Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. Inhaled nitric oxide given to reduce morbidity in very preterm infants does not reduce the prevalence of bronchopulmonary dysplasia and has uncertain effects on long-term outcome.

Inhaled nitric oxide (5 ppm) given early in the course of respiratory illness in infants born before 29 weeks of gestation is not associated with changes in developmental or respiratory outcomes at 2 years of age corrected for prematurity. (Read the full article)

Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deficit/hyperactivity disorder (ADHD), ample evidence demonstrates that they continue to diagnose and treat this disorder suboptimally.

The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. (Read the full article)

Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates.

This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. (Read the full article)

The intestinal microbiome may play a role in immune system maturation, and it has been postulated that early-life probiotic administration may reduce the risk of allergies and asthma in childhood. To date, however, results from clinical trials have been inconsistent.

In this meta-analysis, administration of probiotics in early life may reduce total immunoglobulin E level and protect against atopic sensitization but do not seem to protect against asthma/wheezing. Future trials should carefully select probiotic strains and include longer follow-up. (Read the full article)

Term neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants.

For term neonates born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth. (Read the full article)

Parents of premature infants are susceptible to developing trauma symptoms related to their NICU experience. There are no current well-established interventions that simultaneously address both parental trauma as well as redefinition of the parenting experience.

A brief, cost-effective, and feasible manualized intervention for NICU parents was effective in reducing both parental trauma and depression. Implementation of this intervention in the NICU setting has the potential to improve maternal well-being and infant outcomes. (Read the full article)

Hypovitaminosis D is common among children. Although there is prolific biochemical literature linking vitamin D to enteric immunologic function, there is a paucity of prospective data exploring the role of supplementation in prevention of diarrheal illnesses.

In a high-risk population, quarterly supplementation with 100 000 IU of vitamin D₃ did not reduce the risk for first or recurrent diarrheal illnesses in a population of children aged 1 to 29 months in a low-income inner city setting. (Read the full article)

Participating in a trial may affect processes of care by participating physicians; however, no study has assessed whether it affects processes of care for nonenrolled patients.

Participation in a trial may affect processes of care for nonenrolled patients, even when care providers participating in or familiar with the trial protocol are unaware that data on nonenrolled patients are being collected for a study. (Read the full article)

Preschool language delay is associated with poorer academic performance, more limited employment opportunities, and relationship difficulties. Despite its importance within public health, there has been little progress toward effective population-based prevention and intervention approaches to improve outcomes.

It is feasible to identify low language in 4-year-olds on a population basis and deliver a 1-on-1 intervention. By age 5 years, this resulted in better phonological awareness and letter knowledge. There was weak evidence of better expressive, but not receptive, language. (Read the full article)

Some infants presenting with bronchiolitis are later diagnosed with asthma. Corticosteroid treatment of all infants with bronchiolitis is not clearly efficacious.

We used infant eczema or asthma history in a first-degree relative to select patients with bronchiolitis for dexamethasone or placebo blinded treatment. Dexamethasone treatment of 5 days led to significantly earlier readiness for discharge from infirmary treatment. (Read the full article)

Pediatric functional abdominal pain is common and costly. Cognitive behavior therapy (CBT) is a promising treatment for these complaints, but solid evidence for its effectiveness is lacking.

This randomized controlled trial shows that CBT reduces abdominal pain in 60% of children 1 year after treatment. Six sessions of CBT delivered by trained master’s students in psychology were equally effective as 6 visits to an experienced pediatrician. (Read the full article)

Although providing improved survival for infants with very severe cardiorespiratory problems, the use of neonatal extracorporeal membrane oxygenation has high rates of disability in survivors. Mild hypothermia has been shown to limit brain injury in a range of patient groups, including newborns.

Infants who received extracorporeal membrane oxygenation and mild hypothermia did not show an improved neurodevelopmental outcome, and nonsignificant trends in the data suggested a small adverse effect. Use of hypothermia in other potential patient groups should be thoroughly tested. (Read the full article)

Levels of daily physical activity in children are decreasing worldwide. This implies risk factors for cardiovascular and metabolic diseases.

Strength training makes children not only stronger but significantly increases their daily spontaneous physical activity outside the training intervention. (Read the full article)

The World Health Organization estimates that ~700 million children breathe tobacco smoke polluted air, particularly at home. Educational strategies either directly or indirectly targeting household decision-makers through other family members are effective in reducing children's exposure in private homes.

Intensive intervention was effective in decreasing children’s personal exposure to secondhand smoke (SHS), educating mothers about SHS, and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s personal exposure to SHS was not statistically significant. (Read the full article)

Late-onset sepsis is a frequent complication of prematurity, contributing to morbidity and mortality. Although evidence is accumulating that administration of probiotics to very preterm infants reduces necrotizing enterocolitis (NEC) and all-cause mortality, the effect on late-onset sepsis is less clear.

The probiotic combination Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis reduced NEC in very preterm infants, but not mortality or late-onset sepsis. Probiotics may be of greatest global value in neonatal settings with high rates of NEC. (Read the full article)

Hypertonic saline (3% and 5%), has been shown to improve clinical severity scores and reduce inpatient length of stay, and was associated with a trend toward lower admission rate in acute bronchiolitis.

We are not aware of any previous data using 7% hypertonic saline in bronchiolitis. Our results suggest that 7% saline does not lower clinical severity of illness, admission rate, or length of stay, when compared with normal saline. (Read the full article)

Fewer clinical trials are performed in children compared with other patient populations. It is unknown how well existing pediatric clinical trials are aligned with the needs of children, both in high-income countries and globally.

There is only moderate correlation between clinical trial activity and pediatric burden of disease, with certain conditions substantially underrepresented in the current research portfolio. Our findings provide a benchmark for prioritizing conditions for study, analyzing gaps, and identifying funding priorities. (Read the full article)

Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated.

A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems. (Read the full article)

In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past.

A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control. (Read the full article)

Despite widespread prevalence of vitamin D deficiency, there is a paucity of evidence on the appropriate supplemental dose in preterm infants. Various professional organizations empirically recommend different doses of vitamin D, ranging from 400 to 1000 IU per day.

Daily vitamin D supplementation at a dose of 800 IU compared with 400 IU significantly reduces the prevalence of vitamin D deficiency in preterm infants. The clinical significance of achieving vitamin D sufficiency needs to be studied in larger trials. (Read the full article)

An estimated 9.5% of children are diagnosed with attention-deficit/hyperactivity disorder (ADHD), which affects academic and social outcomes. We previously found significant improvements in ADHD symptoms immediately after neurofeedback training at school.

This randomized controlled trial included a large sample of elementary school students with ADHD who received in-school computer attention training with neurofeedback or cognitive training. Students who received neurofeedback were reported to have fewer ADHD symptoms 6 months after the intervention. (Read the full article)

Pulse oximeter is better than skin color assessment in the initial minutes of life. After sensor application, a delay occurs in the display of reliable saturation and heart rate. An appropriate method of sensor placement can minimize the delay.

Attaching sensor first to oximeter and then to neonate picked up signal faster than attaching it to the neonate first and then to the equipment. However, the time from birth to display of reliable signal was similar between the methods. (Read the full article)

Maintaining high levels of measles-mumps-rubella immunization is an important public health priority that has been threatened by discredited claims about the safety of the vaccine. Relatively little is known about what messages are effective in overcoming parental reluctance to vaccinate.

Pro-vaccine messages do not always work as intended. The effectiveness of those messages may vary depending on existing parental attitudes toward vaccines. For some parents, they may actually increase misperceptions or reduce vaccination intention. (Read the full article)

Diarrhea still remains as a significant cause of morbidity and mortality. Intervention to reduce this risk are needed. Evidence on the effect of Lactobacillus reuteri DSM 17938 to prevent diarrhea in children is scarce.

In healthy children attending day care centers, daily administration of L reuteri DSM 17938 had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infections, with consequent cost saving for the community. (Read the full article)

Integrated or collaborative care intervention models have revealed gains in provider care processes and outcomes in adult, child, and adolescent populations with mental health disorders. However optimistic, conclusions are not definitive due to methodologic limitations and a dearth of studies.

This randomized trial provides further evidence for the efficacy of an on-site intervention (Doctor Office Collaborative Care) coordinated by care managers for children's behavior problems. The findings provide support for integrated behavioral health care using novel provider and caregiver outcomes. (Read the full article)

Medical devices approved for adults can be used to treat children despite the lack of rigorous evidence. In 2007, Congress passed the Pediatric Medical Device Safety and Improvement Act to stimulate pediatric device development.

Most pediatric devices approved since the legislative change have had limited premarket study in children, with pediatric patients representing <10% of trial participants. Postmarketing studies required by the US Food and Drug Administration also yielded limited additional pediatric data. (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)

The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.

AFIX consultations achieved short-term gains in coverage for 11- to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. (Read the full article)

Children with autism sleep poorly compared with their peers. Sensory integration, including use of weighted blankets, is proposed as a means to reduce arousal and stress. There is, however, no evidence that weighted blankets can improve sleep for these children.

This is the first robust study to evaluate the impact of weighted blankets and show that they do not improve sleep parameters in children with autism spectrum disorder. (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)

In-person peer counseling to pregnant and new mothers has been shown to improve breastfeeding modestly in three US RCTs. But this level of support for WIC is unlikely to be scaled up nationally in the current fiscal environment.

We randomly assigned WIC clients to a telephone peer counseling program relative to standard WIC support for breastfeeding. Nonexclusive breastfeeding among Spanish-speakers increased at 1, 3, and 6 months, but the program had much less of an effect on English-speaking clients. (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)

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)

Cardiovascular risk begins in childhood. New clinical guidelines established a care strategy for lowering risks. Incorporation of guidelines into routine practice lags due to barriers related to knowledge and attitudes about guidelines, as well as behaviors of practitioners, patients, and clinical systems.

This study demonstrated that a multifaceted approach including tools, education, and support for changes in practice systems can accelerate the adoption of guidelines during routine pediatric well-child visits, compared with dissemination of the guidelines alone. (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)

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)

Delivering competent oral case presentations is an important clinical communication skill, yet effective means of improving trainees’ presentations have not been identified.

Oral presentation feedback sessions facilitated by faculty by using an 18-item competency-based evaluation form early in pediatric clerkships improved medical students’ subsequent oral presentations. Medical schools should consider implementing this evidence-supported practice. (Read the full article)

There are discrepancies regarding which treatment is best in clinical practice for children with parapneumonic empyema, with some authors favoring video-assisted thoracoscopy and others favoring intrapleural fibrinolytic agents.

This study is one of the few randomized clinical trials on this subject in children and the first multicenter trial. It exclusively included patients with septated empyema. Thoracoscopy and fibrinolysis with urokinase were equally effective for this condition. (Read the full article)

Despite growing interest around clinical screening for health-related social and environmental risk factors, little evidence exists regarding screening formats that maximize disclosure of psychosocial information.

This study compares psychosocial and socioeconomic adversity disclosure rates in face-to-face interviews versus electronic formats in a large, urban pediatric emergency department. (Read the full article)

Fathers’ attitude and support affects breastfeeding outcomes. Fathers are currently not targeted in breastfeeding support and care provided by health care professionals. Breastfeeding interventions delivered to fathers have been shown to increase breastfeeding exclusivity and duration.

A coparenting breastfeeding support intervention delivered to mothers and fathers in the postpartum period showed beneficial effects on breastfeeding duration, paternal breastfeeding confidence, breastfeeding help provided by fathers, and mothers’ satisfaction with fathers’ involvement with breastfeeding. (Read the full article)

Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine.

Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness. (Read the full article)

Frequency of influenza vaccination is low, partially because of missed opportunities to vaccinate. Barriers to implementing successful influenza vaccination reminders in the electronic health record include alert fatigue and incomplete vaccination information due to scattered records.

A noninterruptive, immunization information system–linked influenza vaccination reminder can increase vaccination late in the winter when fewer vaccine doses are usually administered. Tailoring the reminder to clinicians’ needs can increase its use. (Read the full article)

Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion.

Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1–2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. (Read the full article)

Pediatric traumatic brain injury (TBI) contributes to impairments in functioning across multiple settings. Online family problem-solving therapy may be effective in reducing adolescent behavioral morbidity after TBI. However, less is known regarding maintenance of effects over time.

This large randomized clinical trial in adolescents with TBI is the only study to examine maintenance of treatment effects. Findings reveal that brief, online treatment may result in long-term improvements in child functioning, particularly among families of lower socioeconomic status. (Read the full article)

Sleep apnea is a common condition in childhood, mainly managed by tonsillectomy. Codeine was recently contraindicated for pain management after surgery. Controversy exists regarding the safety and effectiveness of alternative medications, morphine, and ibuprofen.

Our findings suggest that ibuprofen does not increase tonsillar bleeding and in combination with acetaminophen is effective for pain management after tonsillectomy. Furthermore, standard morphine doses increased postoperative respiratory events and were not safe in all children. (Read the full article)

Sustained lung inflation and positive end-expiratory pressure would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for respiratory support. Previous clinical studies in preterm infants provided promising results but have some limitations.

This randomized controlled study found that prophylactic sustained lung inflation and positive end-expiratory pressure in the delivery room decreased the need for mechanical ventilation in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome. (Read the full article)

Sleep deprivation is a worldwide problem in adolescents. The effectiveness of sleep education in enhancing sleep knowledge with consequent modification of sleep habits remains uncertain, in view of small sample sizes and lack of control groups in previous studies.

This large-scale, cluster randomized controlled study found that a school-based sleep education program was effective in enhancing sleep knowledge and improving behavioral and mental health, but it had no significant impact on sleep duration or pattern among adolescents. (Read the full article)

Early language delay is common in toddlers and is associated with poor academic outcomes, reading difficulties, and persistent communication problems. Despite these long-term sequelae, few interventions for toddlers with early language delays yield positive expressive and receptive language results.

A 28-session program delivered over 3 months can enhance parent language facilitation strategies. Unusually, the small short-term benefits were mainly in receptive, rather than expressive, language and vocabulary. Extended follow-up could determine the costs versus benefits of this promising approach. (Read the full article)

Topical corticosteroids are often used to treat atopic dermatitis (AD) in infants, although compliance is poor due to concerns over side effects. Pimecrolimus was shown to be a safe and effective noncorticosteroid treatment of AD in infants in short-term studies.

The Petite Study shows that long-term management of mild-to-moderate AD in infants with pimecrolimus or topical corticosteroids was safe without any effect on the developing immune system. Pimecrolimus had similar efficacy to topical corticosteroids and a marked steroid-sparing effect. (Read the full article)

Micronutrient deficiencies, including deficiencies of vitamin B-12 and folate, are common worldwide and may be a contributing factor to the estimated 165 million stunted children.

Routine supplementation of vitamin B-12 improved linear and ponderal growth in subgroups of young Indian children. We provide evidence that vitamin B-12 deficiency is a contributor to poor growth in low- and middle-income countries. (Read the full article)