Phototherapy decreases bilirubin concentration in skin more rapidly than in blood. During and after phototherapy, transcutaneous bilirubin measurements are considered unreliable and therefore discouraged.

Transcutaneous bilirubin underestimates total serum bilirubin by 2.4 mg/dL (SD, 2.1 mg/dL) during the first 8 hours after phototherapy. This gives a safety margin of ~7 mg/dL below the treatment threshold to omit confirmatory blood sampling. (Read the full article)

Direct antiglobulin titer (DAT) positive, blood group A or B newborns born to group O mothers have a high incidence of hyperbilirubinemia, attributable to increased hemolysis.

DAT ++ readings were associated with a higher incidence of hyperbilirubinemia and a greater degree of hemolysis than DAT ± or DAT + counterparts. DAT strength should be taken into consideration when planning treatment strategies or follow-up of ABO-heterospecific newborns. (Read the full article)

Prophylactic indomethacin in extremely low birth weight infants decreases severe intraventricular hemorrhage and patent ductus arteriosus but it is unknown whether concurrent enteral feeding and prophylactic indomethacin is associated with increased risk of spontaneous intestinal perforation.

The combination of prophylactic indomethacin and enteral feeding during the first 3 days after birth does not increase the risk of spontaneous intestinal perforation. (Read the full article)

Preterm birth and faster infant growth have been identified as independent risk factors for autism-spectrum disorders (ASD). However, associations between prematurity and ASD-related traits as a continuum and effects of infant growth among those born preterm are still little studied.

VLBW young adults reported higher levels of ASD-related traits, particularly traits related to poorer social skills. Within the VLBW group, faster growth in weight, height, and head circumference from birth to term was associated with lower levels of ASD-related traits. (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)

Studies have shown that reciprocal vocalizations between mother and infant have positive effects on language development. It has been shown that girls acquire vocabulary and language skills earlier than boys.

Mothers more readily respond to their infant’s vocal cues than fathers, and infants show a preferential vocal response to their mothers in the first months of life. Mothers respond preferentially to infant girls versus boys at birth and 44 weeks. (Read the full article)

A previous study suggested that physicians in 1 practice network were less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for OM for black versus nonblack children.

Nationally, black children with OM are more likely to receive guideline-recommended, narrow-spectrum antibiotics than nonblack children. These findings may reflect inappropriate treatment of OM with the use of broad-spectrum antibiotics in a majority of US children. (Read the full article)

The American Academy of Pediatrics has identified bedding such as pillows, blankets, and quilts as potentially hazardous for the infant sleep environment. Bedding use is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation.

Reported bedding use over or under the infant for infant sleep substantially declined from 1993 to 2010. However, about one-half of US infants are still placed to sleep with potentially hazardous bedding despite recommendations against this practice. (Read the full article)

White matter abnormality (WMA) on neuroimaging is considered a crucial link with adverse neurodevelopmental outcome in preterm infants. Brain MRI is more sensitive in detecting WMA than cranial ultrasound (CUS), but questions remain about timing and prognostic value of modalities.

Near-term CUS and MRI abnormalities were associated with adverse 18- to 22-month outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of later neuroimaging in this large, extremely preterm cohort surviving to near-term. (Read the full article)

Respiratory syncytial virus (RSV) infection is a common cause of pediatric hospitalizations. Mortality rates associated with RSV hospitalizations are based on estimates from studies conducted decades ago. Accurate understanding of mortality is required for identifying high-risk infants and children.

Mortality associated with RSV is uncommon in the 21st century, with annual deaths far lower than previous estimates. The majority of deaths occurred in infants with complex chronic conditions or in those with life-threatening conditions in addition to RSV infection. (Read the full article)

Antibiotic overuse is common and is a major public health threat. The prevalence of antimicrobial stewardship programs in children’s hospitals is growing. Single-center studies reveal that antimicrobial stewardship programs are effective in reducing unnecessary antibiotic use. Multicenter evaluations are needed.

Antibiotic use is declining overall across a large network of freestanding children’s hospitals. Hospitals with formalized antimicrobial stewardship programs experienced greater reductions in antibiotic use than other hospitals, suggesting that these interventions are an effective strategy to address antibiotic overuse. (Read the full article)

Necrotizing enterocolitis is associated with high mortality and morbidity in premature infants. Anaerobic antimicrobial therapy has been associated with increased risk of intestinal strictures in a small randomized trial. Optimal antimicrobial therapy for necrotizing enterocolitis is unknown.

Anaerobic antimicrobial therapy was associated with increased risk of stricture formation. Infants with surgical necrotizing enterocolitis treated with anaerobic antimicrobial therapy had lower mortality. For infants with medical necrotizing enterocolitis, there was no added benefit associated with anaerobic antimicrobial therapy. (Read the full article)

Hospitalized pediatric patients are often exposed to many medications during an inpatient admission. Drug–drug interactions may increase the risk of developing medication-related adverse drug events, leading to serious clinical morbidity and mortality.

Exposure to "major" potential drug–drug interactions occurs in 41% of pediatric hospitalizations in children’s hospitals. One-half of all these exposures were due to less common specific drug pairs (≤3% of patients exposed per hospital day) and thus may be less clinically familiar. (Read the full article)

Although pediatric professional guidelines emphasize addressing a child’s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families’ receipt of community-based resources.

This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families. (Read the full article)

Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks’ gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated.

Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks’ gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. (Read the full article)

Meningococcal disease is a serious but rare infectious disease. In 2012, the incidence of meningococcal disease was at a historic low in the United States; however, incidence remained highest among infants aged <1 year.

This report describes the epidemiology and burden of meningococcal disease in infants aged <1 year in the United States and potential risk factors for transmission to this vulnerable group. These data are key to informing future meningococcal disease vaccination strategies. (Read the full article)

Administration of repeat doses of antenatal glucocorticoids to women at risk for preterm birth after an initial course reduces neonatal morbidity, without affecting rates of neurologic disability in early childhood. However, data on long-term effects on cardiometabolic health are limited.

Exposure to repeat doses of antenatal betamethasone did not increase cardiovascular risk factors at early school age. Clinicians wishing to use repeat antenatal glucocorticoids can be reassured that the risk of future cardiometabolic disease from this therapy is low. (Read the full article)

Application of antenatal corticosteroids to mothers before delivery is highly beneficial to very low birth weight infants. Yet despite widespread quality improvement efforts, many eligible infants fail to receive this therapy.

We demonstrate improvement in antenatal corticosteroid use during the study period. However, significant regional variation persists, which network-level quality improvement efforts might help eliminate. (Read the full article)

Adults born very preterm or with very low birth weight have a lower likelihood of leaving their childhood home, and starting romantic relationships, and are older when experiencing first intercourse or having their first child than their term-born peers.

Compared with term-born individuals, those born preterm perceived themselves less attractive and were less likely to have cohabited or experienced first-time sexual intercourse by young adulthood. This outcome indicates that social outcomes are different among preterm-born individuals. (Read the full article)

Immune-related bioactive proteins are highly concentrated in the colostrum of mothers who deliver preterm infants. Oropharyngeal administration was proposed as a safe and feasible alternative method of providing colostrum to immunocompromised premature infants.

Oropharyngeally administered colostrum during the first few days of life increased urinary secretory immunoglobulin A and lactoferrin, decreased urinary interleukin-1β, reduced salivary transforming growth factor-β1 and interleukin-8, and reduced the occurrence of clinical sepsis in extremely premature infants. (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)

US children consume excessive amounts of sodium and substantial amounts of added sugars. Early life exposures to salt and sugar can set taste preferences and health trajectories.

A substantial proportion of toddler meals and other commercial foods meant for children age ≥12 months are of potential concern because of their high sodium content or presence of ≥1 added sugar. (Read the full article)

Noninvasive ventilation (NIV) reduced the need of intubation in preterm infants with RDS. However, randomized studies comparing nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure are still lacking.

The present study shows no differences in short-term outcomes between 2 different NIV strategies, nasal synchronized intermittent positive pressure ventilation and bilevel continuous positive airway pressure, in preterm infants for the initial treatment of RDS. (Read the full article)

Preterm infants experience disproportionate growth failure postnatally and may be large weight for length despite being small weight for age by hospital discharge. There is no routinely used measure to quantify and monitor disproportionate growth in the NICU.

BMI differs across gender and gestational age. We provide a set of validated reference curves to track changes in BMI for prematurely born infants for use with weight-, length-, and head-circumference-for-age intrauterine growth curves. (Read the full article)

Although the rates of antipsychotic medication treatment are rising for children and adolescents, little is known about the factors associated with this practice.

This study provides some of the first data regarding when and why clinicians decide to use antipsychotic medications. It reveals clues as to how prescribing might better follow best practice guidelines. (Read the full article)

There is growing evidence reporting that moderately preterm, late preterm, and early term infants are at increased risk of developmental delay. The characteristics of this association are not well established in the literature.

In a sample of infants born between 32 and 41 weeks, there was an inverse and "dose response" relationship between gestational age and developmental delay risk using the ASQ at 8 and 18 months of corrected postnatal age. (Read the full article)

Childhood bacteremia caused by vaccine-preventable organisms has substantially declined over the last decade. Recognition of bacteremia in children is difficult, and delayed administration of antibiotics is associated with poor outcomes. Adults with health care–associated Gram-negative bacteremia experience delays in receiving appropriate antibiotics.

Bacteremia in children presenting to the emergency department is increasingly health care associated and resistant to empirical antibiotics. These infections are associated with increased length of stay. Rates of Gram-negative bacteremia have increased, and children with Gram-negative bacteremia experience delayed antibiotic administration. (Read the full article)

Asthma is one of the most common chronic diseases in children. It has been suggested that maternal depression during pregnancy is associated with asthma in the offspring, but the role of antidepressant use during pregnancy is not known.

In our prospective cohort study, we found that maternal antidepressant use during pregnancy generally did not increase the risk of asthma except for use of older antidepressants, which could reflect confounding by the severity of maternal depression. (Read the full article)

In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis.

Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events. (Read the full article)

Preterm infants are at an increased risk of infections; therefore, vaccination is of particular importance. Because immune response data reported for preterm infants may vary according to gestational age and vaccination timing, vaccine responses in this population warrant additional research.

This study evaluated 13-valent pneumococcal conjugate vaccine in preterm infants. Results suggest that this vaccine was well tolerated and immunogenic; most subjects achieved serotype-specific immunoglobulin G antibody levels and functional antibody responses likely to correlate with protection against invasive disease. (Read the full article)

Encephalitis is a serious and disabling condition. There are infectious and immune-mediated causes of encephalitis, but many cases remain undiagnosed.

This large single-center study on childhood encephalitis provides insight into the relative frequency and clinicoradiologic phenotypes of infectious, autoantibody-associated, and unknown encephalitis. Risk factors for an abnormal outcome are also defined. (Read the full article)

Subtherapeutic doses of antibiotics have been used as growth promoters in animal farming since the 1950s. Antibiotic exposure during infancy is associated with increased body mass in humans.

The weight-promoting effect of antibiotics is most pronounced when the exposure occurs at <6 months of age or repeatedly during infancy. Increased body mass is distinctly associated with exposure to cephalosporins and macrolides, especially in boys. (Read the full article)

Trainee success rates with infant lumbar puncture are poor. The model of just-in-time learning via simulation has produced clinical improvement for other medical skills such as cardiac compressions and central line dressing changes.

This is the first study to evaluate the impact of just-in-time-and-place simulation-based learning on success with infant lumbar puncture. The intervention improved clinical behaviors associated with success without making a significant impact on success with the procedure. (Read the full article)

Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is not well described. Further, factors associated with development of neonatal abstinence syndrome, a neonatal opioid withdrawal syndrome is inadequately understood.

Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of neonatal abstinence syndrome. (Read the full article)

Timely immunoprophylaxis and completion of the 3-dose hepatitis B vaccine series represents the cornerstone of perinatal hepatitis B prevention. Immunoprophylaxis for infants born to hepatitis B surface antigen–positive mothers reduces up to 95% of perinatal hepatitis B virus infections.

Despite recommended immunoprophylaxis, perinatal hepatitis B virus infection occurs among ~1% of infants. Infants born to mothers who are younger, hepatitis B e-antigen positive, or who have a high viral load or infants who receive <3 hepatitis B vaccine doses are at greatest risk of infection. (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)

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)

Little is known about the prevalence or outcomes of infants with indeterminate diagnostic results after a positive cystic fibrosis (CF) newborn screen (CF transmembrane conductance regulator–related metabolic syndrome [CRMS]).

CRMS accounted for 15.7% of newborn screened diagnoses in the CF Patient Registry from 2010 to 2012 (CRMS:CF ratio = 5.0:1.0). Although most infants were healthy, some infants demonstrated clinical features concerning for CF. (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)

Suboptimal brain development and increased risk of cognitive deficits are well documented in very low birth weight children. Supplementation with docosahexaenoic acid and arachidonic acid has been associated with positive cognitive effects.

This follow-up study of a randomized controlled trial of supplementation with docosahexaenoic acid and arachidonic acid to very low birth weight infants is the first report on both cognition and brain macrostructure measured with MRI. No cognitive or neuroanatomical effects were detected at 8 years. (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)

The sensitivity of the urinalysis (UA) traditionally has been considered suboptimal in young infants. Whether the finding of a negative UA and a positive urine culture represents a false-negative UA versus a false-positive urine culture remains unclear.

In infants <3 months with bacteremic urinary tract infection, a condition that represents true infection, the UA sensitivity is higher than previously reported for urinary tract infection in general, suggesting that the UA is reliable even in young infants. (Read the full article)

Various clinical and demographic factors are associated with sudden infant death syndrome (SIDS), and an association between altitude of residence and SIDS has been questioned but not yet demonstrated in any large observational studies.

This study demonstrates an association between altitude and SIDS, with higher SIDS rates observed at high elevation (>8000 feet) than at the more moderate elevations (<6000 feet). (Read the full article)

Fifteen percent of tuberculosis cases globally are resistant to the drug isoniazid. Isoniazid resistance puts patients with tuberculosis at risk for poor treatment outcomes and threatens the effectiveness of isoniazid preventive therapy in people with latent tuberculosis infection.

We present the first global and regional estimates of the proportion of children with tuberculosis who have isoniazid-resistant disease, showing large geographic variations in risk of resistance. We estimate the number of annual incident cases of isoniazid-resistant tuberculosis in children. (Read the full article)

US parents trust the health care system and bring their infant children in for preventive care. Previous studies have demonstrated the ability of health care systems to identify, and sometimes address, the economic needs of low-income families.

Families of newborns at a safety-net primary care center have high levels of economic hardship. Compared with controls, Developmental Understanding and Legal Collaboration for Everyone families had accelerated access to concrete supports, improved rates of on-time immunization and preventive care, and decreased emergency department utilization. (Read the full article)

Low case volume has traditionally been associated with poor outcomes in complex surgical procedures, including pediatric liver transplantation.

This retrospective analysis supports the association between low case volume and poorer outcomes in pediatric liver transplantation, and, in addition, shows that candidates listed in low-volume centers have severely limited access to transplantation. (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)

Treatment of idiopathic steroid-resistant nephrotic syndrome is challenging, and therapeutic options are limited. In spite of good initial response with rituximab, responders always remain prone to further relapse, necessitating either repeat course of rituximab or addition of another steroid-sparing immunosuppressant.

Mycophenolate mofetil may be an effective maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory steroid-resistant nephrotic syndrome. (Read the full article)