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Review Article
Gastroenterology
Causes of acute gastroenteritis in Korean children between 2004 and 2019
Eell Ryoo
Clin Exp Pediatr. 2021;64(6):260-268.   Published online September 18, 2020
· Norovirus is the most common virus in Korean children with acute gastroenteritis.
· Escherichia coli and Salmonella spp. are the most common cause of bacterial gastroenteritis in Korean children, with a detection rate of 3%–20%.
· Uncommon bacterial and parasitic gastroenteritis require attention because of increasing international exchange and overseas travel.
Original Article
General Pediatrics
Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study
Sody A. Naimer, Ariel Israel, Aviezer Gabbay
Clin Exp Pediatr. 2021;64(3):130-135.   Published online September 7, 2020
Question: Does a tethered maxillary frenulum in the newborn result in breastfeeding difficulty or other oral symptomatology?
Finding: The analysis of subjects with a tethered maxillary frenulum surveyed beyond a mean 5-year follow-up did not reveal an increase in oral issues versus those of a random agematched control group.
Meaning: These data demonstrate no need to intervene upon the diagnosis of a tethered maxillary frenulum.
Neonatology (Perinatology)
Predictive factors of death in neonates with hypoxic-ischemic encephalopathy receiving selective head cooling
Behnaz Basiri, Mohammadkazem Sabzehei, Mohammadmahdi sabahi
Clin Exp Pediatr. 2021;64(4):180-187.   Published online August 27, 2020
Question: What is the most important factor that increases mortality in infants with hypoxic-ischemic encephalopathy (HIE) who receive selective head cooling?
Finding: All cases of neonatal mortality were severe HIE (stage 3), and a severely abnormal amplitude-integrated electroencephalography and mortality were increased with the need for advanced neonatal resuscitation upon delivery.
Meaning: Advanced neonatal resuscitation affects HIE outcomes, and medical personnel should be prepared to provide the best intervention.
Evaluation of the role of ischemia modified albumin in neonatal hypoxic-ischemic encephalopathy
Mohamed A. Talat, Rabab M. Saleh, Mohammed M. Shehab, Naglaa A. Khalifa, Maha Mahmoud Hamed Sakr, Walaa M. Elmesalamy
Clin Exp Pediatr. 2020;63(8):329-334.   Published online August 15, 2020
Question: What is the value of ischemia modified albumin (IMA) as a diagnostic marker for neonatal hypoxic-ischemic encephalopathy (HIE)?
Finding: IMA levels were significantly higher (nearly double elevation) in hypoxic than healthy newborns in the first few hours after birth in the full-term neonates.
Meaning: IMA can be a reliable marker for the early diagnosis of neonatal HIE and can be a predictor of injury severity.
Hematology
Effects of α-tocopherol on hemolysis and oxidative stress markers on red blood cells in β-thalassemia major
Nora Sovira, Munar Lubis, Pustika Amalia Wahidiyat, Franciscus D. Suyatna, Djajadiman Gatot, Saptawati Bardosono, Mohammad Sadikin
Clin Exp Pediatr. 2020;63(8):314-320.   Published online August 15, 2020
Question: Is the α-tocopherol as an exogenous antioxidant supplementation effective in improving hemolysis and oxidative stress on β-thalassemia major?
Finding: We found significant enhancements in plasma haptoglobin were noted in the α-tocopherol group (3.01 mg/dL; range, 0.60–42.42 mg/dL; P=0.021).
Meaning: The α-tocopherol can improve hemolysis by increasing the haptoglobin level as hemolysis marker.
Review Article
Allergy
Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis
Hye Yung Yum, Eun Kyo Ha, Yoon Ho Shin, Man Yong Han
Clin Exp Pediatr. 2021;64(8):373-383.   Published online August 10, 2020
Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%–89% of the chronic rhinitis cases, affecting 1%–50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally...
Critical Care Medicine
The use of extracorporeal membrane oxygenation in children with acute fulminant myocarditis
Silver Heinsar, Sainath Raman, Jacky Y. Suen, Hwa Jin Cho, John F. Fraser
Clin Exp Pediatr. 2021;64(5):188-195.   Published online August 10, 2020
Acute fulminant myocarditis (AFM) occurs as an inflammatory response to an initial myocardial insult. Its rapid and deadly progression calls for prompt diagnosis with aggressive treatment measures. The demonstration of its excellent recovery potential has led to increasing use of mechanical circulatory support, especially extracorporeal membrane oxygenation (ECMO). Arrhythmias, organ failure, elevated cardiac biomarkers, and decreased ventricular function at presentation...
Adolescence Medicine
The impacts of exercise on pediatric obesity
Ronald J. Headid III, Song-Young Park
Clin Exp Pediatr. 2021;64(5):196-207.   Published online August 4, 2020
Pediatric obesity contributes to the development of vascular dysfunction and metabolic and cardiovascular diseases which have all been shown to track into adulthood, increasing the risk of early mortality. Early exercise intervention is critical for combating obesity-related comorbidities and the optimal exercise prescription has yet to be well documented. Exercise prescriptions to combat pediatric obesity should incorporate both aerobic and muscle-strengthening exercises with an emphasis on long-term adherence.
Original Article
Other
Association between pesticide and polychlorinated biphenyl exposure during pregnancy and autism spectrum disorder among children: a meta-analysis
Fereshteh Mehri, Saeid Bashirian, Salman khazaei, Ensiyeh Jenabi
Clin Exp Pediatr. 2021;64(6):286-292.   Published online July 27, 2020
· This meta-analysis analyzed the association between pesticide and polychlorinated biphenyl (PCB) exposure during pregnancy and autism spectrum disorders (ASD) risk among children.
· A significant association was noted between PCB and pesticide exposure during pregnancy and ASD risk among children (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.26–2.34 and OR, 1.20; 95% CI, 1.02–1.39), respectively.
· Pesticide and PCB exposure during pregnancy may affect ASD risk among children.
Gastroenterology
Noninvasive markers for esophageal varices in children with cirrhosis
Parisa Rahmani, Fatemeh Farahmand, Ghobad Heidari, Azadeh Sayarifard
Clin Exp Pediatr. 2021;64(1):31-36.   Published online July 21, 2020
Question: Can noninvasive biomarkers identify esophageal varices among children with esophageal cirrhosis?
Finding: The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index, platelet count to spleen size ratio, and risk score differed significantly between the patients with and those without esophageal varices.
Meaning: These biological parameters can predict esophageal varices among pediatric patients and indicate the need for esophagogastroduodenoscopy.
Evaluating the effects of probiotics in pediatrics with recurrent abdominal pain
Parisa Rahmani, Azin Ghouran-orimi, Farzaneh Motamed, Alireza Moradzadeh
Clin Exp Pediatr. 2020;63(12):485-490.   Published online July 21, 2020
Question: ecurrent abdominal pain (RAP) is a chief complaint among pediatrics and is associated with reduced quality of life, for both parent and child, and economic burden. Does probiotics reduce the frequency of RAP among children?
Finding: This study reported the effects of Lactobacillus reuteri probiotics among children with RAP as a result of multiple etiologies.
Meaning: The administration of probiotic supplements is significantly associated with pain relief among RAP children presented with functional abdominal pain, irritable bowel syndrome, and functional dyspepsia.
Neonatology (Perinatology)
Knowledge and perceptions of kangaroo mother care among health providers: a qualitative study
Hadi Pratomo, Tiara Amelia, Fatmawati Nurlin, Asri C. Adisasmita
Clin Exp Pediatr. 2020;63(11):433-437.   Published online July 21, 2020
Question: What are health providers’ knowledge and perceptions of Kangaroo mother care (KMC)?
Finding: Health providers’ knowledge of KMC was sufficient; however, some of their perceptions about it could create barriers to the successful implementation of hospital KMC programs.
Meaning: Health providers’ perceptions about KMC should be considered to ensure successful KMC implementation. Locally designed on-site training programs could overcome the challenges.
Cardiology
Age-, sex-, and height-based blood pressure reference charts, Yazd children 6–18 years, Iran
Nastaran ahmadi, Seyedeh Mahdieh Namayandeh, Seyed Mahmood Sadr Bafghi, Mohammad Reza Mohammadi, Masoud Mirzaei, Mohammadtaghi Sarebanhassanabadi, Amir Houshang Mehrparvar, Reza Faraji, Neda Nilforoshan, Ahmad Karimi
Clin Exp Pediatr. 2020;63(8):321-328.   Published online July 21, 2020
Question: What is the 90th, 95th, 99th percentile of blood pressure based on height as the cut point for diagnosis of hypertension in children of our province?
Finding: We used blood pressure of 456 males and 579 females in 6–18 years old in “Iranian Children and Adolescents' Psychiatric Disorders survey.
Meaning: The 90th, 95th, 99th percentiles of systolic and diastolic blood pressure in both sex based on age and 10-cm height intervals were developed in Yazd.
Review Article
Genetics and Metabolism
Understanding the genetics of systemic lupus erythematosus using Bayesian statistics and gene network analysis
Seoung Wan Nam, Kwang Seob Lee, Jae Won Yang, Younhee Ko, Michael Eisenhut, Keum Hwa Lee, Jae Il Shin, Andreas Kronbichler
Clin Exp Pediatr. 2021;64(5):208-222.   Published online July 15, 2020
Bayesian false-discovery probability and false-positive report probability are the 2 major Bayesian methods used to evaluate noteworthiness of a genetic variant.
Application of stricter P value is needed to confirm statistical significance in meta-analyses.
Gene network analysis of noteworthy genetic variants shows a blueprint of the genetic background in complex diseases.
Neurofibromatosis type I: points to be considered by general pediatricians
Eungu Kang, Hee Mang Yoon, Beom Hee Lee
Clin Exp Pediatr. 2021;64(4):149-156.   Published online July 15, 2020
Neurofibromatosis type 1 (NF1), a prevalent genetic disease that is transmitted in an autosomal dominant manner, is characterized by multiple cutaneous café-au-lait spots and neurofibromas as well as various degrees of neurological, skeletal, and neoplastic manifestations. The clinical features of NF1 increase in frequency with age, while the clinical diagnosis can remain undetermined in some pediatric patients. Importantly, affected patients...
Other
Behavioral insomnia in infants and young children
Eun Kyeong Kang, Seung Soo Kim
Clin Exp Pediatr. 2021;64(3):111-116.   Published online July 15, 2020
• Behavioral insomnia is common and affects a child’s daytime functioning and emotions.
• Diagnosing insomnia using the child’s sleep history, a sleep diary/log, and sleep questionnaires is important.
• Behavioral intervention, the main treatment, involves creating positive associations with sleep, establishing a consistent sleep schedule and bedtime routines, and the development of selfsoothing skills.
Original Article
Neonatology (Perinatology)
The protective effect of CXC chemokine receptor 2 antagonist on experimental bronchopulmonary dysplasia induced by postnatal systemic inflammation
Seung Hyun Lee, Chang Won Choi
Clin Exp Pediatr. 2021;64(1):37-43.   Published online July 15, 2020
Question: Can CXC chemokine receptor 2 (CXCR2) antagonist preserve alveolarization by attenuating the inflammation induced by systemic lipopolysaccharide (LPS) administration in a rat model of bronchopulmonary dysplasia (BPD)?
Finding: CXCR2 antagonist significantly decreased neutrophil counts in bronchoalveolar lavage fluid and peripheral blood induced by systemic LPS administration and restored alveolarization in newborn rats.
Meaning: CXCR2 antagonist protected the lungs from the inflammation in a rat model of BPD.
Review Article
Gastroenterology
Changing prevalence of Helicobacter pylori infection in children and adolescents
Ji Sook Park, Jin Su Jun, Ji-Hyun Seo, Hee-Shang Youn, Kwang-Ho Rhee
Clin Exp Pediatr. 2021;64(1):21-25.   Published online July 15, 2020
Although Helicobacter pylori infection rate in children is unclear due to diversity and limitation of diagnostic tests unlike in adults, investigation the childhood prevalence is important for predicting H. pylori-related diseases in the future.
H. pylori infection occurred in early childhood, and declined during 30 years in our study.
Change in risk factors of H. pylori transmission and consensus for eradication therapy in children might further reduce the infection rate.
Original Article
Neonatology (Perinatology)
New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease
Young Mi Yoon, Seong Phil Bae, Yoon-Joo Kim, Jae Gun Kwak, Woong-Han Kim, Mi Kyoung Song, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim
Clin Exp Pediatr. 2020;63(10):395-401.   Published online July 15, 2020
Questions: This study aimed to describe the survival of premature infants with critical congenital heart disease (CHD) and to identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) associated with mortality.
Finding: For premature infants with critical CHD, survival rate was 76.9% and very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS 5 or more were associated with in-hospital mortality.
Meaning: VLBW, PPHN and BPD, as well as M-RACHS≥5, were risk factors for mortality among premature infants with critical CHD.
Critical Care Medicine
Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?
Chanapai Chaiyakulsil, Onsuthi Pharadornuwat
Clin Exp Pediatr. 2021;64(3):123-129.   Published online July 14, 2020
Question: Can central line bundles and feedback reduce central line-associated complications in pediatric patients?
Finding: The central line-related bloodstream infection rate decreased from 10.0 catheter-days to 1.4/1,000 catheter-days at 6-month postintervention. The central line occlusion rate was also decreased.
Meaning: Reinforcing central line care bundles with direct feedback can significantly decrease central line-associated complications in pediatric patients.
Review article
Immunology
Systematic review of literature and analysis of big data from the National Health Insurance System on primary immunodeficiencies in Korea
Sohee Son, Ji-Man Kang, Younsoo Hahn, Kangmo Ahn, Yae-Jean Kim
Clin Exp Pediatr. 2021;64(4):141-148.   Published online July 13, 2020
In this article, a systematic review of reported primary immunodeficiency disease (PID) cases in Korea was performed and we attempted to estimate the number of PID patients and healthcare costs for the first time in Korea. Our review revealed that Korean PID cases are greatly underreported in the literature based on health insurance. Physicians in the field and health care policymakers should be aware of the disease burden of PID.
Original Article
Nephrology (Genitourinary)
Sonographic renal length and volume of normal Thai children versus their Chinese and Western counterparts
Chantima Rongviriyapanich, Thanarat Sakunchit, Chirawat Sudla, Supamas Mungkung, Napapong Pongnapang, Chai Hong Yeong
Clin Exp Pediatr. 2020;63(12):491-498.   Published online July 13, 2020
Question: What is the normal renal size of Thai children and is the renal nomogram comparable to those of Western and Chinese cohorts?
Finding: The renal length of Thai children was moderately correlated with that of Western children, while the age-specific renal volume was significantly smaller than that of Chinese children.
Meaning: Renal size in children can vary among regions and sociodemographic backgrounds; hence, a local reference standard is needed.
Review Article
Immunology
Immunopathogenesis of COVID-19 and early immunomodulators
Kyung-Yil Lee, Jung-Woo Rhim, Jin-Han Kang
Clin Exp Pediatr. 2020;63(7):239-250.   Published online June 18, 2020
The novel coronavirus disease 2019 (COVID-19) is spreading globally. Although its etiologic agent is discovered as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there are many unsolved issues in COVID-19 and other infectious diseases. The causes of different clinical phenotypes and incubation periods among individuals, species specificity, and cytokine storm with lymphopenia as well as the mechanism of damage to organ...
Other
Review of epidemiological studies on air pollution and health effects in children
Jong-Tae Lee
Clin Exp Pediatr. 2021;64(1):3-11.   Published online June 10, 2020
This review summarized the accumulated epidemiologic evidence with emphasis on studies conducted in Korea and heterogeneity in the literature. Based on systematic reviews and meta-analyses, there is consistent evidence on the association between exposure to ambient air pollution and children’s health, especially respiratory health and adverse birth outcomes, and growing evidence on neurodevelopmental outcomes.
Pulmonology
Current perspectives on atypical pneumonia in children
Jung Yeon Shim
Clin Exp Pediatr. 2020;63(12):469-476.   Published online June 10, 2020
Macrolides are the first line treatment in atypical pneumonia caused by M. pneumoniae, C. pneumoniae, and L. pneumophila. Macrolide-resistant mycoplasma pneumonia (MRMP) is emerging worldwide, especially in East Asia. Immune modulators such as corticosteroids or second line antibiotics are treatment options for MRMP. Pediatricians should be careful with empirical therapy of macrolides in children with mild to moderate community-acquired pneumonia not to increase the risk of MRMP.
Original Article
Other
Evaluation of goodness of fit of semiparametric and parametric models in analysis of factors associated with length of stay in neonatal intensive care unit
Fatemeh Kheiry, Sadegh Kargarian-Marvasti, Sima Afrashteh, Abolfazl Mohammadbeigi, Nima Daneshi, Salma Naderi, Seyed Hossein Saadat
Clin Exp Pediatr. 2020;63(9):361-367.   Published online June 10, 2020
Question: Hospitalization in neonatal intensive care unit (NICU) is associated with life-threatening hazards. What factors associated with neonatal length of stay (LOS) in the NICU?
Finding: Breastfeeding, phototherapy, acute renal failure (ARF), mechanical ventilation, and central venous catheter (CVC) access were identified as factors associated with NICU length of stay.
Meaning: Protective effects of breastfeeding and CVC access, whereas increase effects of phototherapy, ARF, and mechanical ventilation in LOS can be supporting evidence to establish effective interventions to reduce length of NICU stay.
General Pediatrics
Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure
Lars Boenicke, Johannes Doerner, Stefan Wirth, Hubert Zirngibl, Mike Ralf Langenbach
Clin Exp Pediatr. 2020;63(7):272-277.   Published online May 15, 2020
Background: The optimal management of perianal abscess in children is controversial.
Purpose: To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods: All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated. Results: Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary...
Neonatology (Perinatology)
Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis
Mahmoud Robati Anaraki, Masoud Nouri-Vaskeh, Shahram Abdoli Oskoei
Clin Exp Pediatr. 2021;64(4):172-179.   Published online May 14, 2020
· Mortality is decreased significantly in meta-analysis of studies in different regimen of fluconazole prophylaxis.
· Significant decrease was seen in incidence of invasive candidiasis-associated mortality in extremely low birth weight infants in same schedules of prophylaxis.
· More studies required to relief the concerns.
Review Article
Neurology
Myelin oligodendrocyte glycoprotein antibody-associated disorders: clinical spectrum, diagnostic evaluation, and treatment options
Yun-Jin Lee, Sang Ook Nam, Ara Ko, JuHyun Kong, Shin Yun Byun
Clin Exp Pediatr. 2021;64(3):103-110.   Published online May 14, 2020
MOG antibody-associated disorder exhibits different pathophysiological and phenotypic findings than both aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder and typical MS. MOG-antibody is of particular interest in pediatric patients with clinical or radiological non-MS typical findings. MOG-antibody was included in a diagnostic algorithm for children recommending for the first time a standardized use in clinical practice except in cases of typical MS.
Endocrinology
Early menarche and its consequence in Korean female: reducing fructose intake could be one solution
Ji Hyun Kim, Jung Sub Lim
Clin Exp Pediatr. 2021;64(1):12-20.   Published online May 14, 2020
In Korea, the average age of menarche has declined sharply. Early menarche is associated with psychosocial and behavioral problems and cardiometabolic disease. Excess fructose intake has been suggested as one cause of early menarche in recent studies, so reducing fructose intake may be one solution.