Although China has the largest birth population in the world and a number of multicenter studies of neonatal respiratory failure are reported, there is a paucity of data regarding outcome measurement of very premature neonates requiring respiratory care and surfactant therapy.

This study is the largest survey, to date, in a Chinese network of 55 NICUs that presents the incidence, morbidity, and mortality rates, with risk factors of neonatal respiratory failure, with special emphasis on surfactant-treated very immature infants. (Read the full article)

There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.

This study combined systematic literature review and the Rand/University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care. (Read the full article)

Adolescence is a time of risk taking, with poor inner-city youth at greater risk than the general population for drug use, school failure, adjudication, and teen parenthood. Little is known regarding these youths’ perceptions and intentions in early childhood.

Poor inner-city children were surprisingly idealistic regarding their future. Despite this, by late adolescence most experienced 1 or more trajectory-altering events. Early childhood experiences, exposure to violence and poor home environment, were factors most strongly associated with these outcomes. (Read the full article)

Childhood gender nonconformity has been associated with poorer relationships with parents, but it is unknown if childhood gender nonconformity is associated with childhood abuse or with posttraumatic stress disorder.

We identify gender nonconformity before age 11 years as a risk indicator for physical, sexual, and psychological abuse in childhood and lifetime probable posttraumatic stress disorder in youth. (Read the full article)

Community-acquired pneumonia (CAP) is a common pediatric illness caused by Streptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.

This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Furthermore, change in therapy did not lead to increased adverse outcomes. (Read the full article)

Studies in the Netherlands show that pubertal blockade at Tanner 2/3 prevents unwanted sex characteristics and improves psychological functioning. Endocrine Society guidelines (2009) recommend pubertal suppression for adolescents with gender identity disorder until approximately age 16.

This is the first study of a US cohort of children and adolescents with gender identity disorder. Patients were referred for medical treatment to a pediatric center that supports a multidisciplinary Gender Management Service. (Read the full article)

Comprehensive home visits conducted by Community Health Workers including environmental remediation and office-based nurse case management improve asthma outcomes.

Implementation of a comprehensive quality improvement program as part of enhanced care of pediatric asthma patients with a history of hospitalizations or emergency department visits can improve health outcomes and be cost-effective as well as reduce health disparities. (Read the full article)

Very preterm children are at risk for developmental problems and, therefore, a systematic follow-up is important. However, the relevance of early follow-up of cognitive development has been questioned because of the divergent data on the prognostic value of early measures.

Good stability of cognitive development was found between the ages of 2 and 5 years. Well-conducted assessment of cognitive development in infancy is both reliable to anticipate later development and clinically valuable to identify those children who need developmental support. (Read the full article)

Active video games can enable children under laboratory conditions to participate in moderate, and even vigorous, physical activity. There are inconsistencies in the literature, however, about whether active video games enable children to increase physical activity under more naturalistic circumstances.

This study tests whether children receiving a new active video game spontaneously engaged in more physical activity, and whether commercially available active video games have a public health benefit. No additional physical activity was detected, suggesting no public health benefit. (Read the full article)

Few studies have examined the reliability of clinical findings in pediatric appendicitis. Clinical prediction rules are most useful if the included variables are reliable across practice settings and practitioners.

Among children who present with possible appendicitis, the interrater reliability varied considerably for patient history and physical examination variables. Those variables with the highest degree of reliability may be best suited for inclusion in appendicitis clinical prediction rules. (Read the full article)

Strategies to assist patients in achieving optimal chronic disease self-management are critical. The complex family and regimen issues surrounding pediatric type 1 diabetes management suggest the need to integrate such strategies into routine clinical care.

This study demonstrates the efficacy of a practical, low-intensity behavioral intervention delivered during routine care for improving glycemic outcomes. Findings indicate that the approach may offer a potential model for integrating medical and behavioral sciences to improve health care. (Read the full article)

Numerous late preterm infants undergo repetitive heel lancing procedures during their first hours of life to evaluate glycemic control. Heel lances are painful and 25% glucose solution is effective on reducing procedural neonatal pain scores and crying behavior.

This noninferiority randomized controlled trial demonstrated that compared with breast milk, 25% glucose provided lower pain scores and reduced duration of cry. Further research is necessary to clarify breast milk’s mechanisms and efficacy on neonatal pain relief. (Read the full article)

Tenfold medication error is a well-recognized risk of pharmacotherapy in pediatric practice but little evidence describes the circumstances of such errors.

This study identified 252 tenfold medication errors, 22 of which resulted in patient harm. We identified opioids and other high-risk medications to be associated with tenfold medication error and frequent, recurrent causes, mechanisms, and error enablers that suggest areas for future improvements. (Read the full article)

Although developmental care in NICUs reduces the stress experienced by preterm infants, the actual level of developmental care may vary and little is known about how the level of developmental care relates to preterm infants’ neurobehavioral performance.

The study demonstrates the relationship between variations in developmental care in NICUs and the neurobehavior of preterm infants. Infants from NICUs with high-quality developmental care compared with infants from units with low quality of care evidenced a better neurobehavioral profile. (Read the full article)

The presumed causes of neonatal deaths globally have remained unchanged over the past decade and include infections (~30%), prematurity (~30%), and asphyxia (~25%). Great uncertainty surrounds these estimates and, in addition, cases are likely misclassified as stillbirths.

These observational findings indicate that asphyxia accounts for a much higher percentage (60% of early deaths). Prematurity (18%), low birth weight (8%), and overt infection are much less common. The 5-minute Apgar score is an unreliable indicator of birth asphyxia. (Read the full article)

Cumulative social factors in childhood have been associated with obesity in adulthood. Little is known regarding the role of accumulation of social stressors and obesity in early life.

Cumulative social adversities were associated with increased odds of early-onset obesity among girls. In addition, those with a higher number of stressors at a single time period had elevated odds for obesity by 5 years of age. (Read the full article)

Following a rapid increase from 1980 to 2001, the prevalence of obesity among school-age children and adolescents in the United States has plateaued. Few studies have examined obesity trends among younger children in the past decade, and findings are inconsistent.

Among children aged <6 years at this multisite pediatric practice, the prevalence of obesity was fairly stable during 1999–2003, but substantially decreased during 2004–2008. This decrease was smaller among children insured by Medicaid than children insured by non-Medicaid health plans. (Read the full article)

Some studies demonstrate that adolescents have different perinatal risks and outcomes than nonadolescents. Few studies have explored the maternity experiences or practices of adolescents that may underlie these differences, or compared these with nonadolescents by using a nationally representative sample.

Adolescents and young adults were more likely to experience physical abuse, late prenatal care initiation, poor prenatal health behaviors, lower breastfeeding initiation and duration rates, postpartum depression, and lower folic acid supplementation than adult women. (Read the full article)

Disparities in outcomes of ethnic minority children have been reported, and have been ascribed to having barriers to access to health care. Minority parents have indicated that difficulties in access are because of problems with transportation and being non-English speaking.

This population-based study of Texas infants with severe congenital heart disease reports that neither home distance from a cardiac center nor Hispanic children having a Latin American–born parent were risk factors for first-year mortality. (Read the full article)

Omega-3 fatty acids (O3FA) are commonly used as complementary treatments in pediatric psychiatric disorders, including Tourette’s disorder (TD), and are well known to have anti-inflammatory properties. However, no studies to date have examined the effects of O3FA on pediatric TD.

This is the first double-blind, placebo-controlled clinical trial of O3FA in pediatric TD. The results indicate that O3FA supplementation may be beneficial in the reduction of tic-related impairment for some children and adolescents with TD, but not tics per se. (Read the full article)

Isolated methylmalonic acidemia, one of the most common inborn errors of organic acid metabolism, is known to be associated with variably impaired intellectual functioning and severe biochemical and clinical abnormalities. However, the neurocognitive outcomes have yet to be fully described.

This research defines the neurocognitive phenotype of isolated methylmalonic acidemia and identifies processing speed as a specific impairment. Clinical, biochemical, and molecular genetic covariates were explored. A history of hyperammonemia at diagnosis was found to correlate with poorer cognitive outcomes. (Read the full article)

Infants weighing 501 to 1500 g are at high risk for mortality and for neonatal morbidities associated with both short- and long-term adverse consequences.

Mortality and major neonatal morbidity in survivors decreased for infants 501 to 1500 g between 2000 and 2009. However, in 2009, a high proportion of these infants still either died or survived after experiencing ≥1 major neonatal morbidity. (Read the full article)

New, effective approaches to obesity prevention are urgently needed. Social network interventions warrant our attention. Social networks play a significant role in adult and adolescent obesity. The role of social networks in pediatric obesity has not been examined.

Afterschool friendship ties play a critical role in setting physical activity patterns in children as young as 5 to 12 years. Children’s activity levels can be changed by the activity level of their social network during a 12-week afterschool program. (Read the full article)

Preterm infants are at a high risk for retinopathy of prematurity (ROP). Several postnatal factors are well known to be associated with ROP. However, the relationships between antenatal or maternal risk factors and ROP are poorly understood.

This study used a large cohort database to study the influence of maternal gestational hypertension and preeclampsia on ROP in preterm infants. The results showed that preeclampsia, but not gestational hypertension, was associated with a reduced risk of ROP in preterm births. (Read the full article)

Although many children are treated in general emergency departments, many such facilities have limited pediatric capabilities. Transfer to academic centers improves outcomes for critically ill patients, but transfers of noncritically ill children have not been well studied.

Although more than half of these patients are seriously ill, many transferred patients are discharged directly from the emergency department or are admitted for less than 24 hours. Orthopedic problems, gastrointestinal conditions, and traumatic head injury are the most common complaints. (Read the full article)

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a significant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling.

We provide the first nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socioeconomic factors and access to health care affect whether adolescents receive these services. (Read the full article)

Preterm children born between 29 and 36 gestational weeks are at higher risk of developmental delay. The Ages and Stages Questionnaires (ASQ) have been recommended as a developmental screening tool.

At 12 months’ corrected age (CA), the ASQ was insufficient in identifying delays on both mental and psychomotor scales of the Bayley Scales of Infant Development but was accurate in detecting mental delay at CA of 24 months. (Read the full article)

Known rates of nonsuicidal self-injury, hurting oneself without the intent to die, are between ~7% and 24% in samples of early adolescents and older adolescents, yet research has not reported rates for youth younger than 11 years old.

Children as young as 7 years old report engaging in nonsuicidal self-injury. There is a grade by gender interaction for nonsuicidal self-injury, such that ninth-grade girls report the greatest rates of engagement and do so by cutting themselves. (Read the full article)

There are limited cross-sectional data from observational studies of adolescents showing that regular participation in physical activity is associated with a higher quality of life status, whereas time spent in screen-based entertainment is associated with a poorer quality of life.

Adolescents who were physically active (particularly engaging in outdoor activity) over a 5-year period had higher quality of life than their less active peers. Conversely, high levels of screen-based entertainment over 5 years negatively affected quality of life status. (Read the full article)

Chronic fatigue syndrome (CFS) is a disabling illness. Some children with chronic disabling fatigue are housebound. Some primary care physicians find making the diagnosis of CFS difficult.

Chronic disabling fatigue is more common in 13-year-olds than previously realized with a population prevalence of ~2.0%. Chronic disabling fatigue in teenagers is more common in those with higher levels of early family adversity. (Read the full article)

Preterm infants from 33 gestational weeks can detect specific shape features (prism and cylinder) by touch (without visual control), and remember them; however, nothing is known about such abilities earlier in development.

The preterm infant, even when very immature (from 28 gestational weeks), is endowed with tactile sensory abilities: the exploration and memorization of an object by touch, the discrimination of a novel object, and the recognition of a familiar object after interference. (Read the full article)

Various studies have documented marked racial/ethnic disparities in children’s receipt of dental services at single time points or brief periods.

This study reveals significant improvements in children’s receipt of dental care overall, as well as a dramatic narrowing of African American/white disparities in children’s receipt of dental services over the last 40 years in the United States. (Read the full article)

Childhood abuse has been associated with obesity risk in adulthood. Little is known regarding the impact of abuse severity on risk, potential mechanisms are poorly understood, and few studies have been conducted among minority populations.

Severity of child/teenager physical and sexual abuse is associated with increased risk for adult obesity and/or central adiposity in adulthood. These are the first such findings in a large cohort of US black women. (Read the full article)

Clinical trials have demonstrated that prophylactic human papillomavirus (HPV) vaccines are highly effective in preventing HPV infection, but the impact of vaccination on HPV prevalence rates in real-world, community settings is uncertain.

This study provides evidence of a substantial decrease in the prevalence of vaccine-type HPV among young women and evidence of herd protection in a community only 4 years after the quadrivalent HPV vaccine was licensed. (Read the full article)

Because most childhood tuberculosis cases are sputum smear-negative, diagnosis relies largely upon clinical presentation, tuberculin skin testing, and chest radiograph. Diagnostic limitations contribute to treatment delays and high mortality. However, childhood tuberculosis (TB) mortality risk factors are not well documented.

This study demonstrates that false-negative TST is common in children with active TB and is associated with increased risk of death. A negative TST should not delay anti-TB therapy. Improved diagnostic modalities are urgently needed in resource-limited settings. (Read the full article)

Food insecurity has been linked to childhood obesity in a number of studies. Few studies have explored potential pathways through which food insecurity is related to child weight, especially in low-income families with young infants.

We found that food insecurity was related to maternal controlling feeding styles and concerns about the infants’ future weight. Early obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure. (Read the full article)

Since the introduction of effective vaccines in the United States, the incidence of invasive Haemophilus influenzae type b (Hib) disease in children aged <5 years has decreased by 99%. In 2007, in response to limited vaccine supply, Hib booster doses were deferred for 18 months.

This review found no significant change in the incidence of invasive Hib disease in the United States during the booster dose deferral period, suggesting that booster dose deferral is a reasonable approach to Hib vaccine shortages in the short-term. (Read the full article)

Childhood obesity is already prevalent by preschool age, particularly among Latinos. Parents have tremendous influence on factors that contribute to childhood obesity (eg, diet, physical activity); thus, family plays a crucial role in pediatric obesity prevention.

This randomized controlled trial examined the effect of a behavioral intervention involving Latino-American parent–preschool-aged child dyads. The intervention resulted in reductions in absolute BMI across the 3-month study period, with patterns suggesting the largest effect for obese children. (Read the full article)

Honey is recommended as a cough medication by the World Health Organization. To date, the efficacy of this treatment has been shown in 2 studies: one tested only buckwheat honey and the other study was not blinded.

In a randomized controlled trial, we compared 3 types of honey versus placebo as a treatment of upper respiratory tract infection–associated cough. These types of honey were superior to placebo in alleviating cough. (Read the full article)

Ideal empirical antibiotic choices are based on local susceptibility data. These choices are important for ensuring positive patient outcomes, but pediatric-specific data may not be available.

Antibiotic susceptibilities differ by age group within a tertiary-care hospital. Knowing these differences, pediatricians chose empirical antibiotic therapy more likely to be successful. Children with infectious diseases would benefit from reporting of pediatric-specific susceptibility results. (Read the full article)

There is evidence from both developed and developing countries that antiretroviral treatment significantly reduces mortality in HIV-infected children. However, in sub-Saharan Africa, numerous health system, financial, and human resource obstacles make delivering quality pediatric HIV care a challenge.

We describe the experience of the Baylor International Pediatrics AIDS Initiative in Malawi, Lesotho, and Swaziland. Despite challenges delivering pediatric treatment in these countries, mortality and clinical outcomes approaching those from developed countries are feasible. (Read the full article)

Birth defects are associated with preterm birth and are a major contributor to infant mortality. There are persistent black-white differences in overall infant mortality and infant mortality attributable to birth defects.

Among infants delivered at 37 to 44 weeks, blacks and Hispanics had significantly higher neonatal and postneonatal mortality attributable to birth defects than whites. Among infants delivered at 20 to 33 or 34 to 36 weeks, neonatal mortality attributable to birth defects was significantly lower among blacks. (Read the full article)

The importance of and interest in childhood mental problems have increased worldwide. There are few population studies on child and adolescent mental health and health-related quality of life (HRQoL).

A social gradient was found in childhood mental health according to maternal education level and social class, but none was found in HRQoL, although children from disadvantaged social classes had somewhat lower HRQoL scores than their more advantaged counterparts. (Read the full article)

Asthma is a major reason for pediatric hospital admission. The Joint Commission requires freestanding children’s hospitals to report compliance with 3 Children’s Asthma Care quality measures. High compliance with these measures should result in decreased admissions and emergency department visits.

Implementation of a standardized care process model for hospitalized asthmatic children resulted in high compliance with all 3 measures. Measures 1 and 2 did not provide an opportunity for improvement. Compliance with measure 3 resulted in significant decreases in readmission. (Read the full article)

Early life nutrition may program pubertal timing. Limited evidence suggests breastfeeding is associated with later puberty and childhood milk consumption with earlier puberty; whether these observations are biologically mediated or confounded by socioeconomic position is unclear.

In a developed non-Western setting with little socioeconomic patterning of pubertal timing, neither breastfeeding nor childhood milk consumption was associated with pubertal timing, suggesting nutritional exposures during potentially critical periods may not have long-term effects on rates of maturation. (Read the full article)

Forearm fractures are unique injuries which are associated with lower bone mineral density in adults and white children. The relationships among bone mineral density, 25-hydroxyvitamin D status, and risk for forearm fracture have not been investigated in African American children.

Our data support an association between both lower bone mineral density and vitamin D deficiency and increased odds of forearm fracture in African American children. Promotion of bone health is indicated in this population. (Read the full article)

Evaluation of neonatal surgical outcomes is necessary to guide improvements in the quality of care. Meaningful comparisons must adjust for factors that alter outcomes independent of the surgical procedures.

Herein is described a method that permits risk adjustment for the broad range of noncardiac neonatal surgery, regardless of gestational age, to permit useful comparisons for quality improvement. (Read the full article)

Despite the dramatic rise in prevalence of metabolic syndrome (MetS) among children and adolescents, and that MetS is associated with cognitive and brain impairments among adults, no data on the impact of MetS on the brain exist in children.

It provides the first data on the impact of MetS on brain in adolescence. We show reductions in cognitive function and brain structural integrity in nondiabetic adolescents with MetS, thus suggesting that even pre-clinical metabolic illness may give rise to brain complications. (Read the full article)

Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.

Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country. (Read the full article)

Pediatric obesity is a prevalent public health issue that is associated with medical and physical consequences. Clinic-based interventions for pediatric obesity are effective, but they have limited reach and are costly.

This is the first examination of an empirically informed, scalable treatment of pediatric overweight and obesity delivered in YMCAs. The results indicate that a scalable, community-based pediatric obesity intervention can produce clinically meaningful changes in weight and quality of life. (Read the full article)