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)

Neonatal sepsis is an important cause of under-5 childhood mortality. Infants born to HIV-infected mothers are at increased risk of morbidity and mortality, even if not having acquired HIV. This association needs further study during the neonatal period.

Maternal HIV infection was associated with increased vaginal colonization by Escherichia ecoli but not group B Streptococcus. Neonates born to HIV-infected mothers were only at increased risk of sepsis if they had acquired HIV-infection, but not if HIV-uninfected. (Read the full article)

Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children.

This study demonstrates that a healthy media use intervention can improve child sleep outcomes and adds evidence that the relationship between media and sleep in preschool-aged children is indeed causal in nature. (Read the full article)

Bronchiolitis is one of the most common infectious respiratory conditions of early childhood, and most children have a mild clinical course. Unfortunately, the small subgroup of children requiring continuous positive airway pressure and/or intubation remains ill-defined.

In children with bronchiolitis, we found several demographic, historical, and clinical factors that predicted the need for mechanical respiratory support including in utero smoke exposure. We also found a novel subgroup of children with bronchiolitis who have a rapid respiratory decline. (Read the full article)

Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.

This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)

Immunization recall systems have been found effective in increasing immunization rates in younger children and adults; however, there have been only a few studies in adolescents and they have produced mixed results.

In this randomized controlled trial, immunization rates were significantly higher 4 weeks after a recall intervention in which both the adolescent’s parents and the adolescent were contacted, but this effect did not persist 1 year after the intervention. (Read the full article)

Micronutrients are essential for brain development during gestation and infancy. Few randomized trials of maternal multiple micronutrient supplementation during pregnancy and postpartum have examined child outcomes beyond the neonatal period or tested which cognitive domains show long-term effects.

Children of undernourished mothers given multiple micronutrients performed as well as children of well-nourished mothers in motor and visual attention/spatial ability at age 42 months; children of undernourished mothers given iron/folic acid showed 4- to 5-month delays in these abilities. (Read the full article)

Materialism and life satisfaction are known to be associated with each other. Research among adults has shown that materialism and life satisfaction negatively affect each other, leading to a downward spiral.

In contrast to research conducted among adults, no longitudinal effect of materialism on life satisfaction was found for 8- to 11-year-olds. However, life satisfaction did negatively affect materialism, but only for children who were frequently exposed to advertising. (Read the full article)

Immature animals exposed to anesthetics display apoptotic neurodegeneration and long-term cognitive deficiencies. In children, studies of cognitive deficits associated with anesthesia exposure have yielded mixed results. No studies to date have used directly administered neuropsychological assessments as outcome measures.

This study examines the association between exposure to anesthesia in children under age 3 and deficits at age 10 by using a battery of directly administered neuropsychological assessments, with deficits found in language and abstract reasoning associated with exposure. (Read the full article)

The higher the predischarge bilirubin percentile reading on the hour of life–specific nomogram, the higher becomes that infant's risk of developing significant hyperbilirubinemia. Neonates in the low-risk zones (≤75th percentile) have a low risk of developing hyperbilirubinemia.

Thirty-two percent of newborns readmitted for hyperbilirubinemia had low-risk zone predischarge bilirubin percentile values, predominantly in the intermediate low-risk zone (41st–75th percentile). The intermediate low-risk zone may not be as low risk as previously thought. (Read the full article)

Skin-to-skin contact with mothers and fathers has been associated with lower pain reactivity and enhanced physiologic recovery after heel lance. The effect of skin-to-skin contact between preterm twins during cobedding on pain response has yet to be studied.

We demonstrate that cobedding significantly diminished time to recovery in preterm twins after heel lance but did not lower pain reactivity. (Read the full article)

Previous studies suggest that abnormal findings on conventional EEG during the neonatal period are associated with death or severe brain injury in preterm infants. However, large cohort studies on preterm EEG for predicting later neurodevelopmental outcome remain scarce.

This study demonstrates precise prognostic values of conventional EEG for predicting neurodevelopmental outcome in the current perinatal care setting. Additionally, its prognostic values are independent of severe injury on neuroimaging and clinical risk factors. (Read the full article)

Risk of preterm birth (PTB) has been noted to be higher for newborns with congenital heart defects (CHDs). The role of associated anomalies, whether PTB is spontaneous or medically induced, or specific categories of CHDs have not been elucidated.

By using population-based data, we found that PTB associated with CHDs was due to spontaneous PTB. Associated anomalies accounted for a small part of this increase, and there were specific associations between categories of CHDs and PTB. (Read the full article)

Rotavirus is a major cause of acute gastroenteritis among children worldwide. Vaccines targeting rotavirus have been demonstrated to be highly efficacious against severe disease in clinical trials and postlicensure studies. Vaccine impact on mild gastroenteritis has not been well studied.

We used a novel surveillance platform consisting of telephone triage data to capture mild gastroenteritis not detected in other surveillance systems. Since rotavirus vaccine licensure, gastroenteritis-related call proportions have declined, and peak gastroenteritis-related calls are correlated with community norovirus circulation. (Read the full article)

Changes in resident work hours are believed to have an impact on resident education and patient safety.

This study provides an understanding of the impact of changes in resident work hours on the staffing strategies of children’s hospitals. (Read the full article)

Pediatric osteoarticular infections can be treated with successful microbiologic and clinical outcomes with a transition from parenteral to oral therapy. The best way to determine the timing of this transition is neither well studied nor standardized.

A total of 193 (99.5%) of 194 pediatric patients with acute bacterial osteoarticular infections were successfully transitioned to oral therapy, determined by using a combination of clinical findings and C-reactive protein levels, representing the largest single-center data set analyzed. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Few longitudinal studies from developing countries have assessed the relation between early maternal depressive symptoms and child growth beyond age 2. The results of these studies have been inconclusive.

Early maternal depressive symptoms were related to higher odds of deficits in stature but not to deficits in weight among preschool- and school-aged children. Well-child care provides opportunities to identify maternal depressive symptoms to prevent future child growth delays. (Read the full article)

Current human milk fortifiers fail to provide the higher protein intake that is now recommended for feeding human milk–fed infants. There is a desire to avoid the use of powdered products when feeding these infants.

A new ultraconcentrated liquid human milk fortifier that provides more protein than current powdered fortifiers is safe and supports better growth in human milk–fed infants than a powdered fortifier. (Read the full article)

The Apgar score is a convenient method to rapidly assess the clinical status of the newborn infant. Recent literature suggests Apgar scores vary widely in preterm infants.

The Apgar signs for respiratory effort, grimace, and muscle tone demonstrated considerable disagreement in preterm infants ≤28 weeks’ gestation. Disagreement exists despite the level of respiratory intervention, continuous positive airway pressure, or intubation, and is likely independent of gestational age. (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)

There are limited data regarding the current status of the pediatric clinical trial enterprise.

Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible. (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)

Invasive Cronobacter infection is a rare but devastating disease known to affect hospitalized premature or immunocompromised infants fed powdered infant formulas (PIFs). PIF labels imply that powdered formulas are safe for healthy, term infants if the label instructions are followed.

Cronobacter can also infect healthy, term infants in the first months of life, even if PIF label instructions are followed. Invasive Cronobacter infection is extremely rare in exclusively breastfed infants or those fed commercially sterile, ready-to-feed formulas. (Read the full article)

Significant variation in congenital hypothyroidism screening operations/performance has been observed in the United States. The origin of this variation remains unknown, in part because of a lack of evaluation. Accordingly, debates persist about optimal screening operations including laboratory testing methods.

Four distinct screening protocols applied to Michigan resident infants are compared in detecting congenital hypothyroidism overall and specific to cases characterized by high initial thyrotropin concentrations thought to have a more severe form of the disease. (Read the full article)

School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is a widely used universal prevention strategy currently implemented in >16 000 schools across the United States. Previous research has shown positive effects on school climate and school-level discipline problems.

This study reports multilevel results on data from a 4-year randomized controlled effectiveness trial of SWPBIS in 37 elementary schools. Results indicate significant impacts on children’s aggressive behavior problems, concentration problems, office discipline referrals, emotion regulation, and prosocial behavior. (Read the full article)

Brain maturation processes of very premature children are adversely affected by serious neonatal infections. Differences in brain development persist into childhood and adolescence, and underpin widespread neurocognitive and behavioral deficits in very preterm children.

We present evidence for long-term beneficial effects of early nutritional intervention with glutamine in very preterm infants on brain development at 8 years of age, mediated by a decrease in the number of serious neonatal infections. (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)

Several meta-analyses evaluating probiotics in preterm infants suggest a beneficial effect for the prevention of necrotizing enterocolitis and death, but less for nosocomial infection. Lactobacillus reuteri may reduce these outcomes because of its immunomodulation and bactericidal properties.

Although L reuteri did not appear to decrease the rate of death or nosocomial infection, the trends suggest a protective role consistent with the literature. Feeding intolerance and duration of hospitalization were significantly decreased in premature infants ≤1500 g. (Read the full article)

Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder of presumed autoimmune or autoinflammatory etiology predominantly affecting children. There are limited data on the characteristics and optimal treatment of CNO in the United States.

A US-based cohort of pediatric CNO patients revealed high rates of personal and familial autoimmunity. Coexisting autoimmunity was a risk factor for widespread involvement. Response to nonsteroidal antiinflammatory drugs was inferior to that with immunosuppressive and biologic agents. (Read the full article)

Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.

US boys appear to be developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys. (Read the full article)

Detained youth represent a vulnerable pediatric population with worse health outcomes than their nondetained peers. To date, little work has been done to determine whether health information technologies may be effectively used to improve the health of this underserved population.

The Internet is accessible to youth involved in the juvenile justice system. A securely accessible online system to store detained youth’s health information may be both feasible and acceptable for engaging these adolescents more actively in their health care. (Read the full article)

Social and environmental risks related to substandard housing contribute to adverse health outcomes. Partnerships between the health care and legal systems can help families address such risks and help clinicians understand the legal context of health.

A medical-legal partnership colocated in a pediatric primary care setting identified and treated a large cluster of poor quality, substandard housing. Housing improvements were possible because of strong collaboration between clinicians, attorneys, community partners, and families. (Read the full article)

Heart rate continues to be the single most important indicator of well-being in a newborn. Availability of a reliable method to determine heart rate in the first minute would help determine resuscitation interventions, particularly for the extremely premature infant.

Electrocardiograms can provide a reliable, continuous heart rate in the most premature infants in the first minute of resuscitation compared with pulse oximeters. (Read the full article)

Nasal continuous positive airway pressure (NCPAP) is commonly given to premature infants with nasal prongs and nasal masks. Prongs and masks appear to injure the nose of preterm infants with equal frequency.

Nasal masks are more effective than nasal prongs for preventing intubation and mechanical ventilation in premature infants within 72 hours of starting NCPAP. (Read the full article)

Postnatal growth restriction of preterm infants is a universal problem. Early "catch-up growth" has been associated with development of metabolic syndrome. In addition, preterm infants appear to be at major risk for developing increased adiposity and insulin resistance.

The consumption of a nutrient-enriched formula after hospital discharge may be beneficial in adequate for gestational age infants both in terms of head circumference growth and fat-free mass gain. (Read the full article)

Randomized controlled trials of early developmental interventions for very preterm infants demonstrate short-term benefits for infant neurobehavioral functioning. The longer-term benefits of these interventions for children and their families are not yet clear.

This randomized trial shows that home-based preventive care over the first year of life for very preterm infants has selective long-term benefits. Caregivers report less anxiety and fewer were at risk for an anxiety disorder. Preschoolers show fewer internalizing behaviors. (Read the full article)

It has been widely thought for the past 20 years that recurrent low blood glucose levels ≤2.5 mmol/L (45 mg/dL), even in the absence of any suggestive clinical signs, can harm a preterm infant’s long-term development.

This prospective study showed the outcome at 2 and 15 years later for the preterm infants who had a blood glucose level this low in the first 10 days of life did not differ from that of matched controls. (Read the full article)

Previous studies have demonstrated that booster seat legislation decreased fatalities in children. However, these studies have not accounted for confounding factors such as other legislation and temporal trends in safety.

This study demonstrates that state booster seat laws are associated with decreased rates of fatalities and injuries in children 4 to 7 years of age in the United States, with the strongest effects in the older children. (Read the full article)

Pediatric specialists are increasingly involved in prenatal care, particularly for congenital fetal conditions. Questions remain about pediatricians’ role in the management of maternal conditions that may affect postnatal health, and the attitudes of obstetric and pediatric specialists around such care.

Obstetric and pediatric specialists’ attitudes differ substantially regarding pediatricians’ role in providing consultation for maternal conditions that may affect a child’s health postnatally, and regarding whether court authorization may be appropriate when a woman refuses certain treatment recommendations. (Read the full article)

It has been suggested that maternal immune activation during pregnancy is associated with cardinal behaviors of autism in the offspring. Epidemiologic studies have yielded conflicting results concerning the association between any infection during pregnancy and the development of autism.

This population-based cohort study investigated the association between specific common infectious diseases, febrile episodes, or use of antibiotics during pregnancy by using maternal population-based self-reported data. (Read the full article)

Stressful events adversely affect the immune system, particularly the natural killer (NK) cells. Infants in the NICUs are exposed to stressful stimuli. The effect of massage therapy on the immune system of preterm infants has not been investigated.

This randomized placebo-controlled study found daily massage performed in stable preterm infants for a minimum of 5 days was associated with an increase in NK cell cytotoxicity despite lower absolute NK cell numbers compared with controls. (Read the full article)

Children born small for gestational age (SGA) have increased risk of perinatal morbidity and mortality, neonatal death, and cerebral palsy (CP). Causes of SGA, such as congenital malformations, intrauterine infections, and preeclampsia, are also risk factors for the same outcomes.

In 90% of singletons born SGA, CP is apparently of prenatal origin. Low proportions of intrapartum events leading to CP could not be fully explained by a higher neonatal mortality rate in SGA than in non-SGA children. (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)

Adolescents have high placebo response rates in depression treatment trials. Screening for depression will likely detect youth with a broad range of symptom severity, including some who would benefit from watchful waiting but might not require active treatment.

The strongest predictors of symptom persistence are depressive symptom severity at presentation and continued symptoms on repeat screening 6 weeks later. These results provide important information for the development of postscreening management protocols in the primary care setting. (Read the full article)

Osteopathy of prematurity continues to occur in preterm infants. Osteopathy of prematurity can cause rib fractures in ex-preterm infants.

Rib fractures in ex-preterm infants are often posterior and multiple. Posterior rib fractures may not be diagnostic of nonaccidental injury in ex-preterm infants. (Read the full article)

Children with medical complexity are high users of acute health care, but little is known about their service use across the continuum of care services and in the context of overall health care expenditures.

Although accounting for <1% of the child population, children with medical complexity use almost one-third of all pediatric health care expenditures and make multiple transitions across providers and health care settings. (Read the full article)

Delayed meconium passage impairs gastrointestinal function in premature infants. No intervention has been identified that accelerates meconium passage sufficiently. Gastrografin is an osmotic contrast agent used for radiologic examination of the bowel or for conservative treatment of uncomplicated meconium ileus.

Gastrografin did not accelerate complete meconium evacuation but stimulated gastrointestinal motility in a randomized, placebo-controlled trial in premature infants. Application shortened the time to full enteral feedings and hospital stay but was associated with necrotizing enterocolitis as a possible adverse event. (Read the full article)

Prenatal cocaine exposure is associated with the trajectories of childhood behavior problems. Exposure effects may also be related to maternal use of other substances during pregnancy, and risk factors other than prenatal exposure may augment the detrimental cocaine effects.

The balance between cumulative risk and protective indexes predicts behavior outcomes, independent of prenatal drug exposure. A high protective index even with a high level of risks can mitigate the detrimental effects of drug exposure on behavior problem trajectory. (Read the full article)

Knowledge is limited regarding the epidemiology of persistent pulmonary hypertension of the newborn (PPHN). Previous work has implicated a host of perinatal risk factors and a few antenatal antecedents of PPHN, including maternal consumption during pregnancy of nonsteroidal antiinflammatory medications.

In contrast to results of previous studies, we found no association between PPHN and maternal consumption during late pregnancy of nonsteroidal antiinflammatory drugs in general or ibuprofen in particular. (Read the full article)