A significant number of children with Kawasaki disease develop coronary artery abnormalities, despite treatment with intravenous immunoglobulin. This systematic review and meta-analysis by Chen and coauthors seeks to examine the effect of adjunctive corticosteroid use in 16 studies involving 2746 cases. Adding corticosteroids to initial intravenous immunoglobulin therapy reduced the risk for coronary artery disease by 68%, but using it as rescue therapy was ineffective. Sundel鈥檚 editorial discusses the need for additional studies to define the subgroups in which treatment with corticosteroids is most beneficial.
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Inappropriate or excessive antibiotic use is associated with multiple adverse effects in very low-birth-weight infants. This cohort study by Ting and coauthors from the Canadian Neonatal Network examines use in neonatal intensive care units across Canada between 2010 and 2014. Higher antibiotic use rates were associated with neonatal morbidities and mortality in infants without culture-proven sepsis or necrotizing enterocolitis. The accompanying editorial by Mukhopadhyay and Puopolo discusses the need to adopt a quality improvement approach to antibiotic use in the neonatal intensive care unit and the need for prospective empirical studies on antibiotic use in this population.
Outcomes of neonates with congenital diaphragmatic hernia are primarily driven by the degree of pulmonary hypoplasia and pulmonary hypertension. Putnam and coauthors for the Congenital Diaphragmatic Hernia Study Group examine inhaled nitrous oxide use in 3367 patients. Use varied from 0% to 100% of infants, with a mean use of 62.3%. Using propensity score analysis, treatment with inhaled nitrous oxide was associated with a 15% higher mortality rate. Current data do not support its use in this disease.
Most children and adolescents have media devices in their sleep environment. Carter and coauthors examine 20 studies involving 125鈥�198 children and the effect of device access and use on sleep quality. Bedtime device use and access to these devices in the sleep environment were associated with inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. Czeisler and Shanahan鈥檚 editorial discusses the need for health care professionals and others to guide parents on appropriate bedtime routines.
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Although most children recover quickly from concussion, approximately 30% experience persistent postconcussion symptoms. This cohort study by Novak and coauthors enrolled children ages 5 to 18 years presenting to the emergency department within 48 hours of sustaining a concussion. Children with persistent symptoms reported lower health-related quality of life for up to 12 weeks after concussion vs those whose symptoms resolved within the first 4 weeks after injury. The editorial by Polster, Giza, and Babikian discusses the implications of this study for clinical decision making in the care of youths with concussion.