Clinical and Experimental Pediatrics

Original Article

Hematology

Peripheral blood cell counts of prematurely born, small for gestational age neonates

Mara O. Zuiderwijk, Sophie Groene, Enrico Lopriore, Vincent Bekker, Michiel H.D. Schoenaker

Clin Exp Pediatr. 2026;69(7):572-581. Published online May 12, 2026

Question: As small for gestational age (SGA) neonates are more susceptible to infections, we hypothesized that their complete blood count and leukocyte differentiation might be affected.
Finding: The counts of multiple blood cells of extreme SGA neonates were affected as illustrated by multivariate analyses, which showed significant decreases in neutrophil, monocyte, lymphocyte, and thrombocyte counts.
Meaning: The mechanisms underlying this phenomenon and its clinical effects require further elucidation.

DOI: https://doi.org/10.3345/cep.2025.02978

Erratum: Authour correciton

Author correction: Bifidobacterium animalis subsp. lactis BLa80 for preventing allergic, respiratory, and gastrointestinal diseases in young children in China: a randomized double-blind placebo-controlled trial

Ke Chen, Xi Zhang, Kaihong Zeng, Jiayi Zhong, Shanshan Jin, Yang Nie, Ping Yang, Nianyang He, Haixia Chen, Yanmei Cao, Yunrong Fu, Ziji Fang, Wei Jiang, Changqi Lium

Clin Exp Pediatr. 2026;69(5):455-455. Published online April 28, 2026

DOI: https://doi.org/10.3345/cep.2026.err01

Editorial

Neurology

Limited improvement in outcomes of infantile epileptic spasms syndrome despite therapeutic advances

Donghwa Yang

Clin Exp Pediatr. 2026;69(5):384-385. Published online April 28, 2026

· Despite advances in treatment, infantile epileptic spasms syndrome remains associated with poor long-term epilepsy and developmental outcomes.
· Improved seizure control alone may not be sufficient, underscoring the need for early diagnosis and etiology-driven management strategies.

DOI: https://doi.org/10.3345/cep.2026.00745

Original Article

Neonatology (Perinatology)

Association between impaired renal function based on decline in serum creatinine level and brain injury in neonates with hypoxic-ischemic encephalopathy

Mélaine Boget, William Rozalen, Jeanne Fayard, Mohamed Boucekine, Diane Gillot, Isabelle Grandvuillemin, Farid Boubred

Clin Exp Pediatr. 2026;69(5):437-442. Published online April 27, 2026

Question: The clinical relevance of impaired renal function (IRF), based on the rate of serum creatinine level decline during the week after birth, in neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy need further investigation.
Finding: In this study, neonates with IRF had 2-fold higher risk of early death or severe brain injury.
Meaning: IRF can be used as a marker of adverse neonatal outcomes.

DOI: https://doi.org/10.3345/cep.2025.02670

Review Article

Gastroenterology

Sarcopenia in pediatric gastroenterology and hepatology: an updated review

Toshifumi Yodoshi

Clin Exp Pediatr. 2026;69(5):366-383. Published online April 27, 2026

Web of Science 2 Crossref 2

Pediatric sarcopenia is common in chronic gastrointestinal and liver diseases, often hidden by normal body mass index or obesity, and predicts worse outcomes. Because growth and puberty alter body composition, assessment should use age- and sex-specific measures of muscle mass and, when feasible, function. Early multidisciplinary intervention—protein-adequate nutrition, resistance-based activity, and disease control—may improve prognosis.

DOI: https://doi.org/10.3345/cep.2026.00234

Original Article

Nutrition

Human milk macronutrient composition and intake in relation to preterm infant growth: a cohort study

Eakkarin Mekangkul, Chonnikant Visuthranukul, Anongnart Sirisabya, Thaninee Chitsinchayakul, Santi Punnahitananda, Sirinuch Chomtho

Clin Exp Pediatr. 2026;69(5):428-436. Published online April 22, 2026

Question: Is macronutrient intake, particularly that from human milk, distinctly associated with the growth of preterm infants?
Finding: Total protein and fat intake derived from human milk and fortifiers showed distinct positive associations with weight gain velocity.
Meaning: Particular attention to protein and fat composition during individualized human milk fortification can optimize weight gain in preterm infants.

DOI: https://doi.org/10.3345/cep.2025.02509

Neurology

Clinical application of whole exome and genome sequencing in pediatric neurodevelopmental disorders

Keun Soo Lee, Seung Hwan Oh, Ja Young Lee, Go Hun Seo, Da Eun Roh, Ji Kyoung Park, Bo Lyun Lee

Clin Exp Pediatr. 2026;69(5):417-427. Published online April 22, 2026

Question: What is the diagnostic utility of whole exome sequencing (WES) and whole genome sequencing (WGS) in unexplained neurodevelopmental disorders (NDDs)?
Finding: WES and WGS achieved a combined diagnostic yield of 39.1% in children with NDDs. Novel variants accounted for over half the pathogenic findings, and trio-based or phenotype-driven testing improved the diagnostic rate.
Meaning: Comprehensive genomic sequencing integrated with clinical phenotyping enhances diagnostic yield among children with NDDs.

DOI: https://doi.org/10.3345/cep.2025.02775

Nephrology (Genitourinary)

Serum metabolomic profile in children with sepsis-associated acute kidney injury

Nisha Chaudhary, Praveen Singh, Abhijeet Saha, Shantanu Sengupta

Clin Exp Pediatr. 2026;69(7):545-554. Published online April 15, 2026

Web of Science 2 Crossref 2

Question: Can the potential metabolites/pathways involved in the pathogenesis of sepsis-associated acute kidney injury (SA-AKI) be identified using metabolomics?
Finding: We identified 18 novel metabolites involved in the pathogenesis of SA-AKI as well as 31 metabolites that were altered in severe AKI. Linoleic acid, linolenic acid, and phospholipid pathways were altered in SA-AKI.
Meaning: Once validated, these markers may be used to diagnose SA-AKI at an early stage before sufficient kidney injury occurs.

DOI: https://doi.org/10.3345/cep.2025.02439

Endocrinology

Intramuscular and subcutaneous gonadotropin-releasing hormone agonist tests for central precocious puberty in girls: a randomized controlled trial

Worapimon Lerdrassameethad, Suttipong Wacharasindhu, Vichit Supornsilchai, Khomsak Srilanchakon

Clin Exp Pediatr. 2026;69(6):518-523. Published online April 15, 2026

Question: Did the intramuscular (IM) and subcutaneous (SC) administration of gonadotropin-releasing hormone (GnRH) agonists have comparable timing and diagnostic utility for evaluating central precocious puberty in girls?
Finding: Both the IM and SC GnRH stimulation tests demonstrated comparable times to peak luteinizing hormone levels.
Meaning: Clinicians may consider the IM route as a time-efficient alternative, as it offers similar diagnostic utility for central precocious puberty without compromising the detection of hypothalamic-pituitary-gonadal axis activation.

DOI: https://doi.org/10.3345/cep.2026.00052

Anthropometric trajectories of Korean children and adolescents with severe obesity

Jeongho Han, Hakyung Lee, Dong Jun Ha, Jieun Lee, Yong Hee Hong, Hwa Young Kim, Jaehyun Kim

Clin Exp Pediatr. 2026;69(6):508-517. Published online April 10, 2026

Question: How do body mass index (BMI) and metabolic markers change over time in severely obese Korean children and adolescents receiving only lifestyle modifications?
Finding: Among 124 participants, BMI z scores decreased modestly over 2.6 years, primarily in younger prepubertal boys. However, most remained severely obese, with minimal improvement in body composition or metabolic markers.
Meaning: Lifestyle interventions alone have limited efficacy for severe pediatric obesity. Early and more intensive treatments are required.

DOI: https://doi.org/10.3345/cep.2025.02999

Pulmonology

High-Risk CCL14 lineage drives severe Mycoplasma pneumoniae pneumonia in children: a study in central China

Chunbo Hao, Zijie Li, Yanjuan Yu, Song Wang, Genhao Wang, Gaijing Jia, Tiantian Sun, Shouhang Chen, Yang Wu, Yu Tang, Fang Wang, Guangcai Duan, Yuefei Jin

Clin Exp Pediatr. 2026;69(6):497-507. Published online April 10, 2026

Web of Science 1 Crossref 1

Question: Are the predominant circulating strains of Mycoplasma pneumoniae associated with disease severity and clinical indicators?
Finding: The common cluster label 14 (CCL14) lineage was a high-risk clone circulating in central China that demonstrated a strong association between severe pediatric pneumonia and a distinct hyperinflammatory profile.
Meaning: Targeted molecular surveillance of the CCL14 lineage may facilitate early risk stratification and guide clinical management to reduce the burden of severe disease.

DOI: https://doi.org/10.3345/cep.2025.02796

Editorial

General Pediatrics

Adiposity rebound in early childhood: understanding body mass index percentiles and monitoring on growth charts to be healthy

Sochung Chung

Clin Exp Pediatr. 2026;69(4):301-303. Published online April 1, 2026

Height, weight, and body mass index percentiles should be tracked in routine childhood health checkups to address the age of adiposity rebound in early childhood. Comprehensive interventional lifestyle counselling in primary practice after growth and nutritional status assessments might be an early, effective strategy for preventing obesity and decreasing the double burden of disease in later life. Therefore, there is an urgent need for a cooperative and supportive health care system.

DOI: https://doi.org/10.3345/cep.2026.00668

Review Article

Neonatology (Perinatology)

Optimal postnatal corticosteroid regimens to prevent bronchopulmonary dysplasia with minimal adverse effects

Ga Won Jeon

Clin Exp Pediatr. 2026;69(4):293-300. Published online March 27, 2026

Postnatal corticosteroids facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD). Despite being commonly used in high-risk infants, administration guidelines have not been established. Early dexamethasone may cause neurodevelopmental harm, and the optimal dosing remains uncertain. Inhaled corticosteroids show inconclusive benefits, whereas intratracheal administration with surfactant appears promising. Thus, corticosteroids should be used cautiously in high-risk, ventilator-dependent infants with severe BPD, and further high-quality trials are needed.

DOI: https://doi.org/10.3345/cep.2026.00108

Original Article

Endocrinology

Thyroid peroxidase gene variants and susceptibility to congenital hypothyroidism and autoimmune thyroid disease among Egyptian pediatric cohort

Hala M. Sakhr, Mohammed H. Hassan, Esraa Abbass Abdallah, Amira Mahmoud Ewis, Mohamed Hesham Mohamed, Shymaa Gaber Rizk

Clin Exp Pediatr. 2026;69(6):486-496. Published online March 26, 2026

Web of Science 1 Crossref 1

Question: Which factors influence pediatric thyroid disorder susceptibility and severity?
Finding: Anemia, selenium deficiency, excess copper, and the thyroid peroxidase (TPO) Arg³⁸⁶His polymorphism, especially with the histidine/histidine genotype, are strongly associated with pediatric thyroid disease and high thyroid-stimulating hormone levels.
Meaning: Pediatric thyroid disorders are multifactorial. The TPO Arg³⁸⁶His variant may help identify children at higher risk of severe thyroid dysfunction, enabling earlier diagnosis, improved risk stratification, and more personalized clinical management.

DOI: https://doi.org/10.3345/cep.2025.02957

Neurology

Classification of neurocognitive impairment in pediatric drug-resistant focal epilepsy by quantifying seizure-affected brain network abnormalities in clinical diffusion-weighted imaging connectome

Jeong-Won Jeong, Min-Hee Lee, Yoon Ho Hwang, Michael Behen, Aimee Luat, Csaba Juhász, Eishi Asano

Clin Exp Pediatr. 2026;69(5):443-454. Published online March 13, 2026

Web of Science 1 Crossref 1

Question: Does epilepsy affect neurocognitive functions in pediatric drug-resistant focal epilepsy?
Finding: Diffusion magnetic resonance imaging (MRI) connectome could identify new imaging markers for seizure-associated structural abnormalities. New markers reflect deviations of local efficiency in neurocognitive networks and provide outstanding discretionary capacity for neurocognitive impairments, achieving an accuracy range of 90%–98% in the independent test patients.
Meaning: Supplementary MRI-driven decisions could be performed for personalized interventions to mitigate long-term neurocognitive effects.

DOI: https://doi.org/10.3345/cep.2025.02936

Hematology

Outcomes of hematopoietic stem cell transplantation for pediatric patients with transfusion-dependent thalassemia in Thailand

Kleebsabai Sanpakit, Kamala Laohverapanich, Bunchoo Pongtanakul, Nattee Narkbunnam, Chayamon Takpradit, Usanarat Anurathapan, Samart Pakakasama, Supanun Lauhasurayotin, Kanhatai Chiengthong, Thirachit Chotsampancharoen, Pornpun Sripornsawan, Piya Rujkijyanont, Duantida Songdej, Nongnuch Sirachainan, Suradej Hongeng

Clin Exp Pediatr. 2026;69(4):340-352. Published online March 13, 2026

Question: Can hematopoietic stem cell transplantation (HSCT) cure pediatric transfusion-dependent thalassemia in Thailand? What influences its outcomes?
Finding: Among 266 HSCT procedures, 5-year overall survival and event-free survival rates were 91.3% and 81.0%, respectively. Outcomes were comparable between related and unrelated donors. Pre-HSCT ferritin >2,500 ng/mL, low CD34+ cell dose, and oral busulfan conditioning were associated with unfavorable survival. Longterm complications affected 22.7% of survivors.
Meaning: Optimizing pre-HSCT care, ensuring adequate grafting, and long-term surveillance are crucial.

DOI: https://doi.org/10.3345/cep.2025.02173

Review Article

Neonatology (Perinatology)

Moving toward meaningful shared decision-making in neonatal care: clinical practice and policy implications in Korea

In Gyu Song, Trisha M. Prentice, Lynn Gillam

Clin Exp Pediatr. 2026;69(4):282-292. Published online March 13, 2026

Web of Science 1 Crossref 1

Shared decision-making (SDM) offers an ethically grounded, relational approach to making difficult decisions in neonatal care. Its effective use depends on recognizing when its use is appropriate and enacted in clinical conversations. In Korea, while parents are often involved in decision-making, SDM is not yet consistently articulated or evaluated as a structured practice. Culturally grounded research, education, and institutional support are needed to strengthen family-centered neonatal care.

DOI: https://doi.org/10.3345/cep.2025.02929

Correspondence and reply

Nephrology (Genitourinary)

Authors’ reply: a commentary on “Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices”

Pornpimol Rianthavorn

Clin Exp Pediatr. 2026;69(4):364-365. Published online March 6, 2026

DOI: https://doi.org/10.3345/cep.2026.00192

Correspondence

Nephrology (Genitourinary)

A commentary on “Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices”

Yanlan Ma, Yunyun Zhu

Clin Exp Pediatr. 2026;69(4):362-363. Published online March 6, 2026

DOI: https://doi.org/10.3345/cep.2025.02712

Original Article

Hematology

Effects of induction-phase acute kidney injury and age at diagnosis on chronic kidney disease in pediatric acute lymphoblastic leukemia: a time-to-event cohort study

Pongpak Phongphiew, Nuanpan Penboon, Kanhatai Chiengthong, Pornpimol Rianthavorn

Clin Exp Pediatr. 2026;69(5):407-416. Published online March 5, 2026

Question: In pediatric acute lymphoblastic leukemia (ALL), what are the incidence and causes of induction-phase acute kidney injury (AKI), and which factors predict chronic kidney disease (CKD)?
Finding: Induction AKI occurred in 43% of patients, while CKD developed in 1 of 8 patients. The 5-year CKD-free survival rate was 94%. Older age at diagnosis was a continuous independent determinant of CKD risk.
Meaning: Induction AKI is common and clinically relevant. Older children warrant closer kidney monitoring during and after therapy.

DOI: https://doi.org/10.3345/cep.2025.02327

Cardiology

Value of demographic factors in early identification of pediatric malignant vasovagal syncope in head-up tilt test

Shuo Wang, Yuwen Wang, Hong Cai, Ping Liu, Fang Li, Chuan Wen, Liqun Liu, Runmei Zou, Cheng Wang

Clin Exp Pediatr. 2026;69(4):353-361. Published online March 5, 2026

Web of Science 1 Crossref 1

Question: Can demographic factors identify pediatric malignant vasovagal syncope pre-head-up tilt test (HUTT)?
Finding: Age/body mass index are independent protectors; <12.9 years age cuts risk 20%/yr.
Meaning: Enables early risk stratification to optimize HUTT safety for children.

DOI: https://doi.org/10.3345/cep.2025.02397

Editorial

Neonatology (Perinatology)

Early prediction of bronchopulmonary dysplasia using new classification in high-risk preterm infants

Ga Won Jeon

Clin Exp Pediatr. 2026;69(3):211-213. Published online February 25, 2026

Crossref 1

The definition of bronchopulmonary dysplasia (BPD) has continued to evolve. Recently, newer definitions based on respiratory support at 36 weeks’ postmenstrual age better predict long-term outcomes but diagnose BPD relatively late. To address this limitation, the New Japanese Classification uses early postnatal factors, including small for gestational age and bubbly or cystic chest radiographic findings, to predict severe BPD and enable early targeted interventions.

DOI: https://doi.org/10.3345/cep.2026.00143

Review Article

Immunology

Multiomics approaches in Kawasaki disease: insights into pathogenesis and emerging directions for diagnosis and treatment

Jong Gyun Ahn, Insoo Kang

Clin Exp Pediatr. 2026;69(3):197-210. Published online February 25, 2026

Web of Science 1 Crossref 2

Kawasaki disease (KD) is an acute febrile vasculitis and the leading cause of acquired heart disease in children. Despite decades of research, the etiology remains unknown and key mechanisms linking systemic inflammation to coronary artery lesions are incompletely defined. High-throughput technologies—including genomics, transcriptomics, proteomics, metabolomics, epigenomics, and immunomics—have enabled systems-level profiling of KD and highlighted reproducible inflammatory and vascular pathways....

DOI: https://doi.org/10.3345/cep.2025.02901

Gastroenterology

Balancing therapeutic benefits and hidden risks of proton pump inhibitors in pediatric practice: a narrative review and update

Maria Rogalidou, Alexandra Papadopoulou

Clin Exp Pediatr. 2026;69(3):186-196. Published online February 25, 2026

Web of Science 1 Crossref 1

Proton pump inhibitors (PPIs) effectively treat acid-related disorders, including gastroesophageal reflux disease, eosinophilic esophagitis, peptic ulcers, and Zollinger-Ellison syndrome. Long-term use, particularly in children, may lead to microbiome alterations, nutrient deficiencies, infections, renal injury, osteoporosis, fractures, and other gastrointestinal changes. PPI therapy should be guided by clear clinical indications, prescribed at the lowest effective dose for the shortest necessary duration, and regularly reassessed to minimize risks in young children.

DOI: https://doi.org/10.3345/cep.2025.02761

Original Article

Neonatology (Perinatology)

Context-dependent features of transcriptomic landscapes in pregnant mother-neonate dyads of preeclampsia

Yu-Chun Cheng, Yun-Ju Lai, Wei-Shiung Lian, Ching-Chang Tsai, Hsin-Hsin Cheng, Hong-Ren Yu, Mao-Meng Tiao, Jiunn-Ming Sheen, Ying-Lun Hsu, Feng-Sheng Wang, I-Chun Lin

Clin Exp Pediatr. 2026;69(5):394-406. Published online February 19, 2026

Question: What genes are commonly altered in mother-neonate dyads immediately after shared exposure to preeclampsia?
Finding: Perinatal/peripartum gene expression in preeclampsia is context-dependent, involves diverse signaling pathways, and is associated with some perinatal features.
Meaning: Our results may help build the fundamentals for managing future cardiometabolic risks in these populations. Further investigation of the long-term influence of these candidate genes on cardiometabolic phenotypes is required.

DOI: https://doi.org/10.3345/cep.2025.02565

Neurology

Long-term outcome in children with infantile epileptic spasms syndrome: a multicenter retrospective study in Korea

Sun Ah Choi, Minhye Kim, Hye Jin Kim, Woo Joong Kim, Byung Chan Lim, Ji Yeon Han, Hunmin Kim, Min-Jee Kim, Mi-Sun Yum, Jiwon Lee, Jeehun Lee, Hyewon Woo, Jon Soo Kim

Clin Exp Pediatr. 2026;69(5):386-393. Published online February 19, 2026

Web of Science 2 Crossref 2

Question: How have epilepsy and cognitive outcomes of children with infantile epileptic spasms syndrome (IESS) evolved over the past 20 years?
Finding: Approximately 78% of children developed chronic epilepsy, and one-third progressed to drug-resistant epilepsy, while 90% of them exhibited intellectual disabilities.
Meaning: Given the poor outcomes associated with IESS, consensus guidelines tailored to Korean clinical practice are required to ensure timely treatment and improve outcomes.

DOI: https://doi.org/10.3345/cep.2025.02089

Editorial

Neurology

Tocilizumab as a key therapeutic option in high-risk pediatric acute necrotizing encephalopathy

Jon Soo Kim

Clin Exp Pediatr. 2026;69(2):114-116. Published online January 26, 2026

· Acute necrotizing encephalopathy (ANE) is a severe, infection- triggered encephalitis driven primarily by cytokine- mediated immune dysregulation rather than direct viral cytotoxicity.
· Tocilizumab, through targeted inhibition of interleukin-6 signaling, is an important therapeutic option for ANE that may improve survival and neurological outcomes of high-risk pediatric patients.

DOI: https://doi.org/10.3345/cep.2026.00073

Review Article

General Pediatrics

Systematic review of influence of ethnicity on efficacy and safety of pharmacotherapy for childhood and adolescent obesity

Surendra Gupta, Purushottam Lal, Abhishek Gupta, Brajesh Raj Chaudhary

Clin Exp Pediatr. 2026;69(2):84-102. Published online January 26, 2026

Ethnic variations may influence the response of children and adolescents to obesity pharmacotherapy. Current evidence does not show consistent differences in efficacy or safety among ethnic groups; however, available data are limited. Larger, ethnically diverse trials are needed to develop personalized obesity treatment strategies.

DOI: https://doi.org/10.3345/cep.2025.02838

Original Article

Neonatology (Perinatology)

Validation of a new Japanese classification for predicting severe bronchopulmonary dysplasia in preterm infants

Masato Ito, Shinya Hirano, Fumihiko Namba

Clin Exp Pediatr. 2026;69(3):274-281. Published online January 20, 2026

Web of Science 1 Crossref 1

Question: Can the revised Japanese classification predict severe bronchopulmonary dysplasia (BPD) early in preterm infants?
Finding: Small for gestational age and bubbly/cystic chest radiographic patterns were independently associated with severe BPD, and subtypes I and III showed particularly strong associations.
Meaning: This classification may facilitate early risk stratification and guide timely supportive strategies to prevent progression to severe BPD.

DOI: https://doi.org/10.3345/cep.2025.02642

Allergy

Can a basophil activation test of cord blood predict a cow's milk allergy?

Dilara Fatma Kocacik Uygun, Durmuş Burgucu, Vedat Uygun, Gül Alkan Bulbul, Fulden Duyar, Cem Yasar Sahnal, Aysen Bingöl

Clin Exp Pediatr. 2026;69(3):257-265. Published online January 20, 2026

Question: Can a basophil activation test (BAT) of cord blood predict a cow's milk allergy?
Finding: Infants with a high casein-BAT value were more likely to develop food allergy symptoms in the first year, whereas cow’s milk BAT showed no predictive association.
Meaning: Cord blood casein BAT may help identify newborns at increased risk for early-life food allergies, enabling closer monitoring and preventive strategies, although larger studies are needed for validation.

DOI: https://doi.org/10.3345/cep.2025.01697

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