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Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

The demand for donor kidneys for transplantation exceeds supply. En bloc kidney transplantation and donation after determination of circulatory death from pediatric donors increases the potential donor pool.

Newborn infants undergoing elective withdrawal of life support in the NICU are a previously unrecognized source of potential kidney donors. (Read the full article)




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Stratification of Risk of Early-Onset Sepsis in Newborns >=34 Weeks' Gestation

The management of term and near-term newborns suspected of early-onset sepsis, particularly when they are not clearly symptomatic, remains controversial. Methods for quantifying risk that combine maternal factors with a newborn's evolving clinical examination have been lacking.

This study provides a method for predicting risk of early-onset sepsis. It combines maternal risk factors with objective measures of a newborn's clinical examination and places newborns into 3 risk groups (treat empirically, observe and evaluate, and continued observation). (Read the full article)




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Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

Payment arrangements that blend global budgets with pay-for-performance are proliferating. However, little is known about how these contracts affect pediatric health care quality and spending for children with and without special health care needs receiving care from large provider organizations.

A prototypical global budget contract significantly improved preventive care quality measures tied to pay-for-performance, especially for children with special health care needs. It did not alter trends for spending or for quality measures that were not tied to pay-for-performance. (Read the full article)




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Association of Maternal Self-Medication and Over-the-Counter Analgesics for Children

Self-medication with over-the-counter (OTC) analgesics, particularly paracetamol (PCM), among children is widespread and increasing. Parents often administer the medicine. The health care system has little knowledge or possibility to regulate OTC medication, and use of PCM for children may be partly unjustified.

Maternal frequent self-medication with OTC analgesics is associated with frequent use of OTC analgesics, particularly PCM, among 6- to 11-year-old schoolchildren, even when the child’s frequency of pain is accounted for. (Read the full article)




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Symmetrical and Asymmetrical Growth Restriction in Preterm-Born Children

Fetal growth restriction, particularly in preterm children, is associated with delayed development and poor growth. Knowledge about the consequences of fetal growth restriction if classified by symmetry is lacking, especially in preterm children.

In preterm children, symmetric and asymmetric growth restriction at birth results in poorer growth later in life. Both groups are at considerable risk of developmental delay because their long-term development is independent of their head circumference at birth. (Read the full article)




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Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

The American Academy of Pediatrics (AAP) and other organizations have recommended critical congenital heart disease (CCHD) pulse oximetry screening. Small studies have revealed lower saturations at higher altitude, but this effect on CCHD screening is unknown. The AAP requested additional studies at altitude to help clarify the dilemma.

The AAP has endorsed higher-altitude studies of CCHD screening. This observational prospective study revealed a higher positive screen rate at moderate altitude than at sea level. These findings suggest that current national recommendations may result in increased screening failures at moderate altitude. (Read the full article)




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Growth Patterns of Large for Gestational Age Children up to Age 4 Years

Preterm (PT) birth is negatively associated with growth. Particularly small for gestational age PT infants are at risk for delays in growth, whereas knowledge about the consequences regarding growth of large for gestational age PT birth is lacking.

During infancy, growth in height, weight, and head circumference of large for gestational age PT infants was well balanced and sufficient. Subsequently, however, weight gain accelerated and resulted in high BMIs compared with the World Health Organization Multicentre Growth Reference Study population. (Read the full article)




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Patterns of Mobile Device Use by Caregivers and Children During Meals in Fast Food Restaurants

Mobile devices are ubiquitous in children’s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiver–child interactions, has not been studied.

In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction. (Read the full article)




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A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults

There is growing understanding of the detrimental effect of paternal depression on children. The transition to fatherhood is a unique time for men. Identifying which fathers are at-risk and when will inform effective methods to help men and their families.

Nonresident fathers have the highest depression symptom scores, peaking before entering fatherhood. Although resident fathers’ scores decrease preceding entry into fatherhood, there is a significant increase from 0 to 5 years of their child’s life when key parent–infant attachment occurs. (Read the full article)




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National Patterns of Codeine Prescriptions for Children in the Emergency Department

Owing to genetic variability in its metabolism, codeine can lead to fatal toxicity or inadequate treatment in pediatric subpopulations and several guidelines have recommended against its use in children. Little is known about codeine prescribing for children in the United States.

There has been a small decline in pediatric codeine prescriptions overall in emergency departments, but no change in prescription for children who have cough or upper respiratory infection, despite professional recommendations against this practice. Substantial numbers of children are being prescribed codeine annually. (Read the full article)




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Cervical Spine Injury Patterns in Children

Practice standards for managing adult cervical spine injuries (CSIs) are well established. However, pediatric CSIs are rare and different from those of adults, preventing extrapolation from adult practice and illustrating the need for larger multicenter investigations of CSIs in children.

This study comprehensively describes CSIs in a large multicenter pediatric cohort. The large number of young children included allowed us to comprehensively explore the relationship between CSI pattern and age, mechanism of injury, comorbid injuries, surgical interventions, and neurologic outcome. (Read the full article)




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Prenatal Tobacco Exposure and Cotinine in Newborn Dried Blood Spots

Cotinine assays for dried blood spots have been developed but not deployed in a large sample of newborn specimens.

Cotinine levels consistent with active maternal smoking were detectable in 12% of newborn blood spots, although 41% of the mothers reportedly did not smoke. Data confirm that reported smoking during pregnancy is an imperfect measure of prenatal tobacco smoke exposure. (Read the full article)




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High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns

Corrosive substance ingestion is a public health issue in developing countries. Stricture formation is a late complication of corrosive substance ingestion. The role of corticosteroids in preventing corrosive-induced strictures is controversial.

High doses of methylprednisolone therapy lead to less frequent stricture formation in grade IIb esophageal burns in children who ingested caustic substances and may improve prognosis. (Read the full article)




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Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.

Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. (Read the full article)




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Effectiveness of Anti-TNF{alpha} for Crohn Disease: Research in a Pediatric Learning Health System

Studies on adult patients who have Crohn disease have shown a comparative benefit of anti-TNFα versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges.

Anti-TNFα therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence. (Read the full article)




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A Parent Questionnaire for Developmental Screening in Infants Born Late and Moderately Preterm

Children born late and moderately preterm are at increased risk of developmental problems compared with term-born peers. Screening for developmental problems in the early years may thus aid in the early identification of children at risk for adverse outcomes.

The Parent Report of Children’s Abilities-Revised has good concurrent validity and 90% sensitivity and 76% specificity for identifying moderate/severe cognitive developmental delay in infants born late and moderately preterm. This parent questionnaire may be used as a clinical screening tool. (Read the full article)




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Inhaled Nitric Oxide Use in Neonates With Congenital Diaphragmatic Hernia

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

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




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A Clinical Prediction Rule for the Severity of Congenital Diaphragmatic Hernias in Newborns

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

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




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The Timing of Cord Clamping and Oxidative Stress in Term Newborns

Clamping and cutting of the umbilical cord at birth is the most prevalent of all operations; however, the optimal timing of cord clamping is still a controversial issue, with different timings offering advantages and disadvantages.

Our findings suggest a protective effect of late cord clamping, increasing the antioxidant capacity and decreasing the inflammatory-mediated effects induced during delivery of term neonates. (Read the full article)




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Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

Total serum bilirubin levels ≥30 mg/dL have been labeled as "hazardous." Levels this high are rare, occurring in 3 to 10 per 100 000 births. Few studies have examined etiologies and long-term outcomes in these infants.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a major identifiable cause, but is under-assessed. Chronic, bilirubin-induced neurotoxicity is rare and only occurred in the setting of additional risk factors (prematurity, G6PD deficiency, sepsis) and at levels far above recommended exchange transfusion thresholds. (Read the full article)




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Cardiovascular Risk Factors in Adolescents Born Preterm

Adolescents and adults born early preterm have higher blood pressure and altered glucose metabolism compared with their term born peers. Evidence of an atherogenic lipid profile is inconsistent. Whether these risks apply to those born less preterm is not known.

In adolescence, girls have higher blood pressure and boys a more atherogenic lipid profile than their term born peers. Overall, our results are consistent with a dose-response relationship between shorter length of gestation and increasing levels of cardiovascular risk factors. (Read the full article)




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Prenatal and Newborn Screening for Critical Congenital Heart Disease: Findings From a Nursery

The detection of critical congenital heart disease by fetal echocardiography or neonatal physical examination can have limitations. The addition of pulse oximetry screening in the newborn nursery increases the rate of diagnosis of these conditions before hospital discharge.

In a tertiary-care center with comprehensive fetal echocardiography, nearly all newborns with critical congenital heart disease are diagnosed prenatally. Pulse oximetry will identify more infants from settings with lower prenatal detection. Improving access to and training in fetal echocardiography should also improve detection of these conditions. (Read the full article)




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Sociodemographic Differences and Infant Dietary Patterns

Despite breastfeeding recommendations by the World Health Organization and the American Academy of Pediatrics, there is less agreement on appropriate use of infant solid foods. There are currently no well-established dietary guidelines for US infants that are similar to the Dietary Guidelines for Americans (aged >2 years).

Distinct dietary patterns exist among US infants and have differential influences on growth. Use of "Infant guideline solids" (vegetables, fruits, baby cereal, and meat) with prolonged breastfeeding is a promising healthy dietary pattern for infants after age 6 months. (Read the full article)




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Differential Maternal Feeding Practices, Eating Self-Regulation, and Adiposity in Young Twins

Restrictive feeding by parents is associated with poorer eating self-regulation and increased child weight status. However, this association could be due to confounding home environmental or genetic factors that are challenging to control.

Differential maternal restrictive feeding is associated with differences in twins' caloric compensation and BMI z score. Controlling for the shared home environment and partially for genetics, these findings further support a true (ie, unconfounded) association between restriction and childhood obesity. (Read the full article)




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Cerebral Palsy Among Children Born Moderately and Late Preterm

The incidence of cerebral palsy is dependent on the gestational age in very preterm infants and risk factors have been identified for term infants. The risk has also proved to be greater among late preterm births compared with term.

The incidence of cerebral palsy was 24-fold in moderately preterm and 6-fold in late preterm infants compared with full-term infants. The most prominent risk factors included asphyxia and intracranial hemorrhage. The incidence diminished over time and with increasing gestational age. (Read the full article)




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Early Weight Loss Nomograms for Exclusively Breastfed Newborns

Exclusively breastfed newborns lose weight daily in the first few days after birth. The amount of weight lost varies substantially between newborns, with higher amounts of weight loss increasing risk for morbidity.

This study presents nomograms demonstrating percentiles for weight loss by delivery mode for those who are exclusively breastfed. The nomograms have potential to be used for early identification of neonates on a trajectory for greater weight loss and related morbidities. (Read the full article)




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Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns

Early diagnosis of LOS in preterm infants may be challenging because of the questionable accuracy of blood culture and the common markers of infections, such as C-reactive protein and procalcitonin.

Our study demonstrated for the first time that P-SEP is an accurate biomarker for the diagnosis of LOS in preterm infants and might contribute to the monitoring of infant response to therapeutic interventions. (Read the full article)




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Maternal Depressive Symptoms During Childhood and Risky Adolescent Health Behaviors

Maternal depression has been associated with adolescent engagement in risky behaviors such as substance use. However, there is a lack of longitudinal research examining timing-specific effects in this relationship.

The results of this study indicate that youth exposed to increasing levels of maternal depressive symptoms in middle childhood are more likely to engage in substance use and delinquent behaviors and have an earlier debut age of these behaviors. (Read the full article)




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Paternal Depression in the Postnatal Period and Child Development: Mediators and Moderators

Parental depression is associated with adverse child outcomes. It is important to understand possible mediators and moderators. Several studies suggest that the family environment or parenting style may be potential pathways for transmission of risk from parents to children.

Paternal depression appears to exert its influence on children’s outcomes through an effect on family functioning (couple conflict and maternal depression), whereas maternal postnatal depression appears to affect children through other mechanisms, potentially including direct mother-infant interaction and care. (Read the full article)




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Independent Living and Romantic Relations Among Young Adults Born Preterm

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)




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Timing of Initial Well-Child Visit and Readmissions of Newborns

Current recommendations for the first outpatient visit for newborns are based on known health risks during the first week of life. Knowledge of the relationship between early well child visits and hospital readmissions may inform newborn health policy interventions.

Newborns who have a first well child visit within the recommended time period after hospital discharge are substantially less likely be readmitted. Obstacles to early follow-up should be addressed to reduce the risk of readmission in this population. (Read the full article)




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Sucrose and Warmth for Analgesia in Healthy Newborns: An RCT

Increasing data suggest that neonatal pain has long-term consequences. Pharmacologic interventions for minor pain are ineffective, and nonpharmacologic techniques (sucrose taste, pacifier suckling, breastfeeding) are effective and now widely used.

The taste of sucrose has been shown to be an effective and widely used analgesic for infants, and this study demonstrates that combining brief exposure to natural radiant warmth with the taste of sucrose improves the analgesic effect for the infant. (Read the full article)




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Government Health Care Spending and Child Mortality

After the recent economic recession, policy interventions including austerity measures led to reductions in government spending on health care in many countries. However, there is limited research into the effects of changes in government health care spending on child health.

Reductions in government health care spending are associated with long-lasting adverse effects on child health globally, especially in low-income countries. Given pressures to diminish health expenditures, we caution that reduced spending should be achieved through increased efficiency of care delivery. (Read the full article)




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Mortality After Burn Injury in Children: A 33-year Population-Based Study

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)




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Executive Function in Adolescents Born <1000 g or <28 Weeks: A Prospective Cohort Study

Preterm children often experience poor executive function (EF; skills underpinning adaptive, goal-directed behavior, and essential for positive academic, occupational, and social outcomes). EF matures across adolescence, but the nature and course of EF deficits for preterm adolescents is not well-described.

Extremely preterm/extremely low birthweight adolescents demonstrated small-to-medium deficits across multiple EF domains compared with normal birthweight controls. Preterm children improved on some EF aspects from age 8 to late adolescence relative to controls, but not on parent-rated behavioral EF. (Read the full article)




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Cow's Milk Contamination of Human Milk Purchased via the Internet

Sharing human milk between those with an abundant supply and those seeking milk for their child is growing in popularity, including that facilitated by Web sites established to link buyers and sellers.

This study documents that human milk purchased via the Internet can be contaminated with cow’s milk, which poses a potential risk to infants with allergy or intolerance to cow’s milk. (Read the full article)




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Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture

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)




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Outcomes of Infants Born to Women Infected With Hepatitis B

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)




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Maternal Prepregnancy Body Mass Index and Child Psychosocial Development at 6 Years of Age

Both obesity and developmental disabilities have increased in recent decades; however, the full long-term effects of prepregnancy obesity on a child’s psychosocial development remain unknown. Limited studies suggest associations between maternal prepregnancy obesity and child psychosocial development.

This study in 6-year-old children provides evidence that severe prepregnancy obesity is associated with adverse child psychosocial outcomes, including attention-deficit/hyperactivity disorder. These findings were not explained by many pregnancy and postpartum factors related to maternal obesity or child development. (Read the full article)




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Inconclusive Diagnosis of Cystic Fibrosis After Newborn Screening

Infants with an inconclusive diagnosis of cystic fibrosis after newborn screening may turn out to have cystic fibrosis. However, little is known about the incidence, characteristics (phenotype and genotype), and outcomes of these infants to guide investigations and follow-up.

In this prospective longitudinal study, a proportion (11%) of infants with an initial inconclusive diagnosis were subsequently diagnosed with cystic fibrosis. This finding underscores the need for follow-up of this population. (Read the full article)




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Developmental Outcomes of Extremely Preterm Infants Born to Adolescent Mothers

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)




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Outcomes of Infants With Indeterminate Diagnosis Detected by Cystic Fibrosis Newborn Screening

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)




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Personal Belief Exemptions to Vaccination in California: A Spatial Analysis

An increasing number of children are unvaccinated at entry into public schools, potentially endangering children who cannot be vaccinated for medical reasons and threatening herd immunity. Voluntary exemptions from immunizations vary geographically and by parental characteristics.

We find that exemption behavior is highest in peripheral areas of cities and that specific types of student populations are associated with high exemption rates. Additionally, there is spatial overlap between clusters of high personal exemption and medical exemption populations. (Read the full article)




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Public Perceptions of the Benefits and Risks of Newborn Screening

Infant screening is valued by members of the lay public, but how different benefits are independently valued, and whether harms are disvalued, is not known. Public expectations of screening can inform decisions about what diseases to screen for.

The public values clinical benefits of screening and disvalues harms, with tolerance for harm proportional to clinical benefit. These findings support newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms. (Read the full article)




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Use of Temporary Names for Newborns and Associated Risks

Because there can be no delay in providing newborns with identification wristbands, some hospitals assign newborns temporary first names such as Babyboy or Babygirl. These nondistinct naming conventions result in a large number of patients with similar identifiers in NICUs.

We performed an intervention study to determine if assigning distinct first names at birth would result in a reduction in wrong-patient errors. We used the Retract-and-Reorder tool, an established, automated tool to detect the outcome measure of wrong-patient electronic orders. (Read the full article)




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Maternal Consequences of the Detection of Fragile X Carriers in Newborn Screening

Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown.

Results suggest that detection and disclosure of FMR1 newborn carrier status may not result in significant adverse events for mothers. (Read the full article)




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Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency

Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.

It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources. (Read the full article)




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Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

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)




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Maternal Report of Advice Received for Infant Care

Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appropriate advice from multiple sources such as family and physicians.

Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; the findings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention. (Read the full article)




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Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children

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)