and may be an early indicator of the biological impact of early adversity. Children exposed to interpersonal violence and family disruptions had significantly shorter telomeres. Gender moderated these associations. (Read the full article)

Rates of performing skeletal survey (SS) for young children presenting with fractures and at risk for abuse vary substantially across providers, with disparities associated with patients’ characteristics. Lack of consensus regarding indications for SS also contributes to this variation.

The results of this study provide a set of explicit consensus guidelines, based on the literature and on the knowledge of experts from several medical specialties, for identifying children with fractures who should undergo an initial SS. (Read the full article)

Pneumonia is a leading cause of hospitalization among children, and readmissions after discharge are common.

Eight percent of children experience a readmission within 30 days after hospital discharge for pneumonia. Readmissions are most common among young children and those with chronic medical conditions, and are associated with substantial costs. (Read the full article)

Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated.

Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms. (Read the full article)

Autism prevalence is reported to be highest among non-Hispanic white children, lower in Hispanic and African American/black children, and highly variable in Asian/Pacific Islanders. More comorbid intellectual disability and delays in expressive language have been observed among Hispanic and African American children.

Maternal nativity is a risk factor for childhood autism in US populations. We observed higher risk of severe autism phenotypes in children of foreign-born black, Central/South American, Filipino, and Vietnamese mothers and US-born African Americans and Hispanics compared with US-born whites. (Read the full article)

Neurocognitive deficits, academic delays, and behavioral and emotional problems are well documented in school-age children in relation to socioeconomic disadvantage and residential instability. Despite adversity, early intervention can facilitate healthy cognitive, emotional, and social development.

Homeless youth demonstrated elevated rates of untreated psychiatric disorders, low academic achievement, and impaired neurocognition. Mental health and neurocognitive symptoms were associated with vocational outcome. Intervention beyond employment services alone is needed to improve functioning. (Read the full article)

Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.

Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families. (Read the full article)