Febrile infants in the first 90 days may have life-threatening serious bacterial infection. Well-appearing febrile infants with serious bacterial infections cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common.

The systemwide implementation of an evidence-based care process model for the care of febrile infants in Intermountain Healthcare was associated with increased delivery of evidence-based care, improved infant outcomes, and lower costs. This model adopted nationally can improve value. (Read the full article)

Infant malnutrition is known to be associated with behavioral and cognitive impairment throughout childhood, adolescence, and young adulthood. However, controlled studies addressing adult outcomes in middle life, including earning potential, educational attainment, and standard of living, are limited.

A discrete episode of moderate to severe malnutrition in infancy, with good rehabilitation thereafter, is associated with lower adult social status and a widening income gap relative to healthy controls, partially attributable to cognitive impairment in the previously malnourished. (Read the full article)

Data suggest that delivery at high-volume, high-technology hospitals reduces neonatal mortality. No study has examined other complications or compared the effects in multiple states by using a study design to control for unmeasured differences in case mix.

The survival benefit to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and varies between states. The survival benefits affect both extremely and moderately preterm infants. Complication rates were similar between hospital types. (Read the full article)

Persistent facial nerve palsy is a well-described neurologic deficit after Lyme neuroborreliosis and occurs in 13% to 20% of children. Other neurologic deficits are less closely described. Nonspecific subjective symptoms are reported as often among patients as controls in previous short-term follow-up studies.

Persistent neurologic deficits, other than facial nerve palsy, were found in 14% of patients, causing impaired fine motor skills, poor balance, or persistent pain. Nonspecific subjective symptoms were reported as often among patients as controls in this long-term follow-up study and should not be considered as sequelae after Lyme neuroborreliosis. (Read the full article)

Eating disorder not otherwise specified (EDNOS) is the most common eating disorder diagnosis. Binge eating disorder, 1 type of EDNOS, is associated with obesity among adults. Little is known about the health outcomes associated with other types of EDNOS.

This is the first study to evaluate the prospective association of full and subthreshold bulimia nervosa, binge eating disorder, purging disorder, and other EDNOSs with specific mental and physical health outcomes. (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)

3,4-Methylenedioxymetham-phetamine (MDMA, ecstasy) is a widely used recreational drug affecting the serotonergic system. Preclinical studies indicate learning/memory problems with fetal exposure. Human infant prenatal exposure was related to alterations in gender ratio and poorer motor development at 4 months.

This is the first study documenting that heavier prenatal 3,4-methylenedioxymethamphetamine exposure predicts poorer infant mental and motor development at 12 months with significant, persistent neurotoxic effects. Language and emotional regulation were unaffected. (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)

Children born late preterm (34–36 weeks’ gestation) are at increased risk of adverse early childhood outcomes compared with term-born children. The impact of the neonatal experience on longer-term outcomes of these infants has not yet been well considered.

This study provides information regarding the development of late preterm infants at 3 years. Late preterm infants who received neonatal intensive or high-dependency care had similar developmental outcomes to children born late preterm who did not receive this care. (Read the full article)

Infant behavioral dysregulation is a common concern, involving irritability, excessive crying, and problems with feeding and sleep. Previous research into its behavioral outcomes has been limited by small cohorts and short follow-up, and findings have been contradictory.

Long-term follow-up of a large cohort showed that infant behavioral dysregulation was a risk factor for maternal-reported behavior concerns at 5 and 14 years, but was unrelated to young adult mental health outcomes. (Read the full article)

Concerns persist about sexual disinhibition after human papillomavirus (HPV) vaccination of preteenage girls. Self-reported surveys have indicated few anticipated behavior changes after HPV vaccination. Little is known about sexual activity–related clinical outcomes after HPV vaccination.

Utilizing managed care organization electronic data, we evaluated the incidence of adverse outcomes of sexual activity among vaccinated preteenage girls and found little difference between those who received HPV vaccine and those who did not. (Read the full article)

Doxorubicin therapy, effective against many malignancies, is limited by cardiotoxicity. Continuous-infusion doxorubicin, compared with bolus-infusion, reduces early cardiotoxicity in adults. Its effectiveness in reducing late cardiotoxicity in children remains uncertain.

This multicenter randomized trial assessed whether continuous-infusion of doxorubicin in pediatric patients provides long-term cardioprotection or improvement in event-free survival over bolus-infusion in acute lymphoblastic leukemia. Continuous-infusion of doxorubicin provided no cardioprotection or improvement in event-free survival. (Read the full article)

Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.

This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims. (Read the full article)

Provider training level is associated with lower rates of successful tracheal intubation in selected neonatal settings. However, little is known about the association of training level with tracheal intubation success and adverse events in the PICU.

Our results demonstrate the association of training level on the first attempt and overall success rate as well as the incidence of adverse tracheal intubation–associated events in a large-scale, prospective assessment across 15 academic PICUs. (Read the full article)

Studies of clinically derived samples of infants with failure to thrive have reported that children remain shorter and lighter than their peers at school-age. Enhanced weight gain ("catch-up") in small infants has been linked to subsequent obesity.

Infants with early weight faltering caught up in weight by 2 years, but height gain remained disproportionally slow. Those with weight faltering later in infancy remained shorter and lighter throughout childhood. Anthropometric outcomes of both groups were within population norms at 13 years. (Read the full article)

Guidelines encourage pediatric health care providers to aid in identifying women with postpartum depression but not postpartum anxiety, yet the major life event of childbirth can be anxiety provoking for many women.

During the postpartum hospital stay, anxiety was far more common than depression among breastfeeding women. Anxiety remained more common for the 6 months after childbirth, and was associated with increased health care use and reduced breastfeeding duration, particularly among primiparous women. (Read the full article)

Although it is known that extremely preterm children are at increased risk for cognitive deficits, academic underachievement, and behavioral problems, the frequency and severity of these impairments may decline with advances in neonatal care.

Despite recent changes in obstetric and neonatal management of extremely preterm infants, the rate of neurobehavioral impairments at school age is still too high. (Read the full article)

Pharmacologic treatment with sapropterin dihydrochloride (6R-tetrahydrobiopterin; BH4) has been an effective option for some phenylketonuria patients since its approval by the US Food and Drug Administration in 2007 and the European Medicines Agency in 2008.

This retrospective multicenter study revealed the long-term effects of sapropterin on metabolic control, dietary tolerance, and the outcome of BH4-responsive phenylketonuria patients harboring specific phenotypes and genotypes. It also confirmed that the minor adverse events disappeared by lowering the dose. (Read the full article)

The remarkable improvement in the survival of extremely premature infants has been well documented. However, there have been few cohort studies large enough to determine the neurodevelopmental outcomes of survivors born at 22 or 23 weeks.

The proportions of unimpaired or minimally impaired were 12.0% at 22 weeks (n = 75) and 20.0% at 23 weeks (n = 245). The outcomes were inferior compared with those for infants born at 24 and 25 weeks, but were improved compared with those in previous studies. (Read the full article)

About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.

In this large randomized controlled trial, anticipatory guidance on the "when, what, and how" of complementary feeding was associated with increased maternal "protective" feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance. (Read the full article)

There is wide variation in testing and treatment of children hospitalized with pneumonia. Limited data are available on diagnostic testing patterns and the association of test utilization with disposition outcomes for children with pneumonia evaluated in the emergency department (ED).

Significant variation exists in testing for pediatric pneumonia. EDs that use more testing have higher hospitalization rates. However, ED revisit rates were not significantly different between high- and low-utilizing EDs, suggesting an opportunity to reduce testing without negatively affecting outcomes. (Read the full article)

Neonatal infections are frequent complications in very preterm infants, already at high risk of neurologic and cognitive disabilities. Few studies have linked neonatal infections and neurodevelopmental outcomes. Those that did evaluated children only to the age of 22 months.

This study assessed the respective effects of early- and late-onset sepsis and their association with 5-year neurodevelopmental outcomes. We identified a significant and cumulative risk of cerebral palsy when episodes of early- and late-onset sepsis were associated. (Read the full article)

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric has examined 30-day risk-adjusted outcomes in children’s surgery. Because of low event rates, initial efforts yielded valid models that did not meaningfully discriminate outcomes among over 20 participating institutions.

Programmatic growth, sampling algorithm refinement, and hierarchical modeling use have resulted in the ability to reliably discriminate performance among hospitals in multiple domains. We report the first actionable peer-reviewed risk-adjusted, multiinstitutional outcome data in children’s surgery. (Read the full article)

Respiratory outcomes of patients with bronchopulmonary dysplasia (BPD) range from no oxygen requirement to chronic respiratory failure. Outcomes of least severe types of BPD are well described. Limited data exist on outcomes of patients with BPD-related chronic ventilator dependency.

Along with a first estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were dependent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation. (Read the full article)

Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes.

This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. (Read the full article)

Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. Inhaled nitric oxide given to reduce morbidity in very preterm infants does not reduce the prevalence of bronchopulmonary dysplasia and has uncertain effects on long-term outcome.

Inhaled nitric oxide (5 ppm) given early in the course of respiratory illness in infants born before 29 weeks of gestation is not associated with changes in developmental or respiratory outcomes at 2 years of age corrected for prematurity. (Read the full article)

Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates.

This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. (Read the full article)

The incidence of pediatric pneumococcal meningitis has declined after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). It is unknown whether the frequency of severe neurologic sequelae and adverse outcomes has changed in the era of widespread PCV7 use.

Pneumococcal meningitis continues to be associated with substantial mortality and long-term morbidity. Sixty-three percent of survivors had neurologic sequelae. More than one-half of the children who were eligible for PCV7 were unimmunized at the time that they developed pneumococcal meningitis. (Read the full article)

Several studies have suggested that probiotics may prevent necrotizing enterocolitis and death in preterm infants. However, there are no data on the preventive effect of probiotics in infants with cyanotic congenital heart disease.

Although duration of hospitalization was not significantly decreased, Bifidobacterium lactis plus inulin appears to decrease the rate of nosocomial infection, necrotizing enterocolitis, and death in infants with cyanotic congenital heart disease. (Read the full article)

Extremely preterm infants are at high risk of neonatal mortality or morbidities. Existing prediction models focus on mortality, specific morbidities, or composite mortality and morbidity outcomes and ignore differences in outcome severity.

A simple and practical statistical model was developed that can be applied on the first day after NICU admission to predict outcome severity spanning from no morbidity to mortality. The model is highly discriminative (C-statistic = 90%) and internally valid. (Read the full article)

Pneumonia is the leading cause of death in young children worldwide. Anemia, widely prevalent globally, is not routinely assessed when treating pneumonia. The effect of anemia and high altitude on outcome of pneumonia is not well described.

Anemia at high altitude increases the risk of poor outcome with severe pneumonia. Children with severe pneumonia at high altitude present with more severe hypoxemia and have a longer time to recovery than children at low altitude. (Read the full article)

Transition from pediatric to adult care is often reported to be unsuccessful. Little evidential research has examined the actual proportion of youth in pediatric versus adult care or impact on health status outcomes after transferring from pediatric to adult care.

Our article extends the literature by providing health transition outcome data, something that has been recognized as a critical gap to developing evidence-based programming and health care transition policy. (Read the full article)

As more children with sickle cell disease survive into adulthood, they are increasingly hospitalized in both children’s and general hospitals and managed by different provider specialists. But it is unknown if hospital type and provider specialty affect patient outcomes.

Using a large national administrative dataset, this study revealed that general hospitals were associated with higher rates of intubation and longer lengths of stay compared with children’s hospitals for adolescents and young adults with SCD admitted with acute chest syndrome. (Read the full article)

Several studies have suggested that very low birth weight young adults have increased risks of physical and health problems, educational underachievement, and poorer social functioning than their peers, but there are limited population-based and longitudinal data.

Former VLBW young adults in this national cohort scored as well as term controls on many measures of health and social functioning, including quality-of-life scores, with some differences largely confined to those with disability at age 7 to 8 years. (Read the full article)

Better postnatal growth, especially head growth, associates with better cognitive development in preterm infants. Suboptimal postnatal growth is more common in infants with poor antenatal growth than in infants with normal growth.

Good weight gain and head circumference growth until 2 years was associated with better 5-year cognitive outcome in non–small for gestational age infants. Good head circumference growth around term age benefits the cognitive outcome of small for gestational age infants. (Read the full article)

Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.

We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years’ corrected age. (Read the full article)

Systematic health disparities in adults with systemic lupus erythematosus are well documented and are likely driven by biologic as well as modifiable factors. Sociodemographic factors and health care delivery characteristics have been associated with poor outcomes.

In hospitalized children with systemic lupus erythematosus, race and ethnicity were associated with increased risk for ICU admissions, end-stage renal disease, and death. Identification of sociodemographic factors associated with outcomes is important to address the needs of these vulnerable patients. (Read the full article)

There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients.

Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. (Read the full article)

Kawasaki disease (KD) results in coronary aneurysm formation and an increased risk of cardiovascular complications. Modern treatment of acute KD with intravenous immunoglobulin substantially reduces the rate of acute aneurysm formation.

This study reveals that long-term cardiovascular outcomes for KD patients in the current era are not significantly different than matched controls without KD. Late cardiovascular complications are almost exclusively seen in patients with persistent coronary aneurysms. (Read the full article)

It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.

This is the first study to provide evidence that preterm infants’ exposure to adult words in the NICU before the mother’s due date are associated with better cognitive and language outcomes at 7 and 18 months’ corrected age. (Read the full article)

In children with congenital toxoplasmosis, ocular lesions can be detected and may relapse after birth despite pre- and postnatal treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.

Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment. (Read the full article)

Encephalitis in children can cause significant neurologic sequelae, such as motor and cognitive impairment. Previous reported data are based mostly on questionnaires and clinical assessments.

Significant cognitive impairment, attention-deficit/hyperactivity disorder, and learning disabilities are common after childhood encephalitis. Even children who were considered fully recovered may be significantly affected. Identifiable pathogens, abnormal neuroimaging, and abnormal neurologic examination on discharge are risk factors of poor outcome. (Read the full article)

Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition, typically identified in adolescence and accompanied by physical and social impairment and mood difficulties. There are no long-term studies on the prognosis of adolescents with JFM into adulthood.

This prospective study demonstrated that pain and other symptoms persisted into adulthood for >80% of JFM patients, with associated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adult fibromyalgia. (Read the full article)

Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation.

Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. (Read the full article)

Integrated or collaborative care intervention models have revealed gains in provider care processes and outcomes in adult, child, and adolescent populations with mental health disorders. However optimistic, conclusions are not definitive due to methodologic limitations and a dearth of studies.

This randomized trial provides further evidence for the efficacy of an on-site intervention (Doctor Office Collaborative Care) coordinated by care managers for children's behavior problems. The findings provide support for integrated behavioral health care using novel provider and caregiver outcomes. (Read the full article)

Preterm infants have transiently lowered thyroid hormone levels during the early postnatal period. Past research suggests that low thyroid hormone levels are related to cognitive and developmental deficits in children born preterm.

Contrary to expectations, in this study of children born <30 weeks’ gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age. (Read the full article)

Congenital pulmonary malformations are mostly identified prenatally. At birth, some children develop respiratory distress, which may be sufficiently severe to require mechanical ventilation and immediate surgery. The factors predictive of neonatal respiratory distress are not well defined.

Malformation volume and prenatal signs of intrathoracic compression are significant risk factors for respiratory complications at birth in fetuses with pulmonary malformations. In such situations, the delivery should take place in a tertiary care center. (Read the full article)

Although a number of randomized controlled trials of erythropoietin administration to preterm infants have been performed, few studies have reported 2-year or longer neurodevelopmental outcomes, and no studies have evaluated neurodevelopmental outcomes of infants randomized to receive Darbepoetin.

This is the first prospectively designed study to evaluate the neurocognitive outcomes of preterm infants randomized to receive Darbepoetin or erythropoietin compared with placebo. Infants in the ESA groups had significantly higher cognitive scores compared with the placebo group. (Read the full article)

Administrative health insurance claims have limitations when measuring care quality.

Children’s care quality measures assessed using administrative claims alone may not accurately reflect care quality. Use of electronic health record data in combination with administrative claims data provides an opportunity for more complete measurement. (Read the full article)

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)