Clinical and Experimental Pediatrics

Review Article

Pulmonology

Evidence-based management guidelines for noncystic fibrosis bronchiectasis in children and adolescents

Eun Lee, Kyunghoon Kim, You Hoon Jeon, In Suk Sol, Jong Deok Kim, Taek Ki Min, Yoon Ha Hwang, Hyun-Ju Cho, Dong In Suh, Hwan Soo Kim, Yoon Hee Kim, Sung-Il Woo, Yong Ju Lee, Sungsu Jung, Hyeon-Jong Yang, Gwang Cheon Jang

Clin Exp Pediatr. 2024;67(9):418-426. Published online January 23, 2024

· We suggest offering long-term macrolides to children with noncystic fibrosis bronchiectasis with frequent exacerbations (conditional recommendation, moderate quality of evidence).
· We do not recommend the routine use of mucolytic agents, inhaled corticosteroids, or nonsteroidal anti-inflammatory drugs to prevent exacerbation of bronchiectasis in children (inconclusive, very low quality of evidence).
· We recommend the use of nebulized hypertonic saline to prevent exacerbations and improve the lung function of children with noncystic fibrosis bronchiectasis (weak recommendation, moderate quality of evidence).

DOI: https://doi.org/10.3345/cep.2023.00871

Original Article

Cardiology

Effect of face mask on pulmonary artery pressure during echocardiography in children and adolescents

Alireza Ahmadi, Mohammad Reza Sabri, Zohreh Sadat Navabi

Clin Exp Pediatr. 2024;67(3):161-167. Published online January 23, 2024

Question: Can face masks alter pulmonary pressure in children and adolescents with and without congenital heart disease?
Findings: Mask removal during echocardiography (ECHO) reduced pulmonary pressure.
Meaning: These findings suggest that face masks should be removed during ECHO in children and adolescents.

DOI: https://doi.org/10.3345/cep.2023.01172

Review Article

Nephrology (Genitourinary)

Effects of diethylene glycol contamination of pharmaceutical products on unexplained acute kidney injury in children: a systematic review

Sani Rachman Soleman, Muhammad Luthfi Adnan, Hilmi Ardian Sudiarto, Satria Bintang Mahathma, Alya Ayu Tazkia, Hana Afifah Firdaus, Alfreda Amelia Khotijah, Miranti Dewi Pramaningtyas, Emi Azmi Choironi

Clin Exp Pediatr. 2024;67(8):395-402. Published online January 4, 2024

Web of Science 1

A recent unexplained acute kidney injury (AKI) outbreak due to pharmaceutical product contamination with diethylene glycol (DEG) raises public attention. Our study revealed that DEG-contaminated paracetamol causes unexplained AKI in children. However, paracetamol is not the only contaminated drug. Other drugs, such as cough expectorants, antihistamines, and sedatives, can also be affected. Other chemicals, such as ethylene glycol and propylene glycol, can also contribute to poisonings.

DOI: https://doi.org/10.3345/cep.2023.01039

Editorial

Neonatology (Perinatology)

Exploring the role of laryngeal masks in neonatal resuscitation

Euiseok Jung

Clin Exp Pediatr. 2024;67(5):247-248. Published online December 28, 2023

· Laryngeal masks (LMs) offer stable airway access and skill retention advantages, making them promising alternatives to positive-pressure ventilation in neonatal care.
· The ease of teaching LM insertion techniques to less experienced providers addresses the need for swift intervention and skill retention.
· Careful consideration of the benefits and challenges of LMs is essential in determining their effective integration into enhanced neonatal resuscitation protocols.

DOI: https://doi.org/10.3345/cep.2023.01200

Impacts of maternal COVID-19 during pregnancy on neonatal health and epidemiology

Jae Woo Lim

Clin Exp Pediatr. 2024;67(3):149-151. Published online December 28, 2023

Newborns born to mothers infected with coronavirus disease 2019 (COVID-19) should be closely monitored for respiratory disorders, such as transient tachypnea of the newborn, regardless of their COVID-19 test results. Further research is required of the development of infants born to mothers with COVID-19. The trends in Korea's birth rate and infant mortality rates have not been significantly affected by COVID-19.

DOI: https://doi.org/10.3345/cep.2023.01452

Clinical Note

Neurology

Expanding association between BICD2 variants and brain malformations and associated lissencephaly

Jaeso Cho, Haeryung Kim, Seoungbok Lee, Jihoon G Yoon, HyeJin Kim, Minhye Kim, Seoyun Jang, Woojoong Kim, Soo Yeon Kim, Jong Hee Chae

Clin Exp Pediatr. 2024;67(1):54-56. Published online December 21, 2023

DOI: https://doi.org/10.3345/cep.2023.01095

Original Article

Adolescence Medicine

Relationship between inflammatory biomarkers and insulin resistance in excess-weight Latin children

Mariano Nicolás Aleman, María Constanza Luciardi, Emilce Romina Albornoz, María Cristina Bazán, Adela Victoria Abregú

Clin Exp Pediatr. 2024;67(1):37-45. Published online December 21, 2023

Web of Science 4 Crossref 4

Question: What is the prevalence of insulin resistance (IR) in excess-weight Latin children, and can proinflammatory biomarkers predict it?
Finding: IR prevalence was elevated and tumor necrosis factor- α, interleukin-6, monocyte chemoattractant protein- 1, soluble CD40 ligand, and high-sensitivity C-reactive protein levels were increased in excess-weight Latin children. However, none predicted IR status.
Meaning: These inflammatory biomarkers were unable to predict IR status. Therefore, further investigations are necessary.

DOI: https://doi.org/10.3345/cep.2022.01382

Review Article

Allergy

Recent advances in food allergen immunotherapy

You Hoon Jeon, Edwin H. Kim

Clin Exp Pediatr. 2024;67(8):386-394. Published online December 7, 2023

Web of Science 1 Crossref 1

· To enhance the safety of food allergen immunotherapy, alternative approaches such as sublingual immunotherapy, epicutaneous immunotherapy, low-dose oral immunotherapy (OIT), and omalizumab with OIT are being explored.
· Factors such as causative allergen type, natural outgrowth, symptom severity, and patient age should be considered.
· Individualized food allergen immunotherapy plans should be established to determine the most beneficial treatment for each patient.

DOI: https://doi.org/10.3345/cep.2023.01004

Neonatology (Perinatology)

Quantifying myelin in neonates using magnetic resonance imaging: a systematic literature review

Nabila Hanem Arshad, Hasyma Abu Hassan, Nur Farhayu Omar, Zurina Zainudin

Clin Exp Pediatr. 2024;67(8):371-385. Published online December 6, 2023

Question: This systematic review attempts to discover the best magnetic resonance imaging (MRI) technique for myelin quantification in neonates by evaluating various MRI parameters and their reproducibility.
Finding: Since the benefits of using synthetic MRI for quantifying myelin in neonates outweigh the very minor draw- backs, it is recommended.
Meaning: The findings suggest the importance of identifying noninvasive MRI techniques available to assess myelin tissue in neonates, which aid in diagnosing neurodevelopmental disorders.

DOI: https://doi.org/10.3345/cep.2023.00514

Original Article

Neurology

Effectiveness of Helmet therapy for infants with moderate to severe positional plagiocephaly

Jeongho Kim, Jina Kim, Kyu Young Chae

Clin Exp Pediatr. 2024;67(1):46-53. Published online December 5, 2023

Web of Science 5 Crossref 7

Question: Is helmet therapy effective for positional plagiocephaly? What factors influence helmet therapy efficacy for positional plagiocephaly?
Finding: Helmet therapy is effective for infants with moderate to severe positional plagiocephaly, and its effectiveness is influenced by age at treatment initiation, severity of head asymmetry, and daily duration of helmet wear.
Meaning: Pediatricians should initiate helmet therapy for positional plagiocephaly sooner, ideally before 9 months of age, to maximize treatment efficacy.

DOI: https://doi.org/10.3345/cep.2023.00626

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

Web of Science 6 Crossref 6

· 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

Editorial

Allergy

Trends in food allergen immunotherapy in Korea after changed national regulations

Tae Won Song

Clin Exp Pediatr. 2024;67(4):201-202. Published online November 21, 2023

National regulations, academic guidelines, and clinical trends in food allergen immunotherapies (FA-AIT) differ among countries and have changed rapidly. Current officially approved FA-AIT are oral immunotherapy (OIT) using heated milk/egg in Korea and peanut OIT using standardized products in the United States and Europe. FA-AIT should be administered by specialist physicians with experience administering oral food challenge tests and managing severe allergic reactions inside and outside research settings.

DOI: https://doi.org/10.3345/cep.2023.01123

Genetics and Metabolism

Advancing orphan drug development for rare diseases

Jung Min Ko

Clin Exp Pediatr. 2024;67(7):356-357. Published online November 17, 2023

Web of Science 1 Crossref 2

· Rare diseases present unique challenges and unmet needs for which the development of orphan drugs tailored to them offers hope.
· Despite the hurdles posed by limited patient populations, orphan drug designations from regulatory agencies provide incentives, such as extended market exclusivity and tax credits, that ignite transformative advances.
· Scientific progress in genomics, personalized medicine, and analytics empowers precise interventions by decoding genetic anomalies and encouraging effective treatments.

DOI: https://doi.org/10.3345/cep.2023.01109

Nephrology (Genitourinary)

Clinical considerations and practical issues of kidney complications in children after COVID-19 infection or vaccination

Jiwon Jung, Joo Hoon Lee

Clin Exp Pediatr. 2024;67(1):35-36. Published online November 17, 2023

· The proper monitoring for and treatment of coronavirus disease 2019 (COVID-19)-induced acute kidney injury, which is common in critically ill children, are recommended.
· Glomerulopathy associated with COVID-19 or its vaccination has been reported, and the overall clinical course is similar to that of non-COVID-19-associated diseases.
· Additional COVID-19 vaccinations are recommended; however, careful and individualized decisions should be made in patients with COVID-19- or vaccination-associated glomerulopathy.

DOI: https://doi.org/10.3345/cep.2023.01074

Review Article

General Pediatrics

Metabolic complications of obesity in children and adolescents

Hyunjin Park, Jung Eun Choi, Seunghee Jun, Hyelim Lee, Hae Soon Kim, Hye Ah Lee, Hyesook Park

Clin Exp Pediatr. 2024;67(7):347-355. Published online November 16, 2023

Web of Science 13 Crossref 14

· Pediatric obesity increases the risk of metabolic complications (insulin resistance, dyslipidemia, nonalcoholic fatty liver disease) and long-term cardiovascular diseases.
· A new obesity definition and various indicators (continuous metabolic syndrome score, pediatric simple metabolic syndrome score, fatty liver index) have been proposed to evaluate children’s susceptibility to metabolic disorders.
· Laboratory and body composition tests in pediatric screenings can identify groups at high risk of metabolic complications of obesity.

DOI: https://doi.org/10.3345/cep.2023.00892

Endocrinology

Association between pre- and postnatal exposure to endocrine-disrupting chemicals and birth and neurodevelopmental outcomes: an extensive review

Ozge Yesildemir, Mensure Nur Celik

Clin Exp Pediatr. 2024;67(7):328-346. Published online November 16, 2023

Web of Science 4 Crossref 7

· Sensitivity to endocrine-disrupting chemical (EDC) exposure increases during critical developmental periods (in embryos, fetuses, and neonates).
· Pre- and postnatal exposure to EDCs is associated with fetal growth restriction, preterm birth, and low birth weight.
· Exposure to EDCs during fetal and early postnatal life can have lasting and lifelong neurodevelopmental outcomes, including autism spectrum, attention deficit hyperactivity, and other cognitive and behavioral disorders.

DOI: https://doi.org/10.3345/cep.2023.00941

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 3 Crossref 4

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

Neonatology (Perinatology)

Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

Asha P. Shetty, Kurvatteppa Halemani, Alwin Issac, Latha Thimmappa, Sanjay Dhiraaj, Radha K, Prabhaker Mishra, Vijai Datta Upadhyaya

Clin Exp Pediatr. 2024;67(2):104-115. Published online November 14, 2023

Web of Science 14 Crossref 24

Question: What emotions do parents experience when their newborns are admitted to the neonatal intensive care unit (NICU)?
Finding: Mothers experienced more anxiety (51%), depression (31%), and stress (41%) symptoms than fathers (26%, 12%, and 22%, respectively).
Meaning: Parents often experience anxiety, stress, and depression following NICU admission. Healthcare workers are responsible for providing regular parental counseling.

DOI: https://doi.org/10.3345/cep.2023.00486

Letter to the Editor

Neonatology (Perinatology)

Association between feeding intolerance and intestinal dysbiosis in very premature infants

Putri Maharani Tristanita Marsubrin, Agus Firmansyah, Rinawati Rohsiswatmo, Zakiudin Munasir, Saptawati Bardosono, Safarina G. Malik, Yuditiya Purwosunu, Ina S. Timan, Tetty Yuniati, Maya Yulindhini

Clin Exp Pediatr. 2023;66(11):501-503. Published online October 24, 2023

DOI: https://doi.org/10.3345/cep.2023.00829

Original Article

Neonatology (Perinatology)

Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study

Sung Hee Lee, Ju Hyun Jin, Jong Ha Yoo, Shin Won Yoon

Clin Exp Pediatr. 2023;66(11):493-500. Published online October 24, 2023

Web of Science 3 Crossref 3

Question: What are the adverse clinical outcomes of neonates of coronavirus disease 2019 (COVID-19)–infected mothers?
Finding: Infants of mothers with COVID-19 were at significantly increased risk of transient tachypnea of the newborn (TTN), use of noninvasive ventilation, and need for supplemental oxygen (P<0.05).
Meaning: Neonates of mothers with COVID-19 are at risk of TTN and require respiratory support. Close monitoring is essential to ensuring timely intervention if required.

DOI: https://doi.org/10.3345/cep.2023.00563

Developmental and Behavioral Medicine

Attention-deficit/hyperactive-impulsive disorder symptoms among grade 1 students with reading disorder in Thailand

Patcharapun Sarisuta, Issarapa Chunsuwan, Tippawan Hansakunachai, Paskorn Sritipsukho

Clin Exp Pediatr. 2023;66(11):485-492. Published online October 24, 2023

Crossref 2

Question: Would students with reading disorder have a significantly higher prevalence of attention-deficit/hyperactiveimpulsive disorder (ADHD) symptoms than neurotypical students?
Finding: Students at risk of reading disorder exhibited significant ADHD symptoms compared with those not at risk of reading disorder according to all presentations of teacher assessments versus only for predominantly inattentive presentations of the parental assessments.
Meaning: Students with reading disorder have a significantly higher prevalence of ADHD symptoms than neurotypical students. Sex, parental education level, average family income, and children’s school affiliation significantly influenced reading disorder prevalence.

DOI: https://doi.org/10.3345/cep.2023.00773

Letter to the Editor

Allergy

Increased serum eosinophilic cationic protein in children with nonspecific chronic cough

Young Hwan Kim, Yoon Young Jang, Jieun Jeong, Hai Lee Chung

Clin Exp Pediatr. 2023;66(10):455-457. Published online September 14, 2023

Web of Science 1 Crossref 1

DOI: https://doi.org/10.3345/cep.2023.00416

Original Article

Developmental and Behavioral Medicine

Impact of short and intensive art-based intervention on symptomatology and social interactions among children with autism spectrum disorder

Deldar Morad Abdulah, Bayar Mohammed Omar Abdulla, Pranee Liamputtong

Clin Exp Pediatr. 2023;66(10):447-454. Published online September 14, 2023

Web of Science 3 Crossref 4

Question: Does a short and intensive art-based intervention affect symptoms and social interactions among children with autism spectrum disorder (ASD)?
Finding: The short and intensive art-based intervention did not affect symptoms in children with ASD level 2 or 3, including social awareness, social cognition, social communication, social motivation, and autistic mannerisms.
Meaning: The short and intensive art-based intervention did not improve the symptoms of patients with ASD.

DOI: https://doi.org/10.3345/cep.2023.00640

Editorial

Infection

COVID-19 infection and vaccination among children

Amnuay Kleebayoon, Viroj Wiwanitkit

Clin Exp Pediatr. 2023;66(12):531-532. Published online August 30, 2023

· Coronavirus disease 2019 (OVID-19) infection and immunization have been linked with kidney problems; however, causality has not been proven.
· Concern about confounders is usually needed.
· Correspondence about a published article on the COVID-19 vaccine

DOI: https://doi.org/10.3345/cep.2023.00899

Review Article

Other

Children’s health affected by parent’s behavioral characteristics: a review

Sung Eun Kim, Jongin Lee

Clin Exp Pediatr. 2024;67(5):232-239. Published online August 21, 2023

Crossref 1

· Parents’ occupational hazards, long working hours, and smoking behaviors should be modified adequately to minimize adverse health effects on their children.
· As of 2023, several diseases from fetal exposure to occupational hazards can be compensated with Industrial Accident Compensation Insurance in South Korea.
· A directed acyclic graph is recommended for medical research to control the effects of parents’ behaviors on children’s health.

DOI: https://doi.org/10.3345/cep.2023.00115

Neonatology (Perinatology)

Influence of infant microbiome on health and development

Noelle Younge

Clin Exp Pediatr. 2024;67(5):224-231. Published online August 21, 2023

Web of Science 3 Crossref 4

· The infant gut microbiome is highly dynamic and individualized.
· Microbes are vertically transmitted from mother to infant during delivery and throughout infancy.
· Delivery mode, gestational age, diet, and antibiotic use influence infant microbiome composition and function.
· In animal studies, the microbiome played critical roles in the structural and functional development of the infant gastrointestinal and immune systems.
· Microbiome-targeted therapies have great potential to reduce infant morbidity and mortality.

DOI: https://doi.org/10.3345/cep.2023.00598

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 7 Crossref 10

· 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

Original Article

Developmental and Behavioral Medicine

Neonatal risk factors associated with attention-deficit/hyperactivity disorder: an umbrella review

Ensiyeh Jenabi, Erfan Ayubi, Sajjad Farashi, Saeid Bashirian, Fereshteh Mehri

Clin Exp Pediatr. 2023;66(10):441-446. Published online July 14, 2023

Web of Science 5 Crossref 5

Question: The risk factors for attention deficit hyperactivity disorder (ADHD), such as breastfeeding, congenital heart disease, and low birth weight, in neonates are not well understood.
Finding: This umbrella review obtained significant effect sizes for ADHD for congenital heart disease (odds ratio [OR], 3.04), low birth weight (OR, 2.25), never breastfed (OR, 1.55), and Apgar score (OR, 1.30).
Meaning: Congenital heart disease, low birth weight, lack of breastfeeding, and Apgar scores were significant factors for ADHD.

DOI: https://doi.org/10.3345/cep.2022.01396

Review Article

Neonatology (Perinatology)

Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks

Eun Song Song, Ga Won Jeon

Clin Exp Pediatr. 2024;67(5):240-246. Published online July 11, 2023

Web of Science 3 Crossref 3

In neonatal resuscitation:
· Laryngeal masks are recommended when endotracheal intubation or positive-pressure ventilation fails.
· Laryngeal masks are useful even during chest compressions.
· Laryngeal masks aid neonates >34 weeks’ gestation and/or with a birth weight >2 kg.
· Main usage barriers include limited experience (81%), preference for endotracheal tubes (57%), and lack of awareness (56%).
· Second-generation laryngeal masks have a built-in esophageal drainage tube that prevents regurgitation into the glottis, and an orogastric tube can be inserted within the esophageal drainage tube to protect against gastric inflation.

DOI: https://doi.org/10.3345/cep.2023.00619

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

Web of Science 1 Crossref 1

· 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

Cited By 31	Neurodevelopmental outcomes of preterm infants
Cited By 29	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 27	Gut microbiota affects brain development and behavior
Cited By 24	Association of gut microbiota with obesity in children and adolescents
Cited By 24	Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

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