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Review Article
Neurology
Neonatal seizures: diagnostic updates based on new definition and classification
Eun-Hee Kim, Jeongmin Shin, Byoung Kook Lee
Clin Exp Pediatr. 2022;65(8):387-397.   Published online April 4, 2022
· Neonatal seizures are often electrographic-only seizures without clinical signs; therefore, the identification of electrical seizure activity on electroencephalography is the gold standard for diagnosis.
· Clinical signs of neonatal seizures are divided into motor or nonmotor seizures, and motor seizures are mostly focal or multifocal.
· Most neonatal seizures are caused by acute symptomatic etiologies, but in cases of intractable seizures, structural, genetic, or metabolic etiologies should be investigated.
Editorial
Endocrinology
Is type 1 diabetes related to coronavirus disease 2019 in children?
Minsun Kim
Clin Exp Pediatr. 2022;65(5):252-253.   Published online March 29, 2022
· Evidence shows that patients with type 1 diabetes have been severely affected by coronavirus disease 2019 (COVID-19) in various ways.
· Although there is no reliable evidence that COVID-19 worsens or induces diabetes, it can impair β-cell insulin secretion and glucose control by inducing inflammation and cytokine production.
· A study is needed of the short- and long-term relationship between diabetes and COVID-19 in the Korean pediatric population.
Cardiology
Coronavirus disease 2019 and mRNA vaccines: what’s next – miRNA?
Joon Kee Lee, Heon-Seok Han
Clin Exp Pediatr. 2022;65(6):302-303.   Published online March 28, 2022
MicroRNAs (miRNAs) are small single-stranded noncoding RNA molecules that function in RNA silencing and the posttranscriptional regulation of gene expression. The potential role of miRNAs as biomarkers of myocarditis is promising, and miRNAs are expected to be utilized in various clinical fields in the future.
Infection
Effects of nonpharmaceutical interventions for coronavirus disease 2019
Jae Hong Choi
Clin Exp Pediatr. 2022;65(5):250-251.   Published online March 22, 2022
∙ Nonpharmaceutical interventions (NPIs) have decreased the incidence of various infectious diseases, including coronavirus disease 2019 (COVID-19).
∙ During the 2-year COVID-19 pandemic, NPIs changed patients’ daily lives, and the impact on mental health was notable.
∙ The effects of NPIs were evaluated in detail, considering both infections and mental health.
Cardiology
Characteristics of z score systems for diagnosing coronary abnormalities in Kawasaki disease
Gyeong-Hee Yoo
Clin Exp Pediatr. 2022;65(9):448-449.   Published online March 14, 2022
Because of the various body sizes of children with Kawasaki disease (KD), coronary artery diameter requires normalization to the body surface area as a z score.
In updated guidelines, coronary artery abnormalities are important criteria in the diagnosis of KD, and z score systems have been accepted to define coronary artery abnormalities.
However, the z score formula should be selected carefully because each yields different results.
Neonatology (Perinatology)
Ideal timing for aggressive screening to detect developmental dysplasia of the hip in term and preterm infants
Won-Ho Hahn
Clin Exp Pediatr. 2022;65(7):346-347.   Published online March 14, 2022
The risk factors and pathogenesis of developmental dysplasia of the hip (DDH) are unclear. Moreover, no universal screening method can entirely eliminate the risk of DDH. However, its incidence is significant and its early detection is critical for improving patient prognosis. Although the ideal evaluation time and risk factors, especially for premature infants, are unclear, the necessity for DDH screening programs for term and preterm infants is emerging.
Letter to the Editor
Infection
Changes in epidemiology of parainfluenza virus and respiratory syncytial virus infection during coronavirus disease 2019 pandemic in Korea
Kyung-Ran Kim, Hwanhee Park, Doo Ri Kim, Yae-Jean Kim
Clin Exp Pediatr. 2022;65(6):320-321.   Published online March 10, 2022
Question: How the epidemiology of other childhood respiratory viruses has changed during coronavirus disease 2019 (COVID-19) in Korea?
Finding: Parainfluenza virus (PIV) typically circulated in the spring, and respiratory syncytial virus (RSV) epidemic started in autumn in Korea before COVID-19 pandemic. PIV and RSV seasons disappeared in 2020 and came back in 2021 with atypical seasonality. PIV season was changed from spring to autumn, and the beginning of RSV season was slightly delayed from autumn to early winter in 2021.
Meaning: Circulation of PIV and RSV was changed to unusual seasons and patterns during COVID-19 pandemic period.
Editorial
Cardiology
Early echocardiographic screening for subclinical myocardial dysfunction in children and adolescents with dyslipidemia: why and when?
Hyun Gyung Lee, Hwa Jin Cho
Clin Exp Pediatr. 2022;65(8):398-400.   Published online March 7, 2022
Dyslipidemia contributes to early atherosclerosis, premature cardiovascular disease, and subclinical ventricular dysfunction in children. This paper highlights the need for echocardiographic evaluation for impaired diastolic function of both ventricles and narrowing of the aortic valve and sinus of Valsalva. Therefore, early echocardiographic screening of children with primary hyperlipidemia should be considered.
Review Article
Cardiology
Implication of microRNA as a potential biomarker of myocarditis
Jin-Hee Oh, Gi Beom Kim, Heeyoung Seok
Clin Exp Pediatr. 2022;65(5):230-238.   Published online March 2, 2022
· Myocarditis was recently examined quantitatively as inflammation of the heart muscle based on endomyocardial biopsy, and its noninvasive diagnosis remains unsatisfactory.
· Additionally, numerous miRNAs (miR-155, miR-146b, miR-590, miR-221, miR-222, etc.) coupled with inflammation or viral activation have been examined in myocarditis patients or mouse models.
· The recent identification of mmu-miR-721 (has-miR-Chr8: 96), a myocarditis-specific microRNA, demonstrated its potential as an acute myocarditis biomarker.
General Pediatrics
Motor performance of children with attention deficit hyperactivity disorder: focus on the Bruininks-Oseretsky Test of Motor Proficiency
Khushboo Prashant Adhvaryu, Suruliraj Karthikbabu, Pratiksha Tilak Rao
Clin Exp Pediatr. 2022;65(11):512-520.   Published online February 17, 2022
· Children with attention deficit hyperactivity disorder (ADHD) tend to have impaired motor performance that may affect their growth and development.
· Although widely used among children with developmental disorders, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) is used sparsely among children with ADHD.
· Assessment by the BOTMP increases our understanding of the motor repertoire of children with ADHD.
· Wider usage of the BOTMP will enable more comprehensive planning of rehabilitation goals to enhance the motor abilities of children with ADHD.
Gastroenterology
Clinical importance of immunonutrition in infants: a review of the recent literature
Ji Sook Park
Clin Exp Pediatr. 2022;65(7):337-343.   Published online February 17, 2022
Nutrients are important in the developing immune system. Human milk supplies diverse bioactives to prevent acute infection or chronic inflammation. Immunoglobulins, lactoferrin, and glutamine in human milk decrease gastrointestinal and respiratory infection. Human milk oligosaccharides promote the growth of intestinal microbiota, the gut barrier, and antimicrobial or antiviral activity. Micronutrients act as anti-inflammatory immunonutrients, too. However, the toxicity of some nutrients from an overdose should be considered.
Letter to the Editor
Other
Changes in air pollution and childhood respiratory viral infections in Korea post-COVID-19 outbreak
Hyung Kyu Park, Jung Yeon Shim
Clin Exp Pediatr. 2022;65(4):211-213.   Published online February 17, 2022
Correspondence and Reply
Neurobehavior
Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis
Hadith Rastad, Mahnaz Seifi Alan
Clin Exp Pediatr. 2022;65(3):152-152.   Published online February 17, 2022
Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis
Ensiyeh Jenabi
Clin Exp Pediatr. 2022;65(3):152-152.   Published online February 17, 2022
Editorial
Infection
Importance of maintaining a high childhood vaccination rate and surveillance program against Japanese encephalitis in Korea
Su Eun Park
Clin Exp Pediatr. 2022;65(3):127-128.   Published online February 16, 2022
∙ Recent epidemiologic changes of Japanese encephalitis (JE) in Korea are area (rural to urban or suburban) and age shift (children to adult).
∙ Although the main factors contributing to recent epidemiologic changes of JE are not well identified, maintaining high vaccination rates of JE appear to be important in preventing of JE in all age groups.
∙ Continuous surveillance for epidemiology and seroprevalence should be carried out.
Review Article
Neurology
Rotavirus infection-associated central nervous system complications: clinicoradiological features and potential mechanisms
Kyung Yeon Lee
Clin Exp Pediatr. 2022;65(10):483-493.   Published online February 7, 2022
∙ Rotavirus infection-associated central nervous system (CNS) complications are fairly common in children.
∙ Common clinicoradiological features include benign convulsions with mild gastroenteritis, acute encephalopathies/encephalitis, cerebellitis, and neonatal rotavirus-associated leukoencephalopathy.
∙ Possible mechanisms for CNS complications include direct viral invasion into the brain via several potential routes such as the blood-brain barrier and vagus nerve, and entry of various brain-damaging mediators and activated immune cells into the brain.
Letter to the Editor
Neonatology (Perinatology)
Telemedicine as progressive treatment approach for neonatal jaundice due to the coronavirus disease 2019 pandemic
Sukanya Sudhir Joshi, Bithiah Roy Benroy, Isabell Nelson Lawrence, Thanuja Jayasri Suresh
Clin Exp Pediatr. 2022;65(5):269-271.   Published online February 7, 2022
Question: How can the management of neonatal jaundice (NJ) be enhanced through telemedicine?
Finding: Teleconsultations, drive-through testing, and the use of an application to assess neonatal jaundice at home are being successfully used, but they must be further researched before being implemented on a larger scale.
Meaning: Recent technology allows for the treatment of NJ at home with an application that helps reduce hospital burden.
Editorial
Allergy
Dietary restriction misconceptions and food allergy education in children with atopic dermatitis
You Hoon Jeon
Clin Exp Pediatr. 2022;65(2):83-84.   Published online January 27, 2022
∙ Food intake strategies for preventing food allergies have undergone major changes over the past 20 years.
∙ In children with atopic dermatitis, indiscriminate food restrictions without diagnostic testing leads to nutritional imbalance and poor growth.
∙ When determining food restrictions for pediatric patients with atopic dermatitis, an accurate food allergy diagnosis must be preceded, and continuous parental education about food intake is required.
Endocrinology
Clinical and diagnostic importance of dyslipidemia in children and adolescents during the coronavirus disease 2019 pandemic
Eun Young Kim
Clin Exp Pediatr. 2022;65(3):129-130.   Published online January 14, 2022
∙ Because childhood lipid concentrations continue into adulthood, early evaluation and treatment are needed, but dyslipidemia awareness is low.
∙ For the prevention and treatment of dyslipidemia in childhood and adolescence, a major risk factor for cardiovascular disease in adulthood, lifestyle modifications, appropriate exercise, and drug treatment are required.
∙ A large-scale study of the prevalence and therapeutic effects of dyslipidemia in children and adolescents in Korea is needed.
Neurology
Cerebrospinal fluid biomarkers in various pediatric neurologic diseases
Jeongho Lee
Clin Exp Pediatr. 2022;65(2):81-82.   Published online January 6, 2022
Cerebrospinal fluid (CSF) has many important biomarkers that are commonly analyzed in pediatric neurologic diseases, including central nervous system infection and inflammation. Neurologic disease in pediatrics is difficult to diagnosis, there are challenges in developing CSF profiles. Some biomarkers are expected to help differential diagnosis.
Endocrinology
Pediatric obesity: life cycle approach of pediatrician and society
Yong Hee Hong
Clin Exp Pediatr. 2022;65(1):29-30.   Published online December 28, 2021
• With the emerging epidemic of pediatric obesity, many endocrine comorbidities classically seen in adulthood are surfacing much earlier in life.
• Appropriate obesity counseling and education should be provided from infancy to adolescence.
• Managing pediatric obesity may require school and society involvement.
Review Article
Neurology
Update on benign convulsions with mild gastroenteritis
Yeong Seok Lee, Ga Hee Lee, Young Se Kwon
Clin Exp Pediatr. 2022;65(10):469-475.   Published online December 27, 2021
∙ The main pathogen for benign convulsions with mild gastroenteritis (CwG) was previously rotavirus; however, cases associated with norovirus are increasing.
∙ CwG is characterized by clustered generalized seizures. Electroencephalography and magnetic resonance imaging show transiently abnormal findings in the acute phase that eventually normalize with progression. Its prognosis is good, and long-term treatment is unnecessary.
∙ There are many reports on the pathophysiological mechanism of CwG, which remains unclear.
Oncology
Application of 3-dimensional printing implants for bone tumors
Jong Woong Park, Hyun Guy Kang
Clin Exp Pediatr. 2022;65(10):476-482.   Published online December 23, 2021
∙ The application of 3-dimensional (3D) printing in orthopedic oncology is summarized into bone and tumor modeling, patient-specific instruments (PSIs), custom-made implants, and tissue engineering.
∙ The 3D-printed customized implant is the most central application, while modeling and PSI often play adjunct roles.
∙ Short-term surgical outcomes of custom-made 3D-printed implants are promising.
Gastroenterology
Factors influencing development of the infant microbiota: from prenatal period to early infancy
Sujin Jeong
Clin Exp Pediatr. 2022;65(9):439-447.   Published online December 23, 2021
∙ Microbial colonization primarily occurs after birth but there may be some colonization in utero, although this remains highly controversial.
∙ Maternal factors during pregnancy affect the infant microbiota: diet, weight, gestational weight gain, and antibiotic usage.
∙ Microbes are passed from mother-to-infant during and after birth. Delivery mode, breastfeeding, early life antibiotic, and proton pump inhibitor treatment have the largest effects on microbial composition in early life.
∙ The early life gut microbiome plays an important role in the development of the immune system and metabolism.
Cardiology
Diagnosis of coronary artery abnormalities in Kawasaki disease: recent guidelines and z score systems
Sung Hye Kim
Clin Exp Pediatr. 2022;65(9):430-438.   Published online December 17, 2021
∙ Kawasaki disease is the leading cause of acquired heart disease among children in the developed countries, and Korea has the second-highest incidence in the world.
∙ Early diagnosis and proper treatment are imperative to prevent coronary complication, and evaluation of coronary artery abnormalities is fundamental.
∙ Recent guidelines have adapted z score system for the diagnosis of coronary artery abnormalities in Kawasaki disease.
∙ Applying z score in diagnosis of coronary abnormalities has better correlation with clinical outcomes than absolute cutoff values.
∙ Calculated z scores could be different according to the z score formula, which might influence the treatment plan.
Neurology
Recent trends of healthcare information and communication technologies in pediatrics: a systematic review
Se young Jung, Keehyuck Lee, Hee Hwang
Clin Exp Pediatr. 2022;65(6):291-299.   Published online December 15, 2021
· The innovation of healthcare information communication technology (ICT) was accelerated with the adoption of electronic health records (EHRs).
· Telemedicine currently has no technical barriers.
· EHRs and personal health records are being connected, and mobile/wearable technologies are being integrated into them.
· Conventional rule-based clinical decision support systems have already been implemented and used in EHRs and PHRs. Artificial intelligence/machine learning improves precision and accuracy.
Neonatology (Perinatology)
Breastfeeding and vitamin D
Ju Sun Heo, Young Min Ahn, Ai-Rhan Ellen Kim, Son Moon Shin; for the Korean Society of Breastfeeding Medicine
Clin Exp Pediatr. 2022;65(9):418-429.   Published online December 14, 2021
∙ Exclusively breastfed infants are at risk of developing vitamin D deficiency associated with hypocalcemia, rickets, and various health outcomes.
∙ The prevalence of vitamin D deficiency in breastfed infants differs vastly between studies and nations at 0.6%–91.1%.
∙ The vitamin D content of breast milk does not meet the requirements of exclusively breastfed infants.
∙ Most international guidelines recommend that breastfed infants be supplemented with 400 IU/day of vitamin D during the first year of life.
∙ Vitamin D intake (milk+supplements) of 800 IU/day can be considered in preterm infants along with biochemical monitoring.
Original Article
Neonatology (Perinatology)
Neonatal sepsis-causing bacterial pathogens and outcome of trends of their antimicrobial susceptibility a 20-year period at a neonatal intensive care unit
Woo Sun Song, Hye Won Park, Moon Youn Oh, Jae Young Jo, Chae Young Kim, Jung Ju Lee, Euiseok Jung, Byong Sop Lee, Ki-Soo Kim, Ellen Ai-Rhan Kim
Clin Exp Pediatr. 2022;65(7):350-357.   Published online December 9, 2021
Question: What is prevalence of bacterial pathogens causing sepsis and their antimicrobial susceptibility over 20 years?
Finding: Coagulase-negative remains most common causative organism. The most common gram-negative organism was Klebsiella pneumonia. The susceptibility of staphylococcus aureus and K. pneumonia showed increased susceptability to oxacillin, cefotaxime and amikacin, gentamicin, respectively.
Meaning: Answers to the question asked is important in choosing antimicrobials and to monitor emergence of multidrug-resistant organisms.
Neurology
Neurodevelopmental outcomes and comorbidities of children with congenital muscular torticollis: evaluation using the National Health Screening Program for Infants and Children database
Og Hyang Kim, Seung Won Lee, Eun Kyo Ha, Ju Hee Kim, Yun Hye Jo, Seongyeong Rhie, Man Yong Han, Kyu Young Chae
Clin Exp Pediatr. 2022;65(6):312-319.   Published online December 9, 2021
Question: What comorbidities are increased in children with congenital muscular torticollis (CMT)? Are there differences in the neurodevelopmental outcomes of children with CMT who received physical therapy versus those who did not?
Finding: The risk of congenital musculoskeletal deformities is increased in CMT. Children who did not receive physical therapy were at greater risk of neurodevelopmental delay.
Meaning: In CMT, musculoskeletal comorbidities should be identified and active early treatment provided.
Review Article
General Pediatrics
A new perspective on cholesterol in pediatric health: association of vitamin D metabolism, respiratory diseases, and mental health problems
Jeana Hong
Clin Exp Pediatr. 2022;65(2):65-72.   Published online December 9, 2021
∙ Pediatric dyslipidemia is associated with several health problems besides cardiovascular diseases.
∙ There is a direct association between pediatric dyslipidemia and low serum vitamin D levels, asthma, and mental health problems regardless of body mass index.
∙ More large-scale nationally representative studies are needed to establish the appropriate cutoff points for the definition of dyslipidemia that is a prerequisite for further epidemiological studies in the Korean pediatric population.