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Original Article
Pulmonology
Nonlinear association between neutrophil-to-lymphocyte ratio and asthma in children and adolescents in the United States: a cross-sectional study
Chuhan Cheng, Liyan Zhang
Clin Exp Pediatr. 2025;68(7):489-496.   Published online March 11, 2025
Question: Is there a nonlinear relationship between neutrophil-to-lymphocyte ratio (NLR) and asthma in children and adolescents?
Finding: NLR showed a nonlinear association with asthma, with an NLR threshold of 2.23 identifying individuals at higher risk.
Meaning: An NLR<2.23 may serve as a potential biomarker for asthma risk assessment and management in pediatric populations, thereby offering a simple tool for the early identification of at-risk individuals.
Clinical Note
General Pediatrics
Aplasia cutis congenita with unique vascular malformation and cranial hypoplasia: a case in a preterm infant
Yasufumi Sakata, Natsumi Fujii, Sadahiro Nomura, Yoshihiro Azuma, Hiroki Hamano, Hidenobu Kaneyasu, Seigo Okada, Kazumasa Takahashi, Shunji Hasegawa
Clin Exp Pediatr. 2025;68(6):472-474.   Published online March 11, 2025
Review Article
Endocrinology
Impact of hematopoietic stem cell transplantation on growth outcomes in mucopolysaccharidosis: a systematic review
Farzaneh Abbasi, Asal Khalili Dehkordi, Reihaneh Mohsenipour
Clin Exp Pediatr. 2025;68(6):417-427.   Published online March 11, 2025
Hematopoietic stem cell transplantation (HSCT) enhances the growth outcomes of pediatric patients with mucopolysaccharidosis, with early intervention leading to improved height, weight, and body mass index. However, achieving a standard adult height remains uncommon among these patients, even in cases of early HSCT. Growth hormone therapy provides short-term benefits but does not address long-term height deficits. Pubertal development is generally normal; however, precocious puberty and pubertal arrest may occur.
Clinical Note
Gastroenterology
Abdominal pain in a young girl: a twist in the tale
Upasana Ghosh, Ankit Agrawal, Umesh Shukla, Vikas Jain, Deeksha Bhalla
Clin Exp Pediatr. 2025;68(5):395-397.   Published online March 11, 2025
· Chronic abdominal pain caused by a gastric trichobezoar is extremely rare among children.
· An indentable epigastric mass is characteristic and upper gastrointestinal endoscopy is diagnostic of a gastric trichobezoar.
· Symptomatic large trichobezoars usually require surgery.
· Neuropsychiatric disorders are often associated with gastric trichobezoar, making a psychiatric evaluation of paramount importance.
Original Article
Critical Care Medicine
Serum amyloid A and proadrenomedullin as early markers in critically ill children with sepsis
Nagwan Y. Saleh, Wafaa M. Abo El Fotoh, Mona S. Habib, Salem E. Deraz
Clin Exp Pediatr. 2025;68(8):578-586.   Published online February 26, 2025
Question: Are serum amyloid A (SAA) and proadrenomedullin (proADM) levels early markers in critically ill children with sepsis?
Finding: This prospective case-control study included 65 critically ill children with sepsis admitted to the pediatric intensive care unit and 31 controls. SAA and proADM levels were significantly higher in patients versus controls.
Meaning: SAA and proADM are promising biomarkers for diagnosing and predicting outcomes in pediatric sepsis.
Neonatology (Perinatology)
Evaluation of total serum bilirubin thresholds for discontinuing phototherapy in jaundiced neonates: a randomized study
Ajay Kumar, Nidhi Jain
Clin Exp Pediatr. 2025;68(7):539-545.   Published online February 26, 2025
Question: What are the outcomes of jaundiced neonates when phototherapy is discontinued at 2 different total serum bilirubin (TSB) thresholds?
Findings: The study involved 80 neonates, comparing a recommended TSB threshold and a lower threshold for phototherapy discontinuation. Results showed a 14.3% reinstitution rate of treatment, with no adverse outcomes.
Meaning: Careful posttreatment monitoring is essential when discontinuing phototherapy, and future research should consider updated guidelines like those from the American Academy of Pediatrics.
Genetics and Metabolism
Role of microRNA-498 and microRNA-410 in neonatal hypoxic-ischemic encephalopathy
Eman Salah Eldeen Arafat, Hasnaa Hesham Abotaleb, Dina Abdel Razek Midan, Abdel Hamid Abdo Ismail, Zeinab Sabri Abouzouna
Clin Exp Pediatr. 2025;68(7):512-521.   Published online February 26, 2025
Question: Is it role of microRNA-410 (miRNA-410) and microRNA-498 (miRNA-498) in neonatal hypoxic-ischemic encephalopathy (HIE)?
Findings: miRNA-498 and miRNA-410 can be auxiliary diagnostic and prognostic tools for neonatal HIE.
Meaning: we can use miRNA-498 and miRNA-410 as markers and indicator for HIE.
Neonatology (Perinatology)
Characterization of gut microbiota in very low birth weight infants with versus without bronchopulmonary dysplasia
Anucha Thatrimontrichai, Manapat Praditaukrit, Gunlawadee Maneenil, Supaporn Dissaneevate, Kamonnut Singkhamanan, Komwit Surachat
Clin Exp Pediatr. 2025;68(7):503-511.   Published online February 26, 2025
Question: Does the gut microbiota differ between very low birth weight (VLBW) infants with versus without bronchopulmonary dysplasia (BPD)?
Finding: Common respiratory pathogens were notably elevated in the BPD group, whereas anaerobic and butyrate-producing taxa, key components of postbiotics, were dominant in the non-BPD group.
Meaning: In gut-lung communication, the interplay between the intestinal and respiratory systems may implicate pro- and postbiotics in VLBW infants with BPD.
Review Article
Critical Care Medicine
Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis
Ambrus Szemere, Alíz Fazekas, Anna Réka Sebestyén, Rani Ezzeddine, Veronika Upor, Marie Anne Engh, Péter Hegyi, Zsolt Molnár, Klára Horváth
Clin Exp Pediatr. 2025;68(6):406-416.   Published online February 19, 2025
Protocolized sedation may reduce ventilation requirements, pediatric intensive care unit length of stay, and sedative exposure. However, it may increase the likelihood of unplanned extubation, highlighting the importance of incorporating preventive measures to mitigate this risk.
Nutrition
The Korea Infant Physical Growth Examination Survey (KIPGroS): a study protocol
Jong Woo Hahn, MinSoo Shin, Jin Gyu Lim, Yoon-Joo Kim, Ki Soo Kang, Narae Lee, Seong Hee Jeong, Mun Hui Jeong, Yeoun Joo Lee, Eui Kyung Choi, Jung Ok Shim, Jee Yoon Park, Chan-Wook Park, Joo Young Kim, Su Jin Jeong, Young Hwa Jung, Jaehyun Kim, Chang Won Choi, Ju Whi Kim, Seung Han Shin, Yun Jeong Lee, Young Ah Lee, Choong-Ho Shin, Seung-sik Hwang, Young Eun Kim, Youn Ha Kang, Kyungwon Oh, Sungha Yun, Jae Sung Ko, Jin Soo Moon
Clin Exp Pediatr. 2025;68(5):352-358.   Published online February 13, 2025
The suitability of World Health Organization (WHO) growth charts for assessing the growth of children under 3 years of age in all countries remains controversial, and their applicability must be evaluated based on country-specific growth data. The Korea Infant Physical Growth Examination Survey evaluated the suitability of WHO growth charts to contribute to the next revision of growth charts in Korea.
Original Article
Nephrology (Genitourinary)
COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus
Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn
Clin Exp Pediatr. 2025;68(6):454-462.   Published online February 3, 2025
Question: What is the acceptance rate for coronavirus disease 2019 vaccination among parents of children with systemic lupus erythematosus (SLE)?
Finding: One-third of parents were hesitant to vaccinate their child. Parental willingness to vaccinate themselves, older patient age, and belief in the vaccine's potency were associated with vaccine acceptance.
Meaning: These findings highlight the need for targeted interventions to improve vaccine acceptance among parents of children with SLE.
Hematology
Impact of Xmn1 polymorphism on hydroxyurea therapy in children with HbE-β non-transfusion dependent thalassemia: a cohort study
Saheli Roy, Paramita Bhattacharya, Atanu Kumar Dutta, Mrinal Kanti Das
Clin Exp Pediatr. 2025;68(6):437-444.   Published online February 3, 2025
Question: Does the T allele of Xmn1 polymorphism favorably influence hydroxyurea efficacy in children of Eastern descent with fetal hemoglobin (HbE)-β nontransfusion dependent thalassemia (NTDT)?
Finding: Decrease in transfusion requirement and increase in height following hydroxyurea therapy was noted in both groups, however, change in CT was more critical than that in CC genotype.
Meaning: T allele of Xmn1 polymorphism favorably influences hydroxyurea efficacy in children with HbE-β NTDT.
Review Article
Allergy
Eosinophil-derived neurotoxin levels can predict allergic disease development and atopic march in children
Zak Callaway, Chang-Keun Kim
Clin Exp Pediatr. 2025;68(6):398-405.   Published online February 3, 2025
· Allergic march occurs in a subset of children, beginning with atopic dermatitis and progressing to food allergies, allergic rhinitis, and/or asthma. Its early diagnosis is important to slowing its progression.
· Eosinophil-derived neurotoxin (EDN), an excellent biomarker of eosinophil activity, is often elevated in allergic diseases.
· EDN levels have been used to predict allergic disease development and diagnose, treat, and monitor allergic diseases.
Original Article
Nutrition
Differential effects of dietary and physical activity interventions on adiposity of children with obesity
Anekchoke Tangtongsoong, Chonnikant Visuthranukul, Yuda Chongpison, Sirinuch Chomtho
Clin Exp Pediatr. 2025;68(5):370-378.   Published online February 3, 2025
Question: How do dietary intake and physical activity affect body mass index (BMI) z scores and adiposity among children with obesity?
Finding: Higher dietary protein and fiber intakes were significantly associated with a decrease in BMI z scores and adiposity among children with obesity.
Meaning: Optimizing dietary interventions by focusing on protein and fiber intakes could be an effective strategy for managing childhood obesity.
Perspective
Other
Telemedicine in pediatrics: things to consider
Sandhya J. Kadam, Archana Reddy Bongurala
Clin Exp Pediatr. 2025;68(4):326-328.   Published online February 3, 2025
This article highlights the benefits, challenges, and current significance of telemedicine. Future research is needed, primarily to address the challenges of optimizing the implementation of telehealth. To use telemedicine effectively and efficiently for the timely diagnosis and management of patients, an evaluation of current telemedicine practice is needed. Analysis of shortcomings and advantages can help enhance healthcare delivery to pediatric patients, making it more accessible for future use.
Original Article
Oncology
Prognostic role of mid-regional pro-adrenomedullin in predicting infection in pediatric cancer with febrile neutropenia
Seham M. Ragab, Sara Mahmoud El-Deeb, Ahmed Saeed, Asmaa A. Mahmoud
Clin Exp Pediatr. 2025;68(6):445-453.   Published online January 13, 2025
· Infection remains a leading cause of death in febrile neutropenia (FN).
· Mid-regional pro-adrenomedullin (MR-ProADM) levels are higher among patients with FN and a bacterial infection.
· A longer FN duration and hospital stay length as well as elevated C-reactive protein, procalcitonin, and MR-ProADM levels are significant risk factors for mortality.
Editorial
Neurology
Screen time and neurodevelopment in preschoolers: addressing a growing concern in pediatric practice
Soongang Park, Hyewon Woo
Clin Exp Pediatr. 2025;68(6):434-436.   Published online January 13, 2025
· Excessive screen time in preschoolers is associated with neurodevelopmental delays, particularly during the early years of life.
· Parental supervision and national guidelines are critical in mitigating the negative impacts of excessive screen time and fostering healthy media habits in preschoolers.
Review Article
Other
Peripheral nerve sheath tumors in the head and neck in patients with APC gene deletion mutations: a case report and scoping review of the literature
Koral M. Blunt, Monirah Albathi, Miriam Conces, Tendy Chiang
Clin Exp Pediatr. 2025;68(6):428-433.   Published online January 13, 2025
In this report, we describe our experience with a patient with an APC-related genetic syndrome who presented with a rare palatal lesion with characteristics of a schwannoma. We discuss the role of immunohistochemical staining in discerning the differential diagnosis.
Original Article
General Pediatrics
The role of serum zinc and selenium levels in etiology of febrile seizures
Yavuz Ataş, Hatice Gamze Poyrazoğlu
Clin Exp Pediatr. 2025;68(5):388-394.   Published online January 13, 2025
Zinc may play a key role in preventing febrile seizures by increasing the seizure threshold and reducing oxidative stress. Incorporating zinc supplements into treatment could help protect children from the adverse effects of febrile seizures and improve their overall outcomes.
Immunology
Serum bactericidal activity against meningococcus in patients with systemic lupus erythematosus
Soyoung Lee, Kyung-Hyo Kim, Ji Hyen Lee, Han Wool Kim
Clin Exp Pediatr. 2025;68(5):362-369.   Published online January 13, 2025
Question: What is the level of immunity against meningococcal infections in patients with systemic lupus erythematosus (SLE) under the age of 19, and is vaccination against meningococcus necessary for these patients, given their susceptibility to infections due to immunosuppressive treatments and disease characteristics?
Finding: Although some of our study patients exhibited serum bactericidal activity against meningococci, most remained seronegative.
Meaning: These findings suggest that patients with SLE who are at risk of meningococcal infection receive appropriate vaccinations.
Review Article
Gastroenterology
Anxiety disorders presenting as gastrointestinal symptoms in children – a scoping review
Anjali Kumar, Pramodh Vallabhaneni
Clin Exp Pediatr. 2025;68(5):344-351.   Published online January 13, 2025
A positive bidirectional relationship between gastrointestinal disorders and anxiety, but with no clear aetiology, was identified. Factors such as somatisation and pain catastrophising resulted in poorer pain-related outcomes in children. Further studies are required to understand this relationship in order to have targeted treatments and ensure better long term outcomes.
Clinical Note
Gastroenterology
Congenital antral web: rare cause of gastric outlet obstruction successfully managed with endoscopic balloon dilatation
Upasana Ghosh, Ujjal Poddar, Srinivas Srinidhi Vadlapudi, Moinak Sen Sarma, Anshu Srivastava
Clin Exp Pediatr. 2025;68(3):266-268.   Published online January 13, 2025
Original Article
Gastroenterology
Differences in immune cells and gene expression in human milk by parity on integrated scRNA sequencing
Dae Yong Yi, Hong-Jai Park, Min Sun Shin, Hyoungsu Kim, Sang Jin Lee, Insoo Kang
Clin Exp Pediatr. 2025;68(2):141-152.   Published online January 10, 2025
Question: Is there a difference in immune cells in human breast milk by parity?
Finding: There were higher proportions of monocytes and T/B cells in the primiparous and multiparous group, respectively. The expression of genes with a direct role in the infant immune system and immune response-related genes were highest in the primiparous group
Meaning: There were parity-dependent differences in the expression of genes between innate and adaptive immune cells.
Neonatology (Perinatology)
Differential roles of interleukin-6 and adrenomedullin in early diagnosis and mortality predictions in late-onset neonatal sepsis
Emilly Henrique dos Santos, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Karen Alessandra Rodrigues, Ronaldo Arkader, Thelma Suely Okay
Clin Exp Pediatr. 2025;68(6):463-471.   Published online December 23, 2024
Question: Can adrenomedullin (ADM) or interleukin-6 (IL-6) detect late-onset neonatal sepsis (LOS) at admission (area under the curve [AUC]>0.90) as an early diagnostic marker?
Finding: Only IL-6 consistently distinguished survivors from nonsurvivors (AUC>0.90) on admission and antibiotic treatment days 3 and 7. C-reactive protein level identified infections from day 3 but failed to predict outcomes (AUC<0.70).
Meaning: IL-6 level can improve LOS diagnosis and prognosis.
Infection
Enteric pathogens implicated in acute infectious diarrhea among young children in resource-limited region with rapidly growing population: a hospital-based cross-sectional study
Aseel Mahmood Ibrahim Al-Mashahedah, Randa Mohammed Dhahi
Clin Exp Pediatr. 2025;68(5):379-387.   Published online December 23, 2024
Question: What are the most common enteric pathogens in acute diarrhea among children younger than 5 years of age, and which age group is most susceptible?
Finding: Bacteria were the most common causative microorganisms of diarrhea, followed by viruses, parasites, and fungi. The 1–2-year age group was the most commonly affected.
Meaning: There is a need to formulate preventive strategies targeting children exposed to enteric pathogens to limit diarrhea.
Review Article
Neonatology (Perinatology)
Recent advances in understanding pathophysiology of non-nutritional stunting in very preterm infants
Eduardo Cuestas, Alina Rizzotti
Clin Exp Pediatr. 2025;68(4):287-297.   Published online December 23, 2024
· Previous reviews of extrauterine growth restriction focused mainly on weight growth restriction caused by nutritional factors or pathological conditions.
· This review summarizes recent developments in the pathophysiology of nonnutritional length growth restriction in very preterm infants with focus on the impact of sustained neonatal inflammation on their short- and long-term outcomes.
· Further research is needed to investigate optimal strategies to improve length growth restriction in very preterm infants.
Original Article
Nephrology (Genitourinary)
C3 glomerulopathy in children: experience at a resource-limited center
Soumya Reddy, Abhishek Ghante, Mahesha Vankalakunti, Anil Vasudevan
Clin Exp Pediatr. 2025;68(4):311-318.   Published online November 28, 2024
Question: What are the clinicopathological features and outcomes of pediatric C3 glomerulopathy (C3G) in resource-limited settings?
Finding: Children with C3G in resource-limited settings have significant morbidities, and most experience kidney sequelae despite treatment. Electron microscopy was performed in only 50% of our patients, while none received complement assays or genetic testing.
Meaning: Pediatric C3G presentation, management, and kidney outcomes vary. Its thorough evaluation and management are challenging in resource-limited settings.
Editorial
Neonatology (Perinatology)
Advancements and challenges in neonatal resuscitation: embracing laryngeal mask airways for improved outcomes
Jang Hoon Lee
Clin Exp Pediatr. 2025;68(4):298-299.   Published online November 28, 2024
Positive pressure ventilation (PPV) is the most critical intervention provided during delivery room resuscitation. In the new guidelines, this recommendation has been expanded to suggest the use of laryngeal mask airyway (LMA) versus face masks for PPV. Evidence-based information and hands-on training related to this practice will help more healthcare providers become familiar with and appropriately use LMA during delivery room resuscitations.
Review Article
Cardiology
Lifelong impact of elevated blood pressure from childhood to adulthood
Junhyun Kwon, Eunji Kim
Clin Exp Pediatr. 2025;68(4):278-286.   Published online November 28, 2024
· Childhood blood pressure (BP) is significantly associated with adult hypertension and cardiovascular disease.
· Despite ongoing debate regarding the need for regular BP screening and early pharmacotherapy in children, the benefits of optimizing BP throughout childhood are clear.
· Childhood presents a critical window for normalizing BP through lifestyle modifications such as reducing sodium intake and increasing physical activity to promote lifelong cardiovascular health and prevent longterm complications.
Neurology
Cerebral organoid research for pediatric patients with neurological disorders
Jin Eun, Jung Eun Lee, Seung Ho Yang
Clin Exp Pediatr. 2025;68(4):269-277.   Published online November 28, 2024
Cerebral organoids obtained from human induced pluripotent stem cells are transforming the study of pediatric neurological diseases by providing more accurate models of human brain development and pathology. These advancements have improved pathology modeling and the potential for novel therapeutic approaches despite existing challenges such as reproducibility and vascularization.
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