Clinical and Experimental Pediatrics

Original Article

Neonatology (Perinatology)

Effect of high-frequency oscillatory ventilation with intermittent sigh breaths on carbon dioxide levels in neonates

Kulthida Baingam, Anucha Thatrimontrichai, Manapat Praditaukrit, Gunlawadee Maneenil, Supaporn Dissaneevate

Clin Exp Pediatr. 2025;68(2):178-184. Published online November 13, 2024

Question: Can sigh breaths (Sighs) application during high-frequency oscillatory ventilation (HFOV) decrease partial pressure of carbon dioxide (PaCO₂) levels?
Finding: The mean PaCO₂ level after Sighs during HFOV was significantly decreased compared to that after HFOV alone (mean difference, -3.6 mmHg).
Meaning: HFOV plus Sighs functionality can reduce PaCO₂ levels. However, further studies are required to conclusively determine the effects of Sighs.

DOI: https://doi.org/10.3345/cep.2024.01011

Developmental and Behavioral Medicine

Characteristics of temper tantrums in 1–6-year-old children and impact on caregivers

Warangkana Prutipaisan, Issarapa Chunsuwan, Tippawan Hansakunachai, Paskorn Sritipsukho

Clin Exp Pediatr. 2025;68(2):170-177. Published online November 13, 2024

Question: What are common tantrum behaviors in preschool children, and how frequently are problematic behaviors observed? Do problematic tantrums have a different emotional impact on caregivers compared to typical tantrums?
Finding: Temper tantrums are common in preschool children, and verbal tantrums are the most common type.
Meaning: Problematic tantrums, defined as tantrums exhibiting aggressive physical behavior, long duration (>15 minutes), or frequent occurrence (>3 days/wk), significantly affected caregivers’ emotions.

DOI: https://doi.org/10.3345/cep.2024.00766

Neurology

Evaluation of pediatric migraine triggers: a single-center study

Hey-Joon Son, Joo-Ok Jin, Kon-Hee Lee

Clin Exp Pediatr. 2025;68(2):163-169. Published online November 11, 2024

Question: What are the primary triggers for pediatric migraines, and how do they impact clinical management?
Finding: Common triggers for pediatric migraines include sleep disturbances, academic stress, and motion sickness, with academic stress identified as the most intense.
Meaning: Recognizing and addressing specific triggers like sleep disturbance and academic stress is crucial to effectively managing pediatric migraines with emphasis on personalized care to improve outcomes.

DOI: https://doi.org/10.3345/cep.2024.00738

Infection

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study

Huiling Zhang, Yilong Wang, Qianyun Ding, Xuekun Li, Sheng Ye

Clin Exp Pediatr. 2025;68(2):153-162. Published online November 11, 2024

· The mortality rate of acute necrotizing encephalopathy was high.
· Laboratory tests revealed that the fatal group had higher creatinine, lactate, activated partial thromboplastin time, thrombin time, interleukin (IL)-6, IL-10, creatine kinase, and D-dimer than survivors.
· The fatal group displayed lower Glasgow Coma Scale scores and arterial pH.

DOI: https://doi.org/10.3345/cep.2024.00794

Gastroenterology

Differences in immune cells and gene expression in human milk by parity on integrated scRNA sequencing

Dae Yong Yi, Hong-Jai Park, Min Sun Shin, Hyoungsu Kim, Sang Jin Lee, Insoo Kang

Clin Exp Pediatr. 2025;68(2):141-152. Published online January 10, 2025

Question: Is there a difference in immune cells in human breast milk by parity?
Finding: There were higher proportions of monocytes and T/B cells in the primiparous and multiparous group, respectively. The expression of genes with a direct role in the infant immune system and immune response-related genes were highest in the primiparous group
Meaning: There were parity-dependent differences in the expression of genes between innate and adaptive immune cells.

DOI: https://doi.org/10.3345/cep.2024.01585

Editorial

Hematology

Absolute versus functional iron deficiency

Hye Lim Jung

Clin Exp Pediatr. 2025;68(2):138-140. Published online November 13, 2024

· Iron deficiency (ID), the most common cause of anemia, can be classified into absolute and functional types. Absolute ID is a state of low total body iron, while functional ID is a state of imbalance between iron demand and iron availability due to inflammation and/or infection.
· ID is diagnosed by serum ferritin and transferrin saturation levels.

DOI: https://doi.org/10.3345/cep.2023.01732

Allergy

Effect of metabolic syndrome on pulmonary dysfunction in children with asthma

Hyo-Bin Kim

Clin Exp Pediatr. 2025;68(2):136-137. Published online November 13, 2024

· The prevalence of metabolic syndrome increased in Korean children during the coronavirus disease 2019 pandemic owing to reduced physical activity resulting from social distancing.
· Metabolic syndrome impacts pulmonary dysfunction in childhood asthma.
· Further studies are needed to understand the mechanism linking asthma and metabolic syndrome and develop interventions.

DOI: https://doi.org/10.3345/cep.2024.00360

Review Article

Gastroenterology

Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and meta-analysis

Duc Long Tran, Phu Nguyen Trong Tran, Paweena Susantitaphong, Phichayut Phinyo, Palittiya Sintusek

Clin Exp Pediatr. 2025;68(2):127-135. Published online November 13, 2024

Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD...

DOI: https://doi.org/10.3345/cep.2024.00927

General Pediatrics

Prevalence of childhood overweight and obesity in Malaysia: a systematic review and meta-analysis

Ker Yang Chua, Ker Yung Chua, Karuthan Chinna, Chooi Ling Lim, Maheeka Seneviwickrama

Clin Exp Pediatr. 2025;68(2):115-126. Published online November 13, 2024

The incidence of childhood obesity is increasing worldwide. National surveys in Malaysia have shown similar trends. This review aimed to increase our understanding of the prevalence and associated factors of childhood overweight, obesity, and excess weight in Malaysia. A systematic review and meta-analysis were conducted of studies reporting the prevalence of overweight and obesity in Malaysian children aged <18 years....

DOI: https://doi.org/10.3345/cep.2024.00899

Hematology

Promising role of voxelotor in managing sickle cell disease in children: a narrative review

Amit Agrawal, Gaurav Jadon, Japna Singh, Dalwinder Janjua

Clin Exp Pediatr. 2025;68(2):106-114. Published online November 13, 2024

Voxelotor has promising ability to increase hemoglobin levels and reduce hemolysis markers in patients with sickle cell disease (SCD). Several preclinical and phase II/III trials have demonstrated its efficacy, dose-dependent responses, and tolerability in children. Ongoing trials are assessing its safety and effectiveness in various populations, including children younger than 12 years. These findings suggest its potential as a disease-modifying drug, warranting further exploration of its role in SCD management.

DOI: https://doi.org/10.3345/cep.2024.00500

Letter to the Editor

Other

Adolescent hypertension and carotid intima-media thickness: significance of submillimetric differences

Christian Saleh

Clin Exp Pediatr. 2025;68(1):104-105. Published online November 28, 2024

DOI: https://doi.org/10.3345/cep.2024.01466

Original Article

Neurology

Instability of revised Korean Developmental Screening Test classification in first year of life

Ji Eun Jeong, You Min Kim, Na Won Lee, Gyeong Nam Kim, Jisuk Bae, Jin Kyung Kim

Clin Exp Pediatr. 2025;68(1):97-103. Published online November 11, 2024

Question: How stable are the revised Korean Developmental Screening Test score classifications in early infancy?
Finding: A significant number of infants improved into the peer and high-level group (≥-1 standard deviations), especially in the gross motor area.
Meaning: The early detection of developmental delay requires a comprehensive medical history, physical and neurological examinations, and repeated developmental screenings.

DOI: https://doi.org/10.3345/cep.2024.00619

Endocrinology

Efficacy of leuprolide acetate versus triptorelin pamoate administered every 3 months for treatment of central precocious puberty

Thanaporn Thaneetrakool, Suphab Aroonparkmongkol, Nattakarn Numsriskulrat, Vichit Supornsilchai, Suttipong Wacharasindhu, Khomsak Srilanchakon

Clin Exp Pediatr. 2025;68(1):91-96. Published online November 6, 2024

Question: What are the differences in efficacy between leuprolide acetate and triptorelin pamoate administered every 3 months for the treatment of central precocious puberty (CPP)?
Finding: There were no significant intergroup differences in luteinizing hormone suppression or predicted adult height at the end of treatment in girls with CPP.
Meaning: Leuprolide acetate and triptorelin pamoate have comparable efficacy for treating CPP.

DOI: https://doi.org/10.3345/cep.2024.00822

Pulmonology

Polysomnographic features of children with obesity: body mass index predict severe obstructive sleep apnea in obese children?

Rungrat Sukharom, Prakarn Tovichien, Kanokporn Udomittipong, Pinyapach Tiamduangtawan, Wattanachai Chotinaiwattarakul

Clin Exp Pediatr. 2025;68(1):80-90. Published online November 6, 2024

Question: How Common is obstructive sleep apnea (OSA) in obese children? OSA is common in obese children, even without habitual snoring.
Finding: Among the subjects, 60.6% had positional OSA, 40.2% had rapid eye movement-related OSA, 59.8% had desaturation, 20.5% had sleep-related hypoventilation, and 5.0% had obesity hypoventilation syndrome. Body mass index (BMI) and neck and waist circumferences were significantly associated with severe OSA.
Meaning: We recommend screening obese children (BMI > 29.2 kg/m²) for OSA.

DOI: https://doi.org/10.3345/cep.2024.00066

Neonatology (Perinatology)

Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebocontrolled randomized trial

Ameneh Lamsehchi, Maryam Shokouhi Solgi, Mohammad Kazem Sabzehei, Behnaz Basiri, Elahe Talebi Ghane, Kiana Kimiaei Asadi, Sina Azadnajafabad

Clin Exp Pediatr. 2025;68(1):73-79. Published online October 31, 2024

Question: What are the short-term outcomes of oropharyngeal administration of colostrum (OAC) in preterm neonates?
Finding: This study demonstrated the significantly lower rates of necrotizing enterocolitis, clinically suspected sepsis, shorter hospital stay, period to full enteral feeding, and antibiotic therapy period in the OAC group.
Meaning: This trial may further expand the clinical application of OAC in premature infants to reduce their length of hospital stay and complications.

DOI: https://doi.org/10.3345/cep.2024.00591

Infection

Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes

Setareh Mamishi, Reihaneh Hosseinpour Sadeghi, Sadaf Sajedi Moghaddam, Babak Pourakbari, Shiva Poormohammadi, Maryam Sotoudeh Anvari, Shima Mahmoudi

Clin Exp Pediatr. 2025;68(1):65-72. Published online October 31, 2024

Question: What is the prevalence of carbapenem resistance in gram-negative bacteria and associated carbapenemase genes?
Findings: This study identified a notable prevalence of carbapenem-resistant gram-negative isolates, with Escherichia coli being the predominant contributor, follow ed by Klebsiella pneumoniae, Acinetobacter baumannii, while bla _OXA48 was the most prevalent carbapenemase gene.
Meaning: These findings highlight the urgent need for proactive measures including the rapid detection of carbapenemase- producing isolates and effective infection control.

DOI: https://doi.org/10.3345/cep.2023.01774

Editorial

Cardiology

What we should know about pediatric heart failure: children are not small adults

Ja-Kyoung Yoon

Clin Exp Pediatr. 2025;68(1):62-64. Published online November 6, 2024

· Pediatric heart failure (PHF) features high morbidity and mortality rates.
· Although adults and children can share a common diagnosis of heart failure, the underlying causes can differ significantly and require distinct therapeutic approaches.
· Treatments designed for adults are often applied to PHF despite the fundamental physiological and developmental differences between them.
· Child-specific data are vital for the development of tailored treatments to meet the unique needs of patients with PHF.

DOI: https://doi.org/10.3345/cep.2023.01130

Review Article

Neonatology (Perinatology)

Need for national guidance regarding proactive care of infants born at 22–23 weeks' gestation

Ga Won Jeon

Clin Exp Pediatr. 2025;68(1):53-61. Published online November 13, 2024

With advancements in neonatal intensive care, the limit of viability has shifted to 22–23 weeks' gestation, whose survival rates vary across countries and institutions. These rates are not static and can be improved through the proactive and centralized care guided by national protocols, including maternal transfer to high-activity regions with better neonatal intensive care practices before delivery.

DOI: https://doi.org/10.3345/cep.2024.01277

Endocrinology

A review of vitamin D deficiency and vitamin D receptor polymorphisms in endocrine-related disorders

Nur Faten Hafizah Rosli, Noor Shafina Mohd Nor, Rose Adzrianee Adnan, Siti Hamimah Sheikh Abdul Kadir

Clin Exp Pediatr. 2025;68(1):30-52. Published online November 6, 2024

Crossref 1

· The prevalence of vitamin D deficiency is high among children and adolescents and mainly attributed to changes in environmental factors.
· Vitamin D hormone-like properties are associated with many endocrine-related disorders.
· The effect of vitamin D is modulated by the vitamin D receptor, polymorphisms of which are reportedly associated with an increased risk of disease development in children and adolescents.

DOI: https://doi.org/10.3345/cep.2024.00227

Other

Global trends in importance of 24-hour movement behaviors to pediatric health: implications for South Korea

Eun-Young Lee, Reyana Jayawardena, Seiyeong Park, Justin Y Jeon, Yeon-Soo Kim, Mark S. Tremblay

Clin Exp Pediatr. 2025;68(1):16-29. Published online November 11, 2024

· The 24-hour movement behavior paradigm provides an important framework for future pediatric health promotion efforts.
· Policy priorities should include advancing surveillance and monitoring assessments related to 24-hour movement behaviors, evaluating their implementation in school and government policies, and building preparedness for future pandemics and natural disasters, including climate change, by promoting healthy 24-hour movement behaviors.
· Future research should advocate for the promotion of 24- hour movement behaviors.

DOI: https://doi.org/10.3345/cep.2024.00178

Microplastic and human health with focus on pediatric well-being: a comprehensive review and call for future studies

Rogers Wainkwa Chia, Ntegang Venant Atem, Jin-Yong Lee, Jihye Cha

Clin Exp Pediatr. 2025;68(1):1-15. Published online November 6, 2024

· Milk and formula are common sources of microplastic in infants.
· Water and air are the most common sources of microplastic pollution from infancy to adolescence.
· Microplastic use by children of all ages can cause cell damage and affect their health.
· Microplastics present in children can be quantified using a stereomicroscope and characterized using micro- Fourier transform infrared spectroscopy.

DOI: https://doi.org/10.3345/cep.2023.01739

Clinical Note

Oncology

Right ventricular mass in a 10-year-old girl with osteosarcoma: an unusual case of asymptomatic cardiac metastasis

Jun Ah Lee, Hyun-Ju Lim, Jong Woong Park, Sang-Hoon Shin, Mi Hyang Kwak

Clin Exp Pediatr. 2024;67(12):725-727. Published online November 26, 2024

DOI: https://doi.org/10.3345/cep.2024.00857

Original Article

Other

Balance assessment with decreased base of support for children with disabilities

Guilherme M. Cesar, Madison Giebler, Thad W. Buster, Judith M. Burnfield

Clin Exp Pediatr. 2024;67(12):718-724. Published online November 11, 2024

Question: Can a balance task with narrowed base of support indicate overall functional balance control in children with disabilities?
Finding: While single-limb standing could explain overall balance control for children with disabilities, it was unrelated with balance control for typically developing children.
Meaning: One balance task with narrowed base of support can be used as practical assessment of balance abilities for children with disabilities when allocated session time is of concern.

DOI: https://doi.org/10.3345/cep.2024.00780

Infection

Clinical, biochemical, and genetic study of TACE/TNF-α/ACE signaling pathway in pediatric COVID-19 infection

Ahmed El-Abd Ahmed, Sawsan M.A. Abuhamdah, Mohammed H. Hassan, Nagwan I. Rashwan, Eman A. Abd-Elmawgood, Haggagy Mansour, Hoda S. Sherkawy, Shymaa G. Rizk

Clin Exp Pediatr. 2024;67(12):704-717. Published online November 27, 2024

Question: Is the tumor necrosis factor (TNF) signaling pathway (TNF-α-converting enzyme [TACE]/TNF-α/angiotensin converting enzyme [ACE]) involved in pediatric coronavirus disease 2019 (COVID-19) infection?
Finding: Significantly increased circulating TACE/TNF-α and decreased ACE2 levels were noted. TNF-α-308G/A plays a significant role in susceptibility to COVID-19 infection among children. The ACE (I/D) (rs4646994) and ACE2 (rs2285666) single nucleotide polymorphisms lack significant associations with pediatric COVID-19 infection.
Meaning: The TNF signaling pathway participates in pediatric COVID-19 infection.

DOI: https://doi.org/10.3345/cep.2024.00941

Cardiology

Comparative analysis of adolescent hypertension definitions for predicting early adulthood carotid artery intima-media thickness: Tehran lipid and glucose study

Maryam Barzin, Shirin Yaghoobpoor, Maryam Mahdavi, Behnaz Abiri, Majid Valizadeh, Fereidoun Azizi, Pooneh Dehghan, Farhad Hosseinpanah

Clin Exp Pediatr. 2024;67(12):694-703. Published online September 12, 2024

Crossref 1

Question: What is the prevalence of HTN among adolescents enrolled in the TLGS according to 3 different accepted definitions (4th report, ESH, and AAP-CPG). Also, what is the ability of each of these definitions in predicting early adulthood CIMT, as a surrogate for cardiovascular disease events?
Finding: The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. The highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively.
Meaning: Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG.

DOI: https://doi.org/10.3345/cep.2024.00248

General Pediatrics

Role of proper postnatal care in continued exclusive breastfeeding among young Indonesian mothers

Wahyu Triadmajani, Shinta Prawitasari, Abdul Wahab

Clin Exp Pediatr. 2024;67(12):686-693. Published online September 12, 2024

Question: Is proper postnatal care (PNC) associated with exclusive breastfeeding (EBF) practice among young Indonesian mothers?
Finding: Proper PNC elevates the likelihood of EBF among Indonesian adolescent mothers aged 15–19 years.
Meaning: Breastfeeding services should be provided during the early postnatal period to support EBF practice among adolescent mothers. High-quality PNC is a tailored intervention for vulnerable populations.

DOI: https://doi.org/10.3345/cep.2024.00815

Nonpharmacological interventions for managing postoperative pain and anxiety in children: a randomized controlled trial

Edlin Glane Mathias, Mamatha Shivananda Pai, Vijay Kumar, Dinesh Narayanakurup, Malavika Kulkarni, Vasudeva Guddattu, Ann-Cathrine Bramhagen, Baby S Nayak, Anice George

Clin Exp Pediatr. 2024;67(12):677-685. Published online October 31, 2024

Question: What is the effect of nonpharmacological interventions on postoperative pain and anxiety among children.
Finding: Nurse-provided distraction interventions reduce pain and anxiety among pediatric surgical patients.
Meaning: The findings suggest that nonpharmacological interventions provided postoperatively to children reduce their pain and anxiety levels.

DOI: https://doi.org/10.3345/cep.2023.01690

Editorial

Allergy

Comorbidities of allergic rhinitis in children

Yong Ju Lee

Clin Exp Pediatr. 2024;67(12):675-676. Published online July 31, 2024

· Allergic rhinitis in children often goes undiagnosed or untreated, with significant systemic complications like sleep disorders, growth issues, and gastrointestinal symptoms linked to nasal obstruction.
· A patient-centered action plan that considers symptom severity, preferences, and comprehensive management of associated complications is essential for effective treatment.

DOI: https://doi.org/10.3345/cep.2024.00164

Advancements in food allergen immunotherapy: improving quality of life and reducing risks

Jihyun Kim

Clin Exp Pediatr. 2024;67(12):672-674. Published online July 31, 2024

· Pediatric food allergies considerably impair patient and family quality of life, particularly those with persistent allergies to common food allergens.
· Recent research has focused on developing diverse approaches to food allergen immunotherapy, showing promising outcomes of oral, sublingual, and epicutaneous immuno therapies.
· Critical considerations in immunotherapy candidate selection underscore the need for personalized approaches and reliable biomarkers in future studies to improve treatment outcomes.

DOI: https://doi.org/10.3345/cep.2023.01718

Review Article

Adolescence Medicine

Ji-Hyun Seo, Sochung Chung

Clin Exp Pediatr. 2024;67(12):664-671. Published online October 31, 2024

· Diet behaviors in children and adolescents are influenced by environmental and sociocultural factors.
· Unhealthy diet behaviors and poor diet quality are the main contributing factors to noncommunicable diseases and mental health problems during childhood and adolescence.
· Smoking and alcohol drinking in children and adolescents may be associated with unhealthy diet behavior or poor diet quality.

DOI: https://doi.org/10.3345/cep.2023.01634

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