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Sugar-Sweetened Beverages and Weight Gain in

2- to 5-Year-Old Children

Sugar-sweetened beverage (SSB) consumption in school-age children and adolescents is linked to heavier weight, and de-creased SSB consumption results in less weight gain. Reports regarding these associations among children aged 2 to 5 years have been mixed.

Preschool-aged and kindergarten children drinking SSB com-pared with infrequent/nondrinkers had higher BMI_zscores. SSB consumption is also associated with higher weight status among children aged 2 to 5 years.

Pneumococcal Meningitis in Children:

Epidemiology, Serotypes, and Outcomes From

1997

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2010 in Utah

The incidence of pediatric pneumococcal meningitis has de-clined after introduction of the 7-valent pneumococcal conju-gate 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 per-cent 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.

Measuring Hospital Quality Using Pediatric

Readmission and Revisit Rates

Readmissions have been identiﬁed as a priority area for pe-diatric inpatient quality measurement nationally. However, it is

unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identiﬁed as high-or low-perfhigh-ormers.

Only a few hospitals that care for children are high- or low-performers when their condition-speciﬁc revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-speciﬁc readmission or revisit meas-ures in pediatric quality measurement.

Use of Urine Testing in Outpatients Treated for

Urinary Tract Infection

The diagnosis of urinary tract infection (UTI) is conﬁrmed by urine testing with urinalysis and culture. No study has char-acterized the use of urine testing in the setting of empirical antibiotic prescription for outpatient UTI in children.

Urine tests are not performed in a substantial percentage of antibiotic-treated pediatric UTIs. Additional research is nec-essary to determine whether empirical antibiotic prescription for UTI in children without urine testing is safe and effective.

Pediatrician Identi

ﬁ

cation of Latino Children at

Risk for Autism Spectrum Disorder

Latino children are diagnosed with autism spectrum disorders (ASDs) less often and later than white children. Primary care pediatricians (PCPs) may play an important role in early ASD identiﬁcation for Latinos.

PCPsﬁnd it more difﬁcult to assess for ASDs in Latinos with Spanish primary language, view Latino parents as less knowledgeable about ASDs, and experience frequent barriers

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to the hospital with skin and soft tissue infections. The yield of blood cultures in this condition is unknown.

Blood cultures are not useful in children admitted to the hospital with uncomplicated skin and soft tissue infections, and they may be associated with increased length of hospital stay.

Natural History of Stuttering to 4 Years of Age: A

Prospective Community-Based Study

Stuttering is extremely common, with 8.5% of children affected by age 3 years in a prospective community-ascertained cohort of Australian children. The natural history and comorbidities of early stuttering are uncertain at the population level.

The cumulative incidence of stuttering was 11% by 4 years. Stuttering children were similar in temperament and social-emotional development but had better verbal and nonverbal skills than their peers. Recovery from stuttering was low; 6.3% 12 months after onset.

Gender Differences in Physiologic Markers and

Health Behaviors Associated With Childhood Obesity

The number of overweight and obese children has dramatically increased in recent decades. To combat this trend, information on possible gender-related differences in risk factors of overweight and obesity is critical.

This study examines associations of gender and physiologic and behavior measurements with potential cardiovascular risk. Lunch consumption and screen time were associated with weight; however, other associations with weight differ by gender. This information can be used to tailor future inter-ventions.

Functional Abdominal Pain in Childhood and

Long-term Vulnerability to Anxiety Disorders

At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood.

This prospective study showed that pediatric FAP was asso-ciated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted,

that is associated with an increased risk of adverse obstetric outcomes.

This study adds knowledge on potential long-term con-sequences 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.

Screening Strategies for Hip Dysplasia: Long-term

Outcome of a Randomized Controlled Trial

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 radiographicﬁndings indicating ace-tabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood.

Increased treatment rates were not associated with avascular necrosis.

Parent and Child Cigarette Use: A Longitudinal,

Multigenerational Study

Adolescents are likely to smoke if their parent(s) smoke. Little research uses prospective longitudinal data from parents and children to more conﬁdently document these intergenerational associations, alongside potential confounders (parental edu-cation) and mediators (school achievement, mental health, older sibling smoking).

Analyses of long-term multigenerational data show how diverse parental smoking trajectories inﬂuence child smoking, con-trolling for measured confounders. The risk of smoking is especially high among children residing with a persistent heavy smoking parent and an older sibling who smokes.

Use of Conventional and Novel Smokeless Tobacco

Products Among US Adolescents

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increasingly promoted to youth in the United States as an alternative to smoking.

Among US students in grades 6 through 12, 5.0% used snuff or chewing or dipping tobacco, whereas 2.2% used snus or dis-solvable tobacco products. Approximately two-thirds of smokeless tobacco users concurrently smoked combustible tobacco; risk perception of all tobacco products was protective of smokeless tobacco use.

Implementation of Critical Congenital Heart

Disease Screening in Minnesota

Pulse oximetry screening at 24 hours of age improves detection of critical congenital heart disease in asymptomatic newborns.

This study describes an initial experience with pulse oximetry screening for critical congenital heart disease and provides a strategy for preparing for state implementation of recent federal newborn screening recommendations.

Cost-Effectiveness of Routine Screening for Critical

Congenital Heart Disease in US Newborns

Critical congenital heart disease (CCHD) was recently added to the US Recommended Uniform Screening Panel for newborns.

Routine screening could cost an estimated additional $6.28 per newborn and $40 385 per life-year gained. The incremental cost of screening might be approximately $0.50 per newborn with reusable sensors. Future analysis of newborn screening programs may help reﬁne these projections.

Factors Associated With Late Detection of Critical

Congenital Heart Disease in Newborns

Newborns with critical congenital heart disease (CCHD) are at risk for cardiovascular collapse or death if discharged from the birth hospital without a diagnosis. Newborn screening aims to identify CCHD missed in prenatal and postnatal examinations.

Birth hospital nursery level and CCHD type were found to be associated with late CCHD detection. Routine newborn screening could conceivably reduce differences in the fre-quency of late diagnosis between birth hospital facilities.

Autistic Traits in Children With and Without ADHD

Studies examining the prevalence and associated features of autistic traits (ATs) in children with ADHD with exclusionary autism spectrum disorders suggest that children with ATs exhibit more severe social and interpersonal dysfunction reminiscent of the deﬁcits in children with autism spectrum disorders.

Our results suggest that ATs are overrepresented in ADHD children when compared with control subjects. They also suggest that the presence of ATs is associated with more severe psychopathology as well as more impaired interpersonal, school, family, and cognitive functioning.

Use of a Computerized Decision Aid for ADHD

Diagnosis: A Randomized Controlled Trial

Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deﬁcit/hyperactivity disorder (ADHD), ample evidence demon-strates that they continue to diagnose and treat this disorder suboptimally.

The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis in-cluding a prospect for higher quality of ADHD management in children.

ADHD and Learning Disabilities in Former Late

Preterm Infants: A Population-Based Birth Cohort

Previous studies have reported that former late preterm infants are at increased risk for future learning and behavioral problems; thus it has been suggested that their development be closely monitored.

This population-based study indicates that the risk for attention deﬁcit/hyperactivity disorder and learning disabilities may not be higher in former late preterm infants, and therefore in-tensive neurodevelopmental follow-up may not be required for all late preterm infants.

Bisphenol A and Chronic Disease Risk Factors in US

Children

Bisphenol A (BPA) is a known endocrine disruptor found in many products with which children come into contact. Although BPA in adults is associated with obesity, diabetes, and car-diovascular disease, little is known about its effects in children.

This study found that higher BPA levels are associated with obesity and abnormal waist circumference–to–height ratio in children.

Urinary Phthalates and Increased Insulin

Resistance in Adolescents

Phthalate exposure has been associated with insulin resistance in animal studies and cross-sectional studies of adults, but has not been studied in adolescents.

We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents. The association is

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Term neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost in-tervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants.

For term neonates born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth.

Rotavirus Vaccination of Very Low Birth Weight

Infants at Discharge From the NICU

Preterm and low birth weight infants are at increased risk of hospitalization due to rotavirus gastroenteritis, and rotavirus vaccine is immunogenic and well tolerated among these infants when provided at or after discharge from the NICU.

Many preterm infants with a birth weight of#1500 g are not eligible to receive rotavirus vaccination because they remain in the NICU beyond the upper age limit recommended for immunization. New strategies are needed.

Probiotic Administration in Early Life, Atopy, and

Asthma: A Meta-analysis of Clinical Trials

The intestinal microbiome may play a role in immune system maturation, and it has been postulated that early-life probiotic administration may reduce the risk of allergies and asthma in childhood. To date, however, results from clinical trials have been inconsistent.

In this meta-analysis, administration of probiotics in early life may reduce total immunoglobulin E level and protect against atopic sensitization but do not seem to protect against asthma/ wheezing. Future trials should carefully select probiotic strains and include longer follow-up.

Risk-Adjusted Hospital Outcomes for Children

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s

Surgery

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 mean-ingfully discriminate outcomes among over 20 participating institutions.

of Minor Blunt Head Trauma

Effective implementation of Pediatric Emergency Care Applied Research Network head trauma rules depends on their early application. As the registered nurse (RN) is often the ﬁrst to evaluate children with blunt head trauma, initial RN assess-ments will be an important component of this strategy.

We demonstrated fair to moderate agreement between RN and physician providers in the application of the Pediatric Emer-gency Care Applied Research Network head trauma rules. Ef-fective implementation strategies may require physician veriﬁcation of RN predictor assessments before computed tomography decision-making.

Two-Year Outcomes of a Randomized Controlled

Trial of Inhaled Nitric Oxide in Premature Infants

Bronchopulmonary dysplasia is associated with increased long-term neurodevelopmental and respiratory morbidity. In-haled 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 re-spiratory 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.

Visual Processing in Adolescents Born Extremely

Low Birth Weight and/or Extremely Preterm

Data available before the 1990s in addition to small studies with clinical populations have shown that ocular growth and de-velopment differ between extremely preterm and term-born children.

Contemporary data on long-term visual outcomes indicate that adolescents born extremely low birth weight and/or extremely preterm exhibit more visual sensory and perceptual morbidity than adolescents born at term.

Unexpected Relationship Between Tympanometry

and Mortality in Children With Nontraumatic Coma

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measurements of middle ear function in the absence of gross anatomic defects and clinical outcome among children with acute nontraumatic coma.

This study reveals an unexpected association between ab-normal middle ear function and death in childhood acute coma. Theseﬁndings call for more investigations on the relationship between middle and inner ear anatomy and function and in-tracranial dynamics and clinical outcomes.

Ethnic Differences in the Link Between Insulin

Resistance and Elevated ALT

Evaluating for elevations in alanine aminotransferase (ALT) is a common screening test for the presence of nonalcoholic fatty liver disease (NAFLD). NAFLD is less common among non-Hispanic blacks. Better predictors of NAFLD are needed to identify indi-viduals in most need of screening.

Relative to other ethnicities, metabolic syndrome and insulin resistance performed poorly at identifying non-Hispanic black

adolescents with ALT elevations. The presence of metabolic syndrome may therefore not be an adequate trigger for NAFLD screening. Triglyceride elevations performed similarly between groups in identifying ALT elevations.

Outcomes of Children With Severe

Bronchopulmonary Dysplasia Who Were Ventilator

Dependent at Home

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 aﬁrst estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were de-pendent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation.

See the table of contents of this issue to learn more about these articles.

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