Clinical and Experimental Pediatrics

Original Article

Neonatology (Perinatology)

Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India

Ritu Sharma, Shikha Seth, Rakhee Sharma, Sanju Yadav, Pinky Mishra, Sujaya Mukhopadhyay

Clin Exp Pediatr. 2021;64(5):239-246. Published online February 16, 2021

Question: Is there any risk of vertical transmission of coronavirus disease 2019 (COVID-19), and what is its neonatal profile?
Finding: Biological samples for vertical transmission were negative in all deliveries; however, 2 neonates tested positive for nasopharyngeal COVID-19 reverse transcription-polymerase chain reaction. No significant neonatal morbidity was observed.
Meaning: COVID-19 does not increase adverse neonatal outcomes and shows a negligible risk of vertical transmission; however, horizontal transmission cannot be underestimated.

DOI: https://doi.org/10.3345/cep.2020.01704

Allergy

Sex-based differences in factors associated with bronchial hyperresponsiveness in adolescents with childhood asthma

Young Hwan Kim, Yoon Young Jang, Jieun Jeong, Hai Lee Chung

Clin Exp Pediatr. 2021;64(5):229-238. Published online January 14, 2021

Web of Science 7 Crossref 7

Question: What factors are associated with bronchial hyperresponsiveness (BHR) in adolescents with childhood asthma?
Finding: Age, mold sensitization, and increased eosinophil count were associated with BHR in boys versus a reduced forced expiratory volume in 1 second/forced vital capacity ratio in girls. Early mold sensitization was a risk factor for persistent BHR in boys only.
Meaning: Sex-specific differences were observed in the factors associated with BHR in adolescents.

DOI: https://doi.org/10.3345/cep.2020.01585

Neonatology (Perinatology)

Predictive factors of death in neonates with hypoxic-ischemic encephalopathy receiving selective head cooling

Behnaz Basiri, Mohammadkazem Sabzehei, Mohammadmahdi sabahi

Clin Exp Pediatr. 2021;64(4):180-187. Published online August 27, 2020

Web of Science 8 Crossref 9

Question: What is the most important factor that increases mortality in infants with hypoxic-ischemic encephalopathy (HIE) who receive selective head cooling?
Finding: All cases of neonatal mortality were severe HIE (stage 3), and a severely abnormal amplitude-integrated electroencephalography and mortality were increased with the need for advanced neonatal resuscitation upon delivery.
Meaning: Advanced neonatal resuscitation affects HIE outcomes, and medical personnel should be prepared to provide the best intervention.

DOI: https://doi.org/10.3345/cep.2019.01382

Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis

Mahmoud Robati Anaraki, Masoud Nouri-Vaskeh, Shahram Abdoli Oskoei

Clin Exp Pediatr. 2021;64(4):172-179. Published online May 14, 2020

Web of Science 12 Crossref 12

· Mortality is decreased significantly in meta-analysis of studies in different regimen of fluconazole prophylaxis.
· Significant decrease was seen in incidence of invasive candidiasis-associated mortality in extremely low birth weight infants in same schedules of prophylaxis.
· More studies required to relief the concerns.

DOI: https://doi.org/10.3345/cep.2019.01431

General Pediatrics

Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study

Sody A. Naimer, Ariel Israel, Aviezer Gabbay

Clin Exp Pediatr. 2021;64(3):130-135. Published online September 7, 2020

Web of Science 5 Crossref 7

Question: Does a tethered maxillary frenulum in the newborn result in breastfeeding difficulty or other oral symptomatology?
Finding: The analysis of subjects with a tethered maxillary frenulum surveyed beyond a mean 5-year follow-up did not reveal an increase in oral issues versus those of a random agematched control group.
Meaning: These data demonstrate no need to intervene upon the diagnosis of a tethered maxillary frenulum.

DOI: https://doi.org/10.3345/cep.2020.00486

Critical Care Medicine

Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?

Chanapai Chaiyakulsil, Onsuthi Pharadornuwat

Clin Exp Pediatr. 2021;64(3):123-129. Published online July 14, 2020

Web of Science 12 Crossref 11

Question: Can central line bundles and feedback reduce central line-associated complications in pediatric patients?
Finding: The central line-related bloodstream infection rate decreased from 10.0 catheter-days to 1.4/1,000 catheter-days at 6-month postintervention. The central line occlusion rate was also decreased.
Meaning: Reinforcing central line care bundles with direct feedback can significantly decrease central line-associated complications in pediatric patients.

DOI: https://doi.org/10.3345/cep.2020.00143

Hematology

Changes in the prevalence of anemia in Korean adolescents, 1998–2018

Jun Young An, Yoo Rha Hong, Seom Gim Kong

Clin Exp Pediatr. 2021;64(2):86-92. Published online November 16, 2020

Web of Science 2 Crossref 2

Question: Over the past 21 years, has the prevalence of anemia decreased among Korean adolescents?
Finding: The prevalence of anemia in boys aged 10–18 years decreased from 3.0% to 0.5% over the study period, whereas that in girls did not change significantly over time (increased from 7.9% to 8.5%).
Meaning: The prevalence of anemia in female adolescents remains high, requiring attention and efforts to improve it.

DOI: https://doi.org/10.3345/cep.2020.01508

Gastroenterology

Value of the International Classification of Diseases code for identifying children with biliary atresia

Pornthep Tanpowpong, Chatmanee Lertudomphonwanit, Pornpimon Phuapradit, Suporn Treepongkaruna

Clin Exp Pediatr. 2021;64(2):80-85. Published online August 24, 2020

Web of Science 1 Crossref 1

Question: What is the value of the diagnostic code in identifying cases of biliary atresia in a large administrative database?
Finding: The diagnostic code’s accuracy and sensitivity are acceptable for identifying algorithm-defined cases. A history of pale stool and a presumed diagnosis of biliary atresia prior to referral added value.
Meaning: The addition of clinical data to the diagnostic code significantly increased the diagnostic yield.

DOI: https://doi.org/10.3345/cep.2020.00423

Neonatology (Perinatology)

The protective effect of CXC chemokine receptor 2 antagonist on experimental bronchopulmonary dysplasia induced by postnatal systemic inflammation

Seung Hyun Lee, Chang Won Choi

Clin Exp Pediatr. 2021;64(1):37-43. Published online July 15, 2020

Web of Science 3 Crossref 3

Question: Can CXC chemokine receptor 2 (CXCR2) antagonist preserve alveolarization by attenuating the inflammation induced by systemic lipopolysaccharide (LPS) administration in a rat model of bronchopulmonary dysplasia (BPD)?
Finding: CXCR2 antagonist significantly decreased neutrophil counts in bronchoalveolar lavage fluid and peripheral blood induced by systemic LPS administration and restored alveolarization in newborn rats.
Meaning: CXCR2 antagonist protected the lungs from the inflammation in a rat model of BPD.

DOI: https://doi.org/10.3345/cep.2020.00381

Gastroenterology

Noninvasive markers for esophageal varices in children with cirrhosis

Parisa Rahmani, Fatemeh Farahmand, Ghobad Heidari, Azadeh Sayarifard

Clin Exp Pediatr. 2021;64(1):31-36. Published online July 21, 2020

Web of Science 8 Crossref 9

Question: Can noninvasive biomarkers identify esophageal varices among children with esophageal cirrhosis?
Finding: The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index, platelet count to spleen size ratio, and risk score differed significantly between the patients with and those without esophageal varices.
Meaning: These biological parameters can predict esophageal varices among pediatric patients and indicate the need for esophagogastroduodenoscopy.

DOI: https://doi.org/10.3345/cep.2019.01599

Nephrology (Genitourinary)

Sonographic renal length and volume of normal Thai children versus their Chinese and Western counterparts

Chantima Rongviriyapanich, Thanarat Sakunchit, Chirawat Sudla, Supamas Mungkung, Napapong Pongnapang, Chai Hong Yeong

Clin Exp Pediatr. 2020;63(12):491-498. Published online July 13, 2020

Crossref 4

Question: What is the normal renal size of Thai children and is the renal nomogram comparable to those of Western and Chinese cohorts?
Finding: The renal length of Thai children was moderately correlated with that of Western children, while the age-specific renal volume was significantly smaller than that of Chinese children.
Meaning: Renal size in children can vary among regions and sociodemographic backgrounds; hence, a local reference standard is needed.

DOI: https://doi.org/10.3345/cep.2019.01676

Gastroenterology

Evaluating the effects of probiotics in pediatrics with recurrent abdominal pain

Parisa Rahmani, Azin Ghouran-orimi, Farzaneh Motamed, Alireza Moradzadeh

Clin Exp Pediatr. 2020;63(12):485-490. Published online July 21, 2020

Web of Science 16 Crossref 17

Question: ecurrent abdominal pain (RAP) is a chief complaint among pediatrics and is associated with reduced quality of life, for both parent and child, and economic burden. Does probiotics reduce the frequency of RAP among children?
Finding: This study reported the effects of Lactobacillus reuteri probiotics among children with RAP as a result of multiple etiologies.
Meaning: The administration of probiotic supplements is significantly associated with pain relief among RAP children presented with functional abdominal pain, irritable bowel syndrome, and functional dyspepsia.

DOI: https://doi.org/10.3345/cep.2019.01613

Acquired noncaustic esophageal strictures in children

Elif Sag, Aysenur Bahadir, Mustafa Imamoglu, Sefa Sag, Gokce Pinar Reis, Erol Erduran, Murat Cakir

Clin Exp Pediatr. 2020;63(11):447-450. Published online October 15, 2020

Web of Science 2 Crossref 4

Question: Which clinical findings suggest esophageal structure in children with dysphagia?
Finding: The presence of solid dysphagia, malnutrition, and a comorbid condition is suggestive of esophageal stricture in children with dysphagia.
Meaning: Patients with findings suggestive of noncaustic esophageal stricture should receive early referral to pediatric gastroenterology units.

DOI: https://doi.org/10.3345/cep.2020.00199

Developmental and Behavioral Medicine

Development of the Korean Developmental Screening Test for Infants and Children (K-DST)

Hee Jung Chung, Donghwa Yang, Gun-Ha Kim, Sung Koo Kim, Seoung Woo Kim, Young Key Kim, Young Ah Kim, Joon Sik Kim, Jin Kyung Kim, Cheongtag Kim, In-Kyung Sung, Son Moon Shin, Kyung Ja Oh, Hee-Jeong Yoo, Hee Joon Yu, Seoung-Joon Lim, Jeehun Lee, Hae-Ik Jeong, Jieun Choi, Jeong-Yi Kwon, Baik-Lin Eun

Clin Exp Pediatr. 2020;63(11):438-446. Published online May 14, 2020

Web of Science 35 Crossref 37

Question: Can the Korean Developmental Screening Test for Infants and Children (K-DST) be a useful screening tool for infants and children in Korea?
Finding: The K-DST has high reliability (internal consistency of 0.73–0.93, test-retest reliability of 0.77–0.88) and a high discriminatory ability with a sensitivity of 0.833 and specificity of 0.979.
Meaning: The K-DST is an effective and reliable screening tool for infants and children with neurodevelopmental disorders in Korea.

DOI: https://doi.org/10.3345/cep.2020.00640

Neonatology (Perinatology)

Knowledge and perceptions of kangaroo mother care among health providers: a qualitative study

Hadi Pratomo, Tiara Amelia, Fatmawati Nurlin, Asri C. Adisasmita

Clin Exp Pediatr. 2020;63(11):433-437. Published online July 21, 2020

Web of Science 7 Crossref 7

Question: What are health providers’ knowledge and perceptions of Kangaroo mother care (KMC)?
Finding: Health providers’ knowledge of KMC was sufficient; however, some of their perceptions about it could create barriers to the successful implementation of hospital KMC programs.
Meaning: Health providers’ perceptions about KMC should be considered to ensure successful KMC implementation. Locally designed on-site training programs could overcome the challenges.

DOI: https://doi.org/10.3345/cep.2018.06506

Risk-based maternal group B Streptococcus screening strategy is compatible with the implementation of neonatal early-onset sepsis calculator

Niek B. Achten, J. Wendelien Dorigo-Zetsma, Annemarie M.C. van Rossum, Rianne Oostenbrink, Frans B. Plötz

Clin Exp Pediatr. 2020;63(10):406-410. Published online April 16, 2020

Web of Science 4 Crossref 5

Question: To what extent does risk-based Group B Streptococcus (GBS) screening influence management recommendations by the early-onset sepsis (EOS) calculator?
Finding: In 97% of the newborn infants, the EOS calculator recommendation remained unchanged after the GBS status at birth was updated to the definitive GBS status.
Meaning: Risk-based GBS screening results are compatible with EOS calculator recommendations.

DOI: https://doi.org/10.3345/cep.2020.00094

Endocrinology

Zinc transporter 8 autoantibody in the diagnosis of type 1 diabetes in children

Nur Rochmah, Muhammad Faizi, Siti Wahyu Windarti

Clin Exp Pediatr. 2020;63(10):402-405. Published online October 6, 2020

Web of Science 8 Crossref 9

Question: Can zinc transporter 8 autoantibody (ZnT8A) be used for diagnosing type 1 diabetes (T1D)?
Finding: Twenty-two of 30 subjects with type 1 diabetes (73.3 %) were positive for ZnT8A compared to 5 of 18 controls (27.8%).
Meaning: ZnT8A has potential for clinical applications in the diagnosis of T1D.

DOI: https://doi.org/10.3345/cep.2019.01221

Neonatology (Perinatology)

New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease

Young Mi Yoon, Seong Phil Bae, Yoon-Joo Kim, Jae Gun Kwak, Woong-Han Kim, Mi Kyoung Song, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim

Clin Exp Pediatr. 2020;63(10):395-401. Published online July 15, 2020

Web of Science 3 Crossref 4

Questions: This study aimed to describe the survival of premature infants with critical congenital heart disease (CHD) and to identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) associated with mortality.
Finding: For premature infants with critical CHD, survival rate was 76.9% and very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS 5 or more were associated with in-hospital mortality.
Meaning: VLBW, PPHN and BPD, as well as M-RACHS≥5, were risk factors for mortality among premature infants with critical CHD.

DOI: https://doi.org/10.3345/cep.2019.01522

Neurobehavior

Association between assisted reproductive technology and autism spectrum disorders in Iran: a case-control study

Ensiyeh Jenabi, Mahdieh Seyedi, Ronak Hamzehei, Saeid Bashirian, Mohammad Rezaei, Katayoon Razjouyan, Salman Khazaei

Clin Exp Pediatr. 2020;63(9):368-372. Published online March 27, 2020

Web of Science 11 Crossref 14

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by impairments in social interaction and verbal and nonverbal communication.
Purpose: Determine the association between use of assisted reproduction technology (ART) and the risk of ASD among children. Methods: This case-control study included 300 participants (100 cases, 200 controls). The control group included women with a child aged 2–10 years without ASD,...

DOI: https://doi.org/10.3345/cep.2020.00073

Other

Evaluation of goodness of fit of semiparametric and parametric models in analysis of factors associated with length of stay in neonatal intensive care unit

Fatemeh Kheiry, Sadegh Kargarian-Marvasti, Sima Afrashteh, Abolfazl Mohammadbeigi, Nima Daneshi, Salma Naderi, Seyed Hossein Saadat

Clin Exp Pediatr. 2020;63(9):361-367. Published online June 10, 2020

Web of Science 3 Crossref 2

Question: Hospitalization in neonatal intensive care unit (NICU) is associated with life-threatening hazards. What factors associated with neonatal length of stay (LOS) in the NICU?
Finding: Breastfeeding, phototherapy, acute renal failure (ARF), mechanical ventilation, and central venous catheter (CVC) access were identified as factors associated with NICU length of stay.
Meaning: Protective effects of breastfeeding and CVC access, whereas increase effects of phototherapy, ARF, and mechanical ventilation in LOS can be supporting evidence to establish effective interventions to reduce length of NICU stay.

DOI: https://doi.org/10.3345/cep.2019.00437

Neonatology (Perinatology)

Evaluation of the role of ischemia modified albumin in neonatal hypoxic-ischemic encephalopathy

Mohamed A. Talat, Rabab M. Saleh, Mohammed M. Shehab, Naglaa A. Khalifa, Maha Mahmoud Hamed Sakr, Walaa M. Elmesalamy

Clin Exp Pediatr. 2020;63(8):329-334. Published online August 15, 2020

Web of Science 5 Crossref 7

Question: What is the value of ischemia modified albumin (IMA) as a diagnostic marker for neonatal hypoxic-ischemic encephalopathy (HIE)?
Finding: IMA levels were significantly higher (nearly double elevation) in hypoxic than healthy newborns in the first few hours after birth in the full-term neonates.
Meaning: IMA can be a reliable marker for the early diagnosis of neonatal HIE and can be a predictor of injury severity.

DOI: https://doi.org/10.3345/cep.2019.01410

Cardiology

Age-, sex-, and height-based blood pressure reference charts, Yazd children 6–18 years, Iran

Nastaran ahmadi, Seyedeh Mahdieh Namayandeh, Seyed Mahmood Sadr Bafghi, Mohammad Reza Mohammadi, Masoud Mirzaei, Mohammadtaghi Sarebanhassanabadi, Amir Houshang Mehrparvar, Reza Faraji, Neda Nilforoshan, Ahmad Karimi

Clin Exp Pediatr. 2020;63(8):321-328. Published online July 21, 2020

Web of Science 4 Crossref 4

Question: What is the 90th, 95th, 99th percentile of blood pressure based on height as the cut point for diagnosis of hypertension in children of our province?
Finding: We used blood pressure of 456 males and 579 females in 6–18 years old in “Iranian Children and Adolescents' Psychiatric Disorders survey.
Meaning: The 90th, 95th, 99th percentiles of systolic and diastolic blood pressure in both sex based on age and 10-cm height intervals were developed in Yazd.

DOI: https://doi.org/10.3345/cep.2019.00094

Hematology

Effects of α-tocopherol on hemolysis and oxidative stress markers on red blood cells in β-thalassemia major

Nora Sovira, Munar Lubis, Pustika Amalia Wahidiyat, Franciscus D. Suyatna, Djajadiman Gatot, Saptawati Bardosono, Mohammad Sadikin

Clin Exp Pediatr. 2020;63(8):314-320. Published online August 15, 2020

Web of Science 10 Crossref 9

Question: Is the α-tocopherol as an exogenous antioxidant supplementation effective in improving hemolysis and oxidative stress on β-thalassemia major?
Finding: We found significant enhancements in plasma haptoglobin were noted in the α-tocopherol group (3.01 mg/dL; range, 0.60–42.42 mg/dL; P=0.021).
Meaning: The α-tocopherol can improve hemolysis by increasing the haptoglobin level as hemolysis marker.

DOI: https://doi.org/10.3345/cep.2019.00542

Allergy

Ten-year trends and prevalence of asthma, allergic rhinitis, and atopic dermatitis among the Korean population, 2008–2017

Jihyun Ha, Seung Won Lee, Dong Keon Yon

Clin Exp Pediatr. 2020;63(7):278-283. Published online January 29, 2020

Web of Science 116 Crossref 113

Background: Major questions remain regarding the agestratified trends of allergic diseases and asthma in Korea.
Purpose: To identify the estimated recent prevalence and 10- year trends in asthma, allergic rhinitis, and atopic dermatitis among the Korean population from 2008 to 2017. Methods: This nationwide cross-sectional survey (Korean National Health and Nutrition Examination Survey) over 10 years (2008–2017) examined representative samples of the...

DOI: https://doi.org/10.3345/cep.2019.01291

General Pediatrics

Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure

Lars Boenicke, Johannes Doerner, Stefan Wirth, Hubert Zirngibl, Mike Ralf Langenbach

Clin Exp Pediatr. 2020;63(7):272-277. Published online May 15, 2020

Web of Science 10 Crossref 10

Background: The optimal management of perianal abscess in children is controversial.
Purpose: To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods: All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated. Results: Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary...

DOI: https://doi.org/10.3345/cep.2019.00969

Immunology

Immunogenicity and safety of a 12-valent pneumococcal conjugate vaccine in infants aged 6–10 weeks: a randomized double-blind active-controlled trial

Jonghoon Shin, Jamaree Teeratakulpisarn, Thanyawee Puthanakit, Tuangtip Theerawit, Ji Hwa Ryu, Jinhwan Shin, Seulgi Lee, Hayoung Lee, Kyungjun An, Hun Kim

Clin Exp Pediatr. 2020;63(7):265-271. Published online December 6, 2019

Web of Science 3 Crossref 2

Question: The immunogenicity and safety of GBP411 when administered to healthy infants are not understood.
Finding: The intergroup differences were not significant for all 12 serotypes after the booster dose. The overall incidence of solicited local adverse events between the groups did not differ significantly.
Meaning: GBP411 with a 2p+1 dosing schedule induced a substantial immune response, and may be safe for administration to healthy infants.

DOI: https://doi.org/10.3345/cep.2019.01067

General Pediatrics

Ability of children to perform touchscreen gestures and follow prompting techniques when using mobile apps

Savita Yadav, Pinaki Chakraborty, Arshia Kaul, Pooja, Bhavya Gupta, Anchal Garg

Clin Exp Pediatr. 2020;63(6):232-236. Published online February 5, 2020

Web of Science 6 Crossref 6

Background: Children today get access to smartphones at an early age. However, their ability to use mobile apps has not yet been studied in detail.
Purpose: This study aimed to assess the ability of children aged 2–8 years to perform touchscreen gestures and follow prompting techniques, i.e., ways apps provide instructions on how to use them. Methods: We developed one mobile app...

DOI: https://doi.org/10.3345/cep.2019.00997

Neonatology (Perinatology)

Synbiotics use for preventing sepsis and necrotizing enterocolitis in very low birth weight neonates: a randomized controlled trial

Ozge Serce Pehlevan, Derya Benzer, Tugba Gursoy, Guner Karatekin, Fahri Ovali

Clin Exp Pediatr. 2020;63(6):226-231. Published online February 5, 2020

Web of Science 21 Crossref 22

Background: Probiotics and prebiotics have strain-specific effects on the host. Synbiotics, a mixture of probiotics and prebiotics, are proposed to have more beneficial effects on the host than either agent has alone.
Purpose: We performed a randomized controlled trial to investigate the effect of Lactobacillus and Bifidobacterium together with oligosaccharides and lactoferrin on the development of necrotizing enterocolitis (NEC) or sepsis...

DOI: https://doi.org/10.3345/cep.2019.00381

Long-term cognitive, executive, and behavioral outcomes of moderate and late preterm at school age

Ju Hyun Jin, Shin Won Yoon, Jungeun Song, Seong Woo Kim, Hee Jung Chung

Clin Exp Pediatr. 2020;63(6):219-225. Published online September 25, 2019

Web of Science 19 Crossref 28

Question: Infants born at moderate to late preterm gestations are known to have little problem later on, but is that really true?
Finding: At school age, cognitive problem was observed in about a quarter of the children. In addition, more than half of the children was suspected of having attention problems.
Meaning: Moderate to late preterm infants are at risk of developing abnormal intelligence and attention problems at early school age, therefore they should not be neglected on longterm follow-up evaluation.

DOI: https://doi.org/10.3345/kjp.2019.00647

Cardiology

Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters

Su Jin Choi, Jung Eun Kwon, Da Eun Roh, Myung Chul Hyun, Hanna Jung, Young Ok Lee, Joon Yong Cho, Yeo Hyang Kim

Clin Exp Pediatr. 2020;63(5):189-194. Published online November 8, 2019

Web of Science 7 Crossref 7

Question: Is echocardiographic examination is useful for surgical method decision in patients with tetralogy of Fallot (TOF)?
Finding: Various echocardiographic parameters serve as predictors for determining surgical methods for TOF patients. However, the PV morphology and tissue characteristics should also be considered.
Meaning: A full dependence on the size of the pulmonary valve annulus (PVA), the z score, and the ratio of the size of PVA to aortic valve annulus or descending aorta surgery may result in inadequate surgical results during TOF total correction.

DOI: https://doi.org/10.3345/kjp.2019.01060

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Original article