Clinical and Experimental Pediatrics

Clinical note

Abdominal lymph nodal tuberculosis causing extrahepatic portal venous obstruction in an adolescent boy

Ankit Agrawal, Upasana Ghosh, Deeksha Bhalla

DOI: https://doi.org/10.3345/cep.2026.00941 [Accepted]

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Editorial

Infection

A commentary on “Effect of varicella vaccine introduction on chickenpox incidence in Kingdom of Bahrain”

Ui Yoon Choi

Clin Exp Pediatr. 2026;69(11):855-857. Published online October 29, 2026

Bahrain’s experience suggests that routine varicella vaccination using a 2-dose schedule can substantially reduce the disease burden. In Korea, where a single-dose schedule has been used since 2005, breakthrough varicella remains common, and 1-dose vaccine effectiveness declines to approximately 50% by 6 years after vaccination. Findings from Bahrain, together with experiences from Germany and the United States, support the consideration of a routine second dose in Korea.

DOI: https://doi.org/10.3345/cep.2026.03202

Guideline

Oncology

Evidence-based clinical practice guidelines for pediatric hepatoblastoma: a systematic review and expert recommendations from Korea

Jin Kyung Suh, Jisun Hwang, Hee Mang Yoon, Kyong Ihn, Jung-Man Namgoong, Jeong A. Park, Jung-Sun Kim, Hyoung Soo Choi, Sung Hye Park, Dong Ah Park, Kyung-Nam Koh

Clin Exp Pediatr. 2026;69(11):912-924. Published online October 23, 2026

This is the first Korean evidence-based clinical practice guideline for pediatric hepatoblastoma. Key recommendations include computed tomography and magnetic resonance imaging for PRETEXT (PRE-Treatment EXTent of disease) staging, cisplatin monotherapy for standard-risk disease, upfront surgery for resectable tumors, metastasectomy for residual lung lesions, and sodium thiosulfate for otoprotection. Well-differentiated fetal histology carries a favorable prognosis, whereas the small cell undifferentiated pattern requires immunohistochemical and molecular testing to exclude malignant rhabdoid tumor.

DOI: https://doi.org/10.3345/cep.2026.02691

Correction

Author Correction: 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(11):925-926. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.01228.e1

Correspondence

Endocrinology

Author's reply to “Parallel trends are not causal evidence: methodological caution regarding the pediatric obesity–youth-onset type 2 diabetes link”

Ashraf T. Soliman

Clin Exp Pediatr. 2026;69(11):908-911. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.02831

A commentary on “Linking pediatric obesity to youth-onset type 2 diabetes: integrated longitudinal and cross-sectional evidence from population-based studies worldwide” – Parallel trends are not causal evidence: methodological caution regarding the pediatric obesity–youth-onset type 2 diabetes link

Ercan Yılmaz, Zeynep Yamancan Yılmaz

Clin Exp Pediatr. 2026;69(11):906-907. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.02768

Original Article

Developmental and Behavioral Medicine

Association between maternal traumatic stress related to Great East Japan Earthquake and behavioral problems in offspring

Shun Tanabe, Masatsugu Orui, Chikana Kawaguchi, Genki Shinoda, Aoi Noda, Mami Ishikuro, Taku Obara, Shinichi Kuriyama

Clin Exp Pediatr. 2026;69(11):878-890. Published online October 22, 2026

Association between maternal traumatic stress related to Great East Japan Earthquake and behavioral problems in offspringQuestion: Does prepregnancy maternal traumatic stress influence behavioral outcomes in early childhood?
Finding: Children born to mothers who reported greater disaster-related traumatic stress showed higher risks of internalizing, externalizing, and total behavioral problems at ages 2 and 3 years consistent with a dose-response relationship.
Meaning: Long-term maternal mental health support covering the broader reproductive period may play a role in addressing intergenerational behavioral problems after large-scale disasters.

DOI: https://doi.org/10.3345/cep.2026.00843

Clinical note

The expanding phenotypic spectrum of PSTPIP1-associated inflammatory diseases: first Korean pediatric cases of familial PAPA and PAMI syndromes

Dahye Lee, Yun Young Choi, Seungbok Lee, Seong Heon Kim

DOI: https://doi.org/10.3345/cep.2026.03181 [Accepted]

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Original Article

Hematology

Hematological alterations in adolescent girls with restrictive anorexia nervosa and secondary amenorrhea at the time of diagnosis

Katarína Šebeková, Alexandra Gaál Kovalčíková, Ľubica Tichá, Ľudmila Podracká

Clin Exp Pediatr. 2026;69(11):891-901. Published online October 19, 2026

Question: Do adolescent girls with restrictive anorexia nervosa and secondary amenorrhea have low blood counts at diagnosis?
Finding: Patients, even those with bone mineral density z scores similar to those of controls and adequate micronutrient levels, exhibited lower blood counts and suppressed bone formation and endocrine parameters compared with healthy age-matched controls.
Meaning: Hematological alterations may occur early in the disease course and complement routine clinical assessments.

DOI: https://doi.org/10.3345/cep.2026.00808

Changes in patient concentration and accessibility across 5 Pediatric Emergency Departments in Daegu, Korea

Woo Bean Yang, Kyungmi Jang, Hee Joung Choi, Dong Won Lee, Jae Young Choe

Background: The coronavirus disease 2019 (COVID-19) pandemic has substantially altered Pediatric Emergency Department (PED) utilization. However, longitudinal changes across multiple PEDs after major policy transitions remain unclear.
Purpose: This study aimed to evaluate changes in utilization, patient distribution, accessibility to pediatric emergency care, and clinical characteristics across 5 participating PEDs in Daegu, Korea. Methods: This multicenter retrospective study analyzed 140,017 visits among patients aged <16 years between January 2019 and May...

DOI: https://doi.org/10.3345/cep.2026.02054 [Accepted]

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Original article

Hepcidin and other obesity-related factors affecting BNT162b2 response in children and adolescents over a 6-month period

Anthie Damianaki, Antonios Marmarinos, Margaritis Avgeris, Dimitrios Gourgiotis, Elpis-Athina Vlachopapadopoulou, Marietta Charakida, Maria Tsolia, Lydia Kossiva

Background: Obesity causes chronic inflammation and metabolic dysregulation of the immune response and increases an individual's susceptibility to severe infection.
Purpose: This study aimed to evaluate the effect of an increased body mass index (BMI), obesity-associated biomarkers, and habitual factors on immune responses following BNT162b2 vaccination in a pediatric population over a 6-month period. Methods: In this prospective, single-center cohort study, the...

DOI: https://doi.org/10.3345/cep.2026.01298 [Accepted]

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Correspondence and Reply

Endocrinology

Authors’ reply to a commentary on “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(10):823-824. Published online September 28, 2026

DOI: https://doi.org/10.3345/cep.2026.02285

Editorial

Neonatology (Perinatology)

Antenatal strategies for prevention of neonatal hypoxic-ischemic encephalopathy: potential role of metformin

Won-Ho Hahn

Clin Exp Pediatr. 2026;69(10):785-787. Published online September 28, 2026

Neonatal hypoxic-ischemic encephalopathy remains a major cause of death and lifelong disability despite therapeutic hypothermia. Antenatal maternal neuroprotective strategies remain underexplored; however, recent preclinical findings suggest that metformin may be a low-cost and mechanistically distinct approach. Further studies are warranted to define its optimal timing, efficacy, and maternal-fetal safety.

DOI: https://doi.org/10.3345/cep.2026.02306

Review Article

Neonatology (Perinatology)

Association between surgical repair timing and mortality in neonates with congenital diaphragmatic hernia: a systematic review and meta-analysis

Veerabhadra Radhakrishna, Bharathi Balachander, Sanjana Hansoge Somanath, Hejmady Aneesh Shenoy, Srinivas Balachander

Clin Exp Pediatr. 2026;69(11):844-854. Published online September 17, 2026

Preoperative stabilization is critical for the management of congenital diaphragmatic hernias. Surgical repair within 24 hours of life significantly increases mortality risk. A 24- to 48-hour stabilization window optimizes survival and resource utilization. Delaying surgery beyond 48 hours offers no additional survival benefits and increases morbidity. In neonates requiring extracorporeal membrane oxygenation, the exact surgical timing does not independently predict mortality.

DOI: https://doi.org/10.3345/cep.2026.01837

Correspondence

Endocrinology

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

Muqaddas Boltaboeva, Abdulhamid Haydarov, Lola Rakhmanova

Clin Exp Pediatr. 2026;69(10):820-822. Published online September 17, 2026

Crossref 1

Current evidence suggests that testosterone therapy is effective in boys with constitutional delay of growth and puberty; however, important knowledge gaps persist regarding genetic predisposition, nutritional and clinical factors, baseline endocrine assessments, and long-term outcomes. Addressing these factors may improve patient selection, optimize treatment strategies, and facilitate more individualized clinical decision-making.

DOI: https://doi.org/10.3345/cep.2026.02159

Original Article

Neonatology (Perinatology)

Maternal metformin protects developing auditory brainstem function after neonatal hypoxia-ischemia in a neonatal rat model

Sei Eun Kim, Joo Young Kweon, Yong Joo Ahn, Jun Hee Kim

Clin Exp Pediatr. 2026;69(10):806-816. Published online September 17, 2026

Web of Science 1 Crossref 1

Question: Does maternal metformin administration during pregnancy protect offspring auditory brainstem function after neonatal hypoxia-ischemia (HI)?
Finding: Maternal metformin prevented HI-induced hearing threshold elevation, preserved auditory brainstem response amplitudes, and partially rescued neuronal and oligodendrocyte lineage cells in the medial nucleus of the trapezoid body.
Meaning: Maternal metformin during gestation may serve as a prenatal neuroprotective strategy against neonatal hypoxic-ischemic brain injury.

DOI: https://doi.org/10.3345/cep.2026.01368

General Pediatrics

Effect of varicella vaccine introduction on chickenpox incidence in Kingdom of Bahrain

Afaf Merza Mohamed, Hasan M. Isa, Malak Husain Hasan, Maram Husain Hasan, Ali K. Moosa, Janan Husain Radhi, Basma Al Saffar, Adel Al Sayyad

Clin Exp Pediatr. 2026;69(11):868-877. Published online September 14, 2026

Question: What was the effect of varicella vaccine introduction on chickenpox incidence in Bahrain?
Finding: Postvaccine introduction in May 2015, new varicella cases declined substantially, particularly among children aged 0–9 years. Most cases are managed in primary healthcare settings, with rare hospitalizations and no reported deaths.
Meaning: Routine varicella vaccination is associated with reduced disease burden, demonstrating sustained high coverage, continued surveillance, and protection of susceptible groups.

DOI: https://doi.org/10.3345/cep.2026.01326

Review Article

Infection

Antibiotic pretreatment and culture yield in pediatric osteoarticular infection: a systematic review and meta-analysis

Mohamad Shieb, Caroline Decesare, Guyu Li, Elizabeth Ristagno

Clin Exp Pediatr. 2026;69(11):825-832. Published online September 14, 2026

In this systematic review and meta-analysis of 9 studies comprising 1,704 tissue culture specimens from children with osteoarticular infection, antibiotic pretreatment was not associated with reduced tissue culture yield (odds ratio, 1.60; 95% confidence interval, 1.23–2.08). Empiric antibiotic therapy should not be withheld to preserve culture yield in suspected osteoarticular infection; invasive cultures should be obtained at the earliest safe opportunity without delaying treatment.

DOI: https://doi.org/10.3345/cep.2026.01634

Atherogenic lipid profile changes and their cardiovascular consequences across degrees of obesity in children and adolescents: a structured narrative review

Ashraf Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Ahmed, Rasha Amin

Childhood and adolescent obesity is strongly associated with an atherogenic lipid profile and silent cardiovascular injury that begins early and evolves over time. In this structured review, we synthesized PubMed-indexed evidence from the past 25 years on lipid profile changes in children and adolescents with varying degrees of obesity— overweight, obesity, and severe obesity—and their cardiovascular consequences from childhood through young adulthood, as well as interventions that improve lipid...

DOI: https://doi.org/10.3345/cep.2026.01739 [Accepted]

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Original Article

Neurology

Prenatal stress via chronic immobilization amplifies N-methyl-D-aspartate-induced spasm-like seizure susceptibility and neuroinflammation in neonatal rats

Hyeok Hee Kwon, Seungyeon Bin, Seung Gyu Choi, Hyo Jung Shin, Joon Won Kang

Clin Exp Pediatr. 2026;69(11):858-867. Published online September 8, 2026

Question: Does chronic prenatal immobilization stress increase an offspring's susceptibility to spasms, and is this associated with altered glial activation and gamma-aminobutyric acid (GABA)ergic signaling in the developing brain?
Finding: Prolonged prenatal stress increases susceptibility to N-methyl-D-aspartate-induced spasms, enhanced glial activation, and impaired GABAergic signaling.
Meaning: Long-term prenatal stress may promote early life epileptogenesis associated with neuroinflammation as well as disrupted inhibitory neurotransmission, although a causal role remains to be established.

DOI: https://doi.org/10.3345/cep.2026.01403

Review Article

Developmental and Behavioral Medicine

Electronic media exposure and neurodevelopment in children under 5 years of age: an updated evidence-based narrative review

Soumi Kundu, Sudip Bhattacharya, Rajan Kumar, Kusum Kumari, Chandrima Biswas, Asha Premlata Omega Oraon, Abhimanyu Ganguly

Clin Exp Pediatr. 2026;69(10):773-784. Published online September 8, 2026

Excessive digital media exposure before 5 years is consistently associated with poorer language development, attention, executive functioning, sleep quality, and socioemotional development. The adverse effects are particularly evident when screen exposure replaces caregiver-child interaction and active play. High-quality educational content combined with caregiver coviewing may mitigate some of these risks. Pediatric counseling should emphasize age-appropriate media use, family media plans, and balanced daily routines.

DOI: https://doi.org/10.3345/cep.2026.01417

Pulmonology

Health literacy and emergency preparedness in pediatric tracheostomy and home ventilation: a practical review

Megan Pilcher, Weerapong Lilitwat

Clin Exp Pediatr. 2026;69(11):833-843. Published online September 7, 2026

For children with tracheostomy and home ventilation, health literacy is a safety capacity, not merely reading ability. Existing guidelines define what a safe discharge system should contain; clinicians must also verify what caregivers can understand, demonstrate, and retain. An author-derived six-domain framework, staged multimodal teaching, teach-back, show-back, simulation, and longitudinal reassessment can translate recommendations into emergency action, while long-term outcome evidence remains limited.

DOI: https://doi.org/10.3345/cep.2026.01802

Immunology

Current review of pediatric Fas-associated death domain protein deficiency: expanding clinical and therapeutic perspectives

Chuin-Hen Liew, Kah Kee Tan, Jelitha Ramachanderam, Sin Yee Teo, Khuen Foong Ng

Clin Exp Pediatr. 2026;69(10):762-772. Published online September 4, 2026

Fas-associated death domain protein deficiency expands beyond a severe infantile immunodeficiency to a broader clinical spectrum in children involving autoimmunity, autoinflammation, and susceptibility to bacterial and viral infections. This review highlights recurrent febrile encephalopathy, invasive pneumococcal disease, and liver dysfunction as key features and identifies later-onset and self-limiting phenotypes.

DOI: https://doi.org/10.3345/cep.2026.01291

Clinical Note

Cardiology

First biallelic CASQ2 variant in a Korean child with catecholaminergic polymorphic ventricular tachycardia

Sang Hun Jung, Shin Hyeung Kwak, Gwang Jun Choi, Ja-Kyoung Yoon, Jin Young Song, I Seok Kang, June Huh

Clin Exp Pediatr. 2026;69(11):902-905. Published online September 1, 2026

DOI: https://doi.org/10.3345/cep.2026.01158

Review Article

Gastroenterology

Patient-derived intestinal organoids in pediatric inflammatory bowel disease: applications in disease modeling and therapeutic response prediction

Ky Young Cho

Clin Exp Pediatr. 2026;69(10):753-761. Published online September 1, 2026

· Patient-derived intestinal organoids provide a human-relevant platform for studying disease mechanisms and evaluating therapeutic responses in pediatric inflammatory bowel disease (PIBD).
· By preserving patient-specific epithelial characteristics, these models enable the functional assessment of disease heterogeneity and drug responsiveness.
· Although technical and biological limitations remain, ongoing advances in immune-inclusive and microphysiological systems are expected to enhance their translational value and support personalized treatment strategies for PIBD.

DOI: https://doi.org/10.3345/cep.2026.00913

Clinical Note

Neurology

Anti-GD1b-positive sensory ataxic Guillain-Barré syndrome with bulbar involvement and Bickerstaff brainstem encephalitis-like features in an adolescent: a case report

Hamza Reaz Aziz, Kirsh Kumar, Nabiha Naveed, Saira Awan

Clin Exp Pediatr. 2026;69(9):743-747. Published online August 27, 2026

DOI: https://doi.org/10.3345/cep.2026.00717

Editorial

Endocrinology

A commentary on “Rising incidence of central precocious puberty in Thailand: a nationwide population-based study before, during, and after the COVID-19 pandemic (2018–2024)”

Won Kyoung Cho

Clin Exp Pediatr. 2026;69(9):704-705. Published online August 27, 2026

Nationwide Thai data showed that central precocious puberty (CPP) incidence rose sharply during the COVID-19 pandemic and plateaued, whereas premature thelarche (PT) continued to increase postpandemic, particularly among girls aged 7-8 years. Because progression from PT to CPP cannot always be predicted at presentation, longitudinal follow up is preferable to reassurance after a single visit. Childhood obesity may further complicate diagnosis by blunting gonadotropin responses, warranting cautious interpretation of stimulation testing.

DOI: https://doi.org/10.3345/cep.2026.02348

Review Article

Endocrinology

Effect of lifestyle interventions on pediatric obesity: a lifestyle medicine systematic review

Jung Eun Choi, Hee Jeoung Lim, Kyung Hee Kim, Hae Soon Kim

Clin Exp Pediatr. 2026;69(9):686-693. Published online August 27, 2026

Lifestyle interventions effectively improve the anthropometric and cardiometabolic outcomes of children and adolescents with overweight or obesity. Multicomponent approaches integrating diet, physical activity, and behavioral strategies demonstrate the most consistent and comprehensive benefits. These findings strongly support the application of lifestyle medicine principles in pediatric obesity management. Long-term integrated interventions addressing multiple health behaviors are needed to ensure sustainable improvements.

DOI: https://doi.org/10.3345/cep.2026.00927

Emergency Medicine

Reconciling conflicting evidence on stress ulcer prophylaxis in critically ill children: a systematic review and meta-analysis

Hiroyuki Oikawa, Shotaro Nozaki, Munehiro Furuichi

Clin Exp Pediatr. 2026;69(9):694-703. Published online August 24, 2026

By appraising all nonrandomized studies using the ROBINS-I V2 (Risk Of Bias In Non-randomized Studies of Interventions, version 2) and finding them at critical risk of confounding, we restricted the synthesis to randomized trials. Stress ulcer prophylaxis (SUP) showed no demonstrated benefit; the previously reported mortality signal was not reproduced, and an exploratory signal of increased central line-associated bloodstream infection could not be excluded. With very low overall certainty, current evidence is insufficient to support routine SUP.

DOI: https://doi.org/10.3345/cep.2026.01823

Clinical Note

Gastroenterology

Achalasia, alacrimia, and normal adrenal function in a toddler: GDP-mannose pyrophosphorylase A-congenital disorder of glycosylation mimicking Allgrove syndrome

Prounika Koppula, Siva Satya Prasun Korrapati, Vybhav Venkatesh

Clin Exp Pediatr. 2026;69(10):817-819. Published online August 19, 2026

DOI: https://doi.org/10.3345/cep.2026.01529

Cited By 71	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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