Clinical and Experimental Pediatrics

Review Article

Infection

COVID-19 among infants: key clinical features and remaining controversies

Nevio Cimolai

Clin Exp Pediatr. 2024;67(1):1-16. Published online November 27, 2023

· Clinical studies of coronavirus disease 2019 (COVID-19) in infants should be supported by rigorous laboratory diagnostic criteria.
· Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads to infants similarly to other viral respiratory infections.
· Among infants ≤1 year of age beyond the immediate postpartum period, COVID-19 is relatively mild, but even the low risk of severe disease requires prevention.
· Comorbidities increase infection vulnerability and complications in infants.
· Clinical and laboratory data do not sufficiently distinguish COVID-19 from other respiratory viral infections.
· Coinfection with SARS-CoV-2 is uncommon among infants.
· Unique infection sequelae, including multi-inflammatory syndrome in children and neonates and long COVID require further study and refinement of diagnostic criteria.
· Infection control standards applied to mother-infant dyads should be tempered by standard preventive strategies, maternal input, accommodation potential, and overall safety.
· Maternal vaccination prevents disease in early infancy.

DOI: https://doi.org/10.3345/cep.2023.00794

Original Article

Gastroenterology

Risk factors of prolonged diarrhea in children under 2 years old

Dedy Rahmat, Agus Firmansyah, Ina S. Timan, Saptawati Bardosono, Joedo Prihartono, Pramita Gayatri

Clin Exp Pediatr. 2023;66(12):538-544. Published online November 16, 2023

Web of Science 1 Crossref 2

Question: What are the risk factors for prolonged diarrhea in children under 2 years old?
Finding: History of antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin levels were the main risk factors of prolonged diarrhea in children under 2 years old with acute diarrhea.
Meaning: Rational antibiotic usage is necessary as well as thorough testing of serum zinc level and fecal alpha-1 antitrypsin levels.

DOI: https://doi.org/10.3345/cep.2023.00668

Review Article

Gastroenterology

Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children

Yu Kyung Cho, Jin Lee, Chang Nyol Paik

Clin Exp Pediatr. 2023;66(9):377-383. Published online August 21, 2023

Web of Science 5 Crossref 6

· Pediatric small intestinal bacterial overgrowth (SIBO) manifestations range from nonspecific abdominal symptoms to malabsorption or malnutrition.
· SIBO is prevalent in children and adolescents with functional abdominal pain disorders.
· Predisposing factors include disturbed intestinal motility, altered anatomy, and/or abnormal body defense systems against intestinal bacteria.
· Breath tests are safe and noninvasive.
· Treatment principles include managing predisposing conditions, nutritional support, symptom control, and antibiotics.

DOI: https://doi.org/10.3345/cep.2022.00969

Nutrition

Macronutrients modified dietary intervention in the management of overweight/obese children and adolescents: a systematic review

Jihyun Park, Oh Yoen Kim

Clin Exp Pediatr. 2024;67(4):191-200. Published online July 11, 2023

· Dietary macronutrient modifications affect the body composition of and metabolic markers in children and adolescents.
· Hypocaloric diets, regardless of macronutrient composition, are reportedly effective for weight loss in obese children.
· Future interventional studies with meta-analyses that include Korean children and adolescents are needed to provide basic information applicable to this population.

DOI: https://doi.org/10.3345/cep.2023.00262

Nephrology (Genitourinary)

Kidney complications associated with COVID-19 infection and vaccination in children and adolescents: a brief review

Hee Sun Baek, Min Hyun Cho

Clin Exp Pediatr. 2023;66(10):424-431. Published online June 28, 2023

Web of Science 3 Crossref 3

Several observational studies have shown that acute kidney injury affects up to 46% of children and adolescents who develop severe postinflammatory responses, such as multisystem inflammatory syndrome in childhood, due to coronavirus disease 2019 (COVID-19). Although causality has not been established, some cases of glomerulopathy or nephrotic syndrome occurring after COVID-19 infection or vaccination have been reported. Therefore, kidney complications associated with these conditions in children and adolescents warrant attention.

DOI: https://doi.org/10.3345/cep.2023.00738

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

Infection

Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment

Ki Wook Yun

Clin Exp Pediatr. 2024;67(2):80-89. Published online June 14, 2023

Web of Science 7 Crossref 9

· Most commonly confirmed causes of community-acquired pneumonia (CAP) in children are Mycoplasma pneumoniae (8%–40%) and respiratory syncytial virus (15%–20%).
· Pyogenic bacteria, most commonly Streptococcus pneumoniae (40%–50%) and Streptococcus pyogenes (10%–25%), are detected in 2%–5% of children hospitalized with CAP.
· CAP should be diagnosed conservatively according to clinical and radiological criteria.
· The etiology should be identified via appropriate test result interpretation.

DOI: https://doi.org/10.3345/cep.2022.01452

Allergy

Moderate to severe atopic dermatitis in children: focus on systemic Th2 cytokine receptor antagonists and Janus kinase inhibitors

Jeong Hee Kim, Mona Salem Samra

Clin Exp Pediatr. 2024;67(2):64-79. Published online June 14, 2023

Crossref 1

· Atopic dermatitis (AD) is characterized by a strong T helper (Th)2 response, although the extents of Th22, Th17/ interleukin (IL)-23, and Th1 responses vary among disease subtypes.
· Children with moderate to severe AD may require early systemic therapy to reduce the systemic inflammation caused by increased Th2 cytokine levels.
· Dupilumab, which blocks IL-4/IL-13 receptor, has equivalent efficacy for extrinsic and intrinsic AD and a favorable safety profile in infants and children aged 6 months and older.

DOI: https://doi.org/10.3345/cep.2022.00346

Original Article

Critical Care Medicine

Timing of parenteral nutrition initiation in critically ill children: a randomized clinical trial

Nagwan Y. Saleh, Hesham M. Aboelghar, Nehad B. Abdelaty, Mohamed I. Garib, Asmaa A. Mahmoud

Clin Exp Pediatr. 2023;66(9):403-411. Published online June 14, 2023

Web of Science 3 Crossref 4

Question: What is the ideal initiation timing of parenteral nutrition for critically ill children?
Finding: This randomized clinical trial of 140 children examined the effects of an early or late start of parenteral nutrition on mechanical ventilation need (primary outcome) and length of stay and mortality (secondary outcomes).
Meaning: Children who received early versus late parenteral nutrition had lower mechanical ventilation need and duration.

DOI: https://doi.org/10.3345/cep.2023.00178

Allergy

Association between dyslipidemia and asthma in children: a systematic review and multicenter cohort study using a common data model

Ji Eun Lim, Hye Min Kim, Ju Hee Kim, Hey Sung Baek, Man Yong Han

Clin Exp Pediatr. 2023;66(8):357-365. Published online June 14, 2023

Web of Science 6 Crossref 7

Question: Is dyslipidemia a risk factor for asthma in children?
Finding: This was a comprehensive systematic review and retrospective multicenter study of the association between dyslipidemia and asthma in children. In a multicenter cohort analysis using the Observational Medical Outcomes Partnership Common Data Model, elevated total cholesterol levels were associated with increased risk of asthma development.
Meaning: These findings suggest an association between dyslipidemia and asthma in children.

DOI: https://doi.org/10.3345/cep.2023.00290

Review Article

Allergy

Trends of vitamin D in asthma in the pediatric population for two decades: a systematic review

Myongsoon Sung

Clin Exp Pediatr. 2023;66(8):339-347. Published online June 14, 2023

· Vitamin D may affect asthma via multiple mechanisms, including lung and optimal immune system functions.
· Many clinical trials have demonstrated the beneficial effects of vitamin D on asthma onset and aggravation. However, definitive clinical trials are lacking, and reports have detailed contradictory effects of vitamin D in children with asthma.
· Some exciting reports stated that obesity and vitamin D deficiency are associated with increased asthma symptoms in the pediatric population.

DOI: https://doi.org/10.3345/cep.2022.01109

Original Article

Gastroenterology

Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

Hasan M. Isa, Fatema A. Alkharsi, Fatema A. Salman, Maryam S. Ali, Zahra K. Abdulnabibi, Afaf M. Mohamed

Clin Exp Pediatr. 2023;66(7):296-306. Published online June 14, 2023

Crossref 1

Question: What causes childhood constipation, and what can predict organic constipation?
Finding: Constipation represents 14.7% of gastroenterology visits. Functional constipation is more common among constipation types, while organic constipation is more common in young children and those with a low body weight, stunted growth, mucus in the stool, and associated diseases.
Meaning: Younger children and those with lower growth or mucus in the stool should be assessed for underlying organic causes of constipation.

DOI: https://doi.org/10.3345/cep.2022.01298

Review Article

Other

MicroRNAs as novel biomarkers for the diagnosis and treatment of pediatric diseases

Hwal Rim Jeong, Il Tae Hwang

Clin Exp Pediatr. 2024;67(3):119-125. Published online May 24, 2023

Web of Science 5 Crossref 3

MicroRNAs (miRNAs) are small noncoding RNAs that regulate gene expression post transcriptionally, and MiRNA expression levels vary with developmental stages. MiRNAs play an important role in several biological processes in children, including growth, neuro-development, inflammation, and tumor formation. Research on miRNAs may uncover the molecular mechanisms underlying various pediatric diseases, leading to the development of novel biomarkers that aid in the diagnosis, treatment, and prognosis of these diseases.

DOI: https://doi.org/10.3345/cep.2023.00171

Original Article

Cardiology

Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5–12 years

Alaba Busola Oladimeji, Moriam Omolola Lamina, Peter Odion Ubuane, Motunrayo Oluwabukola Adekunle, Omolara Adeolu Kehinde, Barakat Adeola Animasahun, Olisamedua FidelisNjokanma

Clin Exp Pediatr. 2023;66(5):215-222. Published online April 18, 2023

Question: Z score reference values for right ventricular size and systolic function in children using echocardiography are available in several countries. Despite the high burden of diseases involving the right ventricle in Nigeria, these reference values have limited applicability.
Finding: The right ventricular sizes of Nigerian children differed from those published elsewhere.
Meaning: These reference values will aid the treatment, monitoring, and pre- and postintervention for Nigerian children.

DOI: https://doi.org/10.3345/cep.2022.01410

Review Article

Cardiology

Arrhythmia and COVID-19 in children

Mi Kyoung Song, Bryan Kwon

Clin Exp Pediatr. 2023;66(5):190-200. Published online April 18, 2023

Web of Science 3 Crossref 4

· Pediatric patients have a relatively low incidence of tachyarrhythmia both in acute coronavirus disease 2019 and multisystem inflammatory syndrome in children (MIS-C), but it was associated with an increased risk of poor outcomes.
· Conduction abnormalities were not uncommon, especially in those with MIS-C. Most patients recovered to normal sinus rhythm; however, some progressed to advanced atrioventricular block and rarely required permanent pacemaker implantation.

DOI: https://doi.org/10.3345/cep.2023.00024

Infection

COVID-19 in immunocompromised children and adolescents

Byung Ok Kwak, Byung Wook Eun

Clin Exp Pediatr. 2023;66(5):182-189. Published online April 18, 2023

Web of Science 8 Crossref 10

Most immunocompromised children and adolescents are not at increased risk of developing severe coronavirus disease 2019 (COVID-19). COVID-19 outcomes for low- or medium-risk immunocompromised children are favorable, while more serious illness reportedly occurs in high-risk immunocompromised children by underlying disease, its treatments, and other factors. Therefore, the early detection and timely management of severe COVID-19 and treatment of underlying disease are important. Hospitalization and COVID-19 vaccination should be carefully considered.

DOI: https://doi.org/10.3345/cep.2022.00878

Endocrinology

Nonalcoholic fatty liver disease and insulin resistance in children

Kyungchul Song, Ho-Seong Kim, Hyun Wook Chae

Clin Exp Pediatr. 2023;66(12):512-519. Published online January 9, 2023

Web of Science 14 Crossref 14

· The prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) increased from 8.2% in 2009 to 12.1% in 2018 in Korea.
· Laboratory tests, biomarkers, and imaging studies are used for the early detection of NAFLD.
· Insulin resistance is closely related to NAFLD.

DOI: https://doi.org/10.3345/cep.2022.01312

Other

Hearing loss in neonates and infants

Goun Choe, Su-Kyoung Park, Bong Jik Kim

Clin Exp Pediatr. 2023;66(9):369-376. Published online January 9, 2023

Web of Science 8 Crossref 10

· Congenital hearing loss is common, with an approximate incidence of 1.5 per 1,000 newborns and affecting 1.2%–11% of preterm and 1.6%–13.7% of neonatal intensive care unit neonates.
· Etiologies vary, and up to 80% of cases are genetic.
· Newborn hearing screenings follow the 1-3-6 rule, and babies at high risk of hearing loss should be referred to otolaryngology for early detection and timely intervention.

DOI: https://doi.org/10.3345/cep.2022.01011

Gastroenterology

Update on eosinophilic gastrointestinal disease beyond eosinophilic esophagitis in children

Hye Ran Yang

Clin Exp Pediatr. 2023;66(6):233-239. Published online January 3, 2023

Web of Science 4 Crossref 3

· Eosinophilic gastrointestinal disease (EGID) is uncommon, with a prevalence of 1–30/100,000 in the general population; however, it is increasing worldwide.
· The diagnosis of EGID is based on histopathological findings of endoscopic mucosal biopsy in which tissue eosinophils are counted in each gastrointestinal tract segment of patients with chronic or recurrent gastrointestinal symptoms.
· Individualized treatment strategies, including adequate dietary and pharmacological therapy, may help improve outcomes of children with EGID.

DOI: https://doi.org/10.3345/cep.2022.01046

General Pediatrics

Korean Developmental Screening Test for Infants and Children (K-DST): development, applications, and implications for future early childhood development interventions

Dooyoung Kim, Young June Choe, Bilal Aurang Zeb Durrani, EunYoung Kim, Junghye Byeon, Baik-Lin Eun

Clin Exp Pediatr. 2023;66(7):288-293. Published online December 22, 2022

Web of Science 11 Crossref 12

· This review discusses the development and application of the Korean Developmental Screening Test for Infants and Children (K-DST) for ensuring early childhood development.
· Various studies have demonstrated the integral role of the K-DST in facilitating the detection of developmental delays and delivery of timely interventions.
· The tailoring of the K-DST to Korean infants and children suggests that other countries may further translate and adapt it.

DOI: https://doi.org/10.3345/cep.2022.00906

Original Article

Infection

Clinical characteristics of pediatric patients infected with SARS-CoV-2 versus common human coronaviruses: a national multicenter study

In Suk Sol, Eun Lee, Hyeon-Jong Yang, Yong Ju Lee, Hye Yung Yum, Mi-Hee Lee, Mi Ae Chu, Hui Jeong Moon, Hyo-Bin Kim, Ju Hee Seo, Jung Yeon Shim, Ji Young Ahn, Yoon Young Jang, Hai Lee Chung, Eun Hee Chung, Kyunghoon Kim, Bong-Seong Kim, Cheol Hong Kim, Yang Park, Meeyong Shin, Kyung Suk Lee, Man Yong Han, Soo-Jong Hong, Eun Kyeong Kang, Chang Keun Kim; on behalf of The Pneumonia & Respiratory Disease Study Group of Korean Academy of Pediatric Allergy and Respiratory Disease

Clin Exp Pediatr. 2023;66(3):134-141. Published online December 22, 2022

Crossref 1

Question: The clinical differences between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and human coronaviruses (HCoV) in children remain unknown.
Finding: This study compared the clinical findings of children infected with SARS-CoV-2 versus HCoV. Its findings suggest that children and adolescents with SARS-CoV-2 have a milder clinical course than those with HCoV.
Meaning: The clinical course of children and adolescents with SARS-CoV-2 should be closely monitored during the coronavirus disease 2019 pandemic.

DOI: https://doi.org/10.3345/cep.2022.00703

Review Article

Gastroenterology

Role of social media use in onset of functional gastrointestinal disorders in children

Mauro Cinquetti, Vanessa Dargenio, Michele Fingerle, Carolina Marchiotto, Marco Biasin, Massimo Pettoello Mantovani, Flavia Indrio

Clin Exp Pediatr. 2023;66(6):226-232. Published online December 21, 2022

Web of Science 3 Crossref 3

· Social media use can cause adverse health outcomes, including gastrointestinal disorders, in children and adolescents.
· Recent findings have shown a high prevalence of social media use and decreased well-being in patients with functional gastrointestinal disorders.
· The biopsychosocial nature of functional gastrointestinal disorders and the clear influence of social media on the psychosocial lives of children suggests the likely involvement of social media in their development.

DOI: https://doi.org/10.3345/cep.2022.00843

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 1 Crossref 1

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

Review Article

Nutrition

Association of gut microbiota with obesity in children and adolescents

Ky Young Cho

Clin Exp Pediatr. 2023;66(4):148-154. Published online November 16, 2022

Web of Science 16 Crossref 17

The gut microbiota is an emerging factor in the development of pediatric obesity, which is affected by renowned risk factors such as diet, lifestyle, and socioeconomic status. This review aimed to describe the association between the gut microbiota and childhood obesity.

DOI: https://doi.org/10.3345/cep.2021.01837

Original Article

Pulmonology

Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress

Kantara Saelim, Busawan Thirapaleka, Kanokpan Ruangnapa, Pharsai Prasertsan, Wanaporn Anuntaseree

Clin Exp Pediatr. 2022;65(12):595-601. Published online November 1, 2022

Web of Science 5 Crossref 5

SpO₂/FiO₂ ratio ≤166, pediatric respiratory rate-oxygenation index <132, and clinical respiratory score ≥6 at 12 hours after high-flow nasal cannula (HFNC) initiation were useful bedside predictors for HFNC failure in pediatric patients.

DOI: https://doi.org/10.3345/cep.2022.00241

Gastroenterology

Ability of polymicrobial probiotic and mono-strain probiotic to reduce functional abdominal pain in children: a randomized clinical trial

Seyed Sajad Jafari, Seyed Mojtaba Hashemi, Bahman Sadeghi, Amir Almasi-Hashiani

Clin Exp Pediatr. 2022;65(12):589-594. Published online October 31, 2022

Web of Science 1

· This study compared the ability of 2 probiotics to reduce and improve functional abdominal pain (FAP) in children.
· In the polymicrobial probiotic (PMP) group, 10.34% of children reported no pain; in the mono-strain probiotic (MSP) group, all patients reported low-degree pain. The mean pain score decreased significantly over time in both groups.
· The use of both PMP and MSP is recommended to reduce pain in patients with FAP.

DOI: https://doi.org/10.3345/cep.2022.00339

Review Article

Nutrition

Total energy expenditure measured by doubly labeled water method in children and adolescents: a systematic review

Nahyun Kim, Jonghoon Park

Clin Exp Pediatr. 2023;66(2):54-65. Published online October 17, 2022

Web of Science 2 Crossref 3

This systematic review summarizes convincing evidence that total energy expenditure (TEE) measured using the doubly labeled water technique increased with age from 1 to 18 years, while fat-free mass (FFM) increased with growth. TEE and in normal-weight participants, while physical activity level did not differ from that of normal-weight participants.

DOI: https://doi.org/10.3345/cep.2022.00472

Pulmonology

Epidemiology and surveillance implications of community-acquired pneumonia in children

Eui Jeong Roh, Jung Yeon Shim, Eun Hee Chung

Clin Exp Pediatr. 2022;65(12):563-573. Published online October 17, 2022

Web of Science 17 Crossref 18

The identification of the causative pathogens of community-acquired pneumonia and appropriate treatment and prevention can reduce mortality and the socioeconomic burden by reducing the medical expenses. The world has been in the coronavirus disease 2019 pandemic since 2020, and there is always a risk of continuous emergence and epidemic of new respiratory infectious diseases. Therefore, it is important to sustain a monitoring system for respiratory infectious diseases including pneumonia.

DOI: https://doi.org/10.3345/cep.2022.00374

Original Article

Neurobehavior

Association between previous abortion history and risk of autism spectrum disorders among offspring: a meta-analysis

Ensiyeh Jenabi, Erfan Ayubi, Saeid Bashirian, Mahdieh Seyedi, Mohammad Rezaei

Clin Exp Pediatr. 2023;66(2):70-75. Published online August 17, 2022

Web of Science 4 Crossref 5

Question: This study aimed to determine whether there is an association between previous abortion history and the risk of autism spectrum disorders (ASDs) among children.
Finding: We found that the risk of ASD associated with previous abortion history had an odds ratio of 1.64 (95% confidence interval, 1.28–2.0; I²=61.7%).
Meaning: These findings suggest a positive and significant association between history of previous abortion and risk of ASD in children.

DOI: https://doi.org/10.3345/cep.2022.00108

Nutrition

Not breastfeeding and risk of autism spectrum disorders among children: a meta-analysis

Ensiyeh Jenabi, Saeid Bashirian, Amir Mohammad Salehi, Salman Khazaei

Clin Exp Pediatr. 2023;66(1):28-31. Published online July 19, 2022

Web of Science 5 Crossref 8

This study aimed to determine whether there is an association between not breastfeeding (versus breastfeeding) and the risk of autism spectrum disorders (ASD) among children. We found that the risk of ASD associated with not breastfeeding had an odds ratio of 1.81 (95% confidence interval, 1.35–2.27; I²=0 %). These findings suggest the importance of breastfeeding in decreasing the risk of ASD among children.

DOI: https://doi.org/10.3345/cep.2021.01872

Cited By 20	Neurodevelopmental outcomes of preterm infants
Cited By 19	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 17	Association of gut microbiota with obesity in children and adolescents
Cited By 14	Gut microbiota affects brain development and behavior
Cited By 14	Nonalcoholic fatty liver disease and insulin resistance in children

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