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Child Abuse and Neglect and Cognitive Function at
14 Years of Age: Findings From a Birth Cohort
Child abuse and neglect are associated with a range of
adverse outcomes including reduced academic performance.
Both abuse and neglect are Independently associated with
reduced cognitive performance at 14 years of age. We used
prospective follow-up of a birth cohort, independent recording
of child-maltreatment reports and substantiation, and
adjustment for multiple potential confounders.
Translation of a Pediatric Asthma-Management Program
Into a Community in Connecticut
Despite the initial release of the National Asthma Education
and Prevention Program asthma guidelines in 1991, primary
care clinicians do not adhere to the guidelines and continue to
underdiagnose and undertreat asthma in children.
An asthma-management program was transferred to 5
communities in Connecticut and resulted in reduced medical
services utilization. The study’s results demonstrate that
pediatricians can use guidelines, and, when used, guidelines
are effective in reducing medical services utilization for
Medicaid-insured children.
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Geographic Maldistribution of Primary Care for Children
Concerns about the sufficiency of the primary care workforce
have led to efforts to train more primary care physicians.
Inequitable distribution of the physician workforce, a long-
standing problem, has received less attention, particularly
with respect to children.
Despite pronounced growth of the primary care workforce for
children, millions of children live in areas with insufficient
local supplies of primary care physicians. More-effective
policies targeting adequate geographic access to primary
care are needed.
National Trends in Visit Rates and Antibiotic Prescribing
for Children With Acute Sinusitis
Streptococcus pneumoniae is a common cause of acute
sinusitis and otitis media, and American Academy of
Pediatrics guidelines recommend amoxicillin as the first-line
antibiotic therapy. Amoxicillin use for otitis media increased
after guideline publication, and visits decreased after vaccine
introduction.
Office and emergency department visits for acute sinusitis
remained stable after vaccine introduction, whereas
amoxicillin use increased substantially, in accordance with the
guidelines. Despite the increase in amoxicillin use,
prescriptions for broad-spectrum agents, especially
macrolides, remain common and unnecessary.
Clinical Prediction Rule for RSV Bronchiolitis in Healthy
Newborns: Prognostic Birth Cohort Study
Hospitalized respiratory syncytial virus (RSV) lower
respiratory tract infection (LRTI) can be predicted by using
host and environmental factors. The impact of outpatient-
treated RSV LRTI includes increased numbers of physician
visits, drug prescriptions, and parents’ missed work days.
A simple prediction rule can identify infants at risk of
outpatient-treated RSV LRTI. The absolute risks of RSV LRTI
range from 3% for children with the lowest prediction rule
score to 32% for children with all predictive factors.
Enhanced Monitoring Improves Pediatric Transport
Outcomes: A Randomized Controlled Trial
There has been a limited amount of research in the pediatric
interfacility-transport environment.
This study is the first randomized controlled trial in the out-of-
hospital pediatric transport environment.
Criminal-Justice and School Sanctions Against
Nonheterosexual Youth: A National Longitudinal Study
Nonheterosexual youth are vulnerable to a variety of health
risks. In addition, anecdotal reports have suggested that they
may be overrepresented among adolescents who have
received a variety of institutional sanctions.
This is the first study to use a nationally representative,
population-based sample to document that nonheterosexual
youth, particularly girls, have greater odds than their peers of
experiencing school and criminal-justice sanctions.
The Tiniest Babies: A Registry of Survivors With Birth
Weight Less Than 400 Grams
There have been isolated reports of single infants surviving
after birth at ⬍400 g. However, these reports have not been
compiled and summarized, and little is known about the early
health and development of these infants.
We have created a Web-based registry of survivors who
weighed ⬍400 g at birth. The Tiniest Babies Registry now
contains data on 110 infants. This report summarizes the
information submitted to the registry about this extraordinary
group of infants.
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Early-Childhood Neurodevelopmental Outcomes Are
Not Improving for Infants Born at <25 Weeks’
Gestational Age
Early-childhood neurodevelopmental outcomes seem to have
improved over the last decade for some groups of preterm
infants, but it is not known whether this trend applies to
extraordinarily preterm infants who are born at ⬍25 weeks’
estimated gestational age.
Despite a dramatic reduction in postnatal steroid exposure,
neurosensory and cognitive outcomes at 18 to 22 months’
corrected age remain guarded and unchanged for infants who
are born at ⬍25 weeks’ estimated gestational age in the
NICHD Neonatal Research Network between 2 recent birth
epochs.
Effects of Serving High-Sugar Cereals on Children’s
Breakfast-Eating Behavior
There are positive health benefits for children who consume
ready-to-eat cereals for breakfast; however, cereal companies
market their high-sugar products extensively to children,
which causes concern that eating these products contributes
to unhealthy levels of added sugar in children’s diets.
Results demonstrate the potential negative effects of serving
high-sugar cereal to children and how it affects their
consumption of cereal, added sugar, and fruit during
breakfast. In addition, they demonstrate that children like and
will eat low-sugar cereals as an alternative.
Adherence to the HPV Vaccine Dosing Intervals and
Factors Associated With Completion of 3 Doses
Vaccination to prevent human papillomavirus infection is safe
and effective. Rates of receiving all 3 doses after initiating
vaccination range from 42% to 60%, according to early
reports from managed health care organizations and the
Centers for Disease Control and Prevention.
We determined that few female patients received the second
and third human papillomavirus vaccine doses early, and
most girls received the second and third doses either late or
not at all. Race, health care use, and insurance were
associated with completion.

Tobacco-Smoke Exposure in Children Who Live in
Multiunit Housing
Exposure to secondhand tobacco smoke is an important cause
of morbidity and mortality among children, even at low levels
of exposure. In a recent national sample, 54% of children who
did not live with a smoker showed measurable amounts of
cotinine.
Children who live in homes in which no one smokes inside
have a 45% increase in cotinine levels if they live in
apartments compared with detached homes. Multiunit
housing may be a significant source of secondhand tobacco-
smoke exposure for children, at levels associated with
morbidity.
Effects of HEPA Air Cleaners on Unscheduled Asthma
Visits and Asthma Symptoms for Children Exposed to
Secondhand Tobacco Smoke
Exposure to secondhand smoke (SHS) is associated with
asthma exacerbations in children. Anticipatory guidance has
failed to reduce SHS in controlled trials. It is not known
whether high-efficiency, particle-arresting (HEPA) air cleaners
can reduce SHS or improve asthma symptoms in children.
HEPA air cleaners led to reductions in unscheduled asthma
visits and fine airborne particle levels but not asthma
symptoms or cotinine levels. HEPA air cleaners may be useful
as part of a multifaceted strategy to reduce asthma morbidity
among children.
Smoke-Free Air Laws and Asthma Prevalence, Symptoms,
and Severity Among Nonsmoking Youth
Smoke-free laws reduce exposure to secondhand smoke, as
measured by cotinine, in both adults and children. In adults,
smoke-free laws have been associated with reductions in
health outcomes such as respiratory symptoms and acute
myocardial infarctions, as well.
This study examined the association between smoke-free laws
and health in children and adolescents. Health outcomes that
have been associated with exposure to secondhand smoke in
children include prevalence of asthma, asthmatic symptoms,
asthma severity, and ear infection.
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Differential Growth Patterns Among Healthy Infants Fed
Protein Hydrolysate or Cow-Milk Formulas
The different classes of formulas, and different brands within
each class, vary in composition and flavor profiles, both of
which may influence feeding and growth patterns. Because
recent evidence suggests that, relative to intact proteins,
hydrolyzed proteins are absorbed and metabolized in a way
that promotes greater satiation, we conducted a randomized
study on healthy, formula-fed infants to determine whether
growth patterns and feeding behaviors differ on the basis of
formula type.
Not all formulas are alike. On the basis of World Health
Organization standards, z-score trajectories indicate that cow-
milk formula-fed infants’ weight gain was accelerated,
whereas protein-hydrolysate formula-fed infants’ weight gain
was normative.
Incidence of Neonatal Herpes Simplex Virus Infections in
the United States, 2006
Neonatal herpes simplex virus infections, although relatively
rare, cause significant morbidity and mortality. Incidence
estimates for neonatal herpes simplex virus from studies
conducted throughout the United States since the early 1980s
have ranged from 4.0 to 76.2 per 100 000 live births.
This report describes neonatal herpes simplex virus incidence
rates specific to regions and demographic groups across the
United States and provides important new information on the
extent of this potentially devastating disease.
Diarrhea-Associated Hospitalizations Among US Children
Over 2 Rotavirus Seasons After Vaccine Introduction
Before 2006, rotavirus was a significant cause of morbidity
among US children ⬍5 years of age. After the introduction of
rotavirus vaccine, many studies documented decreases in the
burden of severe diarrhea among US children during the
2007–2008 rotavirus season.
The reductions in diarrhea-associated hospitalizations
observed among US children in 2007–2008 were sustained in
2008 –2009. The consistency of the reductions over 2 rotavirus
seasons indicates that these changes likely are attributable to
the new rotavirus vaccination program.
Effect of Defibrillation Energy Dose During In-Hospital
Pediatric Cardiac Arrest
Cardiac arrest from ventricular fibrillation/pulseless
ventricular tachycardia (VF/pVT) cardiac arrest is an
important pediatric in-hospital problem. Historically, 2 J/kg
was effective for termination of VF/pVT, but recent case series
of human and animal pediatric defibrillation suggest that 2
J/kg is ineffective.
Two J/kg as the initial shock dose for in-hospital VF/pVT arrest
was substantially less effective than previously reported.
Four J/kg was not associated with increased termination of
VF/pVT or improved survival rates. The optimal pediatric
defibrillation dose remains unknown.
Longitudinal Study of Physical Activity and Sedentary
Behavior in Children
Levels of physical activity during childhood are expected to be
quite stable with age. Physical activity is believed to decline
markedly at adolescence, particularly for girls.
Physical activity declines before adolescence in both boys and
girls. Strategies to prevent the decline in physical activity
should be considered and started for both sexes before
adolescence.
Comparing the Tuberculin Skin Test and T-SPOT.TB Blood
Test in Children
Interferon-␥–release assays are blood tests that offer more
specificity for tuberculosis than the tuberculin skin test. The
performance of this test in children still is being studied.
This study adds more information on the utility of interferon-
␥–release assays for children with tuberculosis disease and
children in varying risk categories for latent tuberculosis
infection.
Prevalence of Noise-Induced Hearing-Threshold Shifts
and Hearing Loss Among US Youths
Voluntary exposure to loud noise may cause hearing loss and
increase the prevalence of hearing impairment among
adolescents. However, cross-sectional surveys of military
conscripts and young adults entering the work force have
revealed no differences in auditory thresholds between
cohorts.
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The overall prevalence of exposure to loud noise or listening
to music through headphones increased among adolescent
National Health and Nutrition Examination Survey participants
in 2005–2006, compared with 1988 –1994; the prevalence of
noise-induced threshold shifts among female youths
increased.
Use of Skeletal Surveys to Evaluate for Physical Abuse:
Analysis of 703 Consecutive Skeletal Surveys
The skeletal survey (SS) is part of the evaluation of suspected
physical abuse. Previous studies focused on the use of the SS
for children whom the diagnosis of abuse was strongly
suspected before completion of the SSs.
This is the first study to describe the use of SSs in a large,
consecutive population of children being evaluated because of
concerns regarding physical abuse.
Variation in Diagnosis of Apnea in Moderately Preterm
Infants Predicts Length of Stay
Apnea of prematurity is expected to be uncommon in
moderately preterm infants. Variation in its diagnosis because
of different monitoring or documentation practices may affect
length of stay in moderately preterm infants.
Using hospital-specific criteria for its diagnosis, we
demonstrated significant intrahospital variability in the
proportion of moderately premature infants diagnosed with
apnea. The proportion of infants diagnosed with apnea had a
substantial impact on site variability in length of stay.
Serum Dioxins and Polychlorinated Biphenyls Are
Associated With Growth Among Russian Boys
The disruption of childhood growth has been linked with
deleterious effects on health in both childhood and adulthood.
There is limited evidence from epidemiological studies that
prenatal and postnatal exposure to dioxins and
polychlorinated biphenyls affects childhood growth.
In this study serum dioxins and polychlorinated biphenyls
were measured in a cohort of Russian boys, who then
underwent follow-up examinations for 3 years. The results
showed that higher levels of serum dioxins and
polychlorinated biphenyls were associated with lower BMI and
linear growth.

Earliest Appropriate Time for Administering
Neurobehavioral Assessment in Newborn Infants
The recommended time for assessing infant neurobehavior
varies. For early-newborn examinations in hospitals, current
practice requires that the infant be examined within ⬃48
hours. It is not known how the amount of time since delivery
may affect the results.
We recommend 20 hours after delivery as the earliest
appropriate time for assessing newborn neurobehavior,
because it allows accurate assessment of newborn
neurobehavior that is less contaminated by the acute effects
of delivery.
Multicenter Crossover Study of Automated Inspired
Oxygen for Mechanically Ventilated Preterm Infants
Many extremely preterm infants spend considerable time
outside the intended arterial oxygen saturation range because
of their respiratory instability and often insufficient or
excessive oxygen supplementation, which increases the risk of
complications associated with hypoxemia and hyperoxemia.
The results show that, under routine conditions, automatic
adjustment of the fraction of inspired oxygen improves
maintenance of pulse oxygen saturation (SpO2) within an
intended range, primarily by avoiding high SpO2 levels, and
reduces oxygen concentration and staff workload.
Integrative Pediatric Care: Parents’ Attitudes Toward
Communication of Physicians and CAM Practitioners
The use of complementary and alternative medicine (CAM)
among children is prevalent in different countries. There have
been limited data on parents’ perspectives toward pediatric
CAM use and its meaning in terms of parent-doctor and
doctor–CAM-practitioner communication.
The study revealed that parents referred to conventional and
CAM clinics expressed distinctive attitudes toward CAM
integration in pediatric care and perceived physician–CAM-
practitioner communication as highly important in promoting
their children’s health and safety.
Association of Smoking Onset With R-Rated Movie
Restrictions and Adolescent Sensation Seeking
Evidence has shown that sensation seeking is positively
related and parental restrictions on R-rated movies are
negatively related to smoking onset in adolescence.
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The current study revealed that, beyond direct influences, the
relationship between adolescents’ sensation seeking and
parental R-rated movie restrictions in explaining smoking
onset is bidirectional in nature.
Intercenter Differences in Bronchopulmonary Dysplasia
or Death Among Very Low Birth Weight Infants
Bronchopulmonary dysplasia is a major cause of morbidity in
premature infants. Outcomes of most neonatal disorders,
including bronchopulmonary dysplasia, vary in incidence
across neonatal centers even after adjustment for
demographic and antenatal characteristics. The factors
responsible for such variation have not been systematically
evaluated.
Bronchopulmonary dysplasia/death rates were found to
demonstrate a moderate clustering effect according to center,
as did clinical variables associated with the outcome.
Persistent center differences after clustered variables were
corrected indicated the presence of as-yet unmeasured center
variables.
Tuberous Sclerosis Complex: Diagnostic Challenges,
Presenting Symptoms, and Commonly Missed Signs
Tuberous sclerosis complex (TSC) is an autosomal dominant
neurocutaneous disorder that is clinically diagnosed.
Diagnosis of TSC may be difficult because no single symptom
is present in all patients, and none are absolutely
pathognomonic.
Presenting symptoms and signs of TSC according to age
group, missed symptoms, and signs that did not lead to
diagnosis are described. Early diagnosis may reduce
morbidity and mortality in patients with TSC.
Prospective Validation of a Novel Strategy for Assessing
Risk of Significant Hyperbilirubinemia
Different risk assessment strategies have been developed to
determine which infants are at greater risk for developing
significant hyperbilirubinemia. Further refinement of such
strategies is needed to provide safe, cost-effective treatment
and follow-up care for these patients.
The present study has validated prospectively a novel strategy
for significant hyperbilirubinemia risk assessment, which
combines predischarge bilirubin percentile and gestational
age data.
Serum Transaminase Levels in Boys With Duchenne and
Becker Muscular Dystrophy
Failure to consider muscle as the origin of persistently high
serum transaminase levels has led to delayed diagnosis and
extensive testing. Even for patients with muscle disease
clinicians have been reluctant to attribute high levels of
alanine transaminase/aspartate transaminase to muscle
alone.
With this mathematical-modeling tool clinicians are provided
with a practical method to assist in interpretation of high
serum transaminase levels in patients with dystrophinopathy.
Breastfeeding Duration and Academic Achievement at
10 Years
It is not clear whether the benefits of breastfeeding on
cognitive development reflect nutritional or socioeconomic
advantages associated with breastfeeding. Some studies have
revealed no differences after adjusting for socioeconomic
status, and maternal verbal ability, whereas others have
shown the benefits.
Predominant breastfeeding for ⱖ6 months was positively
associated with numeracy and literacy achievement
independent of maternal and demographic factors and
cognitive stimulation at home. However, the effectiveness of
breastfeeding differed according to gender; benefits were only
evident for boys.
Economic Evaluation of Caffeine for Apnea of Prematurity
The Caffeine for Apnea of Prematurity Trial demonstrated that
caffeine-treated infants had improved survival rates without
neurodevelopmental impairment at 18 to 21 months’
corrected age compared with those in the placebo group. The
cost implications of this therapy have not been explored.
Caffeine is a cost-saving therapy compared with placebo,
despite the various underlying assumptions regarding unit
prices for medical services and caffeine in sensitivity
analyses. This effect is, in large part, attributed to the reduced
number of days on positive-pressure ventilation.
Pandemic H1N1 in Children Requiring Intensive Care in
Australia and New Zealand During Winter 2009
Pandemic influenza A H1N1-09 had a major and unexpected
impact on critical care worldwide. The Australia and New
Zealand influenza investigators previously reported the effect
of H1N1-09 on critical care in this region.
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This article details the impact of H1N1-09 in children who
required intensive care during the Southern Hemisphere
winter of 2009 and reveals important data that relate to risk
factors, comorbidities, and outcome in children younger than
16.
Predictors of Participant Dropout at Various Stages of a
Pediatric Lifestyle Program
It has been shown that children who drop out of a weight-
management program are more likely to be older, to have an
ethnic minority status, to self-report more depressive
symptoms, and to have lower self-concept scores.
The results of this study indicate that the predictors of
dropping out of treatment are different at various stages.
Some characteristics seem to require attention at an earlier
stage in the treatment to reduce dropout rates.
Excess Weight Loss in First-Born Breastfed Newborns
Relates to Maternal Intrapartum Fluid Balance
Excess weight loss is relatively common in term breastfed
infants, occurring in up to 16% of first-born infants in previous
studies. Delayed onset of lactogenesis and suboptimal infant
breastfeeding behavior were associated with excess weight
loss in multivariate analyses.
This study describes an independent association between
excess weight loss among breastfed infants and maternal
intrapartum fluid balance. The prevalence of excess weight
loss—19% of exclusively breastfed, demographically diverse,
first-born, term infants—was higher than previously reported.
Cord-Blood 25-Hydroxyvitamin D Levels and Risk of
Respiratory Infection, Wheezing, and Asthma
Recent study results have suggested that higher maternal
intake of vitamin D during pregnancy may lower the risk of
wheezing in offspring. The relationship between cord-blood
levels of 25-hydroxyvitamin D and risk of childhood respiratory
outcomes is unknown.
In a population-based birth cohort with excellent 5-year follow-
up, cord-blood 25-hydroxyvitamin D levels had significant
inverse associations with the risk of respiratory infection and
risk of childhood wheezing. In contrast, vitamin D had no
association with incident asthma.

Contrasting Parents’ and Pediatricians’ Perspectives on
Shared Decision-Making in ADHD
Shared decision-making (SDM) is recommended when
multiple evidence-based treatments exist and families value
options differently. Although national guidelines prioritize SDM
in attention-deficit/hyperactivity disorder, little is known
regarding how parents and clinicians understand and
implement SDM in practice.
We found that practical barriers limit the consideration of
evidence-based options in SDM, key participants often are
excluded from the process, and, although parents and
clinicians view SDM favorably, they understand SDM
differently. Implications for clinical practice are discussed.
Testosterone Levels in Umbilical-Cord Blood and Risk of
Pyloric Stenosis
Infantile hypertrophic pyloric stenosis is ⬃5 times more
common in male infants. The male hormone testosterone is
known to induce muscle hypertrophy, and the testosterone
levels are several-fold higher in male infants than female
infants.
This study is the first of its kind, and the results add new
insight to the etiology of pyloric stenosis. No evidence was
found to support the hypothesis that high testosterone levels
at birth are associated with an increased risk of pyloric
stenosis.
See the table of contents of this issue to learn more about these articles.
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Intrauterine Effects of Maternal Prepregnancy
Overweight on Child Cognition and Behavior in 2 Cohorts
Maternal prepregnancy overweight may be associated with
child behavioral problems, such as inattention-hyperactivity,
and lower intellectual function in offspring. However, few
studies have explored this issue, and it is unclear whether
associations, if replicated, reflect biological intrauterine
mechanisms.
In this study, maternal prepregnancy overweight was not
consistently associated with child behavioral problems or
measures of cognitive abilities. We found no strong evidence
of biological intrauterine mechanisms for these associations.
Adverse Events After the Use of Benznidazole in Infants
and Children With Chagas Disease
Treatment of Chagas disease with benznidazole in adults
leads to a high incidence of severe drug reactions. However,
benznidazole seems to lead to less frequent and less severe
adverse drug reactions (ADRs) in children, but there are
scarce data on this subject.
A cohort of children with Chagas disease treated with
benznidazole is described. A lower incidence of ADRs was
observed in smaller children and adults. All ADRs observed
were mild, and treatment response was excellent.
 Pediatrics Digest
Pediatrics 2011;127;D1
DOI: 10.1542/peds.digest1271

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 Pediatrics Digest
Pediatrics 2011;127;D1
DOI: 10.1542/peds.digest1271

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/127/1/D1

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.

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