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Review Article
Neurology
Big data analysis and artificial intelligence in epilepsy – common data model analysis and machine learning-based seizure detection and forecasting
Yoon Gi Chung, Yonghoon Jeon, Sooyoung Yoo, Hunmin Kim, Hee Hwang
Clin Exp Pediatr. 2022;65(6):272-282.   Published online November 26, 2021
· Big data analysis, such as common data model and artificial intelligence, can solve relevant questions and improve clinical care.
· Recent deep learning studies achieved 0.887–0.996 areas under the receiver operating characteristic curve for automated interictal epileptiform discharge detection.
· Recent deep learning studies achieved 62.3%–99.0% accuracy for interictal-ictal classification in seizure detection and 75.0%– 87.8% sensitivity with a 0.06–0.21/hr false positive rate in seizure forecasting.
Other
Knowledge-guided artificial intelligence technologies for decoding complex multiomics interactions in cells
Dohoon Lee, Sun Kim
Clin Exp Pediatr. 2022;65(5):239-249.   Published online November 26, 2021
· The need for data-driven modeling of multiomics interactions was recently highlighted.
· Many artificial intelligence-driven models have been developed, but only a few have incorporated biological domain knowledge within model architectures or training procedures.
· Here we provide a comprehensive review of deep learning models to decipher complex multiomics interactions regarding the biological guidance imposed upon them to facilitate further development of biological knowledge-guided deep learning models.
Letter to the Editor
Oncology
Retrospective review of severe acute respiratory syndrome coronavirus-2 infection in children with acute leukemia from a tertiary care hospital in Northern India
Suhail Chhabra, Aditya Dabas, Richa Mittal, Neha Goel, Ritabrata Roy Chowdhary, Satyendra Batra, Amitabh Singh, Rani Gera
Clin Exp Pediatr. 2022;65(3):150-151.   Published online November 26, 2021
Review Article
Infection
Etiological and pathophysiological enigmas of severe coronavirus disease 2019, multisystem inflammatory syndrome in children, and Kawasaki disease
Jung-Woo Rhim, Jin-Han Kang, Kyung-Yil Lee
Clin Exp Pediatr. 2022;65(4):153-166.   Published online November 23, 2021
· Severe cases of coronavirus disease, Kawasaki disease (KD), and multisystem inflammatory syndrome in children (MIS-C) share similar findings: a protracted clinical course, multiorgan involvement, and similar activated biomarkers.
· Here we propose etiological agents in KD and MIS-C as species in the microbiota and introduce a common pathogenesis through the protein-homeostasis-system hypothesis.
· Early proper dose of corticosteroids and/or intravenous immunoglobulin may help to reduce morbidity and mortality in these diseases.
Original Article
Developmental and Behavioral Medicine
Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis
Siyoung Choe, Jaesin Sa, Jean-Philippe Chaput, Deokjin Kim
Clin Exp Pediatr. 2022;65(2):98-107.   Published online November 23, 2021
Question: What is the overall effect of obesity interventions among Korean children and what affects their effectiveness?
Finding: Interventions were strongly favored over controls. Interventions including at least one physical activity component were significantly better than those that did not. Sex, age, baseline weight category, intervention duration, and the number of intervention components were not significant.
Meaning: Future obesity interventions for Korean children must seek to include physical activity components.
General Pediatrics
Effect of 2–6 weeks of systemic steroids on bone mineral density in children
Athira Kuniyil, Somdipa Pal, Namrita Sachdev, Tribhuvan Pal Yadav
Clin Exp Pediatr. 2022;65(5):254-261.   Published online November 18, 2021
Question: Does steroid use for 2–6 weeks in children affect bone mineral content (BMC) or density (BMD)?
Finding: Steroid use for 2–6 weeks significantly decreased BMC and BMD of the whole body, total body less the head, lumbar spine, and distal radius. A significant negative correlation was observed among BMD, duration, and cumulative dose.
Meaning: Steroid use for 2–6 weeks in children negatively affected BMC and BMD.
Endocrinology
Effects of probiotics combined with dietary and lifestyle modification on clinical, biochemical, and radiological parameters in obese children with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: a randomized clinical trial
Thushara Rodrigo, Samaranayake Dulani, Sumudu Nimali Seneviratne, Arjuna P. De Silva, Jerad Fernando, H. Janaka De Silva, Jayasekera , V. Pujitha Wickramasinghe
Clin Exp Pediatr. 2022;65(6):304-311.   Published online November 11, 2021
Question: Could probiotics be used as a therapeutic modality in nonalcoholic fatty liver disease/nonalcoholic steatohepatitis?
Finding: There seem no added advantages over lifestyle modifications compared to Probiotics.
Meaning: There does not seem to be an advantage of probiotics over lifestyle modifications in improving obesity-associated metabolic derangement in children.
Review Article
Neurobehavior
Psychological aspects in children and parents of children with chronic kidney disease and their families
Alemsungla Aier, Priya Pais, Vijaya Raman
Clin Exp Pediatr. 2022;65(5):222-229.   Published online November 10, 2021
· Childhood chronic kidney disease (CKD) is complex and requires lifetime medical treatment.
· Children with CKD are at risk for emotional, behavioral, social, and academic difficulties that significantly affect their quality of life.
· Caring for children with CKD is stressful for families.
· These unique challenges are crucial and can negatively impact treatment outcomes.
· Awareness of and addressing these evolving psychosocial issues can foster their developing needs.
Original Article
Other
Risk factors and screening timing for developmental dysplasia of the hip in preterm infants
Ga Won Jeon, Hye Jung Choo, Yong Uk Kwon
Clin Exp Pediatr. 2022;65(5):262-268.   Published online November 5, 2021
Question: When is the best screening timing and what is the risk factor for developmental dysplasia of the hip (DDH) in preterm infants?
Finding: Ultrasonography performed earlier than 38 weeks of postmenstrual age caused unnecessary subsequent ultrasonography. DDH did not occur predominantly on the left side or in breech infants.
Meaning: The screening timing, etiology, and risk factors for DDH in preterm infants are somewhat different from those in term infants.
Review Article
Infection
Four months of rifampicin monotherapy for latent tuberculosis infection in children
Chi Eun Oh, Dick Menzies
Clin Exp Pediatr. 2022;65(5):214-221.   Published online October 29, 2021
· Recently, the importance of a short-term treatment regimen including rifamycin has been highlighted in the treatment of latent tuberculosis infection (LTBI).
· Four prospective or retrospective studies in children consistently reported that a 4-month daily rifampicin regimen (4R) had a higher completion rate than and comparable safety to a nine-month daily isoniazid regimen.
· We suggest rifampicin 20–30 mg/kg/day for children aged 0–2 years and 15–20 mg/kg/day for children aged 2–10 years in 4R to treat LTBI.
Correspondence
General Pediatrics
Letter to the editor: Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran
Amar Taksande
Clin Exp Pediatr. 2023;66(9):412-413.   Published online October 27, 2021
Original Article
General Pediatrics
Early initiation of breastfeeding and factors associated with its delay among mothers at discharge from a single hospital
J. Jenifer Florence Mary, R. Sindhuri, A. Arul Kumaran, Amol R. Dongre
Clin Exp Pediatr. 2022;65(4):201-208.   Published online October 18, 2021
Background: According to the National Family Health Survey– 4, in India, 78.9% of deliveries occur in institutions, although only 42.6% of new mothers initiate breastfeeding within 1 hour of delivery.
Purpose: To estimate the proportion of early initiation of breastfeeding (EIBF) among new mothers at discharge from a tertiary care hospital and identify the determinants of delayed initiation of breastfeeding among...
Review Article
Neonatology (Perinatology)
Pathophysiology, classification, and complications of common asymptomatic thrombocytosis in newborn infants
Ga Won Jeon
Clin Exp Pediatr. 2022;65(4):182-187.   Published online October 18, 2021
· Thrombocytosis, common in newborns and infants (<2 years) (3%–13%), is caused by elevated thrombopoietin (TPO) concentrations.
· Serum TPO levels are significantly higher immediately to 1 month postnatal and decrease with age.
· Platelet counts are positively correlated with gestational age at birth and postnatal age.
· Thrombocytosis is more common in preterm than in term infants.
· Thrombocytosis in newborns is reactive and resolves spontaneously without complications.
Endocrinology
Genetic factors in precocious puberty
Young Suk Shim, Hae Sang Lee, Jin Soon Hwang
Clin Exp Pediatr. 2022;65(4):172-181.   Published online October 18, 2021
· Mutations in the kisspeptin (KISS1), kisspeptin receptor (KISS1R), makorin ring finger protein 3 (MKRN3), and delta-like homolog 1 (DLK1) genes are associated with idiopathic central precocious puberty (ICPP).
· A few genes related to pubertal onset have been implicated in ICPP.
· Epigenetic factors such as DNA methylation, histone posttranslational modifications, and noncoding ribonucleic acids may be related to ICPP
Neonatology (Perinatology)
Retinopathy of prematurity: a review of epidemiology and current treatment strategies
Eun Hee Hong, Yong Un Shin, Heeyoon Cho
Clin Exp Pediatr. 2022;65(3):115-126.   Published online October 12, 2021
There have been global tri-phasic epidemic periods of retinopathy of prematurity (ROP). In recent years, its incidence has reportedly been 10%–40% depending on country and study population. Current treatment strategies for ROP include laser photocoagulation, surgical treatment, and anti-vascular endothelial growth factor treatment, the role of which has drawn attention in recent years.
Editorial
General Pediatrics
Is it time to add point-of-care ultrasound education to pediatric residency curriculum?
Shin Ae Yoon
Clin Exp Pediatr. 2022;65(1):33-34.   Published online October 12, 2021
Growing point-of-care ultrasound (POCUS) use in pediatric patients has led to the need for POCUS education for pediatric residents. Recent experimental studies have suggested that POCUS education improves self-rated POCUS confidence and comfort in pediatric resident training. Considering the effective and sustainable POCUS education curriculum in pediatric resident training, simulation-based education would be a solution.
Original Article
Infection
Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city
Mi Ae Chu, Yoon Young Jang, Dong Won Lee, Sung Hoon Kim, Namhee Ryoo, Sunggyun Park, Jae Hee Lee, Hai Lee Chung
Clin Exp Pediatr. 2021;64(12):652-660.   Published online October 12, 2021
Question: What is the natural course of viral load in children with coronavirus disease 2019 (COVID-19)?
Finding: A significant number of patients still had a relatively high viral load once clinically asymptomatic. Nearly half of the patients experienced viral rebound, which contributed to prolonged viral detection in their respiratory specimens.
Meaning: Further studies are needed to determine the clinical significance of viral rebound in asymptomatic or mild pediatric cases of COVID-19.
Letter to the Editor
Infection
Multisystem inflammatory syndrome in children and Kawasaki disease in infants: 2 sides of the same coin?
Hing Cheong Kok, Dinesh Nair, Ke Juin Wong, Siew Moy Fong
Clin Exp Pediatr. 2021;64(11):599-601.   Published online October 7, 2021
Question: Are multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) in infants, 2 sides of the same coin?
Finding: Here we report on a 4-month-old girl with MIS-C and signs of KD with shock. Most (83%) infants with MIS-C had features of KD, especially KD shock syndrome.
Meaning: MIS-C is similar to KD, and likely is a consequence of dysregulated immune responses secondary to sudden acute respiratory syndrome coronavirus 2 infection.
Allergy
Environmental and dietary factors to be checked for treatment of atopic dermatitis in rural children
Sanghwa Youm, Eunjoo Lee, Jeongmin Lee
Clin Exp Pediatr. 2021;64(12):661-663.   Published online October 1, 2021
Question: What are the distinctive features of rural children with atopic dermatitis?
Finding: Birch and dog dander were the second most sensitized aeroallergens (32.6%), followed by house dust mites. Doctors and guardians reported food allergy comorbidities differently (19.9% and 43.5%, respectively). Dietary restrictions without medical evaluation were observed in 39.7% of patients.
Meaning: Effects of pollen distribution and indirect animal exposure should be evaluated. Evidence-based dietary restrictions must be implemented.
Review Article
Neurology
Worldwide national intervention of developmental screening programs in infant and early childhood
Seunghyo Kim
Clin Exp Pediatr. 2022;65(1):10-20.   Published online September 30, 2021
∙ Prevalence rate of developmental disabilities has been reported from 8% to 15% and its rate is increasing worldwide.
∙ The critical period of intervention for developmental delay is before the child reaches 3 years of age.
∙ All primary care pediatricians should conduct developmental surveillance and screening tests to infants and children at scheduled visits. Through this, they are liable for providing early identification and timely intervention.
Editorial
Neurology
Recent studies are focus on the new treatments for hypoxicischemic encephalopathy (HIE) and long-term outcomes in later childhood and adolescence in children with a history on HIE
Eun Sook Suh
Clin Exp Pediatr. 2021;64(12):628-629.   Published online September 30, 2021
Neonatal encephalopathy is the most important reason for morbidity and mortality. The early detection of neonate with high risk for hypoxic ischemic encephalopathy (HIE) and treatment are important for prevent long term complication. Hypothermia is currently standard treatment option for HIE. Several clinical studies have been performed due to improve the long term outcome. New therapeutic options including xenon, allopurinol, erythropoietin, topiramate will help to reduce neuropsychiatric disability.
Original Article
Neonatology (Perinatology)
Is fetal nuchal cord associated with autism spectrum disorder? A meta-analysis
Ensiyeh Jenabi, Maryam Ahmadi, Azam Maleki
Clin Exp Pediatr. 2022;65(3):131-135.   Published online September 24, 2021
Question: Is fetal nuchal cord a risk factor for autism spectrum disorder (ASD)?
Finding: Five articles (1 cohort, 4 case-control; total 3,088 children) were included in the present meta-analysis. Fetal nuchal cord was not a risk factor for ASD (odds ratio, 1.11; 95% confidence interval, 0.66–1.57). There was homogeneity among studies that reported a risk of ASD (I2=0.0).
Meaning: Fetal nuchal cord is not a risk factor for ASD.
Review Article
Infection
Changes in age-specific seroprevalence of Japanese encephalitis virus and impact of Japanese encephalitis vaccine in Korea
Byung Ok Kwak, Young Jin Hong, Dong Hyun Kim
Clin Exp Pediatr. 2022;65(3):108-114.   Published online September 24, 2021
Since the introduction of a universal Japanese encephalitis (JE) vaccination program and urbanization, the incidence of JE has dramatically decreased in Korea. However, recent JE cases have occurred, predominantly among unvaccinated adults and with a shift in age distribution. Continuous surveillance of the seroprevalence of JE is required to establish a proper immunization policy in Korea.
Nephrology (Genitourinary)
Blood pressure measurements and hypertension in infants, children, and adolescents: from the postmercury to mobile devices
Seon Hee Lim, Seong Heon Kim
Clin Exp Pediatr. 2022;65(2):73-80.   Published online September 15, 2021
· Hypertension is defined as a blood pressure (BP) >90th (elevated) or 95th (hypertension) percentile in children by height, age, and sex and >95th percentile in neonates by age, birth weight, and sex.
· Although the oscillometric method can be used for screenings, the auscultatory method remains the gold standard. The hybrid method employs the auscultatory and electronic methods and can reduce bias.
· BP measurement mobile device applications have a potential for development.
Gastroenterology
Upper gastrointestinal tract involvement of Crohn disease: clinical implications in children and adolescents
Eun Sil Kim, Mi Jin Kim
Clin Exp Pediatr. 2022;65(1):21-28.   Published online September 10, 2021
· Clinical manifestations of upper gastrointestinal (UGI) tract involvement in Crohn's disease (CD) are common but often clinically underestimated.
· Diagnosing CD by confirming inflammation of the UGI tract histologically is challenging because macroscopic and microscopic findings overlap with those of other diseases.
· Ongoing efforts are needed to enable a standardized assessment of UGI CD in the future.
Clinical Note
Infection
A neonate infected with coronavirus disease 2019 with severe symptoms suggestive of multisystem inflammatory syndrome in childhood
Fatemeh Eghbalian, Ghazal Sami, Saeid Bashirian, Ensiyeh Jenabi
Clin Exp Pediatr. 2021;64(11):596-598.   Published online September 10, 2021
Question: Can multisystem inflammatory syndrome in childhood (MIS-C) occur in the neonate associated with coronavirus disease 2019 (COVID-19)?
Finding: A 9-day-old neonate infected with COVID-19 had fever, respiratory distress, and gastrointestinal symptoms suggestive of MIS-C. This neonate recovered after treatment with intravenous immunoglobulin (IVIG).
Meaning: IVIG successfully treated a rare case of a 9-day-old neonate with COVID-19 and severe symptoms suggestive of MIS-C.
Original Article
Emergency Medicine
Nonfatal injuries in Korean children and adolescents, 2007–2018
Gyu Min Yeon, Yoo Rha Hong, Seom Gim Kong
Clin Exp Pediatr. 2022;65(4):194-200.   Published online September 9, 2021
Question: How many children and adolescents have experienced nonfatal injuries in the previous year?
Finding: Among Korean children and adolescents, 8.1% experienced at least one injury per year. We found no significant change in the incidence of injuries over the previous 12 years.
Meaning: The incidence of injuries is higher than this estimation; therefore, more attention and effort are needed to prevent injuries among children and adolescents.
Review Article
Endocrinology
Endocrine comorbidities of pediatric obesity
Jieun Lee, Jae Hyun Kim
Clin Exp Pediatr. 2021;64(12):619-627.   Published online August 26, 2021
∙ Pediatric obesity can involve endocrine comorbidities such as prediabetes, type 2 diabetes, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, and central precocious puberty.
∙ Prediabetes and type 2 diabetes in youth aged 10–19 years had a prevalence of 25.9% and 0.6% in 2013–2014, respectively.
∙ Dyslipidemia in Korean adolescents aged 10–18 years had a prevalence of 7.64% (total cholesterol ≥200 mg/dL), 6.09% (low-density lipoprotein cholesterol ≥130 mg/dL), 8.69% (triglyceride ≥150 mg/dL), and 12.52% (high-density lipoprotein cholesterol ≤40 mg/dL) in 2007–2018.
∙ Metabolic syndrome in Korean youth has a prevalence of 1.9%–14.7% in males and 1.7%–12.6% in females with wide variation in definitions.
∙ Appropriate comorbidity screening and management and/or specialist referral are necessary for obese children and adolescents.
Neurology
Promising candidate cerebrospinal fluid biomarkers of seizure disorder, infection, inflammation, tumor, and traumatic brain injury in pediatric patients
Seh Hyun Kim, Soo Ahn Chae
Clin Exp Pediatr. 2022;65(2):56-64.   Published online August 23, 2021
· Pediatric cerebrospinal fluid (CSF) components have been extensively evaluated as biomarkers of various neurologic diseases.
· Several promising candidate CSF biomarkers, including Tau, glial fibrillary acidic protein, neuron-specific enolase, S100β, and interleukins, have been studied in pediatric patients with seizure disorders, central nervous system infections, inflammation, tumors, hypoxic-ischemic encephalopathy, traumatic brain injuries, intraventricular hemorrhage, and congenital hydrocephalus.
· Circulating microRNAs in the CSF are a promising class of biomarkers for various neurological diseases.
Original Article
Other
Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital
Muruganantham Balagurunathan, Thrilok Natarajan, Jothilakshmi Karthikeyan, Venkateshwaran Palanisamy
Clin Exp Pediatr. 2021;64(10):531-537.   Published online August 4, 2021
Question: What are the clinical spectrum, course, and short-term outcomes of multisystem inflammatory syndrome in children (MIS-C)?
Finding: MIS-C can have variable clinical manifestations. Fever is most common, followed by gastrointestinal and cardiovascular symptoms. Early identification and appropriate management lead to favorable outcomes.
Meaning: MIS-C can present in a myriad of ways and severities. High suspicion is necessary to ensure its early identification and appropriate management and favorable patient outcomes.


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