Clinical and Experimental Pediatrics

Original Article

General Pediatrics

Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review

Preyal D. Jain, Akshatha Nayak, Shreekanth D. Karnad, Kaiorisa N. Doctor

Clin Exp Pediatr. 2022;65(3):142-149. Published online June 11, 2021

Question: What are the primary motor and balance dysfunctions in children with Down syndrome?
Finding: These individuals have gross delays, altered balance, and inefficient compensatory mechanisms.
Meaning: Neuromuscular and musculoskeletal impairments due to the chromosomal abnormality lead to developmental delay. These children also exhibit poor balance with greater instability and inefficient compensatory mechanisms including altered center of pressure displacement and trunk stiffening that predisposes them to falls.

DOI: https://doi.org/10.3345/cep.2021.00479

Pulmonology

Modified high-flow nasal cannula for children with respiratory distress

Sarocha Itdhiamornkulchai, Aroonwan Preutthipan, Jarin Vaewpanich, Nattachai Anantasit

Clin Exp Pediatr. 2022;65(3):136-141. Published online May 24, 2021

Question: Can the modified high-flow nasal cannula (HFNC) provide alternative respiratory support for children with acute respiratory distress?
Finding: A total of 74 patients were assigned to the modified or commercial HFNC groups. The intubation rate, length of hospital stay, and adverse events did not differ between the 2 groups.
Meaning: The modified HFNC can provide alternative respiratory support for pediatric respiratory distress.

DOI: https://doi.org/10.3345/cep.2020.01403

Neonatology (Perinatology)

Is fetal nuchal cord associated with autism spectrum disorder? A meta-analysis

Ensiyeh Jenabi, Maryam Ahmadi, Azam Maleki

Clin Exp Pediatr. 2022;65(3):131-135. Published online September 24, 2021

Crossref 1

Question: Is fetal nuchal cord a risk factor for autism spectrum disorder (ASD)?
Finding: Five articles (1 cohort, 4 case-control; total 3,088 children) were included in the present meta-analysis. Fetal nuchal cord was not a risk factor for ASD (odds ratio, 1.11; 95% confidence interval, 0.66–1.57). There was homogeneity among studies that reported a risk of ASD (I²=0.0).
Meaning: Fetal nuchal cord is not a risk factor for ASD.

DOI: https://doi.org/10.3345/cep.2021.00514

Developmental and Behavioral Medicine

Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis

Siyoung Choe, Jaesin Sa, Jean-Philippe Chaput, Deokjin Kim

Clin Exp Pediatr. 2022;65(2):98-107. Published online November 23, 2021

Question: What is the overall effect of obesity interventions among Korean children and what affects their effectiveness?
Finding: Interventions were strongly favored over controls. Interventions including at least one physical activity component were significantly better than those that did not. Sex, age, baseline weight category, intervention duration, and the number of intervention components were not significant.
Meaning: Future obesity interventions for Korean children must seek to include physical activity components.

DOI: https://doi.org/10.3345/cep.2021.00409

General Pediatrics

Effect of maternal and child factors on stunting: partial least squares structural equation modeling

Agus Santosa, Essa Novanda Arif, Dinal Abdul Ghoni

Clin Exp Pediatr. 2022;65(2):90-97. Published online May 4, 2021

Web of Science 14 Crossref 20

Question: What effects do maternal and child factors have on stunting? Are there significant indicators of stunting?
Finding: Child and maternal factors had 49.8% and 30.3% effects on stunting, respectively. The primary child factor was infant formula dose, while the primary maternal factor was nutritional status.
Meaning: More attention to nutritional status during pregnancy and ensuring the appropriate dose of infant formula at ages 6–24 months can prevent stunting.

DOI: https://doi.org/10.3345/cep.2021.00094

Endocrinology

Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis

Azam Maleki, Saeid Bashirian, Ali Reza Soltanian, Ensiyeh Jenabi, Abdollah Farhadinasab

Clin Exp Pediatr. 2022;65(2):85-89. Published online April 15, 2021

Web of Science 6 Crossref 7

Question: Have polycystic ovary syndrome (PCOS) increased risk of having an offspring with attention-deficit/hyperactivity disorder (ADHD)?
Finding: Six articles (3 cohort and 3 case-control studies; 401,413 total ADHD cases) met the study criteria. Maternal PCOS was associated with an increased risk of ADHD in the offspring based on odds ratio (OR) and relative ratio (RR) (OR, 1.42; 95% confidence interval [CI], 1.27–1.57) and (RR, 1.43; 95% CI, 1.35–1.51), respectively.
Meaning: Our study showed that maternal PCOS is a risk factor for ADHD.

DOI: https://doi.org/10.3345/cep.2021.00178

Cardiology

Vasovagal syncope with mild versus moderate autonomic dysfunction: a 13-year single-center experience

Han Eoul Lee, Dong Won Lee

Clin Exp Pediatr. 2022;65(1):47-52. Published online June 1, 2021

Web of Science 1 Crossref 1

Question: It is well known that autonomic dysfunction contributes to vasovagal syncope (VVS). Does the degree of autonomic dysfunction contribute to clinical manifestations, diagnostic methods, treatment, and prognosis?
Finding: The clinical manifestations, diagnostic methods, treatment, and prognosis differ between patients with mild and moderate degrees of autonomic dysfunction.
Meaning: VVS is caused by autonomic dysfunction, but autonomic dysfunction severity need not be classified.

DOI: https://doi.org/10.3345/cep.2021.00052

General Pediatrics

Global relationship between parent and child obesity: a systematic review and meta-analysis

Ju Suk Lee, Mi Hyeon Jin, Hae Jeong Lee

Clin Exp Pediatr. 2022;65(1):35-46. Published online March 29, 2021

Web of Science 35 Crossref 39

Question: Are parent and child obesity correlated worldwide?
Finding: Overweight and obese status of parents and children were significantly associated worldwide. The association between parent and child obesity was stronger in Asia than in Europe and the Middle East, and in high-income than in middle- and low-income countries.
Meaning: Childhood obesity is highly influenced by parental weight status, indicating that parents could play an important role in its prevention.

DOI: https://doi.org/10.3345/cep.2020.01620

Infection

Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city

Mi Ae Chu, Yoon Young Jang, Dong Won Lee, Sung Hoon Kim, Namhee Ryoo, Sunggyun Park, Jae Hee Lee, Hai Lee Chung

Clin Exp Pediatr. 2021;64(12):652-660. Published online October 12, 2021

Web of Science 3 Crossref 4

Question: What is the natural course of viral load in children with coronavirus disease 2019 (COVID-19)?
Finding: A significant number of patients still had a relatively high viral load once clinically asymptomatic. Nearly half of the patients experienced viral rebound, which contributed to prolonged viral detection in their respiratory specimens.
Meaning: Further studies are needed to determine the clinical significance of viral rebound in asymptomatic or mild pediatric cases of COVID-19.

DOI: https://doi.org/10.3345/cep.2020.02033

General Pediatrics

Efficacy of probiotics for managing infantile colic due to their anti-inflammatory properties: a meta-analysis and systematic review

Reza Shirazinia, Ali Akbar Golabchifar, Mohammad Reza Fazeli

Clin Exp Pediatr. 2021;64(12):642-651. Published online April 12, 2021

Web of Science 6 Crossref 8

Question: Do probiotics reduce colic symptoms?
Finding: Probiotics reduced colic symptoms in colicky infants probably due to the anti-inflammatory properties.
Meaning: Probiotics may be an effective and less noxious way to manage infantile colic.

DOI: https://doi.org/10.3345/cep.2020.01676

Other

Spatial modeling of mortality from acute lower respiratory infections in children under 5 years of age in 2000–2017: a global study

Ali Almasi, Sohyla Reshadat, Alireza Zangeneh, Mehdi Khezeli, Raziyeh Teimouri, Samira Rahimi Naderi, Shahram Saeidi

Clin Exp Pediatr. 2021;64(12):632-641. Published online March 19, 2021

Question: We assessed the spatial modeling of mortality from acute lower respiratory infections in children under 5 years old during 2000–2017 using a global data.
Finding: The total number of child deaths during the study period decreased, while the number of hot spots increased among countries.
Meaning: Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot formed in Europe over the study period.

DOI: https://doi.org/10.3345/cep.2020.01438

General Pediatrics

Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia

Vivi Ninda Sutriana, Mei Neni Sitaresmi, Abdul Wahab

Clin Exp Pediatr. 2021;64(11):588-595. Published online March 15, 2021

Web of Science 14 Crossref 23

Question: Is the incidence of childhood pneumonia influenced by breastfeeding and basic immunization status?
Finding: Exclusive breastfeeding and complete basic immunization status have an effect in limiting the incidence of childhood pneumonia.
Meaning: While exclusive breastfeeding and complete basic immunization the Expanded Program on Immunization status are important factors for reducing the incidence of childhood pneumonia, indoor air pollution was also a significant risk factor.

DOI: https://doi.org/10.3345/cep.2020.00339

Cardiology

Assessment of cardiac function in syncopal children without organic causes

Heoungjin Kim, Lucy Youngmin Eun

Clin Exp Pediatr. 2021;64(11):582-587. Published online March 10, 2021

Crossref 1

Question: Does a subtle deterioration in cardiac function affect the severity of syncope in patients without underlying disease?
Finding: For syncope patients with reasonable cardiac function but without underlying disease, tissue Doppler imaging (TDI) measurements helped reveal subtle differences in cardiac function with syncope and predicted the severity of syncope or a potential recurrent event.
Meaning: TDI measurements might be a useful indicator for predicting the severity of syncope.

DOI: https://doi.org/10.3345/cep.2019.01046

Original article

Infection

The global prevalence of Toxocara spp. in pediatrics: a systematic review and meta-analysis

Behnam Abedi, Mehran Akbari, Sahar KhodaShenas, Alireza Tabibzadeh, Ali Abedi, Reza Ghasemikhah, Marzieh Soheili, Shnoo Bayazidi, Yousef Moradi

Clin Exp Pediatr. 2021;64(11):575-581. Published online February 5, 2021

Web of Science 10 Crossref 12

Is the global prevalence of toxocariasis high among children? The prevalence of toxocariasis is high in pediatric patients. Asian children are more susceptible to the disease than other children. Its virulence varies among different socioeconomic classes in various countries. Hand washing after soil contact, routine pet deworming, and appropriate disposal of pet feces in households with Asian pediatrics are needed to prevent toxocariasis.

DOI: https://doi.org/10.3345/cep.2020.01039

Original Article

Neurobehavior

Association between small for gestational age and risk of autism spectrum disorders: a meta-analysis

Ensiyeh Jenabi, Saeid Bashirian, Zahra Asali, Mahdieh Seyedi

Clin Exp Pediatr. 2021;64(10):538-542. Published online January 28, 2021

Web of Science 18 Crossref 19

• The relationship between small for gestational age (SGA) and autism spectrum disorders (ASDs) and remains conflicting.
• We showed based on odds ratio reports in epidemiological studies that SGA can increase the risk of ASD and SGA is a risk factor for ASD.
• The association between SGA and the risk of ASD has further momentum to the current public health emphasis on appropriate prepregnancy weight and weight gain during pregnancy

DOI: https://doi.org/10.3345/cep.2020.01956

Other

Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital

Muruganantham Balagurunathan, Thrilok Natarajan, Jothilakshmi Karthikeyan, Venkateshwaran Palanisamy

Clin Exp Pediatr. 2021;64(10):531-537. Published online August 4, 2021

Web of Science 8 Crossref 13

Question: What are the clinical spectrum, course, and short-term outcomes of multisystem inflammatory syndrome in children (MIS-C)?
Finding: MIS-C can have variable clinical manifestations. Fever is most common, followed by gastrointestinal and cardiovascular symptoms. Early identification and appropriate management lead to favorable outcomes.
Meaning: MIS-C can present in a myriad of ways and severities. High suspicion is necessary to ensure its early identification and appropriate management and favorable patient outcomes.

DOI: https://doi.org/10.3345/cep.2021.00374

Endocrinology

Correlation between total air pollutant emissions and incidence of type 1 diabetes in the Russian Federation

Hoon Sung Choi, Jin Taek Kim, Ji-Young Seo, Faina Linkov, Evgeniy Shubnikov, Hong Kyu Lee

Clin Exp Pediatr. 2021;64(10):525-530. Published online January 18, 2021

Web of Science 3 Crossref 4

Question: Is there a quantitative relationship between air pollutant emissions and the incidence of type 1 diabetes (T1D)?
Finding: The incidence of T1D in each region of the Russian Federation correlated with the total air pollutants emitted each year.
Meaning: These findings suggest that air pollution contributes to the development of T1D.

DOI: https://doi.org/10.3345/cep.2020.01501

Neurobehavior

Is there an association between labor induction and attention-deficit/hyperactivity disorder among children?

Ensiyeh Jenabi, Mahdieh Seyedi, Saeid Bashirian, Bita Fereidooni

Clin Exp Pediatr. 2021;64(9):489-493. Published online February 5, 2021

Web of Science 2 Crossref 3

· This meta-analysis pooled all observational (case-control and cohort) studies to obtain the association between labor induction and the risk of attention-deficit/hyperactivity disorder (ADHD) among children.
· The findings showed that labor induction is not associated with increased risk of ADHD among children.

DOI: https://doi.org/10.3345/cep.2020.01557

Allergy

Cohort profile: National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008)

Ju Hee Kim, Jung Eun Lee, So Min Shim, Eun Kyo Ha, Dong Keon Yon, Ok Hyang Kim, Ji Hyeon Baek, Hyun Yong Koh, Kyu Young Chae, Seung Won Lee, Man Yong Han

Clin Exp Pediatr. 2021;64(9):480-488. Published online January 5, 2021

Web of Science 47 Crossref 47

This national cohort study included all Korean children born in 2008 and 2009 observed over a period of more than 10 years. Our findings demonstrate that it is possible to analyze disease onset prior to hospitalization based on information such as lifestyle, eating habits, and risk factors by integrating National Health Insurance System data with national health screening data.

DOI: https://doi.org/10.3345/cep.2020.01284

Nutrition

Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery

Nehal El Koofy, Hadeer Mohamed Nasr Eldin, Wesam Mohamed, Mostafa Gad, Sara Tarek, Gamal El Tagy

Clin Exp Pediatr. 2021;64(9):473-479. Published online November 16, 2020

Web of Science 6 Crossref 8

Question: Is malnutrition a risk factor for postoperative complications in pediatric surgical patients?
Finding: There is a high incidence of malnutrition in pediatric surgical patients. Stunting increases the risks of postoperative complications and extended hospital stays, while underweight status contributes to extended hospital stays.
Meaning: Preoperative nutritional assessments are crucial to improving postoperative outcomes. Anemia increases the risk of postoperative complications and should be corrected preoperatively.

DOI: https://doi.org/10.3345/cep.2020.00458

Neonatology (Perinatology)

Effects of carnosine and hypothermia combination therapy on hypoxic-ischemic brain injury in neonatal rats

Jun Chul Byun, Seong Ryong Lee, Chun Soo Kim

Clin Exp Pediatr. 2021;64(8):422-428. Published online February 24, 2021

Web of Science 5 Crossref 6

Question: How can we further improve the neuroprotective effects of hypothermia in newborns with hypoxic-ischemic (HI) brain injury?
Finding: Combination carnosine and hypothermia therapy effectively reduced brain damage in neonatal rats. The in situ zymography, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, and immunofluorescence study results showed that neuroprotective effects were achieved with combination therapy only.
Meaning: Carnosine and hypothermia have synergistic neuroprotective effects against brain damage following HI injury

DOI: https://doi.org/10.3345/cep.2020.01837

Infection

Prevalence of methicillin-resistant Staphylococcus aureus in Iranian children: a systematic review and meta-analysis

Farhad Sarrafzadeh, Seyed Mojtaba Sohrevardi, Hamid Abousaidi, Hossein Mirzaei

Clin Exp Pediatr. 2021;64(8):415-421. Published online November 20, 2020

Web of Science 6 Crossref 5

The pooled prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 42% among culture-positive cases of S. aureus, 51% in hospitalized children, and 14% in healthy children. The high prevalence of MRSA in Iranian children may be due to insufficient infection control measures in hospitals, inappropriate use of methicillin, inadequate staff training, and over-prescription of antibiotics in Iran.

DOI: https://doi.org/10.3345/cep.2020.00255

Allergy

Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1–3 years

Jihyun Lee, Meeyong Shin, Bora Lee

Clin Exp Pediatr. 2021;64(8):408-414. Published online November 1, 2020

Web of Science 6 Crossref 6

Question: Is age at the time of complementary food introduction associated with asthma and atopic dermatitis (AD) in early childhood?
Finding: We found no significant association between age at the time of complementary food introduction and the incidence of AD and asthma in Koreans aged 1–3 years.
Meaning: Our findings suggest that the influence of individual allergenic foods on the development of AD and asthma should be clarified.

DOI: https://doi.org/10.3345/cep.2020.01382

Emergency Medicine

Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center study

Meraj Siddiqui, Ayşe Gültekingil, Oğuz Bakırcı, Nihal Uslu, Esra Baskın

Clin Exp Pediatr. 2021;64(7):364-369. Published online May 18, 2021

Web of Science 9 Crossref 7

Question: What are the differences between coronavirus disease 2019 (COVID-19) and influenza infections in children?
Finding: Pediatric COVID-19 patients predominantly exhibited respiratory and/or gastrointestinal symptoms, neurological manifestations, olfactory/gustatory dysfunction, elevated monocytes, mildly elevated C-reactive protein, and unilateral or diffuse abnormalities on chest x-ray. Patients with underlying medical conditions had higher intensive care unit admission rates and should be followed closely.
Meaning: The clinical presentations of pediatric COVID-19 patients varied from asymptomatic/mild to severe.

DOI: https://doi.org/10.3345/cep.2021.00066

Nephrology (Genitourinary)

Expression profiling of cultured podocytes exposed to nephrotic plasma reveals intrinsic molecular signatures of nephrotic syndrome

Stuti Panigrahi, Varsha Chhotusing Pardeshi, Karthikeyan Chandrasekaran, Karthik Neelakandan, Hari PS, Anil Vasudevan

Clin Exp Pediatr. 2021;64(7):355-363. Published online November 1, 2020

Web of Science 1 Crossref 1

Question: Is it possible to classify nephrotic syndrome (NS) through gene expression profiling of podocytes exposed to NS plasma?
Finding: Our data showed different expression profiles in podocytes exposed to nephrotic plasma from different clinical groups, suggesting the molecular stratification of patients into intrinsic subtypes.
Meaning: Transcriptome profiling of podocytes treated with NS plasma can stratify patients into intrinsic subtypes and provide insight into the molecular mechanisms of podocyte injury.

DOI: https://doi.org/10.3345/cep.2020.00619

Urinary neutrophil gelatinase-associated lipocalin: a marker of urinary tract infection among febrile children

Ji Hyun Moon, Kee Hwan Yoo, Hyung Eun Yim

Clin Exp Pediatr. 2021;64(7):347-354. Published online October 17, 2020

Web of Science 14 Crossref 12

Question: Reliably diagnosing urinary tract infection (UTI) in febrile children is often difficult. Can urinary neutrophil gelatinase-associated lipocalin (uNGAL) better predict UTI and acute pyelonephritis (APN) than serum C-reactive protein (CRP) and white blood cell (WBC) count?
Finding: uNGAL better facilitated the prediction of UTI and APN, than serum CRP and WBC counts in febrile children.
Meaning: uNGAL is a suitable biomarker for UTI and APN in febrile children.

DOI: https://doi.org/10.3345/cep.2020.01130

Developmental and Behavioral Medicine

Is meconium exposure associated with autism spectrum disorders in children?

Ensiyeh Jenabi, Erfan Ayubi, Salman Khazaei, Saeid Bashirian, Mojtaba Khazaei

Clin Exp Pediatr. 2021;64(7):341-346. Published online October 4, 2020

Crossref 1

• Meconium exposure is weakly associated with an increased risk of autism spectrum disorder (ASD) development in children.
• More evidence based on large prospective cohort studies is required to conclude whether meconium exposure is associated with an increased risk of ASD.

DOI: https://doi.org/10.3345/cep.2020.01053

Gastroenterology

Celiac disease in children: Increasing prevalence and changing clinical presentations

Hasan M. Isa, Eman Farid, Jaafar J. Makhlooq, Afaf M. Mohamed, Jumana G. Al-Arayedh, Fawzeya A. Alahmed, Shima Medani

Clin Exp Pediatr. 2021;64(6):301-309. Published online October 17, 2020

Web of Science 4 Crossref 5

Question: What are the prevalence and clinical characteristics of celiac disease (CD) in children in Bahrain?
Finding: We found a significant increase in CD prevalence over the last decade (P=0.0001). A male predominance was noted. Atypical presentations were common. Most patients had poor adherence to a gluten-free diet.
Meaning: CD is an underdiagnosed condition. Atypical symptoms should be considered to prevent missing patients with CD.

DOI: https://doi.org/10.3345/cep.2020.00304

Infection

Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

Woosuck Suh, Bi Na Kim, Hyun Mi Kang, Eun Ae Yang, Jung-Woo Rhim, Kyung-Yil Lee

Clin Exp Pediatr. 2021;64(6):293-300. Published online October 14, 2020

Web of Science 5 Crossref 7

Question: How has the antibiotic susceptibility of urinary pathogens changed and what does it imply?
Finding: A yearly increase in multidrug-resistant and extended-spectrum β-lactamase (ESBL)–producing pathogens was observed. A higher recurrence rate was observed in cases of febrile urinary tract infection caused by ESBL producers in patients with underlying vesicoureteral reflux (VUR).
Meaning: The initial empirical antibiotic should reflect the changing susceptibility patterns and underlying VUR status.

DOI: https://doi.org/10.3345/cep.2020.00773

Other

Association between pesticide and polychlorinated biphenyl exposure during pregnancy and autism spectrum disorder among children: a meta-analysis

Fereshteh Mehri, Saeid Bashirian, Salman khazaei, Ensiyeh Jenabi

Clin Exp Pediatr. 2021;64(6):286-292. Published online July 27, 2020

Web of Science 8 Crossref 4

· This meta-analysis analyzed the association between pesticide and polychlorinated biphenyl (PCB) exposure during pregnancy and autism spectrum disorders (ASD) risk among children.
· A significant association was noted between PCB and pesticide exposure during pregnancy and ASD risk among children (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.26–2.34 and OR, 1.20; 95% CI, 1.02–1.39), respectively.
· Pesticide and PCB exposure during pregnancy may affect ASD risk among children.

DOI: https://doi.org/10.3345/cep.2020.00864

Cited By 21	Neurodevelopmental outcomes of preterm infants
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Cited By 17	Association of gut microbiota with obesity in children and adolescents
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Cited By 16	Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

Original article