Clinical and Experimental Pediatrics

Editorial

Infection

Catheter care bundle and feedback to prevent central line-associated bloodstream infections in pediatric patients

Hye-Kyung Cho

Clin Exp Pediatr. 2021;64(3):119-120. Published online December 8, 2020

• Intravascular catheter-related infection is an important cause of morbidity and mortality in children, and care bundles are effective and cost-saving in pediatric and neonatal patients.
• Providing regular feedbacks to critical care practitioners is helpful to maintain compliance to care bundle.
• Establishing a bundle policy (insertion and maintenance), monitoring compliance, and providing regular feedbacks are necessary for prevention of central line-associated bloodstream infections in pediatric patients.

DOI: https://doi.org/10.3345/cep.2020.01186

Clinical note

Immunology

Salivary and lacrimal gland enlargement with serum immunoglobulin G4 elevation

Jinseok Lee, Da-Eun Kim, Jeong-Hwan Yang, Misun Lim, Hye Yung Yum, JoongGon Kim

Clin Exp Pediatr. 2021;64(2):93-95. Published online December 8, 2020

Question: What diseases should be considered in a 15-year-old girl presenting enlarged lacrimal and salivary glands?
Finding: Laboratory tests revealed elevated IgG4 levels. A submandibular gland biopsy showed lymphoplasmacytic infiltration and more than 40 immunoglobulin G4 (IgG4)-positive cells per high-power field. The patient was diagnosed with IgG4-related disease.
Meaning: Although rare in children, IgG4-related disease should be considered a differential diagnosis in children with enlarged salivary and lacrimal glands.

DOI: https://doi.org/10.3345/cep.2020.01319

Editorial

Cardiology

Where should we start to improve pediatric heart transplantation outcomes?

Jinyoung Song

Clin Exp Pediatr. 2021;64(2):76-77. Published online November 25, 2020

· Pediatric heart transplantation is achieving better outcomes.
· The waitlist mortality is still high, especially in Korea, and should be reduced.
· The use of ventricular assist device is promising and might offer improved waitlist mortality rates.

DOI: https://doi.org/10.3345/cep.2020.00584

Guideline

Endocrinology

2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents

Jung Sub Lim, Eun Young Kim, Jae Hyun Kim, Jae-Ho Yoo, Kyung Hee Yi, Hyun Wook Chae, Jin-Ho Choi, Ji Young Kim, Il Tae Hwang; the Committee of Dyslipidemia of Korean Children and Adolescents on behalf of Korean Society of Pediatric Endocrinology (KSPE)

Clin Exp Pediatr. 2020;63(12):454-462. Published online November 25, 2020

Web of Science 9 Crossref 10

Question: How are children and adolescents with dyslipidemia treated and managed in Korea?
Finding: 2017 guidelines recommend to measure nonfasting non-HDL-C as a screening test and introduce new diet methods: Cardiovascular Health Integrated Lifestyle Diet (CHILD)-1, CHILD-2-low-density lipoprotein cholesterol, and CHILD-2-triglyceride. Statin is the only drug approved in children older than 10 years.
Meaning: New clinical practice guidelines for treating and managing dyslipidemia of Korean children and adolescents are provided.

DOI: https://doi.org/10.3345/cep.2020.01340

Original Article

Infection

Prevalence of methicillin-resistant Staphylococcus aureus in Iranian children: a systematic review and meta-analysis

Farhad Sarrafzadeh, Seyed Mojtaba Sohrevardi, Hamid Abousaidi, Hossein Mirzaei

Clin Exp Pediatr. 2021;64(8):415-421. Published online November 20, 2020

Web of Science 6 Crossref 5

The pooled prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 42% among culture-positive cases of S. aureus, 51% in hospitalized children, and 14% in healthy children. The high prevalence of MRSA in Iranian children may be due to insufficient infection control measures in hospitals, inappropriate use of methicillin, inadequate staff training, and over-prescription of antibiotics in Iran.

DOI: https://doi.org/10.3345/cep.2020.00255

Perspective

Other

Role of the Korea National Institute of Health in the children’s health effect study of particulate matter

Young Youl Kim

Clin Exp Pediatr. 2021;64(4):139-140. Published online November 17, 2020

Particulate matter (PM) adversely affects children’s lungs and cognitive development, and an early exposure to it can lead to chronic metabolic diseases. The Korea National Institute of Health convened a Task Force on the Health Impact of PM to produce scientific evidence and promote technological developments to prevent PM-induced health effects.

DOI: https://doi.org/10.3345/cep.2020.00780

Original Article

Nutrition

Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery

Nehal El Koofy, Hadeer Mohamed Nasr Eldin, Wesam Mohamed, Mostafa Gad, Sara Tarek, Gamal El Tagy

Clin Exp Pediatr. 2021;64(9):473-479. Published online November 16, 2020

Web of Science 6 Crossref 8

Question: Is malnutrition a risk factor for postoperative complications in pediatric surgical patients?
Finding: There is a high incidence of malnutrition in pediatric surgical patients. Stunting increases the risks of postoperative complications and extended hospital stays, while underweight status contributes to extended hospital stays.
Meaning: Preoperative nutritional assessments are crucial to improving postoperative outcomes. Anemia increases the risk of postoperative complications and should be corrected preoperatively.

DOI: https://doi.org/10.3345/cep.2020.00458

Clinical note

Nephrology (Genitourinary)

Extracorporeal membrane oxygenation with systemic heparinization as a rescue therapy for acute life-threatening pulmonary thromboembolism complicating nephrotic syndrome

Kyusang You, So Mi Kim, Dongmin Kim, Kyoungmin Ryu, Mee Jeong Lee

Clin Exp Pediatr. 2021;64(8):430-432. Published online November 16, 2020

Web of Science 1 Crossref 1

Question: How would you treat acute life-threatening pulmonary thromboembolism occurring in nephrotic patients?
Finding: A 16-year-old woman with minimal change-associated nephrotic syndrome presented with cardiac arrest caused by an acute bilateral pulmonary thromboembolism. Her hemodynamics stabilized with resolution of thrombi while on venoarterial extracorporeal membrane oxygenation (ECMO) and systemic heparinization.
Meaning: In selected cases, ECMO with systemic heparinization may rescue patients from acute life-threatening pulmonary thromboembolism even without reperfusion therapy.

DOI: https://doi.org/10.3345/cep.2020.01550

Original Article

Hematology

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

Jun Young An, Yoo Rha Hong, Seom Gim Kong

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

Web of Science 2 Crossref 2

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

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

Review Article

Allergy

Food allergies and food-induced anaphylaxis: role of cofactors

Meeyong shin

Clin Exp Pediatr. 2021;64(8):393-399. Published online November 12, 2020

Web of Science 10 Crossref 24

Question: What are the roles of cofactors in food allergies and food-induced anaphylaxis?
Finding: Cofactors reportedly play a role in approximately 14%–30% of anaphylactic reactions. Cofactors such as exercise, infection, nonsteroidal anti-inflammatory drugs, dehydration, and alcohol can increase intestinal permeability and antigen uptake, thereby causing allergic symptoms.
Meaning: Routine assessment of the possible involvement of cofactors is essential for the management of patients with food-induced anaphylaxis.

DOI: https://doi.org/10.3345/cep.2020.01088

Editorial

Neurology

Psychogenic nonepileptic seizures; beyond differentiating from epileptic seizures

Sang Ook Nam

Clin Exp Pediatr. 2021;64(6):282-283. Published online November 12, 2020

DOI: https://doi.org/10.3345/cep.2020.01207

Letter to the Editor

Gastroenterology

Functional gastrointestinal disorders and smartphone use in adolescents

Mauro Cinquetti, Marco Biasin, Marco Ventimiglia, Linda Balanzoni, Denise Signorelli, Angelo Pietrobelli

Clin Exp Pediatr. 2021;64(9):494-496. Published online November 9, 2020

Web of Science 4 Crossref 5

Question: Are functional gastrointestinal disorders (FGIDs) common in Italy? If so, what are the associated risk factors?
Finding: In this cross-sectional study of 1,594 adolescents, the prevalence of FGIDs was 30.9% and was mainly associated with smartphone addiction.
Meaning: Smartphone use and dietary habits should be monitored in children with FGIDs.

DOI: https://doi.org/10.3345/cep.2020.01326

Editorial

Neurology

Recent trends in autism spectrum disorder research using text mining of PubMed: importance of early detection

Seung Soo Kim

Clin Exp Pediatr. 2021;64(7):339-340. Published online November 9, 2020

Behavioral therapy, the most widely proven intervention for the core symptoms of autism spectrum disorder (ASD), is required for life for individuals with ASD. Parent involvement, early detection, and early therapy play important roles. We must organize the risk factors for ASD and develop a screening tool that can be easily applied in the clinical, daycare, or school setting.

DOI: https://doi.org/10.3345/cep.2020.01564

Review Article

Neonatology (Perinatology)

Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up

Yumi Kono; on behalf of the Neonatal Research Network of Japan

Clin Exp Pediatr. 2021;64(7):313-321. Published online November 9, 2020

Web of Science 23 Crossref 25

· Very low birth weight infants remain at high risk of developing neurodevelopmental impairments in early childhood.
· It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.
· All possible strategies should be employed to maintain good compliance after neonatal intensive care unit discharge.

DOI: https://doi.org/10.3345/cep.2020.01312

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

Letter to the Editor

General Pediatrics

Skipping breakfast is associated with lifestyle habits among Japanese pupils

Jun Kohyama

Clin Exp Pediatr. 2021;64(8):433-435. Published online November 4, 2020

Crossref 1

Question: Breakfast is important; however, adolescents are increasingly skipping it.
Finding: Skipping breakfast is independently associated with sleepiness, physical inactivity, dinner irregularity, screen time on school days, poor academic performance, after-school activity, and decreased sleep duration before school day.
Meaning: Reducing screen time on school days, after-school activity, and irregular dinner habits might decrease breakfast skipping, resulting in decreased sleepiness and improved academic performance.

DOI: https://doi.org/10.3345/cep.2020.01263

Original Article - Clinical trial

WITHDRAWN:Randomized controlled trial of effect of N-acetylcysteine as an antioxidant on iron overload in children with thalassemia major

Yasmen A Mohamed, Mohamed H Meabed, Amany Ashraf, Dalia S Morgan, Mostafa G Abdul Latif, Rehab M Abd-Elkareem, Heba M Ahmed

Background: β-Thalassemias are characterized by the presence of mutations in the globin gene that result in the absence or reduced synthesis of β-globin chains of the hemoglobin tetramer. Several studies have reported increased oxidative stress in β-thalassemia major (β-TM) patients. N-acetylcysteine (NAC), a derivative of L-cysteine amino acid, is commonly used as a mucolytic drug. Numerous studies have reported efficient...

DOI: https://doi.org/10.3345/cep.2020.00227

Original Article

Allergy

Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1–3 years

Jihyun Lee, Meeyong Shin, Bora Lee

Clin Exp Pediatr. 2021;64(8):408-414. Published online November 1, 2020

Web of Science 6 Crossref 7

Question: Is age at the time of complementary food introduction associated with asthma and atopic dermatitis (AD) in early childhood?
Finding: We found no significant association between age at the time of complementary food introduction and the incidence of AD and asthma in Koreans aged 1–3 years.
Meaning: Our findings suggest that the influence of individual allergenic foods on the development of AD and asthma should be clarified.

DOI: https://doi.org/10.3345/cep.2020.01382

Nephrology (Genitourinary)

Expression profiling of cultured podocytes exposed to nephrotic plasma reveals intrinsic molecular signatures of nephrotic syndrome

Stuti Panigrahi, Varsha Chhotusing Pardeshi, Karthikeyan Chandrasekaran, Karthik Neelakandan, Hari PS, Anil Vasudevan

Clin Exp Pediatr. 2021;64(7):355-363. Published online November 1, 2020

Web of Science 1 Crossref 1

Question: Is it possible to classify nephrotic syndrome (NS) through gene expression profiling of podocytes exposed to NS plasma?
Finding: Our data showed different expression profiles in podocytes exposed to nephrotic plasma from different clinical groups, suggesting the molecular stratification of patients into intrinsic subtypes.
Meaning: Transcriptome profiling of podocytes treated with NS plasma can stratify patients into intrinsic subtypes and provide insight into the molecular mechanisms of podocyte injury.

DOI: https://doi.org/10.3345/cep.2020.00619

Urinary neutrophil gelatinase-associated lipocalin: a marker of urinary tract infection among febrile children

Ji Hyun Moon, Kee Hwan Yoo, Hyung Eun Yim

Clin Exp Pediatr. 2021;64(7):347-354. Published online October 17, 2020

Web of Science 14 Crossref 12

Question: Reliably diagnosing urinary tract infection (UTI) in febrile children is often difficult. Can urinary neutrophil gelatinase-associated lipocalin (uNGAL) better predict UTI and acute pyelonephritis (APN) than serum C-reactive protein (CRP) and white blood cell (WBC) count?
Finding: uNGAL better facilitated the prediction of UTI and APN, than serum CRP and WBC counts in febrile children.
Meaning: uNGAL is a suitable biomarker for UTI and APN in febrile children.

DOI: https://doi.org/10.3345/cep.2020.01130

Gastroenterology

Celiac disease in children: Increasing prevalence and changing clinical presentations

Hasan M. Isa, Eman Farid, Jaafar J. Makhlooq, Afaf M. Mohamed, Jumana G. Al-Arayedh, Fawzeya A. Alahmed, Shima Medani

Clin Exp Pediatr. 2021;64(6):301-309. Published online October 17, 2020

Web of Science 4 Crossref 5

Question: What are the prevalence and clinical characteristics of celiac disease (CD) in children in Bahrain?
Finding: We found a significant increase in CD prevalence over the last decade (P=0.0001). A male predominance was noted. Atypical presentations were common. Most patients had poor adherence to a gluten-free diet.
Meaning: CD is an underdiagnosed condition. Atypical symptoms should be considered to prevent missing patients with CD.

DOI: https://doi.org/10.3345/cep.2020.00304

Review Article

Neurology

Myths and truths about pediatric psychogenic nonepileptic seizures

Jung Sook Yeom, Heather Bernard, Sookyong Koh

Clin Exp Pediatr. 2021;64(6):251-259. Published online October 17, 2020

Web of Science 11 Crossref 11

• Psychogenic non-epileptic seizures (PNES) are events that look like epileptic seizures but are not caused by abnormal electrical discharges.
• PNES are a manifestation of psychological and emotional distress.
• Treatment for PNES does not begin with the psychological intervention but starts with the diagnosis and how the diagnosis is delivered.
• A multifactorial biopsychosocial process and a neurobiological review are both essential components when treating PNES

DOI: https://doi.org/10.3345/cep.2020.00892

Original Article

Gastroenterology

Acquired noncaustic esophageal strictures in children

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

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

Web of Science 2 Crossref 4

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

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

Infection

Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

Woosuck Suh, Bi Na Kim, Hyun Mi Kang, Eun Ae Yang, Jung-Woo Rhim, Kyung-Yil Lee

Clin Exp Pediatr. 2021;64(6):293-300. Published online October 14, 2020

Web of Science 5 Crossref 7

Question: How has the antibiotic susceptibility of urinary pathogens changed and what does it imply?
Finding: A yearly increase in multidrug-resistant and extended-spectrum β-lactamase (ESBL)–producing pathogens was observed. A higher recurrence rate was observed in cases of febrile urinary tract infection caused by ESBL producers in patients with underlying vesicoureteral reflux (VUR).
Meaning: The initial empirical antibiotic should reflect the changing susceptibility patterns and underlying VUR status.

DOI: https://doi.org/10.3345/cep.2020.00773

Endocrinology

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

Nur Rochmah, Muhammad Faizi, Siti Wahyu Windarti

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

Web of Science 8 Crossref 10

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

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

Editorial

Neonatology (Perinatology)

Risk factors for in-hospital mortality in premature infants with critical congenital heart disease

Jeonghee Shin

Clin Exp Pediatr. 2020;63(10):391-392. Published online October 6, 2020

Web of Science 1 Crossref 1

The incidence and mortality rates of critical congenital heart disease (CHD) are higher in preterm than in term infants. The risk factors for in-hospital mortality in premature infants with critical CHD are unclear. However, the mortality of preterm infants with critical CHD may be related to CHD complexity as well as gestational age, birth weight, the presence of prematurity-associated comorbidities, and the treatment itself.

DOI: https://doi.org/10.3345/cep.2020.00444

Original Article

Developmental and Behavioral Medicine

Is meconium exposure associated with autism spectrum disorders in children?

Ensiyeh Jenabi, Erfan Ayubi, Salman Khazaei, Saeid Bashirian, Mojtaba Khazaei

Clin Exp Pediatr. 2021;64(7):341-346. Published online October 4, 2020

Crossref 1

• Meconium exposure is weakly associated with an increased risk of autism spectrum disorder (ASD) development in children.
• More evidence based on large prospective cohort studies is required to conclude whether meconium exposure is associated with an increased risk of ASD.

DOI: https://doi.org/10.3345/cep.2020.01053

Editorial

Cardiology

When should mechanical circulatory support be considered in pediatric patients with acute fulminant myocarditis?

Hye Won Kwon

Clin Exp Pediatr. 2021;64(5):227-228. Published online September 22, 2020

Acute fulminant myocarditis is an uncommon syndrome characterized by sudden and severe cardiac inflammation, which leads to cardiogenic shock, ventricular arrhythmia, heart blocks, or multiorgan failure. Despite aggressive clinical course, patients with acute fulminant myocarditis have better outcomes than those with the nonfulminant type when appropriately supported during the acute phase of the disease. Therefore, early recognition of deteriorating myocarditis and timely mechanical circulatory support are crucial to improve outcomes.

DOI: https://doi.org/10.3345/cep.2020.01165

Nephrology (Genitourinary)

Inhibition of the renin-angiotensin system during fetal kidney development

Eujin Park

Clin Exp Pediatr. 2021;64(3):121-122. Published online September 22, 2020

Web of Science 1 Crossref 1

· Fetal exposure to renin-angiotensin system (RAS) inhibitors leads to short- and long-term kidney complications.
· Women of reproductive age who are absolutely indicated for RAS inhibitors should be adequately informed of the risks for the duration of treatment.

DOI: https://doi.org/10.3345/cep.2020.01228

Clinical note

Infection

Coronavirus disease 2019 in a 2-month-old male infant: a case report from Iran

Hosein Heydari, Seyed Kamal Eshagh Hossaini, Ahmad Hormati, Mahboubeh Afifian, Sajjad Ahmadpour

Clin Exp Pediatr. 2020;63(12):499-502. Published online September 21, 2020

Crossref 1

DOI: https://doi.org/10.3345/cep.2020.00941 Retraction in: Clin Exp Pediatr 2022;65(8):417

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