Clinical and Experimental Pediatrics

Original Article

Neonatology (Perinatology)

Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study

Sung Hee Lee, Ju Hyun Jin, Jong Ha Yoo, Shin Won Yoon

Clin Exp Pediatr. 2023;66(11):493-500. Published online October 24, 2023

Question: What are the adverse clinical outcomes of neonates of coronavirus disease 2019 (COVID-19)–infected mothers?
Finding: Infants of mothers with COVID-19 were at significantly increased risk of transient tachypnea of the newborn (TTN), use of noninvasive ventilation, and need for supplemental oxygen (P<0.05).
Meaning: Neonates of mothers with COVID-19 are at risk of TTN and require respiratory support. Close monitoring is essential to ensuring timely intervention if required.

DOI: https://doi.org/10.3345/cep.2023.00563

Developmental and Behavioral Medicine

Impact of short and intensive art-based intervention on symptomatology and social interactions among children with autism spectrum disorder

Deldar Morad Abdulah, Bayar Mohammed Omar Abdulla, Pranee Liamputtong

Clin Exp Pediatr. 2023;66(10):447-454. Published online September 14, 2023

Web of Science 2 Crossref 3

Question: Does a short and intensive art-based intervention affect symptoms and social interactions among children with autism spectrum disorder (ASD)?
Finding: The short and intensive art-based intervention did not affect symptoms in children with ASD level 2 or 3, including social awareness, social cognition, social communication, social motivation, and autistic mannerisms.
Meaning: The short and intensive art-based intervention did not improve the symptoms of patients with ASD.

DOI: https://doi.org/10.3345/cep.2023.00640

Neurology

Long-term neurological cognitive, behavioral, functional, and quality of life outcomes after fetal myelomeningocele closure: a systematic review

Andre Marolop Pangihutan Siahaan, Martin Susanto, Sarma Nursani Lumbanraja, Dwi Herawati Ritonga

Clin Exp Pediatr. 2023;66(1):38-45. Published online November 30, 2022

Web of Science 3 Crossref 3

· Fetal myelomeningocele closure significantly improved long-term neurological cognitive, behavioral, functional, and quality of life outcomes, most likely by reducing hydrocephalus rates.
· However, fetal myelomeningocele closure is associated with a significant risk of pregnancy complications, especially premature rupture of membranes and preterm delivery.

DOI: https://doi.org/10.3345/cep.2022.01102

Neonatology (Perinatology)

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

Gayoung Lee, Juyoung Lee, Ga Won Jeon, Yong Hoon Jun

Clin Exp Pediatr. 2023;66(1):32-37. Published online December 15, 2022

Web of Science 3 Crossref 3

Question: Is a commercial thickened formula able to alleviate oral feeding-associated desaturation and bradycardia in preterm infants?
Finding: Thickened formula feeding significantly reduced oral feeding-associated desaturation and bradycardia in preterm infants.
Meaning: Thickened formula feeding stabilizes oxygen saturation and heart rate during oral feeding among preterm infants with feeding difficulties.

DOI: https://doi.org/10.3345/cep.2022.00780

Review Article

Endocrinology

Association between pre- and postnatal exposure to endocrine-disrupting chemicals and birth and neurodevelopmental outcomes: an extensive review

Ozge Yesildemir, Mensure Nur Celik

Clin Exp Pediatr. 2024;67(7):328-346. Published online November 16, 2023

Web of Science 2 Crossref 2

· Sensitivity to endocrine-disrupting chemical (EDC) exposure increases during critical developmental periods (in embryos, fetuses, and neonates).
· Pre- and postnatal exposure to EDCs is associated with fetal growth restriction, preterm birth, and low birth weight.
· Exposure to EDCs during fetal and early postnatal life can have lasting and lifelong neurodevelopmental outcomes, including autism spectrum, attention deficit hyperactivity, and other cognitive and behavioral disorders.

DOI: https://doi.org/10.3345/cep.2023.00941

Allergy

Action-plan and as-needed therapy in allergic rhinitis

Hyeon-Jong Yang

Clin Exp Pediatr. 2024;67(6):267-273. Published online May 21, 2024

Web of Science 3 Crossref 2

· The guidelines may not work in the real world.
· An action-plan reflecting patient’s severity and variable of symptoms, values and preferences as well as the benefits and harms of treatment, may be a useful alternative.
· The action plan and as-needed therapy must include the following elements: when, what, how, and why.
· Action plan and as-needed therapy can help patients manage their symptoms more effectively.

DOI: https://doi.org/10.3345/cep.2023.00654

Neonatology (Perinatology)

Influence of infant microbiome on health and development

Noelle Younge

Clin Exp Pediatr. 2024;67(5):224-231. Published online August 21, 2023

Web of Science 1 Crossref 2

· The infant gut microbiome is highly dynamic and individualized.
· Microbes are vertically transmitted from mother to infant during delivery and throughout infancy.
· Delivery mode, gestational age, diet, and antibiotic use influence infant microbiome composition and function.
· In animal studies, the microbiome played critical roles in the structural and functional development of the infant gastrointestinal and immune systems.
· Microbiome-targeted therapies have great potential to reduce infant morbidity and mortality.

DOI: https://doi.org/10.3345/cep.2023.00598

Cardiology

Heart failure in children and adolescents: an update on diagnostic approaches and management

Amit Agrawal, Dalwinder Janjua, Abdulrahman Ahmed Alsayed Ali Zeyada, Ahmed Taher Elsheikh

Clin Exp Pediatr. 2024;67(4):178-190. Published online June 19, 2023

Web of Science 2 Crossref 2

· Pediatric heart failure (PHF) is a clinical syndrome featuring various symptoms (shortness of breath, ankle swelling, fatigue) and signs (pulmonary crackles, peripheral edema).
· Congenital heart diseases are the most common underlying etiology of PHF, whereas myocarditis and primary cardio-myopathies are common in children without structural ab-normalities.
· PHF pathophysiology is complex and multifactorial and varies by etiology and age.
· PHF management includes decongestive therapy, treatment of underlying causes, preventing progression, and managing pulmonary or systemic obstructions.
· Drugs should be chosen based on pharmacodynamics, clinical manifestations, hemodynamic state, and renal function.

DOI: https://doi.org/10.3345/cep.2023.00528

Original Article

Neurology

Changes in frequency of benign convulsions with mild gastroenteritis and their viral causes before and during the COVID-19 pandemic: a single-center study

Hyejin Na, Sanghoon Lee, Seo Hee Kim, Young Ok Kim

Clin Exp Pediatr. 2024;67(4):213-220. Published online March 19, 2024

Web of Science 2 Crossref 2

Question: Did coronavirus disease 2019 (COVID-19) affect the frequency, seasonal variation, or virus type of benign convulsions with mild gastroenteritis (CwG)?
Findings: We compared 41 cases of CwG before and during the COVID-19 pandemic. After March 2020, frequency did not change significantly (18 patients vs. 23 patients), seasonal variation was lost, and number of cases of enteric adenovirus-associated CwG increased (1 cases vs. 7 cases).
Meaning: The COVID-19 pandemic affected CwG.

DOI: https://doi.org/10.3345/cep.2023.01137

Review Article

Allergy

Practical issues of oral immunotherapy for egg or milk allergy

Sukyung Kim, Kangmo Ahn, Jihyun Kim

Clin Exp Pediatr. 2024;67(3):140-148. Published online June 19, 2023

Web of Science 2 Crossref 2

· Oral immunotherapy should be supervised by pediatricians with experience administering oral food challenge tests and managing allergic reactions.
· Food allergen intake is gradually increased and maintained for years.
· Patients may experience allergic reactions and psychological problems.
· Adjunctive therapies (biologics, antihistamines, and leukotriene receptor antagonists) may improve efficacy and safety.
· Contraindications include uncontrolled asthma, malignancy, active autoimmune disorders, and beta-blocker usage.

DOI: https://doi.org/10.3345/cep.2023.00234

Editorial

Endocrinology

Nonalcoholic fatty liver disease in children and adolescents

Hae Sang Lee

Clin Exp Pediatr. 2024;67(2):90-91. Published online January 24, 2024

Web of Science 2 Crossref 2

· With the increase in childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become a concern in recent years.
· NAFLD is strongly associated with insulin resistance.
· Lifestyle modifications are the mainstay treatment for NAFLD.

DOI: https://doi.org/10.3345/cep.2023.00752

Review Article

Endocrinology

Growth plate closure and therapeutic interventions

Ja Hyang Cho, Hae Woon Jung, Kye Shik Shim

Clin Exp Pediatr. 2024;67(11):553-559. Published online October 28, 2024

Web of Science 2 Crossref 2

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.

DOI: https://doi.org/10.3345/cep.2023.00346

Neonatology (Perinatology)

Demographic transition in South Korea: implications of falling birth rates

Chae Young Kim, Sung-Hoon Chung

Clin Exp Pediatr. 2024;67(10):498-509. Published online June 27, 2024

Web of Science 2 Crossref 2

· Since 1960, South Korea's TFR decreased from 6.33 to 0.78 in 2022, below the 2.1 replacement level since 1983, with women's average age at first marriage rising to 31.3 in 2022.
· Policies needed: financial incentives, longer parental leave, better childcare.
· The U.S. (15.3% immigrants) and Germany (18.8%) use immigration to maintain demographic stability, a strategy South Korea is considering.

DOI: https://doi.org/10.3345/cep.2023.01599

Nephrology (Genitourinary)

X-linked hypophosphatemic rickets: from diagnosis to management

Eujin Park, Hee Gyung Kang

Clin Exp Pediatr. 2024;67(1):17-25. Published online June 14, 2023

Web of Science 2 Crossref 2

· X-linked hypophosphatemia (XLH), the most common cause of hypophosphatemic rickets, affects 1/20,000 people.
· XLH is caused by a loss-of-function mutation of the PHEX gene.
· Its main pathogenesis is elevated fibroblast growth factor-23 (FGF23) level.
· Burosumab, an FGF23 inhibitor, was developed in the early 2000s.
· Burosumab was approved in Korea in 2020 for XLH patients aged 1+ years with radiographic evidence of bone disease.

DOI: https://doi.org/10.3345/cep.2022.01459

Original Article

Neurology

Effectiveness of Helmet therapy for infants with moderate to severe positional plagiocephaly

Jeongho Kim, Jina Kim, Kyu Young Chae

Clin Exp Pediatr. 2024;67(1):46-53. Published online December 5, 2023

Web of Science 1 Crossref 2

Question: Is helmet therapy effective for positional plagiocephaly? What factors influence helmet therapy efficacy for positional plagiocephaly?
Finding: Helmet therapy is effective for infants with moderate to severe positional plagiocephaly, and its effectiveness is influenced by age at treatment initiation, severity of head asymmetry, and daily duration of helmet wear.
Meaning: Pediatricians should initiate helmet therapy for positional plagiocephaly sooner, ideally before 9 months of age, to maximize treatment efficacy.

DOI: https://doi.org/10.3345/cep.2023.00626

Review Article

Nutrition

Protein substitutions as new-generation pharmanutrition approach to managing phenylketonuria

Fatma Nur Keskin, Teslime Özge Şahin, Raffaele Capasso, Duygu Ağagündüz

Clin Exp Pediatr. 2023;66(8):320-331. Published online November 1, 2022

Web of Science 2 Crossref 2

Phenylketonuria, an autosomal recessive disease that results from the inability to metabolize phenylalanine, is currently treated with medical nutrition therapy. New treatment approaches such as tetrahydrobiopterin, glycomacropeptide, large neutral amino acids, pegvaliase, and gene therapy significantly impact disease management and dietary enrichment. This article also reviews animal and human studies that have evaluated the efficacy and safety of these new protein substitutes.

DOI: https://doi.org/10.3345/cep.2022.00584

Original Article

Neurology

Need for palliative care from birth to infancy in pediatric patients with neurological diseases

Raffaele Falsaperla, Silvia Marino, Carla Moscheo, Lucia Giovanna Tardino, Simona Domenica Marino, Concetta Sciuto, Piero Pavone, Giovanna Vitaliti, Federica Sullo, Martino Ruggieri

Clin Exp Pediatr. 2023;66(8):350-356. Published online June 14, 2023

Web of Science 2 Crossref 2

Question: What are the current palliative care protocols, palliative course, and implementable palliative care programs for hospitalized pediatric patients with neurological diseases in Italy?
Finding: We studied 34 newborns with nervous system diseases, all of whom had a poor prognosis.
Meaning: Despite current legislation in Italy, no palliative care network has been implemented. Given the vast number of patients with neurological conditions, standardized palliative care guidelines and protocols are required.

DOI: https://doi.org/10.3345/cep.2023.00129

Letter to the Editor

Developmental and Behavioral Medicine

Effect of rolling over pattern and caregiver perception on plagiocephaly in Korean infants

Jin A Yoon, Soo-Yeon Kim, Yong Beom Shin

Clin Exp Pediatr. 2023;66(6):272-273. Published online May 24, 2023

Web of Science 2 Crossref 2

DOI: https://doi.org/10.3345/cep.2023.00108

Review Article

Gastroenterology

High-resolution esophageal manometry in children

Yogesh Waikar

Clin Exp Pediatr. 2023;66(4):155-160. Published online October 17, 2022

Web of Science 2 Crossref 2

High-resolution esophageal manometry can be safely performed in children where recurrent vomiting and persistent dysphagia is the working diagnosis after excluding nonluminal and structural obstructive pathologies using pediatric upper gastrointestinal endoscopy. Normal manometry values are available. Clinical picture, biochemical tests, radiological interpretation, and endoscopic findings with manometry completes the analysis of patients with recurrent vomiting and dysphagia.

DOI: https://doi.org/10.3345/cep.2022.00787

Original Article

Infection

Predicting COVID-19 transmission in a student population in Seoul, South Korea, 2020–2021

Young Hwa Lee, Han Ho Kim, Young June Choe

Clin Exp Pediatr. 2023;66(4):173-178. Published online December 22, 2022

Web of Science 2 Crossref 2

Question: What is the spatial distribution and determinants of coronavirus disease 2019 (COVID-19) infection among students in Korea?
Finding: The community population was closely associated with the risk of COVID-19, and the number of students per school class were inversely associated with COVID-19 rates in students.
Meaning: Our finding suggests that controlling the community-level burden of COVID-19 can help prevent sudden acute respiratory syndrome coronavirus 2 infection in school-aged children.

DOI: https://doi.org/10.3345/cep.2022.00983

Editorial

Nephrology (Genitourinary)

Optimal hemodialysis treatment for pediatric kidney failure patients

Yo Han Ahn

Clin Exp Pediatr. 2023;66(3):125-126. Published online February 15, 2023

Web of Science 2 Crossref 2

· Although the basic concept of hemodialysis (HD) is similar in adults and children, specific factors must be considered in the latter, including the small dialyzer and circuit, difficult vascular access, and frequent complications.
· HD-associated complications include catheter-related problems, hemodynamic instability, and neurodevelopmental and cognitive dysfunction.
· Pediatric HD is challenging, and steady efforts are needed to perform it safely and reduce its complications, thereby improving clinical outcomes.

DOI: https://doi.org/10.3345/cep.2022.01431

Original Article

Gastroenterology

Association between maternal weight gain during pregnancy and child’s body mass index at preschool age

Jeewon Shin, Yoowon Kwon, Ju Hee Kim, Su Jin Jeong

Clin Exp Pediatr. 2023;66(2):76-81. Published online November 30, 2022

Web of Science 2 Crossref 2

Question: What are the risk factors of newborn birth weight? Does gestational weight gain and prepregnancy body mass index affect childhood weight?
Finding: Excess maternal weight gain increases the risk of overweight/obesity, newborn birth weight, and child body mass index at 4–6 years.
Meaning: Maternal weight control before and during pregnancy should be well controlled.

DOI: https://doi.org/10.3345/cep.2022.01158

Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis

Gilbert Sterling Octavius, Michelle Imanuelly, Johan Wibowo, Nadia Khoirunnisa Heryadi, Melanie Widjaja

Clin Exp Pediatr. 2023;66(11):477-484. Published online June 14, 2023

Web of Science 2 Crossref 2

Question: The inferior vena cava to aorta (IVC/Ao) ratio measured via ultrasound has been touted as a promising noninvasive technique to assess clinically significant dehydration in pediatric patients.
Finding: Our meta-analysis found that IVC/Ao ratio had a positive likelihood ratio of 3.2 (95% confidence interval [CI], 2.1–5.1) and negative likelihood ratio of 0.18 (95% CI, 0.12–0.28).
Meaning: Hence, IVC/Ao ratio is insufficient to exclude or confirm significant dehydration in pediatric patients.

DOI: https://doi.org/10.3345/cep.2022.01445

Developmental and Behavioral Medicine

Attention-deficit/hyperactive-impulsive disorder symptoms among grade 1 students with reading disorder in Thailand

Patcharapun Sarisuta, Issarapa Chunsuwan, Tippawan Hansakunachai, Paskorn Sritipsukho

Clin Exp Pediatr. 2023;66(11):485-492. Published online October 24, 2023

Crossref 2

Question: Would students with reading disorder have a significantly higher prevalence of attention-deficit/hyperactiveimpulsive disorder (ADHD) symptoms than neurotypical students?
Finding: Students at risk of reading disorder exhibited significant ADHD symptoms compared with those not at risk of reading disorder according to all presentations of teacher assessments versus only for predominantly inattentive presentations of the parental assessments.
Meaning: Students with reading disorder have a significantly higher prevalence of ADHD symptoms than neurotypical students. Sex, parental education level, average family income, and children’s school affiliation significantly influenced reading disorder prevalence.

DOI: https://doi.org/10.3345/cep.2023.00773

Review Article

Infection

Safety monitoring of COVID-19 vaccines: February 26, 2021, To June 4, 2022, Republic of Korea

Yeon-Kyeng Lee, Yunhyung Kwon, Yesul Heo, Eun Kyoung Kim, Seung Yun Kim, Hoon Cho, Seontae Kim, Mijeong Ko, Dosang Lim, Soon-Young Seo, Enhi Cho

Clin Exp Pediatr. 2023;66(10):415-423. Published online June 13, 2023

Web of Science 2 Crossref 2

· Enhanced safety monitoring system of coronavirus disease 2019 (COVID-19) vaccines were implemented to detect signals rapidly as part of the national COVID-19 vaccination program.
· As of June 4, 2023, reported adverse events after COVID-19 vaccination was 0.38% among 125,107,883 doses of COVID- 19 vaccines administered.
· Most reported adverse reactions after COVID-19 vaccinations have shown nonserious and mild intensity.

DOI: https://doi.org/10.3345/cep.2022.00815

Editorial

Pulmonology

Community-acquired pneumonia in Korean children: time to read between the lines

Dong In Suh

Clin Exp Pediatr. 2023;66(1):22-23. Published online November 10, 2022

Web of Science 2 Crossref 2

· Various studies have reported the etiology of community-acquired pneumonia (CAP) in Korean children
· Factors other than etiology are equally important to a compre hensive understanding of CAP
· Knowledge from archived reports is no longer directly applicable to the current CAP and requires careful modification

DOI: https://doi.org/10.3345/cep.2022.00941

Original Article

Neonatology (Perinatology)

Differential roles of interleukin-6 and adrenomedullin in early diagnosis and mortality predictions in late-onset neonatal sepsis

Emilly Henrique dos Santos, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Karen Alessandra Rodrigues, Ronaldo Arkader, Thelma Suely Okay

Clin Exp Pediatr. 2025;68(6):463-471. Published online December 23, 2024

Crossref 1

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.

DOI: https://doi.org/10.3345/cep.2024.01543

Review Article

Allergy

Global burden of asthma among children and adolescents with projections to 2050: a comprehensive review and forecasted modeling study

Tae Hyeon Kim, Hyunjee Kim, Jiyeon Oh, Soeun Kim, Michael Miligkos, Dong Keon Yon, Nikolaos G Papadopoulos

Clin Exp Pediatr. 2025;68(5):329-343. Published online April 22, 2025

Crossref 1

Pediatric asthma can persist to adulthood and must be effectively managed. This review examined the prevalence of asthma among individuals younger than 20 years and revealed a decline from 1990 to 2021, higher rates in males, and a peak in children aged 5–9 years. Despite a projected continued decrease in prevalence by 2050, asthma will remain a significant health concern for children and adolescents.

DOI: https://doi.org/10.3345/cep.2025.00423

Original Article

General Pediatrics

Knowledge, attitude, and practice regarding dengue vaccine: a baseline study of community members and health providers in Indonesia

Abdul Wahab, Ida Safitri Laksanawati, Retna Siwi Padmawati, Asal Wahyuni Erlin Mulyadi, Wahyu Triadmajani, Jarir At Thobari

Clin Exp Pediatr. 2025;68(3):228-237. Published online November 13, 2024

Web of Science 1 Crossref 1

Question: Do community members and health providers show different level of knowledge, attitude, and practice towards dengue vaccine?
Finding: These 2 groups only differed in practice component, while the knowledge and attitude constituents were relatively low for both.
Meaning: There is an urgent need to deliver educational interventions to raise awareness of community members and health providers regarding dengue vaccination.

DOI: https://doi.org/10.3345/cep.2024.00962

Endocrinology

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency

Pattara Wiromrat, Yutapong Raruenrom, Phanpaphorn Namphaisan, Nantaporn Wongsurawat, Ouyporn Panamonta, Chatlert Pongchaiyakul

Clin Exp Pediatr. 2025;68(3):238-246. Published online November 13, 2024

Crossref 1

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.

DOI: https://doi.org/10.3345/cep.2024.01060

Cited By 25	Neurodevelopmental outcomes of preterm infants
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Cited By 20	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 19	Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis
Cited By 18	Nonalcoholic fatty liver disease and insulin resistance in children

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