Clinical and Experimental Pediatrics

Review Article

Critical Care Medicine

The use of extracorporeal membrane oxygenation in children with acute fulminant myocarditis

Silver Heinsar, Sainath Raman, Jacky Y. Suen, Hwa Jin Cho, John F. Fraser

Clin Exp Pediatr. 2021;64(5):188-195. Published online August 10, 2020

Acute fulminant myocarditis (AFM) occurs as an inflammatory response to an initial myocardial insult. Its rapid and deadly progression calls for prompt diagnosis with aggressive treatment measures. The demonstration of its excellent recovery potential has led to increasing use of mechanical circulatory support, especially extracorporeal membrane oxygenation (ECMO). Arrhythmias, organ failure, elevated cardiac biomarkers, and decreased ventricular function at presentation...

DOI: https://doi.org/10.3345/cep.2020.00836

Neonatology (Perinatology)

Clinical implications of coronavirus disease 2019 in neonates

Do-Hyun Kim

Clin Exp Pediatr. 2021;64(4):157-164. Published online February 4, 2021

Web of Science 11 Crossref 9

• Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was detected in approximately 3% of neonates of mothers with coronavirus disease 2019 (COVID-19).
• Neonatal COVID-19 is relatively benign with 16%–22.4% cases asymptomatic.
• Neonates with pre-existing medical conditions and preterm infants are at a higher risk of severe COVID-19.
• Requirement for neonatal mechanical ventilation is 20%–22.4% (vs. 4% in children)
• Low birth weight (13.9%) and premature birth (22.2%) affect neonates of mothers with COVID-19.

DOI: https://doi.org/10.3345/cep.2020.01795

Genetics and Metabolism

Neurofibromatosis type I: points to be considered by general pediatricians

Eungu Kang, Hee Mang Yoon, Beom Hee Lee

Clin Exp Pediatr. 2021;64(4):149-156. Published online July 15, 2020

Web of Science 12 Crossref 13

Neurofibromatosis type 1 (NF1), a prevalent genetic disease that is transmitted in an autosomal dominant manner, is characterized by multiple cutaneous café-au-lait spots and neurofibromas as well as various degrees of neurological, skeletal, and neoplastic manifestations. The clinical features of NF1 increase in frequency with age, while the clinical diagnosis can remain undetermined in some pediatric patients. Importantly, affected patients...

DOI: https://doi.org/10.3345/cep.2020.00871

Review article

Immunology

Systematic review of literature and analysis of big data from the National Health Insurance System on primary immunodeficiencies in Korea

Sohee Son, Ji-Man Kang, Younsoo Hahn, Kangmo Ahn, Yae-Jean Kim

Clin Exp Pediatr. 2021;64(4):141-148. Published online July 13, 2020

Crossref 3

In this article, a systematic review of reported primary immunodeficiency disease (PID) cases in Korea was performed and we attempted to estimate the number of PID patients and healthcare costs for the first time in Korea. Our review revealed that Korean PID cases are greatly underreported in the literature based on health insurance. Physicians in the field and health care policymakers should be aware of the disease burden of PID.

DOI: https://doi.org/10.3345/cep.2019.01347

Review Article

Other

Behavioral insomnia in infants and young children

Eun Kyeong Kang, Seung Soo Kim

Clin Exp Pediatr. 2021;64(3):111-116. Published online July 15, 2020

Web of Science 11 Crossref 13

• Behavioral insomnia is common and affects a child’s daytime functioning and emotions.
• Diagnosing insomnia using the child’s sleep history, a sleep diary/log, and sleep questionnaires is important.
• Behavioral intervention, the main treatment, involves creating positive associations with sleep, establishing a consistent sleep schedule and bedtime routines, and the development of selfsoothing skills.

DOI: https://doi.org/10.3345/cep.2020.00052

Neurology

Myelin oligodendrocyte glycoprotein antibody-associated disorders: clinical spectrum, diagnostic evaluation, and treatment options

Yun-Jin Lee, Sang Ook Nam, Ara Ko, JuHyun Kong, Shin Yun Byun

Clin Exp Pediatr. 2021;64(3):103-110. Published online May 14, 2020

Web of Science 4 Crossref 3

MOG antibody-associated disorder exhibits different pathophysiological and phenotypic findings than both aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder and typical MS. MOG-antibody is of particular interest in pediatric patients with clinical or radiological non-MS typical findings. MOG-antibody was included in a diagnostic algorithm for children recommending for the first time a standardized use in clinical practice except in cases of typical MS.

DOI: https://doi.org/10.3345/cep.2019.01305

General Pediatrics

Association between maternal smoking during pregnancy and risk of bone fractures in offspring: a systematic review and meta-analysis

Erfan Ayubi, Saeid Safiri, Kamyar Mansori

Clin Exp Pediatr. 2021;64(3):96-102. Published online February 5, 2020

Web of Science 10 Crossref 10

Question: What is the effect of maternal smoking during pregnancy (MSDP) on the risk of bone fractures in the offspring?
Finding: After the adjustment for misclassification, MSDP may be associated with a 27% increased risk of bone fracture in the offspring (pooled odds ratio, 1.27; 95% confidence interval, 1.00–1.62; I²=0%; P=0.537)
Meaning: Preventive measures and health education programs should be designed and implemented to encourage women to stop smoking, especially during.

DOI: https://doi.org/10.3345/cep.2019.01466

Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019

Ji Hee Kwak, Soo-Young Lee, Jong-Woon Choi; the Korean Society of Kawasaki Disease

Clin Exp Pediatr. 2021;64(2):68-75. Published online December 30, 2020

Web of Science 57 Crossref 61

Hundreds of cases of children and adolescents with hyperinflammatory responses such as Kawasaki disease have been reported amid the coronavirus disease 2019 (COVID-19) pandemic, leading to coining of the new term COVID-19–associated multisystem inflammatory syndrome in children. In this review article, we introduce the illness and describe its case definitions, epidemiology, pathogenesis, clinical features, treatments, and outcomes.

DOI: https://doi.org/10.3345/cep.2020.01900

Allergy

Eosinophils and childhood asthma

Bong Seok Choi

Clin Exp Pediatr. 2021;64(2):60-67. Published online January 6, 2021

Web of Science 9 Crossref 10

•In allergic eosinophilic asthma, eosinophils act as important effector cells and antigen-presenting cells, while in nonallergic eosinophilic asthma, type 2 innate lymphoid cells play an important role in eosinophil activation.
•Sputum eosinophil counts can be helpful for evaluating allergic airway inflammation in asthma.
• Anti-interleukin-5 has broadened the scope of asthma treatment.

DOI: https://doi.org/10.3345/cep.2020.00717

Cardiology

Pediatric heart transplantation: how to manage problems affecting long-term outcomes?

Young Hwue Kim

Clin Exp Pediatr. 2021;64(2):49-59. Published online April 8, 2020

Crossref 5

Since the initial International Society of Heart Lung Transplantation registry was published in 1982, the number of pediatric heart transplantations has increased markedly, reaching a steady state of 500–550 transplantation annually and occupying up to 10% of total heart transplantations. Heart transplantation is considered an established therapeutic option for patients with end-stage heart disease. The long-term outcomes of pediatric heart...

DOI: https://doi.org/10.3345/cep.2019.01417

Gastroenterology

Changing prevalence of Helicobacter pylori infection in children and adolescents

Ji Sook Park, Jin Su Jun, Ji-Hyun Seo, Hee-Shang Youn, Kwang-Ho Rhee

Clin Exp Pediatr. 2021;64(1):21-25. Published online July 15, 2020

Web of Science 32 Crossref 35

Although Helicobacter pylori infection rate in children is unclear due to diversity and limitation of diagnostic tests unlike in adults, investigation the childhood prevalence is important for predicting H. pylori-related diseases in the future.
H. pylori infection occurred in early childhood, and declined during 30 years in our study.
Change in risk factors of H. pylori transmission and consensus for eradication therapy in children might further reduce the infection rate.

DOI: https://doi.org/10.3345/cep.2019.01543

Endocrinology

Early menarche and its consequence in Korean female: reducing fructose intake could be one solution

Ji Hyun Kim, Jung Sub Lim

Clin Exp Pediatr. 2021;64(1):12-20. Published online May 14, 2020

Web of Science 12 Crossref 10

In Korea, the average age of menarche has declined sharply. Early menarche is associated with psychosocial and behavioral problems and cardiometabolic disease. Excess fructose intake has been suggested as one cause of early menarche in recent studies, so reducing fructose intake may be one solution.

DOI: https://doi.org/10.3345/cep.2019.00353

Other

Review of epidemiological studies on air pollution and health effects in children

Jong-Tae Lee

Clin Exp Pediatr. 2021;64(1):3-11. Published online June 10, 2020

Web of Science 22 Crossref 22

This review summarized the accumulated epidemiologic evidence with emphasis on studies conducted in Korea and heterogeneity in the literature. Based on systematic reviews and meta-analyses, there is consistent evidence on the association between exposure to ambient air pollution and children’s health, especially respiratory health and adverse birth outcomes, and growing evidence on neurodevelopmental outcomes.

DOI: https://doi.org/10.3345/cep.2019.00843

Infection

The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity

Maximilian Andreas Storz

Clin Exp Pediatr. 2020;63(12):477-482. Published online November 5, 2020

Web of Science 56 Crossref 60

Large-scale quarantine and home confinement during the coronavirus disease 2019 (COVID-19) pandemic will impose new and unfamiliar stressors on children, thereby worsening the childhood obesity epidemic. Physical, nutritional, and psychosocial factors that promote obesity in children during this special situation complementarily contribute to an unprecedented obesogenic environment. Involved stakeholders, including governments, schools, and families, must make all efforts to minimize the impact of the COVID-19 epidemic on childhood obesity.

DOI: https://doi.org/10.3345/cep.2020.01081

Pulmonology

Current perspectives on atypical pneumonia in children

Jung Yeon Shim

Clin Exp Pediatr. 2020;63(12):469-476. Published online June 10, 2020

Web of Science 16 Crossref 22

Macrolides are the first line treatment in atypical pneumonia caused by M. pneumoniae, C. pneumoniae, and L. pneumophila. Macrolide-resistant mycoplasma pneumonia (MRMP) is emerging worldwide, especially in East Asia. Immune modulators such as corticosteroids or second line antibiotics are treatment options for MRMP. Pediatricians should be careful with empirical therapy of macrolides in children with mild to moderate community-acquired pneumonia not to increase the risk of MRMP.

DOI: https://doi.org/10.3345/cep.2019.00360

Allergy

Pollen-food allergy syndrome in children

You Hoon Jeon

Clin Exp Pediatr. 2020;63(12):463-468. Published online May 14, 2020

Web of Science 11 Crossref 16

The prevalence of pollen-food allergy syndrome (PFAS) in Korean children with pollen allergy was recently reported to be 42.7%. PFAS can cause a wide range of symptoms from mild allergy to severe anaphylaxis depending on the nature of food allergens that share the epitopes with pollen. Cases of anaphylaxis caused by PFAS have recently increased. Treatments for PFAS should be individualized for patients according to the severity of symptoms.

DOI: https://doi.org/10.3345/cep.2019.00780

Neurology

Health effects of electromagnetic fields on children

Jin-Hwa Moon

Clin Exp Pediatr. 2020;63(11):422-428. Published online May 26, 2020

Web of Science 33 Crossref 31

· The nervous systems of children are more vulnerable to the effects of electromagnetic waves than adults.
· The exposure to electromagnetic fields (EMFs) among children should be minimized.
· According to International Agency for Research on Cancer EMFs are possibly carcinogenic, it should not be overlooked or interpreted with bias.

DOI: https://doi.org/10.3345/cep.2019.01494

Other

Comparison of diagnostic and treatment guidelines for undescended testis

Jaeho Shin, Ga Won Jeon

Clin Exp Pediatr. 2020;63(11):415-421. Published online March 23, 2020

Web of Science 20 Crossref 22

Primary caregivers should consider surgical specialist referral of patients with undescended testis if no descent occurs by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. Orchiopexy is recommended between 6 and 18 months at the latest. The original location of the testes and the age at orchiopexy are predictive factors for infertility and malignancy later in life.

DOI: https://doi.org/10.3345/cep.2019.01438

Endocrinology

Air pollution and childhood obesity

Moon Young Seo, Shin-Hye Kim, Mi Jung Park

Clin Exp Pediatr. 2020;63(10):382-388. Published online March 27, 2020

Web of Science 39 Crossref 40

Questions: What are the possible effects of air pollution on the occurrence of childhood obesity and what are the mechanisms?
Finding: Epidemiologic studies suggest that air pollutants might act as obesogens in the pediatric population, and their possible mechanisms include oxidative stress, physical inactivity, and epigenetic modulation.
Meaning: This paper reviews updated information on air pollution, one of the modifiable environmental factors in childhood obesity.

DOI: https://doi.org/10.3345/cep.2020.00010

Allergy

Montelukast use over the past 20 years: monitoring of its effects and safety issues

Yong Ju Lee, Chang-Keun Kim

Clin Exp Pediatr. 2020;63(10):376-381. Published online February 5, 2020

Web of Science 20 Crossref 17

Although the efficacy of montelukast is inferior to that of ICS, both physicians and parents prefer montelukast to ICSs.
EDN may be a useful biomarker for the treatment and monitoring of preschool children with asthma.
The US FDA requires boxed warning about serious neuropsychiatric events of montelukast, therefore, physicians should consider the benefits and risks of montelukast before prescribing it.

DOI: https://doi.org/10.3345/cep.2019.00325

Pulmonology

Overview of management of children with COVID-19

Dyah Kanya Wati, Arya Krisna Manggala

Clin Exp Pediatr. 2020;63(9):345-354. Published online July 17, 2020

Web of Science 4 Crossref 4

The specific treatments for COVID-19 in children remain inconclusive and debatable despite effectively decreasing its signs and symptoms.
The need for clinical trials and reports should be investigated.

DOI: https://doi.org/10.3345/cep.2020.00913

Gastroenterology

Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors

Sowon Park, Yunkoo Kang, Hong Koh, Seung Kim

Clin Exp Pediatr. 2020;63(9):337-344. Published online December 6, 2019

Web of Science 15 Crossref 17

Inflammatory bowel disease (IBD) is a chronic relapsing immune-mediated disease of the intestinal tract. Although its prevalence is reportedly lower in Asia than in Western countries, the rapid increase in the incidence of IBD has drawn attention to its etiology, including genetic susceptibility and environmental factors. Specifically, recent studies concerning dietary treatments and intestinal microbiota suggest that these factors may...

DOI: https://doi.org/10.3345/cep.2019.00500

Nutrition

Components of human breast milk: from macronutrient to microbiome and microRNA

Su Yeong Kim, Dae Yong Yi

Clin Exp Pediatr. 2020;63(8):301-309. Published online March 23, 2020

Web of Science 160 Crossref 172

Human breast milk (HBM) is essential for the infant’s growth and development right after birth and is an irreplaceable source of nutrition for early human survival. Various infant formulas have many similarities to HBM in many components, but there is no perfect substitute for HBM. Recently, various breast milk components and their roles have been studied according to the development...

DOI: https://doi.org/10.3345/cep.2020.00059

Neurology

Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum

Joo Hee Seo, Yun-Jin Lee, Ki Hyeong Lee, Elakkat Gireesh, Holly Skinner, Michael Westerveld

Clin Exp Pediatr. 2020;63(8):291-300. Published online August 16, 2019

Web of Science 8 Crossref 8

Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis...

DOI: https://doi.org/10.3345/kjp.2019.00598

Neonatology (Perinatology)

Short- and long-term outcomes of very low birth weight infants in Korea: Korean Neonatal Network update in 2019

Jang Hoon Lee, YoungAh Youn, Yun Sil Chang; Korean Neonatal Network

Clin Exp Pediatr. 2020;63(8):284-290. Published online February 5, 2020

Web of Science 20 Crossref 22

The Korean Neonatal Network (KNN) has collected population-based data for very low birth weight infants (VLBWIs) born in Korea since 2013. The survival rate of all VLBWIs was 86% in Korea. The overall prevalence of cerebral palsy was 6.2%–6.6%. Bilateral blindness and hearing loss were reported in 0.2%–0.3%, 0.8%–1.9%, respectively. The KNN has published annual reports and papers for facilitating the improvement of VLBWIs outcome in Korea.

DOI: https://doi.org/10.3345/cep.2019.00822

Pulmonology

The past, present, and future of humidifier disinfectant-associated interstitial lung diseases in children

Eun Lee, So-Yeon Lee, Soo-Jong Hong

Clin Exp Pediatr. 2020;63(7):251-258. Published online December 9, 2019

Web of Science 13 Crossref 15

Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%−58.0%. Although...

DOI: https://doi.org/10.3345/cep.2019.01326

Immunology

Immunopathogenesis of COVID-19 and early immunomodulators

Kyung-Yil Lee, Jung-Woo Rhim, Jin-Han Kang

Clin Exp Pediatr. 2020;63(7):239-250. Published online June 18, 2020

Crossref 33

The novel coronavirus disease 2019 (COVID-19) is spreading globally. Although its etiologic agent is discovered as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there are many unsolved issues in COVID-19 and other infectious diseases. The causes of different clinical phenotypes and incubation periods among individuals, species specificity, and cytokine storm with lymphopenia as well as the mechanism of damage to organ...

DOI: https://doi.org/10.3345/cep.2020.00759

Allergy

Drug Allergy in Children: What Should We Know?

Ji Soo Park, Dong In Suh

Clin Exp Pediatr. 2020;63(6):203-210. Published online November 12, 2019

Web of Science 15 Crossref 15

The drug allergy “label” may have a lifetime of consequences for a child. Many children with alleged drug allergies are proven to be tolerant to the culprit medication when challenged. The field of drug hypersensitivity is a recently evolving field of research, but studies on its epidemiology and diagnostic tools are lacking in children. Clinical history is significant in the...

DOI: https://doi.org/10.3345/kjp.2019.00675

Neurology

Genetic tests by next-generation sequencing in children with developmental delay and/or intellectual disability

Ji Yoon Han, In Goo Lee

Clin Exp Pediatr. 2020;63(6):195-202. Published online November 4, 2019

Crossref 32

Developments in next-generation sequencing (NGS) techogies have assisted in clarifying the diagnosis and treatment of developmental delay/intellectual disability (DD/ID) via molecular genetic testing. Advances in DNA sequencing technology have not only allowed the evolution of targeted panels but also, and more currently enabled genome-wide analyses to progress from research era to clinical practice. Broad acceptance of accuracy- guided targeted gene...

DOI: https://doi.org/10.3345/kjp.2019.00808

Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children

Ara Ko, Joon Soo Lee

Clin Exp Pediatr. 2020;63(5):171-177. Published online November 13, 2019

Web of Science 8 Crossref 9

Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are responsible for drug-resistant chronic focal epilepsy, and are the second-most common reason for epilepsy surgery in children. LEATs are extremely responsive to surgical treatment, and therefore epilepsy surgery should be considered as a treatment option for LEATs. However, the optimal time for surgery remains controversial, and surgeries are often delayed. In this review, we...

DOI: https://doi.org/10.3345/kjp.2019.01151

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Review article