Design, Setting, and Participants  Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941).

Main Exposure  Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester).

Main Outcome Measure  Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders.

Results  The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect).

Conclusions  Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.

Design  Quantitative and qualitative analysis of semi-structured one-on-one interviews.

Setting  The PICUs at 2 tertiary care hospitals.

Participants  English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week.

Intervention  Semi-structured one-on-one interviews.

Results  Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition.

Conclusion  Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

Design  Thirty years of longitudinal data from the Panel Study of Income Dynamics survey data set.

Setting  Nationally representative sample of the US population.

Participants  Approximately 90 000 childhood years of information are pooled together to create a series of life tables that span the ages of 1 to 20 years.

Main Outcome Measure  Self-reporting measure of whether survey households received the Food Stamp Program during the prior year.

Results  Between the ages of 1 to 20 years, nearly half (49.2%) of all American children will, at some point, reside in a household that receives food stamps. Households in need of the program use it for relatively short periods but are also likely to return to the program at several points during the childhood years. Race, parental education, and head of household's marital status exert a strong influence on the proportion of children residing in a food stamp household.

Conclusions  American children are at a high risk of encountering a spell during which their families are in poverty and food insecure as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child's overall health.

Design  Case-control study.

Setting  Medical centers and a pregnancy care center in Reno, Nevada.

Participants  Participants (n = 14) were women who gave birth to infants with gastroschisis at either of the 2 medical centers in Reno, Nevada, from April 5, 2007, through April 4, 2008. Controls (n = 57) were selected from the same pregnancy center providing perinatal care to the cases and were matched 4:1 to the case mothers by maternal date of birth within 1 year.

Main Exposures  Environmental exposures and illnesses during pregnancy.

Outcome Measures  Association of gastroschisis with illnesses, medications, or environmental exposures.

Results  Gastroschisis was associated with the use of methamphetamine (odds ratio [OR], 7.15; 95% confidence interval [CI], 1.35-37.99) or any vasoconstrictive recreational drug (methamphetamine, amphetamine, cocaine, ecstasy) (OR, 4.46; 95% CI, 1.21-16.44) before pregnancy. When we limited self-reported illnesses to those occurring during the first trimester of pregnancy, chest colds (OR, 16.77; 95% CI, 1.88-150.27) and sore throats (OR, 12.72; 95% CI, 1.32-122.52) were associated with gastroschisis.

Conclusions  These findings add strength to the hypothesis that use of methamphetamine and related drugs is a risk factor for gastroschisis and raise questions about the risks associated with infections.

Design  Randomized, double-blind, controlled trial.

Setting  Single-center urban pediatric emergency department.

Participants  Infants younger than 12 months with mild to moderate bronchiolitis.

Interventions  Patients were randomized to receive nebulized racemic epinephrine in either hypertonic or normal saline.

Outcome Measures  The primary outcome measure was the change in respiratory distress, as measured by the Respiratory Assessment Change Score (RACS) from baseline to 120 minutes. The change in oxygen saturation was also determined. Secondary outcome measures included the rates of hospital admission and return to the emergency department.

Results  Forty-six patients were enrolled and evaluated. The 2 study groups had similar baseline characteristics. The RACS from baseline to 120 minutes demonstrated no improvement in respiratory distress in the hypertonic saline group compared with the normal saline control group. The change in oxygen saturation in the hypertonic saline group was not significant when compared with the control group. Rates of admission and return to the emergency department were not different between the 2 groups.

Conclusions  In the treatment of acute bronchiolitis, hypertonic saline and epinephrine did not improve clinical outcome any more than normal saline and epinephrine in the emergency setting. This differs from previously published results of outpatient and inpatient populations and merits further evaluation.

Trial Registration  isrctn.org Identifier: ISRCTN66632312

Design, Setting, and Participants  Cross-sectional, ecological analysis of 9268 seventh- and ninth-grade students in 19 public schools participating in The California Endowment's Healthy Eating Active Communities program.

Main Outcome Measures  Cardiorespiratory fitness (mile time) and body mass index. Independent variables included students' perceptions and behaviors related to daily physical activity opportunities, assessed via anonymous survey. Ecological analysis was used to link survey data with fitness and body mass index data within each school. Linear regression identified associations between youths' perceptions/behaviors and fitness/body mass index.

Results  As the proportion of students reporting enjoying physical education, walking to school, and spending 20 minutes or longer in exercise during physical education increased from 0% to 100%, mile time decreased overall (–2.7 minutes; P = .03), mile time decreased among seventh graders (–3.3 minutes; P = .02), and body mass index z scores decreased among ninth graders (–0.7; P = .045), respectively. Each additional day students reported being active on school grounds outside school hours was associated with decreased mile time (–0.5 minute; P = .02). Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit (odds ratio = 1.5; P < .001).

Conclusions  Physical education is a valuable policy opportunity to improve student health. Promoting active transport may improve fitness but must be done in conjunction with community partnerships to improve the food environment in the vicinity of schools. Promoting the use of school grounds outside school hours (such as after-school programs) should also be prioritized in response to youth obesity.

Design  We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood.

Setting  All participants in the study were residents of the United States enrolled in junior high school or high school during the 1994-1995 school year.

Participants  More than 20 000 adolescents from nationally representative data interviewed at wave I (1994-1995) and followed up in wave II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health when the sample was in early adulthood.

Main Exposures  Race/ethnicity, immigrant generation, and sex.

Outcome Measure  Body mass index.

Results  Findings indicate significant differences in both the level and change in BMI across age by sex, race/ethnicity, and immigrant generation. Females, second- and third-generation immigrants, and Hispanic and black individuals experience more rapidly increasing BMIs from adolescence into young adulthood. Increases in BMI are relatively lower for males, first-generation immigrants, and white and Asian individuals.

Conclusion  Disparities in BMI and prevalence of overweight and obesity widen with age as adolescents leave home and begin independent lives as young adults in their 20s.

Design  Transversal cohort study.

Setting  Hospital de São João and Hospital de Crianças Maria Pia, Porto, Portugal, between May 2006 and March 2007.

Participants  One hundred thirty-eight obese children and adolescents (62 boys; mean age, 10.8 years [range, 4-16 years]). Participants were grouped according to (1) apo E polymorphism: presence of the apo E alleles 2 or 4 in E2 (n = 11) and E4 (n = 31) carriers, respectively, or as E3/E3 (n = 94) (carriers of E2/E4 [n = 2] were excluded from apo E analysis because they carry both alleles) and (2) BMI z score: group 1, BMI z score less than 2 (n = 31); group 2, BMI z score of 2 or more and less than 2.5 (n = 65); and group 3, BMI z score of 2.5 or more (n = 42).

Main Outcome Measures  Lipid variable comparisons between apo E polymorphism and BMI z score groups and influence of BMI z score and adiponectin level, adjusted for apo E polymorphism, on total cholesterol to high-density lipoprotein cholesterol and apo A-I to apo B ratios.

Results  E4 carriers presented with a worse lipid profile when compared with E2 and E3/E3 carriers. There was also a clear risk of worsening for the group with the highest BMI z score. Apolipoprotein E polymorphism, BMI z score, and adiponectin level were significantly associated with total cholesterol to high-density lipoprotein cholesterol (standardized β coefficient = 0.283, 0.354, and –0.292, respectively; P < .001 for all) and apo A-I to apo B (standardized β coefficient = –0.372, –0.284, and 0.327, respectively; P < .001 for all) ratios.

Conclusion  Our data suggest a more atherogenic lipid profile for some apo E genotypes and for increasing BMI z score, whereas adiponectin level seems to play a protective role.

Design  The Fragile Families and Child Wellbeing Study, a prospective cohort study.

Setting  Data collected at home and by telephone from parents of children born from 1998 to 2000 from 20 cities.

Participants  Mothers who completed a 36-month in-home survey and met inclusion criteria (n = 3128).

Main Exposure  Direct child TV exposure and household TV use were the primary explanatory variables. Additional risk factors included neighborhood disorder and maternal factors like depression.

Outcome Measures  Childhood aggression was assessed with the Child Behavior Checklist/2-3. Multivariate linear regression models were used to examine associations between TV measures, additional risk factors, and childhood aggression.

Results  Children who were spanked in the past month (β = 1.24, P < .001), lived in a disorderly neighborhood (β = 2.07, P < .001), and had a mother reporting depression (β = 0.92, P < .001) and parenting stress (β = 0.16, P < .001) were significantly more likely to exhibit aggressive behavior. Direct child TV exposure (β = 0.16, P < .001) and household TV use (β = 0.09, P < .001) were also significantly associated with childhood aggression, even when controlling for other factors.

Conclusions  Three-year-old children exposed to more TV, both directly and indirectly, are at increased risk for exhibiting aggressive behavior. Further research is essential to determine whether pediatric recommendations concerning TV and children should include limits for general household TV use.

Design  Randomized controlled trial.

Setting  Home and center based.

Participants  Three hundred seventy-seven intervention (INT) and 608 nonintervention (NI) children, stratified by birth-weight categories 2001 to 2500 g and 2000 g or less.

Intervention  Educational intervention from nursery discharge until age 3 years.

Main Outcome Measures  Eight-year weight, height, head circumference, and body mass index.

Results  Complete data were available for 313 INT children and 491 NI children. Adjusting for child birth weight, birth-weight category, treatment group x birth-weight category interaction, sex, race, and Neonatal Health Index; maternal education and preconception weight; and site, the INT children at age 8 years were significantly taller (127.6 vs 126.6 cm; P = .02) and had a larger head circumference (52.5 vs 52.1 cm; P < .001) than the NI children. The prevalence of both overweight (9%) and underweight (4.5%) was the same in both treatment groups. Lighter low-birth-weight INT children had greater 8-year weight (28.0 vs 26.8 kg; P = .02), larger head circumference (52.6 vs 52.1 cm; P < .001), and larger height (127.6 vs 126.5 cm; P = .05) compared with their counterparts in the NI group.

Conclusion  Low-birth-weight preterm children, specifically the lighter low-birth-weight group, who received the Infant Health and Development Program educational intervention were heavier and taller and had greater head circumference compared with NI children in the same birth-weight category.

Data Sources  We searched PubMed for publications between March 1999 and March 2009 that created transcutaneous nomograms. We performed the same search among abstracts presented in the past 2 years at meetings of the Pediatric Academic Societies or the European Society for Paediatric Research.

Study Selection  Inclusion criteria were gestational age of at least 35 weeks among study subjects, the use of an electronic transcutaneous bilirubinometer, and creation of a nomogram based on hour-specific bilirubin values. Four articles met the selection criteria.

Data Extraction  Jaundice risk factors were analyzed, and raw data were analyzed using nonlinear regression to describe trends in bilirubin levels and kinetics. The bilirubin exaggerated rate of rise needed to cross percentile curves was calculated.

Data Synthesis  Significant differences in bilirubin values exist across populations, and there is substantial variability in rates of rise. Hispanic neonates demonstrate higher rates of rise and later plateaus. Bilirubin rates of rise tend to plateau and become null (equilibrium between bilirubin production and elimination) at about 96 hours of life. Rates of rise needed to cross percentile curves decrease over time but are lower (approximately 0.11 mg/dL/h [to convert bilirubin level to micromoles per liter, multiply by 17.104]) in the first 48 hours of life than previously thought.

Conclusions  Transcutaneous bilirubin levels plateau and then decrease after about 96 hours of life in healthy neonates, with some differences across populations. A bilirubin rate of rise higher than in the previous period implies that bilirubin production exceeds elimination and indicates high risk for subsequent hyperbilirubinemia in neonates.