Febrile neutropenia is a common complication in children with cancer. Traditionally, even low-risk episodes have been managed entirely in an inpatient setting, and discharge of the patients has been delayed until resolution of fever and sustainable hematopoietic recovery.

The results of this decision-analytic model evaluating low-risk febrile neutropenia episodes suggest that the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences. Uncertainty remains whether intravenous or oral treatment might be the preferable route of drug administration in an ambulatory setting. (Read the full article)

Corticosteroids inhibit the expression of many proinflammatory cytokines released during the course of community-acquired pneumonia infection. Corticosteroids have been found in some studies to be associated with improved clinical outcomes in adults with pneumonia. No studies have investigated corticosteroid use in children with pneumonia.

Results showed that corticosteroid treatment in children with pneumonia is common and its use is highly variable across institutions. Although corticosteroid therapy may benefit children with acute wheezing treated with β-agonists, corticosteroid therapy may lead to worse outcomes for children without wheezing. (Read the full article)

Autism has been associated with pregnancy and birth complications that may indicate a suboptimal prenatal environment. Although the interpregnancy interval (IPI) may affect the prenatal environment, the association between the IPI and risk for autism is not known.

Using full-sibling pairs from a large population, the authors examined the association between autism and IPIs. Second-born children conceived after an IPI of <12 months had more than threefold increased odds of autism relative to those with IPIs of ≥36 months. (Read the full article)

The current standard of care includes informing women about prenatal testing and newborn screening for cystic fibrosis and providing genetic counseling to parents whose child is referred for sweat-testing. Despite counseling, early data identified some persistent confusion about residual risk.

Prenatal discussions about carrier testing and newborn screening for cystic fibrosis are not routine. Parental anxiety about abnormal results from a screen is decreased after speaking to a genetic counselor when scheduling the sweat test. Despite counseling, residual risk continues to be poorly understood. (Read the full article)

Several qualitative studies have revealed that caregivers use infant fussing as a cue for beginning complementary feeding (CF). Despite a higher prevalence of early CF among black infants, few studies have quantitatively examined the role of maternal perception of infant fussiness.

Results of this study show that in a cohort of low-income, black, first-time mothers, early CF was highly prevalent and that maternal perception of infant temperament, breastfeeding, and maternal obesity and depression were important factors related to early CF. (Read the full article)

The associations between food insecurity and child well-being have been well studied on the basis of household levels of food insecurity, as reported by heads of households.

Household measures, however, may not capture gender biases in food insecurity and morbidity. This study assessed adolescents' own experience with food insecurity and how it was associated with morbidity and the effect of gender in this process. (Read the full article)

Cardiovascular risk factors predict the development of premature atherosclerosis. As the number of risk factors increases, so does the extent of these lesions. Assessment of cardiovascular risk factors is an accepted practice in adults but is not used in pediatrics.

In this study, the authors discuss how the presence of ≥2 cardiovascular risk factors is associated with vascular changes in adolescents. The findings were compared with the Patholobiological Determinants of Atherosclerosis in Youth risk score to demonstrate that a simple method of clustering is a reliable tool to use in clinical practice. (Read the full article)

The use of steroids as a treatment for patients with Duchenne muscular dystrophy results in a slower progression in weakness. Bisphosphonates often are used in conjunction with steroid therapy to enhance bone health.

The combination of steroids and bisphosphonates seems to be associated with significantly improved survival rates compared with treatment with steroids alone. (Read the full article)

Intussusception is the most common cause of intestinal obstruction in young children. To date, there have been no prospective studies that have been able to develop a reliable clinical prediction model to determine which patients are at low risk for intussusception.

This study is the largest prospective cohort study to date to evaluate children with possible intussusception. It includes both univariate and multivariate analyses to develop clinical prediction models for patients at low risk for intussusception. (Read the full article)

The National Children's Study, a large-scale, longitudinal, birth cohort study of US children that endeavors to identify preventable and environmental origins of chronic diseases, has begun recruitment.

In a highly diverse, urban setting, pregnant women can be recruited to participate in the National Children's Study at rates similar to those obtained in clinic settings. Refinements to the pregnancy screener and other components are needed to optimize implementation. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) has been the initial respiratory support for many preterm infants with respiratory distress syndrome (RDS). Nasal intermittent positive-pressure ventilation (NIPPV) seems to increase the beneficial effects of NCPAP by combining it with ventilatory inflations.

This study suggests that NIPPV, as an intial respiratory support for preterm infants with RDS, is feasible and safe and may have beneficial effects, when compared with NCPAP. (Read the full article)

For treatment of obesity in preadolescent children, approaches that focus on parents taking sole responsibility for implementing weight-management strategies may be most effective. However, the optimal content, intensity, and duration of programs for obese children remain unclear.

Targeting parents only, a 10% relative weight loss is achievable in moderately obese preadolescent children and can be maintained 2 years from baseline, which justifies an investment in treatment as a secondary obesity-prevention strategy. (Read the full article)

For mothers of children with chronic medical conditions or disabilities, such as epilepsy or cerebral palsy, a history of maternal unresolved grief regarding the child's diagnosis has been associated with insecure infant-mother attachment.

Unresolved grief related to a preterm birth is associated with the development of insecure infantmother attachment. Mothers with resolved grief after preterm birth are 2.9 times as likely to have securely attached infants, compared with mothers with unresolved grief. (Read the full article)

Neurocognitive testing is recommended for the assessment of sport-related concussions. Computerized neurocognitive tests are more sensitive and more efficient than traditional neuropsychological testing in assessing sport-related concussions.

We describe the current prevalence of computerized neurocognitive testing, the relative use of the various computerized programs, the types of clinicians interpreting test scores, and associations of computerized tests with timing of return-to-play and medical provider type managing the athlete. (Read the full article)

The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF).

Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury. (Read the full article)

The efficacy of intravenous immunoglobulin and corticosteroid pulse combination therapy for refractory Kawasaki disease has been established. The Egami score can be used to predict which patients are likely to have refractory Kawasaki disease.

As a new strategy for primary treatment, intravenous immunoglobulin and corticosteroid pulse combination therapy is safe and effective for patients predicted to have refractory Kawasaki disease based on the Egami score. (Read the full article)

Over 500 000 children in the United States sustain a traumatic brain injury (TBI) each year. Headaches are commonly reported after TBI in adults, but little is known about the epidemiology of headache after pediatric TBI.

Headaches are more common 3 months after pediatric TBI than after arm injury. The frequency of headache after TBI is related to patient gender, age, and injury severity. Headaches after mild TBI were most common among girls and teenagers. (Read the full article)

Media reports suggest that adolescents are being charged with sex crimes and even placed on sex offender registries because of participating in the "sexting" of sexual images, but the nature and outcomes of such incidents have not been described empirically.

This is the first study to examine types of sexting cases handled by police. It informs clinicians by identifying characteristics of "aggravated" versus milder incidents and finding that most youth were not arrested. Sex offender registration was rare. (Read the full article)

Primary hypertension is a growing concern in adolescents due to its association with the obesity epidemic. Recent studies have examined underdetection and underdiagnosis of hypertension in adolescents but medical management of primary hypertension in adolescents is not well-described.

Our study describes patterns of antihypertensive prescribing for adolescents with primary hypertension including the use of monotherapy versus combination therapy by physicians of different specialties and factors associated with receipt of antihypertensive therapy over a multi-year period. (Read the full article)

Most childhood HIV is acquired through perinatal transmission, some of which is preventable. Practitioners need to understand what proportion of perinatally acquired HIV infections are attributable to missed prevention opportunities.

Missed prevention opportunities include lack of early HIV testing for pregnant women; suboptimal use of antiretroviral medications during pregnancy, labor, or delivery or for the neonate; breastfeeding; and vaginal delivery when maternal viral load was ≥1000 copies/mL. (Read the full article)

Aluminum is ubiquitous and exposure is unavoidable. Adverse health effects have been associated with large exposures in workers or those with chronic kidney disease. There are no established age-specific reference ranges or toxicity data for populations of healthy children.

We demonstrate the wide variability of aluminum reference ranges in biological samples and that the ranges are not based on studies including healthy children. Further research is necessary to establish clinically relevant reference ranges for healthy children. (Read the full article)

Pediatric weight gain is a critical aspect of the obesity epidemic. Chronic stress produces physiologic perturbations capable of altering brain mechanisms related to eating as well as those implicated in self-regulatory behaviors.

We show that early childhood risk exposures are associated with weight gain in adolescence, independent of childhood BMI. We also find that deficiencies in self-regulatory processes help explain the link between chronic stress and adiposity. (Read the full article)

Gallbladder disease in children is an evolving entity and studies suggest an increasing frequency of symptomatic pediatric gallbladder disease and resultant cholecystectomies.

Hispanic ethnicity and obesity are epidemiologically significant risk factors for symptomatic gallbladder disease in the pediatric population. (Read the full article)

Two UK models predict the risk of mortality in very preterm Western infants (1) alive at onset of labor and (2) admitted for neonatal intensive care. Prognostic models need temporal and geographic validation to evaluate their performance.

The 2 models showed very good performance in a recent large cohort of very preterm infants born in another Western country. The accurate performance of both models suggests application in clinical practice (Read the full article)

The prevalence of asthma and smoking among adolescents in Jordan is high. Well-designed, school-based, peer-led education programs can have a positive impact on asthma self-management in adolescents. Student peer leaders can be useful and responsible partners in health promotion programs.

A peer-led asthma education program —Adolescent Asthma Action—for adolescents developed in Australia was adapted to suit non–English-speaking cultures in the Middle East. Peer-led education led to improved self-management of asthma and motivated students to avoid smoking. (Read the full article)

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a progressive, inherited neuromuscular disease manifesting with diaphragmatic paralysis in the first year of life. All patients need mechanical ventilation.

We describe the natural course of SMARD1, developed a scoring system, and defined prognostic values. The clinical outcome of the patients was heterogeneous, and residual enzymatic activity of the IGHMBP2 protein was associated with a more benign disease course. (Read the full article)

Blood pressure and heart rate are altered by sleep state and postnatal age in healthy term and preterm infants. Preterm infants have altered blood pressure responses to head-up tilting during sleep.

Preterm birth has marked effects on the maturation of baroreflex sensitivity during sleep, which may contribute to the greater vulnerability of preterm infants to sudden infant death syndrome. (Read the full article)

Chorioamnionitis is associated with preterm birth and an increased risk of common adverse outcomes of prematurity, including early-onset sepsis and neurodevelopmental impairment. The effect of chorioamnionitis on postnatal immune function and risk of late-onset infection is unknown.

Chorioamnionitis, which complicates many preterm births, is independently associated with a significantly reduced risk of late-onset sepsis in preterm infants. The findings suggest that chorioamnionitis may modulate the development of postnatal immunity in a clinically significant manner. (Read the full article)

Clinical trials in children with severe traumatic brain injury (TBI) are challenging. To date, no work has been published that permits clinical investigators to estimate the number and compositional features of sites from which to recruit children with severe TBI into clinical trials.

Children with severe TBI are infrequent. Less than 5% of all US hospitals discharged more than 78% of severe TBI cases. To maximize enrollment efficiency for future clinical trials, attention has to be paid to selecting appropriate hospital sites. (Read the full article)

The medical home is associated with beneficial outcomes in children with special health care needs and in the entire pediatric population. It is unknown if it benefits the majority of the pediatric population (ie, children without special health care needs).

This study is the first to demonstrate an association between the medical home and beneficial health care utilization, child health, and health-promoting behavior outcomes in children without special health care needs. (Read the full article)

Very low birth weight (VLBW) male neonates appear to have increased mortality. VLBW female neonates appear to have better long-term outcomes.

VLBW male neonates have increased mortality and poorer neurological outcome. This gender difference appears to disappear at weeks' gestation. (Read the full article)

Prematurely born children have an increased prevalence of behavioral problems in the long term. Knowledge regarding the effects of early intervention programs is sparse, and more randomized controlled trials are warranted.

A modified version of the Mother-Infant Transaction Program showed beneficial effects on behavioral outcomes reported by both parents of preterm infants with birth weights of <2000 g at a corrected age of 5 years. (Read the full article)

Human rhinovirus infections are common in children. Although historically associated with upper respiratory tract illness, rhinoviruses are increasingly recognized for their role in the exacerbation of asthma. Their role in bronchiolitis and severe lung disease in premature infants is unclear.

The authors of this study prospectively explore the role of rhinoviruses in premature infants using molecular techniques and identify these agents as the most frequent cause of hospitalization in this population. (Read the full article)

Extreme preterm birth is associated with developmental shortcomings that may reduce exercise capacity and participation in physical activities in later life. The number of studies addressing these issues in adolescent populations is limited, test methods differ, and results are diverging.

Exercise capacity after preterm birth was in the same range as in term-born control subjects. Participation in physical activity was lower in preterm subjects compared with control subjects; however, the response to exercise in terms of increased aerobic capacity was similar. (Read the full article)

The American Academy of Pediatrics recommends routine alcohol screening for all adolescents. Problem-based substance use screens for adolescents exist, but have limitations. A consumption-based alcohol screen could provide an empirically validated, very brief method to screen youth for alcohol-related problems.

National sample data indicate that frequency of alcohol use has high sensitivity and specificity in identifying youth with alcohol-related problems. A range of age-specific frequency cut scores perform well; specific cut points can be selected based on the screening context. (Read the full article)

Upper respiratory tract infections (URIs) are very common in children. Currently, there are no effective preventive measures for URI. There are no studies on the effect of montelukast for prevention of URI.

In a randomized, double-blind, placebo-controlled study of preschool-aged children, 12-week prophylactic treatment with montelukast did not reduce the incidence of URI. (Read the full article)

Eating disorders are characterized by preoccupation with weight and shape, which is manifested by a refusal to maintain a normal weight. An exact determination of expected body weight (EBW) is critical for diagnosis and clinical management of these disorders.

The McLaren and Moore methods present with several limitations when calculating EBW for adolescents with eating disorders. A commonly agreed upon method for EBW calculation such as the BMI percentile method is recommended for clinical and research purposes. (Read the full article)

Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume–outcome relationship.

A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. (Read the full article)

Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking.

Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time. (Read the full article)

Recommendations in pediatrics call for general developmental screening of young children; however, research suggests social-emotional development, in particular, is important as an initial indicator of general well-being versus risk, and may warrant inclusion in screening protocols.

Via a social-emotional screening program, significant percentages of children can be identified as being at risk for social-emotional problems, and colocation of an early childhood psychologist promotes the ability to effectively address young children’s social-emotional development within their medical home. (Read the full article)

Newborn screening (NBS) programs may store bloodspot samples and use them for secondary purposes, such as research. Recent public controversies and lawsuits over storage and secondary uses underscore the need to engage the public on these issues.

This public engagement study identifies values underlying citizens’ acceptance of and discomfort with research from NBS samples. Well-designed methods of public education and civic discourse on the risks and benefits of storage and secondary uses of NBS samples are required. (Read the full article)

Refugee children arriving in the United States have had higher rates of elevated blood lead levels than US-born children. The Centers for Disease Control and Prevention recommends blood lead screening of all refugee children within 3 months after their arrival in the United States.

This is the first investigation we are aware of to examine and identify risk factors for lead poisoning among US-bound refugee children living in camps overseas, before their arrival in the United States. (Read the full article)

Over the past decade, drug oversight committees and professional organizations have debated the evidence regarding cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deficit/hyperactivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this controversy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deficit/hyperactivity disorder before prescribing stimulants. (Read the full article)

The retention and use of residual bloodspots is a practice of many state newborn screening programs. This practice has become controversial, and little is known about public attitudes on the retention and research use of newborn residual bloodspots.

This study offers a detailed analysis of public attitudes regarding bloodspot retention and use for biomedical research. The results also offer insights on how education regarding this practice influences support for newborn screening and residual bloodspot use. (Read the full article)

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspecific clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been associated with pseudo-outbreaks.

Contamination of specimens with vaccine derived Bordetella pertussis DNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modifiable factors. (Read the full article)

Registries have been established in a number of countries to monitor the health of patients with cystic fibrosis. Few international comparisons have been made between registries. International data registry comparisons may be useful for informing best practice and benchmarking.

Registry comparisons are feasible but are limited by factors such as nonstandardization of data collection. Lung function was lower in Australian children with cystic fibrosis compared with their US counterparts after adjusting for the benefits of diagnosis after newborn screening. (Read the full article)

Studies of the association between process and outcome measures of the quality of acute asthma care for children have been mixed. These studies are limited by small, single-institution settings or by examining the association at the aggregate level.

This first multicenter analysis of the process-outcome association in acute asthma care for children revealed no association. Because the validity of process measures depends on association with outcomes, further study is needed before implementing existing process measures as performance metrics. (Read the full article)

Traumatic brain injury in school-aged children is associated with intellectual, behavioral, and social deficits. Research into outcomes of children injured before 3 years of age is limited despite data suggesting a high incidence of injury in this age group.

Results show that a moderate to severe traumatic brain injury before 3 years of age is associated with lowered cognitive function. Furthermore, this study highlights the link between social disadvantage and poor outcomes after traumatic brain injury in early childhood. (Read the full article)

Mixed prevalence rates of co-occurring psychiatric and neurodevelopmental conditions have been reported in children diagnosed with an autism spectrum disorder (ASD). ASD diagnoses remain fairly stable within a continuum, but some do not meet criteria for an ASD diagnosis years after initial diagnosis.

Co-occurring neurodevelopmental and psychiatric conditions may explain, in part, why the diagnosis of an ASD may change with age. (Read the full article)

Childhood UV light exposures, specifically sunburns, have been shown to be associated with melanoma development later in life.

To date, most studies in this age group have been cross sectional in nature. This is the first prospective study of sunburn and sun behaviors in this age group. (Read the full article)