Compared with their peers, pediatric residents who report exposure to community settings anticipate greater future community involvement at the end of training. The impact of community pediatrics training on actual future community involvement is not known.

Pediatricians exposed to enhanced community pediatrics training during residency report greater participation in community activities and greater related skills than their peers nationally. (Read the full article)

Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.

Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing. (Read the full article)

Early referral of infants with critical congenital heart disease (CCHD) is recommended to reduce mortality. However, few population-based data have been published showing the relationship between CCHD neonatal mortality and timing of cardiac evaluation at a specialty center.

In neonates with CCHD, 35% were not evaluated at a cardiac center by 4 days of age. These cases accounted for a significant number of CCHD deaths. This information enhances the rationale for pulse oximetry screening of neonates for CCHD. (Read the full article)

Passive or opt-out consent has been successfully used to recruit subjects in several investigational studies. However, institutional review boards are often inconsistent in their application of federal regulations regarding passive consent.

This study documented the variability among 24 local institutional review boards in their application of federal regulations regarding passive consent and parental acceptance of a passive consent strategy in a multicenter pediatric study. (Read the full article)

Massachusetts implemented a major health reform in 2006 to reduce uninsurance, improve access to care, and increase financial protection for its citizens, but little is known about its effect on privately and publicly insured children with special health care needs.

Massachusetts health reform improved access to specialists for privately insured children with special health care needs but did not reduce uninsurance, increase access to primary care, or improve financial protection. National reform may produce similarly modest outcomes for these children. (Read the full article)

Few studies have performed precise cardiovascular assessments and regular follow-up of congenital rubella syndrome (CRS) patients’ clinical courses. A few studies have reported mortalities among children who have CRS; however, the causes of death have not been precisely described.

A total of 38 CRS cases in Vietnam were studied after a rubella outbreak in 2011. The mortality associated with pulmonary hypertension was significantly high if untreated. Conducting careful cardiologic assessments and providing continuous follow-up for each patient is required. (Read the full article)

Socioeconomic status (SES) often influences timeliness of health care delivery, even in publicly funded systems. Children need prompt surgical care for a variety of time-sensitive developmental conditions, and children of lower SES may be especially vulnerable to delays in surgery.

It is unknown whether a publicly funded system’s ability to provide timely pediatric surgical care is related to SES. In 39 327 consecutive surgical cases, we demonstrate that SES need not influence timeliness of surgical care in a publicly funded system. (Read the full article)

There is growing support for adopting the milliliter as the standard unit for liquid medication instruction; teaspoon and tablespoon units can be confusing and may endorse kitchen spoon use. There are concerns that parents may not understand milliliter-based instructions.

Parents who used milliliter-only units made fewer dosing errors than those who used teaspoon or tablespoon units. Moving to a milliliter-only standard could reduce confusion and decrease medication errors, especially for parents with low health literacy and non-English speakers. (Read the full article)

Sleep disturbance affects 47% to 60% of children with atopic dermatitis and is a leading cause of impaired quality of life for the patients and their family.

Sleep disturbance in children with atopic dermatitis can be predicted by a Scoring Atopic Dermatitis index of ≥48.7, and lower nocturnal melatonin secretion might play a role in the pathophysiology. (Read the full article)

The role of inhaled nitric oxide (INO) in the treatment of newborns with congenital diaphragmatic hernia (CDH) is poorly defined and not rigorously proven. Contemporary rates of INO use for CDH have not been reported.

INO use in neonates with CDH is widespread, and has increased in many US tertiary pediatric hospitals without associated decrease in extracorporeal membrane oxygenation use or mortality. (Read the full article)

Predicting high-risk populations in congenital diaphragmatic hernia (CDH) can help target care strategies. Prediction rules for infants with CDH often lack validation, are aimed at a prenatal population, and are of limited generalizability. We cannot currently discriminate the highest risk neonates during the crucial period shortly after birth.

This clinical prediction rule was developed and validated on an international database. It discriminates patients and high, intermediate, and low risk of mortality; is easy to apply; and is generalizable to most infants with CDH. (Read the full article)

Most therapeutic products used in children have not been studied in that population. There is a need for special incentives and market protection (pediatric exclusivity) to compensate drug sponsors for studying these products in children.

Of 189 products studied under pediatric exclusivity, 173 (92%) received new labeling information. Pediatric efficacy was not established for 78 (42%), including 81% of oncology drugs. Probability of demonstrating efficacy was related to therapeutic area and year exclusivity was granted. (Read the full article)

Previous studies showed that prevalence of abdominal obesity among US children and adolescents increased significantly between 1988–1994 and 2003–2004. However, little is known about recent time trends in abdominal obesity since 2003–2004.

In 2011–2012, 17.95% of children and adolescents aged 2 to 18 years were abdominally obese defined by waist circumference. The prevalence of abdominal obesity leveled off among US children and adolescents from 2003–2004 to 2011–2012. (Read the full article)

Mothers of children with neurodevelopmental disabilities often experience poor health, high stress, anxiety, and depression. Highly stressed parents are less effective in their parenting roles, risking their children's developmental progress.

Evidence-based interventions in mindfulness and positive psychology significantly reduce distress in mothers of children with disabilities. Well-trained peer-mentors are effective interventionists. Adult-oriented services are needed for these mothers to improve their mental health and sustain their caregiving over the long-term. (Read the full article)

After neonatal extracorporeal membrane oxygenation treatment, children are at risk for neurodevelopmental problems including delayed motor function. So far this has only been studied cross-sectionally until age 7 years.

We describe, in a nationwide evaluation, the longitudinal course of motor function development after neonatal extracorporeal membrane oxygenation with persisting problems up to 12 years. At risk are children with congenital diaphragmatic hernia and those with chronic lung disease. (Read the full article)

Numerous studies have demonstrated clinical benefits of medical emergency team (MET) implementation, including reductions in mortality, cardiac arrests, and critical deterioration events. No studies have evaluated the financial costs and benefits of METs.

The costs of operating an MET can plausibly be recouped with a modest reduction in critical deterioration events. Hospitals reimbursed with bundled payments could see real financial savings by reducing critical deterioration events with a MET. (Read the full article)

To date, studies of adaptive behavior in fragile X syndrome have focused on particular age points, either longitudinally or cross-sectionally across a broad age spectrum. Studies have shown variable patterns in adaptive behavior among people with fragile X syndrome.

This study fills a critical gap in knowledge about the profile of adaptive behavior across childhood, adolescence, and young adulthood in fragile X syndrome. This study is the first to incorporate longitudinal data from an age-matched typically developing group. (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)

Neonatal narcotic abstinence syndrome (NAS) has become more prevalent in the United States. There is no strong evidence base for NAS treatment and thus no consensus regarding NAS management, including the best treatment drug or best taper strategy.

This study demonstrates that regardless of the initial treatment opioid chosen, use of a standard treatment protocol with stringent weaning guidelines reduces duration of opioid exposure and length of hospital stay for infants with NAS. (Read the full article)

A previous study suggested that spine and pelvis views may be omitted from the follow-up skeletal survey protocol for suspected child abuse, when these views are normal on the initial skeletal survey, without limiting the sensitivity of the study.

This multicenter study provides estimates of the risk of missing occult fractures in the evaluation of suspected child abuse with omission of spine and pelvis views from the follow-up skeletal survey protocol. Results may be used to update practice recommendations. (Read the full article)

A substantial gap exists between what is recommended for effective primary care of children and what takes place. Patient-centered health information technologies have been used to gather information and counsel parents, however, have not been integrated directly with electronic health records nor been speech-based to improve decision-making at the point-of-care.

This study shows that a ubiquitous technology, the telephone, can be successfully used to automatically assess and counsel parents before pediatric primary care visits as well as inform their primary care clinicians in a way that is feasible and effective for multiple important issues. (Read the full article)

High-fidelity simulation improves individual skills in neonatal resuscitation. Usually, training is performed in a simulation center. Little is known about the impact of in situ training on overall team performance.

In situ high-fidelity simulation training of 80% of a maternity’s staff significantly improved overall team performance in neonatal resuscitation (technical skills and teamwork). Fewer hazardous events occurred, and delay in improving the heart rate was shorter. (Read the full article)

Children with cognitive delay have been shown to have more behavior problems than typically developing children; however, few studies have investigated this relationship over time or among very young children.

Our findings provide some of the first national, prospective evidence that having a cognitive delay may place children at risk for developing and maintaining behavior problems before school age. Early identification and intervention may improve outcomes for these children. (Read the full article)

Clinical decisions must be medically necessary to be approved by insurers. There is a federally mandated medical necessity standard for children in Medicaid, but not in private plans. American Academy of Pediatrics policy calls on pediatricians to help define pediatric medical necessity.

This study reviewed pediatric medical necessity definitions in Medicaid state statutes, regulations, and provider manuals. The federal standard was not replicated on all levels, and provider manuals were least likely to have it. Pediatricians should engage in defining pediatric standards. (Read the full article)

There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed.

We observed wide variation in admission rates for common pediatric conditions across US children’s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department. (Read the full article)

Lower respiratory tract infections (LRTIs), including pneumonia, are in the top 10 causes of death among children in the United States. In high-income countries, 3% to 14% of LRTI hospitalizations have been reported to require admission to an ICU.

During 2007–2011, approximately 31 289 hospitalizations for severe LRTI occurred in children each year in the United States. Children <1 year of age had the highest rates of severe LRTI and accounted for 30% of severe LRTI hospitalizations. (Read the full article)

Arthropod-borne viruses are important causes of neurologic infections among children in the United States. The epidemiology of these diseases is complex and relates to multiple factors, including vector biology, animal reservoirs, weather, and human behavior.

National surveillance data from 2003 to 2012 will improve understanding of the geographic, temporal, and clinical trends in pediatric neuroinvasive arboviral disease, and will inform decision-making for clinicians, public health authorities, and the general public. (Read the full article)

Previous studies examining developmental outcomes associated with late preterm and early term birth have shown mixed results. Many of these studies did not fully take into account the role of the social environment in child development.

Social factors, not late preterm or early term birth, were the strongest predictors of poor developmental outcomes at 2 to 3 and 4 to 5 years. The influence of mild prematurity may lose strength beyond the neonatal period. (Read the full article)

The prevalence of disability in childhood has been on the rise for the past several decades. Children living in poverty are more likely to have chronic health conditions and experience disabilities.

The percentage of children with disabilities rose 16% between 2001 and 2011. Economically disadvantaged children had the highest rates of disability, but economically advantaged children experienced greater increases in disability. Disability due to neurodevelopmental or mental health conditions rose substantially. (Read the full article)

The World Health Organization recommends using vaccination contacts to deliver high-dose vitamin A supplementation (VAS) to children aged 6 to 59 months. The effect of this policy on overall child mortality has not been assessed.

In this first randomized controlled trial of VAS at routine vaccination contacts after 6 months, VAS had no overall effect on mortality but was associated with reduced mortality in girls and increased mortality in boys. (Read the full article)

With the publication of evidence-based guidelines for asthma, bronchiolitis, and pneumonia, numerous efforts have been made to standardize and improve the quality of care. However, despite these guidelines, variation in care exists.

This study establishes clinically achievable benchmarks of care for asthma, bronchiolitis, and pneumonia. Using a published method for achievable benchmarks of care, we calculated average utilization among the high-performers, which can serve as achievable goals for local quality improvement. (Read the full article)

Rates of human papillomavirus (HPV) vaccination lag behind other adolescent vaccines. Research indicates that provider recommendation is the key to improving HPV vaccination rates and that most adolescents who are unvaccinated received other vaccines, indicating missed opportunities for HPV vaccination.

This study explores in-depth the content of provider–patient conversations that either create or prevent opportunities for HPV vaccination. Effective and ineffective conversations are presented with the goal of providing practical tools to improve communication regarding HPV vaccines. (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)

Adolescent males from low-income communities are a group at increased risk of obesity and related health concerns. Obesity prevention interventions targeting adolescents have so far had mixed success. Targeted interventions, tailored for specific groups, may be more appealing and efficacious.

A multicomponent school-based intervention using smartphone technology can improve muscular fitness, movement skills, and key weight-related behaviors among low-income adolescent boys. (Read the full article)

Growth impairment in sickle disease has been a consistent finding in published reports. Hydroxyurea (HU) decreases vasoocclusive events and increases hemoglobin levels, which may improve growth. However, HU may adversely affect growth in young children by its effect on DNA synthesis.

Height, weight, and head circumference were normal in HU-treated children in the study as compared with the World Health Organization standards. Height, weight, and BMI z scores were similar in placebo and treatment groups. There were no harmful effects of HU on growth. (Read the full article)

Asymptomatic neonatal subdural hemorrhage (SDH) is common, resolves within 4 weeks, and is typically infratentorial or posterior when supratentorial. Subdural hemorrhages may occur after cardiac surgery in infancy. Some hypothesize a causal relationship between hypoxia and SDH in infancy.

Asymptomatic neonatal SDH is often supratentorial and over the convexities. Small infratentorial SDHs may persist for ≤90 days. In young infants with congenital heart disease, an association between hypoxia and SDH could not be demonstrated. (Read the full article)

Pediatric primary care has undergone a cultural shift. Changes in electronic health records, certification requirements, and practice structure have left many physicians feeling too busy to participate in research. Practice-based research networks must adapt to fit the current climate.

Adding quality improvement activities that meet Maintenance of Certification Part 4 criteria to research study design adds value to a practice-based research protocol. This incentive meets the needs of busy physicians, and may help researchers meet study recruitment goals. (Read the full article)

Stimulant medications are indicated for treatment of childhood attention-deficit/hyperactivity disorder (ADHD), but there is concern that stimulants may negatively affect growth. However, no longitudinal, population-based studies have examined height into adulthood for childhood ADHD cases.

This longitudinal, population-based study shows that neither childhood ADHD itself nor treatment with stimulants is associated with significant deficits in height into adulthood. (Read the full article)

Being bullied can lead to adverse physical and mental health outcomes. Individuals who experience a sudden traumatic event often have short-term disturbances in their sleep patterns. Ongoing trauma may result in extended periods of sleep disruption.

Being bullied in elementary school predicts parasomnias, such as nightmares and night terrors, years later. General practitioners, pediatricians, parents, and teachers may consider parasomnias as potential signs of being bullied. (Read the full article)

Health care–associated infections are harmful, costly, and preventable, yet there remain limited data as to their population incidence among hospitalized neonates and children in the United States.

Incidence rates of central line–associated bloodstream infections and ventilator-associated pneumonia decreased among critically ill neonates and children during a 5-year period in the United States. National efforts to improve patient safety through decreasing HAIs have been effective. (Read the full article)

Cancer continues to be the leading disease-related cause of death among children and adolescents in the United States. More information is needed about recent trends.

This study provides recent, robust data supporting the increasing incidence of pediatric thyroid cancer and rising overall cancer rates among African American children and adolescents and is the first study to describe increasing rates of pediatric renal carcinoma. (Read the full article)

Despite child-resistant packaging requirements for most medications and safe storage education for all medicines, tens of thousands of young children are brought to emergency departments and thousands are hospitalized annually after ingesting prescription medications. Targeted prevention efforts may be needed.

Twelve medications were implicated in nearly half of hospitalizations for prescription medication ingestions. Buprenorphine and clonidine were most commonly implicated and had the highest hospitalization rates when accounting for outpatient use. Prevention efforts should focus on most commonly implicated medications. (Read the full article)

Public awareness and usage of physician-rating Web sites have been increasing over the last few years. Such ratings can influence adults’ decisions about choosing a physician, but their influence on decisions for children’s physicians has not been characterized.

In this nationally representative survey of parents, we found that the majority (74%) are aware of rating Web sites and slightly more than one-quarter (28%) had sought information on rating Web sites when choosing a primary care physician for their children. (Read the full article)

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important risk factor for neonatal jaundice in Nigeria. It is associated with severe hyperbilirubinemia among infants exposed to icterogenic agents. Elevated bilirubin levels have occasionally been demonstrated in G6PD-deficient infants without exposure to icterogenic agents.

Even without exposure to known icterogens, G6PD-deficient infants have a more rapid hematocrit decline and higher bilirubin levels than their G6PD-intermediate and G6PD-normal counterparts throughout the first week of life. (Read the full article)

Infants who require positive pressure ventilation at birth are considered to be at risk for subsequent compromise and are recommended to receive postresuscitation care. The supportive evidence and details of this care have not been fully investigated.

We investigate the need for postresuscitation care in infants who require positive pressure ventilation at birth, review the aspects of care needed, and explore the important risk factors most predictive of it. (Read the full article)

In HIV-infected children, decisions to start antiretroviral therapy must weigh immunologic benefits against potential risks. Current guidelines recommend using CD4 percentage and age when deciding to start treatment. Population-level effects of these factors on immunologic recovery are unknown.

Starting antiretroviral therapy at higher CD4 percentages and younger ages maximizes potential for immunologic recovery. However, not all benefits are sustained, and viral failure may occur. Our results help clinicians better weigh immunologic benefits against viral failure risks. (Read the full article)

More than 200 million children <5 years old in low- and middle-income countries are not reaching their potential in cognitive development because of factors associated with poverty.

Poverty affects children’s cognition as early as 7 months and continues to increase until 5 years of age. It is mainly mediated by parental education, birth weight, home stimulation throughout the 5 years, and growth in the first 24 months. (Read the full article)

Children who have attention-deficit/hyperactivity disorder (ADHD) attending clinical services have poorer outcomes in adolescence on a range of measures. However, it is unknown how early in development these impairments appear, particularly for community-ascertained samples.

At age 6 to 8 years, children in the community with ADHD have significantly poorer mental health, academic performance and social function compared with control children. Children who have impairing ADHD symptoms should be referred early for assessment and intervention. (Read the full article)

Physical activity programs have been shown to have positive implications for children’s cognitive performance and brain structure and function. However, additional randomized controlled trials are needed to determine whether daily physical activity influences executive control and its neural underpinnings.

The randomized controlled trial, designed to meet daily physical activity recommendations, used behavioral and electrophysiological measures of brain function to demonstrate enhanced attentional inhibition and cognitive flexibility among prepubertal children. (Read the full article)

Sleep disorders are common in children and adolescents and have a substantial negative impact on daily life and school performance. Long-term evaluations of the efficacy and safety of pharmacologic treatment options for sleep disorders are lacking in pediatric patients.

These 2 studies provide the first evaluation of the effectiveness and safety of eszopiclone in children and adolescents with insomnia associated with ADHD. Data presented here encompass longer-term (up to 1 year) pediatric exposure to eszopiclone. (Read the full article)