Clinical and Experimental Pediatrics

Original Article

Red cell distribution width and reticulocyte hemoglobin content as predictors of iron depletion in children with cyanotic congenital heart disease

Hanyudh Prichayudh, Kanhatai Chiengthong, Khwaunrat Whaidee, Navaporn Phiphattanatikanunt, Vidhavas La-orkhun, Pornthep Lertsapcharoen

Background: Iron-deficiency anemia is challenging to diagnose in patients with cyanotic congenital heart disease (CCHD) because of the high hemoglobin concentration as a compensatory mechanism for cyanosis.
Purpose: This study aimed to identify predictive parameters of iron depletion status and assess the prevalence of iron deficiency in patients with CCHD. Methods: A descriptive study enrolled patients with CCHD aged 6 months to...

DOI: https://doi.org/10.3345/cep.2026.00241 [Accepted]

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Perspective

Neonatology (Perinatology)

Neonatal care in a low-birthrate society: insights from population-based observations in Japan

Hirokazu Arai, Hiroshi Miura, Yohei Onodera, Hiroyuki Adachi, Akira Sato, Tomoo Ito, Masaru Mizuno

Clin Exp Pediatr. 2026;69(8):683-685. Published online July 24, 2026

Declining birth rates are reshaping neonatal care. In low-birthrate settings, shifts in the underlying causes of neonatal death, including greater use of perinatal palliative care for trisomy 18 and challenges in maintaining expertise in extremely low-birth-weight infants, may contribute to fluctuations in neonatal mortality. These observations highlight the need for a coordinated system-level support.

DOI: https://doi.org/10.3345/cep.2026.01095

Clinical Note

Nephrology (Genitourinary)

A rare genetically confirmed case of apparent mineralocorticoid excess syndrome due to a homozygous HSD11B2 variant in a 2-year-old child with severe hypertension: response to targeted therapy

Bashair Alabbasi, Mugahid Elamin, Ghadah Alsallum, Ghada Alzahrany

Clin Exp Pediatr. 2026;69(8):676-679. Published online July 24, 2026

DOI: https://doi.org/10.3345/cep.2026.01473

Editorial

Neurology

Network-based biomarkers in pediatric drug-resistant epilepsy

Joseph Lim, Jaeso Cho, Hunmin Kim

Clin Exp Pediatr. 2026;69(8):636-638. Published online July 24, 2026

Conventional preoperative evaluation in pediatric drug-resistant epilepsy relies on clinical surrogates that quantify seizure exposure but not its impact on brain networks. A newly developed diffusion-weighted imaging connectome biomarker, anchored to intracranial electroencephalography-confirmed seizure onset zones and resolved across 6 neurocognitive domains, addresses this gap. This individualized approach classifies cognitive impairment with high accuracy and may offer a more precise, clinically interpretable tool to inform surgical timing.

DOI: https://doi.org/10.3345/cep.2026.01774

Original Article

Impact of bacterial infection on native liver survival in children with cirrhosis due to biliary atresia

Varissara Kaewchaivijit, Pornthep Tanpowpong, Songpon Getsuwan, Sophida Boonsathorn, Chatmanee Lertudomphonwanit, Suporn Treepongkaruna

Background: Biliary atresia (BA) is a common cause of cirrhosis in children, and serious bacterial infections may worsen clinical outcomes.
Purpose: To study the characteristics, associated factors, and outcomes of infections in children with cirrhosis secondary to BA. Methods: A retrospective cohort study was conducted in children aged <18 years with cirrhosis due to BA between 2014 and 2023. Patients were categorized...

DOI: https://doi.org/10.3345/cep.2026.00388 [Accepted]

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Review Article

Endocrinology

Linking pediatric obesity to youth-onset type 2 diabetes: integrated longitudinal and cross-sectional evidence from population-based studies worldwide

Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Mohamed, Ahmed Elawwa

Clin Exp Pediatr. 2026;69(8):622-635. Published online July 20, 2026

Pediatric obesity and youth-onset type 2 diabetes have increased simultaneously across 6 continents over the last 25 years. Approximately 75% of affected youths are obese at diagnosis, beta-cell declines occur rapidly, and microvascular complications occur early. Glucagon-like peptide-1 receptor agonists and bariatric surgery achieve meaningful weight loss and glycemic improvement; however, the primary prevention of childhood obesity remains the most powerful strategy for arresting this epidemic.

DOI: https://doi.org/10.3345/cep.2026.01228

Clinical note

Marifat Ganieva, Muqaddas Boltaboeva, Umida Ganiyeva, Oksana Efimenko, Abdulhamid Haydarov, Sherzod Toshboyev

DOI: https://doi.org/10.3345/cep.2026.00563 [Accepted]

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Original Article

Neurology

Patient-independent automated pediatric seizure monitoring based on expert-labeled electrographic ictal data as core reference knowledge

Yoon Gi Chung, Jaeso Cho, Anna Cho, Hunmin Kim, Byung Chan Lim

Clin Exp Pediatr. 2026;69(8):665-675. Published online July 14, 2026

Question: Can deep learning models trained on expert-verified electroencephalography segments reliably detect seizures and be applied to single-channel wearable monitoring?
Finding: This technique demonstrated 80.1%–100% sensitivity and low false-alarm rates. On 1,604 expert-labeled segments, the model outperformed previous studies in terms of latency and accuracy across unseen datasets.
Meaning: Expert-labeled data are essential for achieving universal seizure detection. This channel-specific approach enabled efficient and continuous monitoring using wearable devices.

DOI: https://doi.org/10.3345/cep.2026.01011

Review Article

Other

Virtual reality for managing pain and fear and anxiety during pediatric needle procedures: an umbrella review

Thomas Saliba, Guillaume Fahrni

Clin Exp Pediatr. 2026;69(8):609-621. Published online July 14, 2026

Meta-analyses suggest that virtual reality (VR) reduces self-reported pain, fear, and anxiety in children during needle procedures but has high heterogeneity, high overlap between primary studies, and low methodological quality, leading to a "very weak" GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification. Clinicians should view VR as a promising additional distraction tool; however, VR cannot yet replace current analgesic and anxiolytic strategies. Future research should focus on age-stratified analyses, measurement tool standardization, and modern VR technology

DOI: https://doi.org/10.3345/cep.2026.01221

Clinical Note

Neonatology (Perinatology)

Peters anomaly: a rare etiology of corneal clouding in the newborn

Gregory Ison, Srividya Naganathan

Clin Exp Pediatr. 2026;69(8):680-682. Published online July 13, 2026

DOI: https://doi.org/10.3345/cep.2026.00794

Original Article

Gastroenterology

Prognosis of pediatric hepatic Wilson disease with ATP7B loss of function variants

Amresh Kumar Mishra, Moinak Sen Sarma, Anchal Dubey, Pratik Gadekar, Amita Moirangthem, Anshu Srivastava, Amrita Mathias

Clin Exp Pediatr. 2026;69(8):646-654. Published online July 13, 2026

Question: Do the loss of function (LOF) of ATP7B mutated variants affect the severity or outcomes of hepatic Wilson disease (WD)?
Finding: LOF is associated with advanced liver disease, portal hypertension, and extrahepatic involvement. LOF did not determine hepatic or overall outcomes. ATP7B: c.813C>A (truncation variant) has an aggressive course with higher predisposition to acute liver failure. Lower serum exchangeable copper levels and higher disappearance of Kayser-Fleischer ring were observed in ATP7B: c.3809A>G (nontruncation variant) suggesting a better effect of chelation and lesser systemic copper.
Meaning: Truncation of the ATP7B protein determines the severity of the phenotype in WD.

DOI: https://doi.org/10.3345/cep.2026.00689

Neonatology (Perinatology)

Efficacy and safety of home-based fiberoptic blanket versus hospital-based light-emitting diode phototherapy for neonatal jaundice: a retrospective cohort study from Thailand

Chayatat Ruangkit, Thanyathorn Thaninjeerawat, Saitarn Klaidangklum, Saowalak Prasopa, Pongsakorn Atiksawedparit, Sasivimon Soonsawad

Clin Exp Pediatr. 2026;69(8):655-664. Published online July 1, 2026

Question: Is a home-based fiberoptic phototherapy blanket as effective and safe as hospital-based overhead light-emitting diode phototherapy for the treatment of neonatal jaundice?
Finding: Home phototherapy (HPT) resulted in a slower bilirubin reduction rate than inpatient phototherapy (IPT); however, both modalities achieved the therapeutic targets without phototherapy-related complications.
Meaning: With careful patient selection, structured monitoring, and reliable follow-up, HPT is a safe and feasible alternative to IPT for neonatal jaundice.

DOI: https://doi.org/10.3345/cep.2026.00703

Other

Association between sodium content of intravenous immunoglobulin and electrolyte changes and clinical course of Kawasaki disease

Yoshitaka Watanabe, Naomi Yagi, Toya Hattori, Chisato Oyake, Shota Endo, Maria Yoshimi, Takayoshi Kyoda, Hirokazu Ikeda

Clin Exp Pediatr. 2026;69(8):639-645. Published online July 1, 2026

Question: Hyponatremia in Kawasaki disease is associated with inflammation and disease severity. Intravenous immunoglobulin (IVIG) formulations feature various sodium contents. What is the clinical impact of such variations?
Finding: IVIG sodium content was associated with sodium, potassium, and protein level changes.
Meaning: Coronary outcomes were similar but electrolyte changes differed: high-sodium IVIG caused hypokalemia, whereas low-sodium IVIG caused hyponatremia. IVIG preparation requires consideration when interpreting laboratory values.

DOI: https://doi.org/10.3345/cep.2026.00619

Editorial

Pulmonology

Telomere biology disorders in childhood interstitial lung disease: new insights from the chILD-EU cohort

Andrew Courtwright

Clin Exp Pediatr. 2026;69(7):542-544. Published online June 30, 2026

Greiner-Mai et al. expand recognition of telomere biology disorder (TBD)-associated interstitial lung disease (ILD) in children, demonstrating heterogenous radiographic and ILD subtypes in combination with variable extrapulmonary phenotypes, even in the absence of ultrashort peripheral blood telomere length (TL). While their findings highlight some of the limitations of current TL testing methods, they introduce critical questions regarding family screening and the role of antifibrotic and telomere-directed therapies in children with TBD-related ILD.

DOI: https://doi.org/10.3345/cep.2026.01389

Clinical Note

Neurology

Fulminant early-onset subacute sclerosing panencephalitis masquerading as leukodystrophy: a diagnostic challenge

Kaushik Ragunathan, Deb Kumar Boruah, Vishnupriya Veeraraghavan, Jaya Shankar Kaushik

Clin Exp Pediatr. 2026;69(7):604-608. Published online June 18, 2026

DOI: https://doi.org/10.3345/cep.2026.00696

Original Article

Pulmonology

Telomere biology disorders associated with childhood interstitial lung disease

Maria Greiner-Mai, Christina Katharina Rapp, Katrin Knoflach, Daniel Gräfe, Franz Wolfgang Hirsch, Julia Ley-Zaporozhan, Simone Reu-Hofer, Julia Hentschel, Stefan Zielen, Monika Helena Tedy, Heymut Omran, Ernst Rietschel, Tuğba Sismanlar Eyuboglu, Ayse Tana-Aslan, Nagehan Emiralioglu, Nicola Ullmann, Samuele Naviglio, Massimo Maschio, Fabian Beier, Tuğba Ramaslı Gürsoy, Matthias Griese, Freerk Prenzel

Clin Exp Pediatr. 2026;69(7):593-603. Published online June 18, 2026

Web of Science 1 Crossref 1

Question: What are the pulmonary manifestations and clinical characteristics of telomere biology disorders in children with interstitial lung disease?
Finding: Telomere biology disorders are an important but often underrecognized cause of childhood interstitial lung disease and are associated with variable pulmonary, radiologic, and histopathologic findings, frequent multisystem involvement, and often severe disease progression.
Meaning: Early genetic testing and multidisciplinary evaluation are essential for timely diagnosis, optimized management, and improved outcomes in affected children.

DOI: https://doi.org/10.3345/cep.2026.00290

Review Article

Endocrinology

Testosterone therapy in boys with constitutional delay of growth and puberty: a PubMed-based systematic review and exploratory meta-analysis

Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Ahmed, Khaled A. Siddiq, Mohammed Qusad, Mohamed AlKhalaf

Clin Exp Pediatr. 2026;69(7):531-541. Published online June 18, 2026

In boys with constitutional delay of growth and puberty, a short course of low-dose testosterone consistently accelerates linear growth and advances pubertal maturation. Long-term follow-up studies do not show a clinically meaningful effect of conservative regimens on near-adult height. As the pooled quantitative evidence represents only 46 boys in 2 controlled studies, treatment should remain individualized, while larger randomized trials using standardized patient-reported outcomes are needed.

DOI: https://doi.org/10.3345/cep.2026.00675

Original Article

Other

Did government subsidy program improve quality of care for children with complex chronic conditions in children’s hospitals? A quasi-experimental study in South Korea

Riyoung Na, Myoung-Hee Kim, Seok-Jun Yoon

Clin Exp Pediatr. 2026;69(7):582-592. Published online May 28, 2026

Question: Do government-funded Specialized Public Medical Centers for Children (SPMCCs) improve the quality of care for pediatric patients requiring complex and intensive medical care?
Finding: The SPMCC hospital designation reduced 30-day readmission rates among pediatric patients with severe conditions.
Meaning: Government investments are associated with improved quality of care for children with complex chronic conditions. Therefore, sustained government funding is essential to enhancing pediatric care quality.

DOI: https://doi.org/10.3345/cep.2026.00199

Clinical Note

Gastroenterology

Ultrasonographic features of 5-aminosalicylic acid intolerance in pediatric ulcerative colitis

Hirotoki Murashige, Yasufumi Sakata, Yoshihiro Azuma, Shunji Hasegawa

Clin Exp Pediatr. 2026;69(6):524-526. Published online May 28, 2026

Web of Science 1

DOI: https://doi.org/10.3345/cep.2025.02446

Review Article

Allergy

Update on pediatric allergic rhinitis: narrative review based on guideline updates

Jung Yeon Shim

Clin Exp Pediatr. 2026;69(6):473-483. Published online May 28, 2026

Intranasal corticosteroids remain the cornerstone treatment for moderate to severe allergic rhinitis. The 2024–2025 Allergic Rhinitis and its Impact on Asthma guideline update suggests that fixed intranasal antihistamine–intranasal corticosteroid combinations may provide greater symptom control in allergic rhinitis than either agent alone. A control-based patient-centered approach that incorporates real-world evidence is essential for optimizing treatment outcomes in children.

DOI: https://doi.org/10.3345/cep.2026.00444

Editorial

Cardiology

Beyond morphometry: the atrial septal defect pressure gradient as a dynamic predictor of mitral valve growth in borderline left hearts

Han Ki Park

Clin Exp Pediatr. 2026;69(6):484-485. Published online May 27, 2026

Traditional morphometric scores often fail to predict the success of biventricular repair of borderline left hearts. Wang et al. demonstrated that a low atrial septal defect (ASD) pressure gradient is a critical functional predictor of mitral valve growth. By integrating ASD hemodynamics with anatomical data, clinicians can better identify candidates for biventricular repair, proving that the "grey zone" is narrower than previously thought and improving outcomes for vulnerable neonates.

DOI: https://doi.org/10.3345/cep.2026.01081

Review Article

Nutrition

Dietary fiber in pediatric gastrointestinal health: a narrative review of evidence and challenges

Rohit Das, Bipashna Thatal, Buddhiman Tamang

Clin Exp Pediatr. 2026;69(6):456-472. Published online May 27, 2026

Dietary fiber plays a critical role in pediatric gastrointestinal health by modulating gut microbiota, improving bowel function, and supporting immune development. Evidence consistently supports its benefit in functional constipation, while effects on abdominal pain, inflammatory bowel disease, and irritable bowel syndrome remain variable due to differences in fiber type, dosage, and study design. Clinically, fiber should be used as an adjunct therapy within individualized dietary and behavioral management strategies for children.

DOI: https://doi.org/10.3345/cep.2026.00276

Original Article

Neonatology (Perinatology)

Association between base excess levels and clinical outcomes among very low birth weight infants: a multicenter birth cohort study in South Korea

Ji Yoo Kim, Hyeon Jin Kim, Heeyoon Choi, Minji Kim, Jinseok Lee, Yong Sung Choi, Dong Keon Yon

Clin Exp Pediatr. 2026;69(7):555-562. Published online May 21, 2026

Question: Is metabolic acidosis at birth in very low birth weight infants (VLBWIs) associated with long-term clinical outcomes?
Finding: Metabolic acidosis at birth was associated with increased mortality, adverse respiratory outcomes, neurological morbidities, and infection-related and gastrointestinal outcomes.
Meaning: VLBWIs with metabolic acidosis are at high risk of systemic complications. This finding emphasizes the need for close monitoring and comprehensive care.

DOI: https://doi.org/10.3345/cep.2025.02817

Gastroenterology

Distinct age-dependent phenotypes of abnormal liver function tests derived from national Emergency Department data

Dong-Uk Kim, Shinjie Choi, Yeji Kim, Lia Kim, Jung Ok Shim, Jin Soo Moon, Jong Woo Hahn, Hye Ran Yang, Ju Young Chang, Jae Sung Ko

Clin Exp Pediatr. 2026;69(7):563-571. Published online May 14, 2026

Question: What are the clinical phenotypes and pathogen associations of pediatric and adult Emergency Department visits for abnormal liver function tests?
Finding: Pediatric visits showed fever-predominant profiles with temporal correlations with respiratory viruses, whereas adult visits revealed population-level temporal associations between enteric pathogens and infectious gastroenteritis, upper gastrointestinal disorders, and metabolic comorbidity clustering.
Meaning: These findings provide novel population-level evidence of age-specific pathogen associations and support distinct age-stratified clinical diagnostics.

DOI: https://doi.org/10.3345/cep.2026.00038

Clinical Note

Gastroenterology

Esophagopleural fistula following coin impaction in a female toddler: successful management using through-the-scope clips

Sarthak Chakrabarti, Nikhil Sonthalia, Kaustabh Chaudhuri, Tamashis Mukherjee, Uday Chand Ghoshal, Mahesh Kumar Goenka

Clin Exp Pediatr. 2026;69(6):527-530. Published online May 14, 2026

DOI: https://doi.org/10.3345/cep.2026.00654

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

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

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