The medical home is associated with beneficial outcomes in children with special health care needs and in the entire pediatric population. It is unknown if it benefits the majority of the pediatric population (ie, children without special health care needs).

This study is the first to demonstrate an association between the medical home and beneficial health care utilization, child health, and health-promoting behavior outcomes in children without special health care needs. (Read the full article)

Very low birth weight (VLBW) male neonates appear to have increased mortality. VLBW female neonates appear to have better long-term outcomes.

VLBW male neonates have increased mortality and poorer neurological outcome. This gender difference appears to disappear at weeks' gestation. (Read the full article)

Prematurely born children have an increased prevalence of behavioral problems in the long term. Knowledge regarding the effects of early intervention programs is sparse, and more randomized controlled trials are warranted.

A modified version of the Mother-Infant Transaction Program showed beneficial effects on behavioral outcomes reported by both parents of preterm infants with birth weights of <2000 g at a corrected age of 5 years. (Read the full article)

Predischarge serum or transcutaneous bilirubinometry (TcB) measurements are recommended as appropriate screening options for identifying infants at risk for neonatal hyperbilirubinemia (NH). Visual inspection for jaundice is not reliable at identifying infants with NH in the community.

When compared with visual inspection alone, coordinated TcB screening for NH in acute-care and community settings is associated with significant improvements in laboratory utilization, patient care, convenience, and safety. (Read the full article)

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspecific clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been associated with pseudo-outbreaks.

Contamination of specimens with vaccine derived Bordetella pertussis DNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modifiable factors. (Read the full article)

Traumatic brain injury in school-aged children is associated with intellectual, behavioral, and social deficits. Research into outcomes of children injured before 3 years of age is limited despite data suggesting a high incidence of injury in this age group.

Results show that a moderate to severe traumatic brain injury before 3 years of age is associated with lowered cognitive function. Furthermore, this study highlights the link between social disadvantage and poor outcomes after traumatic brain injury in early childhood. (Read the full article)

Mixed prevalence rates of co-occurring psychiatric and neurodevelopmental conditions have been reported in children diagnosed with an autism spectrum disorder (ASD). ASD diagnoses remain fairly stable within a continuum, but some do not meet criteria for an ASD diagnosis years after initial diagnosis.

Co-occurring neurodevelopmental and psychiatric conditions may explain, in part, why the diagnosis of an ASD may change with age. (Read the full article)

Recent studies have called into question the benefit of perioperative corticosteroids in children undergoing heart surgery, but have been limited by small sample size, the lack of placebo control, and the grouping of various steroid regimens together in analysis.

We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates and found no mortality or length-of-stay benefit associated with any regimen, and a higher risk of infection in certain subgroups. (Read the full article)

The standard initial management for infants and children with acute pyelonephritis is intravenous antibiotic treatment.

Our results support the use of an oral cefixime treatment of initial episodes of acute pyelonephritis involving a gram-negative bacteria strain in children aged 1 month to 3 years who are without urological abnormalities and without clinical hemodynamic impairment. (Read the full article)

Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever.

Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.5°F was associated with adverse neonatal outcomes, with the rate of adverse outcomes increasing directly with maximum maternal temperature. Without temperature elevation, epidural use was not associated with adverse neonatal outcomes. (Read the full article)

The evidence base for obesity prevention is extremely limited. Although minority youth are at higher risk of obesity, and early childhood is a critical period for prevention, only 1 program has demonstrated sustained effects on obesity in young minority children.

Among youth at high risk for obesity based on income, minority status, and child behavior problems, early intervention that promotes effective parenting led to meaningful differences in obesity in preadolescence. Early family intervention is an innovative and promising approach. (Read the full article)

Recent studies report that overall computed tomography utilization in the emergency department has continued to rise. Increased computed tomography use is concerning because of the association with radiation exposure and the potential risk of radiation-induced malignancy, which is highest in children.

Our data showed no overall increase in computed tomography utilization through 2010. In areas where alternative non–radiation-based modalities were options, there were decreased trends in computed tomography use and increased use of potential alternative non–radiation-based modalities. (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)

The number of individuals diagnosed with autism spectrum disorders (ASDs) continues to increase in the United States and other developed countries. Most prevalence estimates indicate that ASD is diagnosed less commonly in Hispanic individuals compared with non-Hispanic (NH) white populations.

Prevalence of ASD in Arizona’s population-based cohort is higher than reported previously. Prevalence in the Hispanic population and NH white population increased significantly over time, with a significant decrease in the gap between Hispanic and NH white prevalence. (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)

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)

Sleep-disordered breathing is associated with neurobehavioral morbidity in children. Prior related research has generally been cross-sectional or short (ie, 1–2 years) follow-up studies of a single symptom (ie, snoring, obstructive sleep apnea, mouth breathing), with limited control for confounders.

Sleep-disordered breathing was assessed as a trajectory of combined symptoms from 6 months to 69 months, in more than 11 000 children. Sleep-disordered breathing was associated with 40% and 60% more behavioral difficulties at 4 and 7 years, respectively. (Read the full article)

Preterm infants are at increased risk of behavioral problems, which has been associated with maternal distress. Paternal psychological well-being is less studied. Parents’ concerns may affect their perceptions or attitudes and have negative effects on the behavior of the child.

Parents report more behavior problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence. Also, the paternal psychological well-being contributes to the behavioral development of a preterm child. (Read the full article)

Several studies have analyzed fatal or nonfatal youth injury incidence in US agricultural settings, but none have combined those estimates to form an overall picture. The only detailed study of costs related to such injuries is restricted to nonfatal injury.

This study provides a comprehensive analysis of the annual incidence and cost of agricultural youth injuries in the United States. It analyzes them from different perspectives: fatal versus nonfatal, at work versus not at work, and requiring hospitalization versus not requiring hospitalization. (Read the full article)

Previous research on the cost of childhood autism has been restricted primarily to studying direct costs (money outlays) incurred by publicly and privately funded service systems.

This study estimates the economic impact on the family and examines indirect costs to families in the form of parental labor market productivity losses. (Read the full article)

Transcutaneous bilirubinometry was originally developed as a potential replacement for invasive blood sampling, but its clinical application is still limited to a screening method for hyperbilirubinemia. Reasons for this limited clinical value may be diverse.

This study provides insight into the reasons for the limited clinical value of transcutaneous bilirubinometry. This aids to both better interpretation of the measured TcB value from a patient and to possible improvement of the clinical value of the technique. (Read the full article)

The survival of extremely low birth weight infants in resource-limited situations is dismal due to limited neonatal intensive care facilities. Nasal continuous positive airway pressure resulted in an increased survival of these infants, but many still require back-up ventilation.

Nasal continuous positive airway pressure and intubation, surfactant, and extubation practiced in a neonatal high care ward with limited resources and limited back-up ventilatory facilities can improve the survival of extremely low birth weight infants. (Read the full article)

Autism is widely considered a heterogeneous disorder in terms of etiology and phenotype. Although autism is usually a lifelong disorder, little is known about the rate or timing of how children develop regarding their communication and social functioning.

Utilizing annual evaluations for a large population of children with autism, we describe the 6 most common trajectories from diagnosis through age 14 years. Trajectories revealed considerable variation, and high socioeconomic status children were more likely to experience rapid improvement. (Read the full article)

Diabetes during pregnancy has been associated with general development impairments in offspring; however, associations between autism and maternal diabetes have been inconsistent. Few studies have examined related conditions accompanied by underlying increased insulin resistance and their association with developmental outcomes.

This population-based study in young children provides evidence that maternal metabolic conditions are a risk factor for autism, developmental delay without autistic symptoms, and impairments in several domains of development, particularly expressive language, after adjusting for sociodemographic and other characteristics. (Read the full article)

Clinical decision support systems offer a way to help physicians use evidence-based guidelines for screening. Screening patients for common developmental, psychosocial, and behavioral issues informs the clinical decision-making process and may improve patient outcomes.

The Child Health Improvement through Computer Automation system, a clinical decision support system and an electronic medical record, is able to effectively screen patient families in the waiting room by using a tailored questionnaire. The study reveals positive screening rates for identifiable risks in a very large representative urban population by using Child Health Improvement through Computer Automation’s questionnaire. (Read the full article)

High or low lymphocyte counts at birth have been reported as a marker for subsequent intraventricular hemorrhage, retinopathy of prematurity, and periventricular leukomalacia. However, this conclusion is questionable because reference ranges for lymphocyte counts have not been constructed by using large numbers of neonates.

This study provides reference ranges for lymphocytes of neonates. A high count at birth is associated with early onset sepsis and IVH and a low count with early onset sepsis, IVH, and retinopathy of prematurity. Among neonates with birth asphyxia, a low count identifies a high risk for death. (Read the full article)

Nonadherence to antiretroviral therapy among children and youth with HIV is a frequent problem that can result in treatment failure and disease progression for this population. Children and adolescents face different barriers to adherence than adults infected with HIV.

Few studies have examined specific barriers to adherence as reported by children with perinatally acquired HIV and their caregivers. This report examines the agreement between child and caregiver perceptions of adherence barriers and the factors associated with these barriers. (Read the full article)

As a result of safety and environmental concerns about mercury, aneroid sphygmomanometers have replaced mercury-filled devices for blood pressure measurements. Despite this change, few studies have compared the 2 devices.

Little clinical variation exists between blood pressure measurements obtained from an aneroid or mercury device, suggesting that either device could be used in a research or clinical setting. (Read the full article)

Cross-sectional studies have demonstrated associations between the white matter injury and cognitive impairment in very preterm born children. Longitudinal studies confirmed the relationships between cerebral MRI at term and neurodevelopmental outcomes at up to 2 years old.

White matter injury (but not gray matter injury) on term MRI predicted cognitive impairments of very preterm born infants at 9 years old. Qualitative assessment of white matter signal intensities showed limited predictive values of cognitive impairments. (Read the full article)

Although several randomized trials have examined the efficacy of serotonin receptor inhibitors in the treatment of repetitive behaviors, there still remains clinical uncertainty as to whether these agents are effective in treating such behaviors in children and adults with autism spectrum disorders.

The goal of this meta-analysis was to examine randomized trials of serotonin receptor inhibitors for treating repetitive behaviors in autism spectrum disorders. Although a small but significant effect of these agents was observed, this effect is likely due to the selective publication of trial results. (Read the full article)

We lack prospective studies documenting "dosage effects" of chronic child maltreatment for both subsequent adolescent and adult outcomes. It is unknown whether effects are linear, shelving, or exponential, and we lack data across domains of outcomes.

Chronic child maltreatment reports are a robust indicator of future negative health and behavioral outcomes. There is a dose-response relationship between chronicity and outcomes in adolescence, but this is attenuated in adulthood once adverse child outcomes are controlled. (Read the full article)

Primary care settings provide an important venue for early detection of substance use and intervention, but adolescent screening rates need improvement. Screening and brief interventions appear effective in reducing adult problem drinking but evidence for effectiveness among adolescents is needed.

A computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents’ use of alcohol and cannabis. (Read the full article)

Conflicting results exist concerning long-term outcome in healthy infants with metabolic acidosis at birth.

Neonates who appear well after perinatal metabolic acidosis do not have an increased risk of neurologic or behavioral problems in need of referral actions or pedagogic arrangements at the age of 6.5 years. (Read the full article)

Information on infant safety after exposure to maternal antiretroviral regimens during pregnancy in international clinical trials is lacking. As antiretroviral drugs are released to populations in resource-limited settings through clinical trials, it becomes critical to collect pediatric outcome data.

The study demonstrates the feasibility of reporting infant outcomes following adult antiretroviral trials in developing countries, provides HIV-free infant survival and prospective growth data in association with maternal parameters, and details morbidity, mortality, and genetic defects following maternal antiretroviral exposure. (Read the full article)

Previous research has identified low rates of employment and postsecondary education for youth with autism, but generalizability has been limited by small samples.

Using national data, the authors of this study found that youth with autism are at high risk for no postsecondary education or employment, especially in the first 2 years after high school. Findings highlight the need for improved transition planning. (Read the full article)

Late-onset hypocalcemia is common in neonates, often presents with seizures or tetany, and is often attributed to transient hypoparathyroidism.

Late-onset hypocalcemia in neonates is often a sign of coexisting vitamin D deficiency and hypomagnesemia and is readily managed with therapy of limited duration, and neonates presenting with tetany or seizures due to hypocalcemia are unlikely to benefit from neuroimaging studies. (Read the full article)

Most acute wheezing episodes in preschool children are associated with rhinovirus, which decreases extracellular adenosine triphosphate levels, leading to airway surface liquid dehydration and submucosal edema, which cause failure of mucus clearance. These children respond poorly to available treatments.

Hypertonic saline inhalation, a pro–airway surface liquid hydration therapy, significantly decreases both length of stay by 33% (1 day) and the absolute risk of hospitalization by 30% in preschool children presenting with acute wheezing episode to the emergency department. (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)

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Our findings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to improve morbidity-free survival. (Read the full article)

Observation studies and short-term prospective intervention studies have shown that physical activity positively affects the accrual of bone mass and size during growth; however, fracture risk has not been evaluated.

This study reports the long-term results of a prospective intervention with increased physical activity at a population-based level and for the first time evaluated the clinical relevant end point, fracture risk. (Read the full article)

Adherence to guidelines has generally been shown to improve patient care and reduce the cost of care. Current understanding of the varying reasons why clinicians deviate from guidelines is based on surveys and retrospective reviews.

We examined clinician deviations from guidelines in a prospective fashion and attempted to categorize those deviations. Better elucidation of clinician reasoning behind deviations may inform care improvement and help define strategies to eliminate unjustifiable deviations. (Read the full article)

Group B Streptococcus (GBS) is a common cause of meningitis in young infants. Studies from the 1980s revealed that GBS meningitis resulted in substantial mortality and reported that survivors of the infection had a high likelihood of adverse neurodevelopmental outcome.

Contemporary long-term outcomes for children surviving GBS meningitis reveal that 56% are functioning normally. The remainder sustained mild-to-moderate (25%) or severe (19%) neurodevelopmental impairment, highlighting the need for GBS prevention and for ongoing developmental follow-up for GBS meningitis survivors. (Read the full article)

Children in foster care are at elevated risk for adverse outcomes. Placement instability and failure to achieve timely permanence exacerbate that risk. A handful of studies have found that parent-management training is effective in promoting placement stability and timely permanence.

Unlike parent-management training, youth focused interventions have not been systematically evaluated for their impact on placement and permanency outcomes. A mentoring and skills group intervention for preadolescents in foster care demonstrated better placement and permanency outcomes, especially for high-risk subgroups. (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)

Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age.

Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas that of respiratory illness severity increases with advancing postnatal age. (Read the full article)

A wide variety of prescription drugs are prescribed to US children. Although one of the steps in assessing the risk/benefit of therapies in the pediatric population is to understand how they are used, pediatric drug utilization is not well characterized.

By using large prescription databases, this study examines the frequency and patterns of national outpatient drug utilization (acute and chronic medications) in US infants, children, and adolescents for 2002 through 2010. (Read the full article)

Prevalence estimates for neurologic and neurodevelopmental disorders in children vary widely, and there is uncertainty as to what extent the individual disorders overlap. Most previous prevalence studies have been based on survey data and not on specialist-confirmed diagnoses.

This study used nationwide register data to determine the proportions of Norwegian children diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder, epilepsy, and cerebral palsy and to study how the disorders overlap. All diagnoses were specialist-confirmed. (Read the full article)

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)