Most cited
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Most-cited articles are from the articles published during the last two years (2024 ~ ).
- Original Article
- Pulmonology
- Nonlinear association between neutrophil-to-lymphocyte ratio and asthma in children and adolescents in the United States: a cross-sectional study
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Chuhan Cheng, Liyan Zhang
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Clin Exp Pediatr. 2025;68(7):489-496. Published online March 11, 2025
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Question: Is there a nonlinear relationship between neutrophil-to-lymphocyte ratio (NLR) and asthma in children and adolescents?
Finding: NLR showed a nonlinear association with asthma, with an NLR threshold of 2.23 identifying individuals at higher risk.
Meaning: An NLR<2.23 may serve as a potential biomarker for asthma risk assessment and management in pediatric populations, thereby offering a simple tool for the early identification of at-risk individuals. |
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- Editorial
- General Pediatrics
- Global breastfeeding efforts: a long way to go
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Hye-Jung Shin
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Clin Exp Pediatr. 2025;68(4):300-302. Published online November 13, 2024
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· Despite much effort, breastfeeding practices remain unsatisfactory worldwide.
· Effective breastfeeding-promoting interventions are needed that are appropriate for age, culture, and social environment.
· Interventions can promote breastfeeding, especially in younger populations such as adolescent mothers. |
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- Original Article
- Pulmonology
- Impact of obesity on pulmonary function of preschool children: an impulse oscillometry study
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Anuvat Klubdaeng, Kanokporn Udomittipong, Apinya Palamit, Pawinee Charoensittisup, Khunphon Mahoran
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Clin Exp Pediatr. 2025;68(4):319-325. Published online November 13, 2024
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Question: Does obesity in preschool children affect lung function, and which obesity indices can predict such alterations?
Finding: Preschool children with obesity exhibit impaired lung function characterized by elevated total and peripheral airway resistance. Waist-to-height ratio was the strongest predictor of such changes.
Meaning: Early obesity prevention and treatment are needed. Monitoring waist-to-height ratio, body weight, and body mass index may help identify children at risk of altered lung function. |
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- Review Article
- General Pediatrics
- Prevalence of childhood overweight and obesity in Malaysia: a systematic review and meta-analysis
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Ker Yang Chua, Ker Yung Chua, Karuthan Chinna, Chooi Ling Lim, Maheeka Seneviwickrama
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Clin Exp Pediatr. 2025;68(2):115-126. Published online November 13, 2024
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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.... |
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- Original Article
- Critical Care Medicine
- Cytokine profile of Post–cardiopulmonary bypass in children
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Kantara Saelim, Kanokpan Ruangnapa, Jirayut Jarutach, Pongsanae Duangpakdee, Smonrapat Surasombatpattana, Pharsai prasertsan
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Clin Exp Pediatr. 2025;68(12):1015-1022. Published online September 19, 2025
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Question: Can cytokine levels predict low cardiac output syndrome (LCOS) in children post–cardiopulmonary bypass?
Finding: Elevated interleukin (IL)-6, IL-8, and tumor necrosis factor-α levels were associated with LCOS, with an increase in IL-8 of >56 pg/mL from baseline to immediately postoperative being the strongest predictor.
Meaning: Monitoring immediately postoperative IL-8 levels may help identify pediatric patients at risk of LCOS, enabling timely interventions to improve outcomes. |
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- Infection
- Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes
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Setareh Mamishi, Reihaneh Hosseinpour Sadeghi, Sadaf Sajedi Moghaddam, Babak Pourakbari, Shiva Poormohammadi, Maryam Sotoudeh Anvari, Shima Mahmoudi
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Clin Exp Pediatr. 2025;68(1):65-72. Published online October 31, 2024
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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. |
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- Editorial
- Genetics and Metabolism
- Advancing orphan drug development for rare diseases
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Jung Min Ko
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Clin Exp Pediatr. 2024;67(7):356-357. Published online November 17, 2023
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· Rare diseases present unique challenges and unmet needs for which the development of orphan drugs tailored to them offers hope.
· Despite the hurdles posed by limited patient populations, orphan drug designations from regulatory agencies provide incentives, such as extended market exclusivity and tax credits, that ignite transformative advances.
· Scientific progress in genomics, personalized medicine, and analytics empowers precise interventions by decoding genetic anomalies and encouraging effective treatments. |
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- Original Article
- Neonatology (Perinatology)
- Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status
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Sung-Hoon Chung, Chae Young Kim, Yong-Sung Choi, Myung Hee Lee, Jae Woo Lim, Byong Sop Lee, Ki-Soo Kim; the Korean Neonatal Network
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Clin Exp Pediatr. 2024;67(11):619-627. Published online September 12, 2024
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Question: How do structural and staffing characteristics of neonatal intensive care units (NICUs) influence the mortality rates of very low birth weight infants (VLBWIs)?
Findings: NICUs with higher staffing levels, particularly with more neonatologists, and those offering advanced care levels were associated with lower mortality rates. Additionally, regional disparities were observed, with some areas demon-strating significantly higher survival rates.
Meaning: Adequate staffing and equitable regional distribution of medical resources are crucial for improving survival outcomes in VLBWIs. Efforts to enhance NICU staffing and address regional healthcare disparities are essential for optimizing care quality and reducing mortality in this vulnerable population. |
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- Review Article
- Endocrinology
- Growth plate closure and therapeutic interventions
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Ja Hyang Cho, Hae Woon Jung, Kye Shik Shim
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Clin Exp Pediatr. 2024;67(11):553-559. Published online October 28, 2024
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Height gains result from longitudinal bone growth. Upon adequate growth, growth plate closure limits longitudinal bone growth. To date, gonadotropin-releasing hormone analogs, aromatase inhibitors, C-type natriuretic peptide analogs, and fibroblast growth factor receptor 3 inhibitors have been studied or used as therapeutic interventions to delay growth plate closure and increase human height. The development of more effective therapeutic modalities for short stature, precocious puberty, and skeletal dysplasia is anticipated. |
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- Lifelong medical challenges and immunogenetics of Turner syndrome
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Won Kyoung Cho
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Clin Exp Pediatr. 2024;67(11):560-568. Published online July 31, 2024
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· This summary emphasizes the importance of the early diagnosis of Turner syndrome (TS) and presents a multidisciplinary approach to its prevention and management, high-lighting the need for customized care.
· Advancements in immunogenetic research may improve our understanding of TS and improve its outcomes.
· TS encompasses a wide array of medical challenges, including cardiovascular, endocrine, autoimmune, and mental health issues, as well as a heightened cancer risk. |
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- Original Article
- Nephrology (Genitourinary)
- Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices
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Nuanpan Penboon, Pornpimol Rianthavorn
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Clin Exp Pediatr. 2026;69(2):130-139. Published online October 23, 2025
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Question: In children with proliferative lupus nephritis, do National Institutes of Health-modified indices and treatment choices predict long-term kidney function?
Finding: Higher chronicity index scores, especially tubular atrophy and interstitial fibrosis, predicted kidney impairment. Additionally, the use of mycophenolate mofetil (MMF) for maintenance therapy was associated with a lower risk of kidney function decline.
Meaning: The early recognition of chronic lesions and MMF-based maintenance therapy may improve kidney outcomes in childhood-onset lupus nephritis. |
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- Allergy
- Maternal sleep disorders during pregnancy and subsequent risk of allergic diseases in Japanese children: the TMM BirThree Cohort Study
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Ami Uematsu, Masatsugu Orui, Mami Ishikuro, Keiko Murakami, Aoi Noda, Genki Shinoda, Taku Obara, Shinichi Kuriyama
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Clin Exp Pediatr. 2026;69(1):36-45. Published online October 22, 2025
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Question: Associations have been made between maternal sleep disorders during pregnancy and allergic diseases including bronchial asthma, atopic dermatitis, food allergy, and allergic conjunctivitis/rhinitis/hay fever in their children.
Finding: In the crude model, sleep disorders during pregnancy were associated with all examined allergic diseases in children. After adjustment, significant associations remained for atopic dermatitis and allergic conjunctivitis/rhinitis/hay fever.
Meaning: The study highlights associations between maternal sleep and child allergic diseases. |
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- Review Article
- Other
- Cost-effectiveness of newborn screening for severe combined immunodeficiency: a systematic review
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Rezwanul Rana, Syed Afroz Keramat, Moin Ahmed
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Clin Exp Pediatr. 2025;68(9):628-640. Published online April 16, 2025
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Universal newborn screening for severe combined immunodeficiency (SCID) demonstrates robust cost-effectiveness across diverse high-income healthcare systems, both from healthcare and societal standpoints. Early detection yields substantial savings. While uncertainties persist, impacting precise cost-effectiveness, the overall finding is positive. Future research must prioritize enhanced data collection and statistical rigor to refine our understanding of SCID's economic impact within the Australian context. |
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- Original Article
- Cardiology
- Unsustainable and overworked: unpacking the challenges faced by pediatric cardiologists and cardiac surgeons in Korea
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Soo In Jeong, GI Beom Kim, Sung Hye Kim, Jae Yoon Na, Hong Ju Shin, Sin Weon Yun, Lucy Youngmin Eun, Sang Yun Lee, Chang-Ha Lee, Kwang Ho Choi, Seul Gi Cha, Mi Young Han
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Clin Exp Pediatr. 2025;68(9):732-741. Published online August 6, 2025
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Question: What are the key challenges affecting pediatric cardiologists and cardiac surgeons in Korea?
Finding: Excessive workloads, low procedural volumes, and legal risks contribute to high burnout. Regional disparities limit skill maintenance and threaten workforce sustainability.
Meaning: Targeted policies ensuring fair workloads, legal protections, and regional support are essential to stabilizing the pediatric cardiac workforce and maintaining high-quality care. |
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- Editorial
- General Pediatrics
- Artificial intelligence in pediatric healthcare: bridging potential, clinical practice, and ethical considerations
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Yoon Lee, Seohyun Hong, Dong Keon Yon
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Clin Exp Pediatr. 2025;68(9):652-655. Published online August 28, 2025
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· Artificial intelligence (AI) holds transformative potential for pediatric healthcare, with applications spanning prevention, diagnosis, treatment, and follow-up across diverse subspecialties; however, ethical concerns, scarcity of pediatric- specific data, and limited funding remain significant challenges.
· International consensus on pediatric AI guidelines, expanding child-specific datasets, and incorporating explainable AI are essential to ensure safety and trust.
· Multicenter collaboration and increased investment can address these gaps, enabling equitable, reliable, and pediatric- centered AI solutions. |
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- Original Article
- Hematology
- Hematopoietic stem cell transplantation in pediatric patients with type VI mucopolysaccharidosis
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Vedat Uygun, Koray Yalçın, Hayriye Daloğlu, Seda Öztürkmen, Suna Çelen, Suleimen Zhumatayev, Gülsün Karasu, Akif Yeşilipek
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Clin Exp Pediatr. 2025;68(8):601-607. Published online March 11, 2025
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Question: Could hematopoietic stem cell transplantation (HSCT) be an alternative to enzyme replacement therapy (ERT) for type VI mucopolysaccharidosis (MPS VI)?
Finding: HSCT is generally not offered due to reports of high toxicity and mortality. However, we detected fewer complications and graft-versus-host disease cases and no deaths with HSCT.
Meaning: HSCT is both less expensive than ERT and permanent; thus, it should be considered an alternative treatment for MPS VI. |
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- Review Article
- Immunology
- NLRP3 inflammasome: a key player in neonatal brain injury
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Cagla Kiser, Ilkcan Ercan, Defne Engur, Sermin Genc
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Clin Exp Pediatr. 2025;68(7):475-485. Published online April 1, 2025
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Hypoxic-ischemic encephalopathy is the major cause of neonatal brain injury. NOD-like receptor family pyrin domain containing 3 inflammasome activation leads to neuroinflammation, which significantly affects newborn mortality. The establishment of preventive and therapeutic strategies against brain damage requires a thorough understanding of the mechanisms underlying neuroinflammation and inflammasome activation in the neonatal brain. |
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- Original Article
- Neonatology (Perinatology)
- Differential roles of interleukin-6 and adrenomedullin in early diagnosis and mortality predictions in late-onset neonatal sepsis
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Emilly Henrique dos Santos, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Karen Alessandra Rodrigues, Ronaldo Arkader, Thelma Suely Okay
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Clin Exp Pediatr. 2025;68(6):463-471. Published online December 23, 2024
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Question: Can adrenomedullin (ADM) or interleukin-6 (IL-6) detect late-onset neonatal sepsis (LOS) at admission (area under the curve [AUC]>0.90) as an early diagnostic marker?
Finding: Only IL-6 consistently distinguished survivors from nonsurvivors (AUC>0.90) on admission and antibiotic treatment days 3 and 7. C-reactive protein level identified infections from day 3 but failed to predict outcomes (AUC<0.70).
Meaning: IL-6 level can improve LOS diagnosis and prognosis. |
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- Nephrology (Genitourinary)
- COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus
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Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn
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Clin Exp Pediatr. 2025;68(6):454-462. Published online February 3, 2025
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Question: What is the acceptance rate for coronavirus disease 2019 vaccination among parents of children with systemic lupus erythematosus (SLE)?
Finding: One-third of parents were hesitant to vaccinate their child. Parental willingness to vaccinate themselves, older patient age, and belief in the vaccine's potency were associated with vaccine acceptance.
Meaning: These findings highlight the need for targeted interventions to improve vaccine acceptance among parents of children with SLE. |
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- Review Article
- Neonatology (Perinatology)
- Recent advances in understanding pathophysiology of non-nutritional stunting in very preterm infants
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Eduardo Cuestas, Alina Rizzotti
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Clin Exp Pediatr. 2025;68(4):287-297. Published online December 23, 2024
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· Previous reviews of extrauterine growth restriction focused mainly on weight growth restriction caused by nutritional factors or pathological conditions.
· This review summarizes recent developments in the pathophysiology of nonnutritional length growth restriction in very preterm infants with focus on the impact of sustained neonatal inflammation on their short- and long-term outcomes.
· Further research is needed to investigate optimal strategies to improve length growth restriction in very preterm infants. |
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- Perspective
- Other
- Telemedicine in pediatrics: things to consider
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Sandhya J. Kadam, Archana Reddy Bongurala
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Clin Exp Pediatr. 2025;68(4):326-328. Published online February 3, 2025
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This article highlights the benefits, challenges, and current significance of telemedicine. Future research is needed, primarily to address the challenges of optimizing the implementation of telehealth. To use telemedicine effectively and efficiently for the timely diagnosis and management of patients, an evaluation of current telemedicine practice is needed. Analysis of shortcomings and advantages can help enhance healthcare delivery to pediatric patients, making it more accessible for future use. |
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- Editorial
- Neonatology (Perinatology)
- The predetermined future: tackling South Korea’s total fertility rate crisis
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Jin Kyu Kim
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Clin Exp Pediatr. 2025;68(3):225-227. Published online November 6, 2024
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· South Korea faces a severe demographic crisis with the lowest global fertility rate. Despite significant investments, the total fertility rate continues to decline.
· It is necessary to fully mobilize national capabilities and execute comprehensive strategies that focus on both intangible and tangible values.
· Immediate and decisive action is essential to addressing these challenges effectively. |
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- Original Article
- Endocrinology
- Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency
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Pattara Wiromrat, Yutapong Raruenrom, Phanpaphorn Namphaisan, Nantaporn Wongsurawat, Ouyporn Panamonta, Chatlert Pongchaiyakul
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Clin Exp Pediatr. 2025;68(3):238-246. Published online November 13, 2024
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Question: What is the prevalence of an impaired trabecular bone score (TBS), a measure of bone microarchitecture, in adolescents with 21-hydroxylase deficiency (21OHD)? Do prednisolone and hydrocortisone affect TBS differently in this patient population?
Finding: Impaired TBS was observed in 18% of participants. Prednisolone use negatively impacted TBS change.
Meaning: Impaired TBS is prevalent among adolescents with 21OHD. Prednisolone impairs trabecular bone microarchitecture development. |
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- Review Article
- Gastroenterology
- Practical concepts and strategies for early diagnosis and management of eosinophilic gastrointestinal disorders in East-Asian children
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Byung-Ho Choe
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Clin Exp Pediatr. 2025;68(3):185-198. Published online November 13, 2024
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Eosinophilic gastrointestinal disorders (EGIDs) often coexist with functional gastrointestinal disorders (FGIDs) and other IgE or non-IgE mediated GI diseases. Diagnosing EGIDs requires a high index of suspicion and a comprehensive approach to differentiate them from conditions like inflammatory bowel disease. Tests such as fecal calprotectin and biopsies aid in severe cases. Maintaining a food diary helps identify triggers for long-term elimination. Awareness and education are key to effective management. |
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- Endocrinology
- Hidden link between endocrine-disrupting chemicals and pediatric obesity
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Min Won Shin, Shin-Hye Kim
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Clin Exp Pediatr. 2025;68(3):199-222. Published online November 28, 2024
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Studies indicate potential connections between exposure to endocrine-disrupting chemicals (EDCs) and childhood obesity. Variations in the impact of EDCs in epidemiological studies may result from differences in exposure concentrations and timing, measurement methods, and interactive effects of multiple EDCs. Longitudinal studies on exposure to multiple EDCs are crucial to elucidating their contribution to pediatric obesity and minimize the adverse health consequences of EDC exposure. |
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- Original Article
- Developmental and Behavioral Medicine
- Characteristics of temper tantrums in 1–6-year-old children and impact on caregivers
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Warangkana Prutipaisan, Issarapa Chunsuwan, Tippawan Hansakunachai, Paskorn Sritipsukho
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Clin Exp Pediatr. 2025;68(2):170-177. Published online November 13, 2024
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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. |
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- Review Article
- Nutrition
- Exploring nutritional screening tools for hospitalized children: a narrative review
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Pankaj Soni, Amit Agrawal, Gaurav Jadon
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Clin Exp Pediatr. 2025;68(12):963-970. Published online October 22, 2025
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Malnutrition is frequently identified in hospitalized children, and the use of nutritional screening tools is crucial for assessing their nutritional status during their hospital admission and stay. Common tools include the Pediatric Yorkhill Malnutrition Score, Screening Tool for Assessment of Malnutrition in Pediatrics, and Screening Tool for Risk of Nutritional Status and Growth. However, these tools have varying sensitivities and specificities, and none is recommended for all hospitalized children. |
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- Original Article
- Infection
- Evolving treatment strategies for invasive Streptococcus pyogenes in children in the postpandemic era
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Laura Buricchi, Giuseppe Indolfi, Marco Renni, Elisabetta Venturini, Luisa Galli, Elena Chiappini
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Clin Exp Pediatr. 2025;68(11):921-931. Published online August 11, 2025
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Question: What are the roles of linezolid, intravenous immunoglobulin (IVIG), and corticosteroids in pediatric invasive group A streptococcal infection (iGAS)? Can any improve outcomes beyond beta-lactams and clindamycin?
Finding: Two of 46 patients with iGAS died. Nearly all received beta-lactams plus clindamycin. Linezolid was effective in refractory cases. IVIG and corticosteroids had variable efficacies.
Meaning: Linezolid may be valuable in refractory cases. IVIG may be considered in severe presentations. The role of corticosteroids remains less clearly defined. |
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- Endocrinology
- Long-term epidemiological insights into rickets: a nationwide population-based retrospective study
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Chun-Hao Chu, Ying-Chuan Chen, Pei-Yao Liu, Chun-Chieh Hu, Yu-Lung Lin, Feng-Chih Kuo, Chieh-Hua Lu, Tzu-Ju Hsu, Yu-Tung Hung, Fuu-Jen Tsai, Chien-Ming Lin
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Clin Exp Pediatr. 2025;68(11):879-891. Published online August 20, 2025
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Question: What are the nationwide trends and mortality risk factors of nutritional versus hereditary rickets among children in Asia?
Finding: In 2012–2018, the incidence of rickets steadily increased, whereas mortality rates declined. Mortality is associated with a low household income, anemia, chronic kidney disease, secondary hyperparathyroidism, and a prolonged hospital stay.
Meaning: Early diagnosis and targeted interventions addressing social and medical vulnerabilities are critical to reducing ricket-related mortality. |
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- Infection
- Construction and validation of predictive models for intravenous immunoglobulin–resistant Kawasaki disease using an interpretable machine learning approach
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Linfan Deng, Jian Zhao, Ting Wang, Bin Liu, Jun Jiang, Peng Jia, Dong Liu, Gang Li
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Clin Exp Pediatr. 2024;67(8):405-414. Published online July 23, 2024
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Question: Is there a reliable model to predict intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD)?
Finding: We constructed 5 machine learning models to predict IVIG-resistant KD. Extreme gradient boosting (XGBoost) model was superior to logistic, support vector machine, light gradient boosting machine and multiple layers perception models. The SHAP (SHapley Additive exPlanations) value interpreted the contribution of each feature in XGBoost model.
Meaning: XGBoost model showed the excellent performance to predict IVIG-resistant KD with explainable and visualizable machine learning algorithm. |
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