Burns are a leading cause of pediatric emergency department visits and hospitalizations and are often associated with significant long-term physical and psychological consequences and long-term medical and nursing treatments. Little is known of the long-term impacts of burns on mortality.

Children with burns had a 1.6 times greater rate of long-term mortality than a matched population-based cohort of children with no injury. Total mortality burden based on in-hospital deaths alone underestimates the true burden from both minor and severe burns. (Read the full article)

Pediatric palliative care (PPC) improves the quality of life for children with life-limiting illness and their families. The association between PPC and health care costs is unclear and has not been studied over time.

PPC recipients were more medically complex. Receipt of PPC was associated with lower costs when death was near but with greater costs among survivors. When controlling for medical complexity, costs did not differ significantly according to receipt of PPC. (Read the full article)

Pediatric residents may not be achieving competency in neonatal intubation. Opportunities for intubation during residency are decreasing. A precise definition of competency during training is lacking.

Bayesian statistics may be used to describe neonatal intubation competency in residents. At least 4 successful intubations are needed to achieve competency. The first 2 intubation opportunities appear to predict how many intubation opportunities are ultimately needed to achieve competency. (Read the full article)

Smoking has been found to increase the risk of some specific congenital anomalies; however, results remain inconsistent. Nicotine replacement therapy (NRT) is increasingly being used as for smoking cessation in pregnancy although little is known about its association with congenital anomalies.

Being prescribed NRT while pregnant was not associated with major congenital anomalies (MCA), except a small increase in respiratory anomalies (3/1000 births). This must be considered in context of the rarity of MCAs and higher morbidities in the NRT group. (Read the full article)

Although physicians worry that communicating about prognosis or life-threatening illness can take away hope, previous work suggests that prognosis communication may even enhance hope. The nature of hopes held by parents of children with advanced cancer was not previously understood.

Parents in our study frequently recognized their child’s poor prognosis, yet held many different hopes, including for cure, quality of life, and meaningful relationships. Parents who hoped for cure often recognized that this was not possible for their child. (Read the full article)

Although treatment of infection is a mainstay of neonatal intensive care, little attention has focused on the proportion of patient antibiotic exposures validated by clinical indications that are unambiguous.

Septic workups in 127 California NICUs reveal similar burdens of proven infection, yet patient antibiotic exposures in those NICUs vary 40-fold. Because antibiotic stewardship principles dictate that antibiotic use should correlate with burden of infection, some NICUs overuse antibiotics. (Read the full article)

Considerable differences in outcome after extremely preterm birth have been reported between centers and regions providing a comparative level of care, but the reasons for these variations have been poorly examined.

In extremely preterm fetuses alive at the mother’s admission for delivery, and in infants born alive, mortality up to 2.5 years is reduced in regions with a more active use of perinatal interventions without increased neurodevelopmental morbidity. (Read the full article)

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

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

Heart rate (HR) increases with increasing body temperature. Previous studies have characterized the relationship among HR, age, and temperature for patients in primary care and emergency department settings but not in hospitalized children.

Our data demonstrate an overall increase in HR by ~10 beats/minute for each 1°C increase in body temperature. Expected heart rates for hospitalized children differ from those for primary care and emergency department patients at the same age and temperature. (Read the full article)

Clinical trials of the quadrivalent human papillomavirus vaccine show it to be highly efficacious in preventing vaccine-type–specific cervical dysplasia and anogenital warts, but few studies have assessed its effects in the real world and none have done so at the program/population level.

This study provides strong evidence of the early benefits of quadrivalent human papillomavirus vaccination on reductions in cervical dysplasia and possible reductions in anogenital warts among girls aged 14 to 17 years, offering additional justification for not delaying vaccination until girls are older. (Read the full article)

Neurodevelopmental disabilities are the most common, and potentially the most damaging, sequelae of congenital heart defects. Children with congenital heart defects undergoing surgery in infancy have problems with reasoning, learning, executive function, inattention and impulsive behavior, language skills, and social skills.

Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk infants with congenital heart defects survive cardiac surgery, a growing population will require significant societal resources. (Read the full article)

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

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

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

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

Meaningful use (MU) incentive payments have been developed to encourage adoption and use of electronic health records (EHRs). Several studies have revealed children’s hospitals have unique barriers to the use of EHRs but were relatively early adopters of information technology.

Although a minority of children’s hospitals have succeeded with MU incentives, freestanding children’s hospitals are significantly more likely to succeed. Improvement of EHRs for pediatric use should focus on information exchange, quality reporting, and MU relevance to pediatrics. (Read the full article)

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

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

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

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

Parental hesitancy about childhood vaccines is prevalent and related to delay or refusal of immunizations. Physicians are highly influential in parental vaccine decision-making, but may lack confidence in addressing parents’ vaccine concerns.

A physician-targeted communications intervention designed to reduce maternal vaccine hesitancy through the parent-physician relationship did not affect maternal hesitancy or physician confidence communicating with parents. Further research should determine the most effective approaches to addressing vaccine hesitancy. (Read the full article)

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

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

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

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

Postnatal growth failure is common for very low birth weight infants. Although many of the major morbidities experienced by these infants during their initial NICU stays have decreased in recent years, it is unclear whether growth has improved.

For infants weighing 501 to 1500 g, average growth velocity increased and postnatal growth failure decreased from 2000 to 2013. Still, in 2013, half were discharged with a weight below the 10th percentile for postmenstrual age. (Read the full article)

The 2011 national guidelines for the management of pediatric community-acquired pneumonia recommended narrow-spectrum antibiotic therapy (eg, ampicillin) for most children hospitalized with pneumonia. Before the release of the guidelines, the use of broader-spectrum antibiotics (eg, third-generation cephalosporins) was much more common.

After release of the guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with pneumonia. Changes were most apparent among institutions that proactively disseminated the guidelines, underscoring the importance of local efforts for timely guideline implementation. (Read the full article)

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

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

Medicaid made substantial investments in enhanced prenatal and postnatal care programs to address maternal and infant health, including infant mortality. Evaluations of population-based programs are few, and although some have reported reductions in infant mortality, they have methodological limitations.

A population-based home visitation program can be a successful approach to reduce infant mortality. The reduced risk of infant death is consistent with previous findings on the effects of the program on health care utilization and birth outcomes. (Read the full article)

Although existing analyses of inpatient pediatric pulmonary hypertension (PH) care have established an association with substantial morbidity and mortality, these investigations have been limited to small single-institution series or focused registries representative of selected patient subgroups.

This study provides the first contemporary, national trend analysis of inpatient care for children with PH. Pediatric PH is associated with a rapidly increasing number of hospital discharges and magnitude of resource utilization, and the makeup of this population is changing. (Read the full article)

War-affected youth often suffer from multiple co-occurring mental health problems. The relationship of these conditions to later mental health has yet to be thoroughly investigated. There is a need to explore potential targets for mental health interventions.

After controlling for preexisting conditions and contemporary confounders, internalizing (depression and anxiety) remained the major predictor of future mental health symptoms (internalizing symptoms, prosocial attitudes/behaviors, and posttraumatic stress symptoms). Interventions targeting internalizing in war-affected youth hold promise. (Read the full article)

Neonatal coarctation of the aorta (CoA) is a life-threatening cardiac defect, but because symptoms may be lacking initially, newborns with this defect are frequently discharged from the hospital undiagnosed. Delayed diagnosis of CoA is associated with increased morbidity and mortality.

This population-based study analyzes the contribution of prenatal ultrasound and postnatal pulse oximetry screening to the timely diagnosis of neonatal CoA. Both screening methods had low sensitivity for CoA. Nearly half of all newborns with isolated CoA were discharged undiagnosed. (Read the full article)

Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric inpatient care quality remains unknown.

Most children are admitted to hospitals in which all-condition measures of inpatient quality are powered to show differences in performance from average, but most condition-specific measures are not. Policy on incentives for pediatric inpatient quality should take these findings into account. (Read the full article)

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

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

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

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

Prenatal diagnosis may lead to benefits in outcomes for certain forms of critical congenital heart disease. Despite recognized benefits, single-center studies and focused regional efforts suggest that prenatal detection rates for congenital heart disease remain low in the United States.

We describe prenatal detection rates for a large cohort of neonates and infants undergoing heart surgery across a range of congenital heart defects. Additionally, this study adds new information by demonstrating geographic variability of prenatal detection rates across the United States. (Read the full article)

Interactive activities and routines promote early childhood language skills and subsequent educational achievement. Population studies describing parent-child participation in interactive activities and their associations with early child development among vulnerable populations are needed.

Significant disparities exist in parenting practices that promote child development between economically advantaged and disadvantaged parents. Participating in less interactive activities was associated with increased risk of developmental delay among low-income families, suggesting a need to enrich parenting practices. (Read the full article)

Late preterm infants, compared with full-term infants, have less proficiency in reading and math at school age, with increased need for individualized educational plans and special education services. They also have lower cognitive performance on standardized IQ exams.

Late preterm infants have worse outcomes at school entry, and development is variable during the preschool years, so socioeconomic status, language spoken in the home, maternal education, maternal race, and being a late preterm infant have a large impact. (Read the full article)

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

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

Childhood inflammatory mediators are associated with adult obesity, but the stimuli that initiate and perpetuate chronic inflammation start in early life are largely unknown.

Childhood infection-related hospitalization was independently associated with adverse adult metabolic variables, which suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases. (Read the full article)

Concern of the risk of malignancy from ionizing radiation has prompted many to advocate for judicious use of computed tomography (CT) and as low as necessary radiation doses administered per scan. Recent analysis has shown a decline in CT utilization.

We identified decreases in CT utilization between 2004 and 2012 for the 10 most common diagnostic groups receiving CT. Decreases were typically associated with increases in alternate imaging modalities. We provide a possible reason for the decrease in CT utilization. (Read the full article)

Infants born very prematurely or with a very low birth weight are known to have an increased risk of attention-deficit/hyperactivity disorder (ADHD). Results concerning late preterm children are controversial and studies examining fetal growth represented by weight for gestational age are scarce.

We demonstrate that each declining week of gestation increases the risk of ADHD. Also, late preterm infants have an increased risk. Furthermore, as weight for gestational age becomes smaller than 1 SD below the mean, the risk of ADHD increases. (Read the full article)

Subjective social status (SSS), a person’s sense of their or their family’s position in the socioeconomic hierarchy, is strongly related to adult health but is not a robust predictor of adolescent health. Developmental trajectories of SSS underlying this discrepancy are unknown.

Five SSS trajectories are present in adolescence/emerging adulthood. Four stably reflect objective socioeconomic status. The fifth represents a subset of socially disadvantaged youth with "rose-colored glasses" early on. Lower SSS and membership in the fifth trajectory increase health risk. (Read the full article)

Adding second-stage automated auditory brainstem response (ABR) testing for infants who failed the initial OAE test in a two-stage neonatal hearing screening has been shown to reduce false referrals to the hearing clinic.

Infants with hearing loss may be missed by a 2-stage hearing screening because they pass the automated ABR test. In our study, a significant number of infants with hearing loss >45 decibel hearing level passed screening with automated ABR. (Read the full article)

Congenital cytomegalovirus infection is the leading infectious cause of neurologic disabilities and sensorineural hearing loss in children. Little is known concerning the frequency and impact of vestibular disorders induced by cytomegalovirus infection.

This study reports on the largest cohort of vestibular assessment of children congenitally infected with cytomegalovirus, demonstrating vestibular damages, and analyzes the correlations between vestibular dysfunction and hearing impairment or severity of infection. Cytomegalovirus infection affects postural development in children. (Read the full article)

Use of a standard treatment protocol with stringent weaning guidelines for infants with neonatal abstinence syndrome supports improved outcomes including shorter duration of opioid exposure and length of hospital stay.

We demonstrate generalizability of a protocol-driven weaning strategy for improvement in hospital outcomes for neonatal abstinence syndrome. After adoption, adherent protocol-adopting centers improved outcomes and eliminated differences in outcomes compared with centers with preexisting stringent weaning protocols. (Read the full article)

Infants with neonatal abstinence syndrome are hospitalized for longer after birth and are more likely to be from highly vulnerable families. Determining long-term outcomes is difficult because this is a large and chaotic population.

(Read the full article)

Minimal parent supervision and early pubertal maturation independently forecast alcohol misuse among adolescent girls. It is not known if pubertal timing amplifies risks associated with inadequate supervision during the formative years when youth are first exposed to alcohol.

Early maturing girls who enter secondary school with high levels of behavioral autonomy report a dramatic increase in alcohol abuse. The etiology of their problems with alcohol can be traced, in part, to heightened risks arising from low parent supervision. (Read the full article)

Urologic outcomes of prenatal myelomeningocele closure have previously been reported. This study, however, represents a large, prospectively followed cohort of these patients and presents detailed findings of urologic outcomes. To our knowledge, this is the largest study of this type.

Our study is the only trial to compare urologic outcomes in children with myelomeningocele having undergone prenatal closure with those who had postnatal repair in a prospective and systematic manner. We report our findings at 12 and 30 months. (Read the full article)

Children with life-threatening complex chronic conditions (LT-CCCs) experience high hospital use.

Hospital use in the last year of life for these children varies by type and number of LT-CCCs. Most children with ≥3 LT-CCCs are admitted to the hospital for more than 2 months in the last year of life. (Read the full article)

Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.

This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article)

A number of studies have reported an association between birth by cesarean delivery and adverse childhood health outcomes such as obesity, asthma, atopy, and a number of neurodevelopmental abnormalities. However, these studies have had limited capacity to control for confounders.

Using a prospective cohort while controlling for birth factors, social vulnerability, maternal BMI, and breastfeeding, we found few differences between children delivered by cesarean delivery and those born vaginally. Higher child BMI was explained by maternal BMI. (Read the full article)

Seven percent of children in the United States receive mental health services each year. There are more pediatric outpatient mental health care visits to primary care physicians (PCPs) than to psychiatrists. Mental health utilization patterns regarding different conditions and medication prescribing are unknown.

One-third of children with mental health conditions see PCPs only. A greater proportion of children with attention-deficit/hyperactivity disorder see PCPs for this than do those with anxiety/mood disorders. Children seeing PCPs are prescribed psychotropic medications more often than those seeing psychiatrists. (Read the full article)

Endotracheal intubation is a mandatory skill for neonatal trainees. It is a difficult skill to acquire, and success rates of junior doctors are low and falling.

Videolaryngoscopy allows the supervisor to share the intubator’s view of the airway and provide more informed guidance. Teaching intubation using a videolaryngoscope with the screen visible to the instructor results in significantly higher success rates for inexperienced doctors. (Read the full article)

Communication between parents and providers is an important driver of parent experience of care. The impact of nighttime communication, which has become increasingly relevant after changes in resident physician duty hours, on parent experience is unknown.

Parent communication with nighttime doctors and nurses, and parent perceptions of communication and teamwork between these providers, may be important drivers of parent experience. Efforts to improve nighttime communication, both with parents and between team members, may improve parent experience. (Read the full article)

The impact of neonatal abstinence syndrome is of concern because the number of newborns showing symptoms of withdrawal after intrauterine drug exposure is increasing worldwide. Newborns developing neonatal abstinence syndrome require prolonged medical treatment and longer hospital admission after birth.

This first randomized controlled trial presents data on newborns with neonatal abstinence syndrome treated with laser acupuncture. The findings suggest that adjuvant laser acupuncture has the potential to reduce duration of morphine therapy and length of hospital stay. (Read the full article)