Clinical and Experimental Pediatrics

Original Article

Cardiology

Unsustainable and overworked: unpacking the challenges faced by pediatric cardiologists and cardiac surgeons in Korea

Soo In Jeong, GI Beom Kim, Sung Hye Kim, Jae Yoon Na, Hong Ju Shin, Sin Weon Yun, Lucy Youngmin Eun, Sang Yun Lee, Chang-Ha Lee, Kwang Ho Choi, Seul Gi Cha, Mi Young Han

Clin Exp Pediatr. 2025;68(9):732-741. Published online August 6, 2025

Question: What are the key challenges affecting pediatric cardiologists and cardiac surgeons in Korea?
Finding: Excessive workloads, low procedural volumes, and legal risks contribute to high burnout. Regional disparities limit skill maintenance and threaten workforce sustainability.
Meaning: Targeted policies ensuring fair workloads, legal protections, and regional support are essential to stabilizing the pediatric cardiac workforce and maintaining high-quality care.

DOI: https://doi.org/10.3345/cep.2025.01123

Gastroenterology

Treatment targeting pediatric inflammatory bowel disease-associated anemia: experience from a single tertiary center

Ana S.C. Fernandes, Sara Azevedo, Ana Rita Martins, Ana Isabel Lopes

Clin Exp Pediatr. 2025;68(9):722-731. Published online June 10, 2025

Question: Does treating iron deficiency (ID) using intravenous iron in pediatric inflammatory bowel disease (IBD) feature long-term safety and efficacy?
Finding: Intravenous iron supplementation was safe and effective. However, the ID recurrence rate was higher than expected.
Meaning: Proactive screening and treatment of ID in pediatric IBD are essential. The Ganzoni formula likely underestimates the iron requirements of pediatric patients. Prospective trials are needed to optimize iron treatment dosing.

DOI: https://doi.org/10.3345/cep.2025.00640

Oncology

Allogeneic stem-cell transplantation following chimeric antigen receptor T-cell therapy for treatment of relapsed/refractory hematologic malignancy in children and young adults: a systematic review and meta-analysis

Ghea Mangkuliguna, Edi Setiawan Tehuteru, Reganedgary Jonlean, Nicholas Adrianto, Stella Kallista

Clin Exp Pediatr. 2025;68(9):712-721. Published online July 4, 2025

Question: Does consolidative allogeneic stem cell transplantation (allo-SCT) after chimeric antigen receptor (CAR) T-cell therapy improve outcomes of children and young adult patients with relapsed/refractory hematologic malignancies?
Finding: The meta-analysis showed reduced relapse rates and favorable survival trends with allo-SCT despite low evidence quality.
Meaning: Consolidative allo-SCT after CAR T-cell therapy may enhance survival; however, further clinical studies are needed.

DOI: https://doi.org/10.3345/cep.2025.00031

Basic Research

Linezolid mitigates tissue injury in experimental model of pediatric testicular torsion: TLR-4/MAPK/NF-κB involvement

Moein Ghasemi, Abolfazl Basiri, Houman Kazemzadeh, Mohammad Amin Manavi, Seyed Mohammad Tavangar, Ahmad Reza Dehpour, Hamed Shafaroodi

Clin Exp Pediatr. 2025;68(9):700-711. Published online August 26, 2025

Question: What pharmacological strategies can limit ischemia-reperfusion injury in pediatric patients with testicular torsion?
Finding: In a rat model of testicular torsion, linezolid reduced oxidative stress, inflammation, and tissue injury via the Toll-like receptor 4/mitogen-activated protein kinase/nuclear factor kappa beta pathway.
Meaning: Linezolid may offer a pharmacological approach to attenuate testicular damage in pediatric patients with testicular torsion, warranting further clinical investigation.

DOI: https://doi.org/10.3345/cep.2025.00080

Pulmonology

Effect of vitamin C supplement in treatment of childhood pneumonia requiring hospitalization: a randomized controlled trial

Chutima Phuaksaman, Katechan Jampachaisri, Klaita Srisingh

Clin Exp Pediatr. 2025;68(9):690-699. Published online April 1, 2025

This study assessed the effects of vitamin C on children with community-acquired pneumonia (CAP). Vitamin C supplementation improved clinical symptoms within 48–72 hours compared to placebo but did not reduce the length of hospital stay (LOS). These findings suggest that vitamin C is beneficial for managing CAP severity, but does not affect LOS.

DOI: https://doi.org/10.3345/cep.2025.01970

Association of macrophage migration-inhibitory factor gene and growth differentiation factor 15 gene polymorphisms and their circulating levels with respiratory distress syndrome among preterm neonates

Ali Helmi Bakri, Mohammed H. Hassan, Khaled Abdalla Abd-Elbaseer, Mahmoud Abo-Alhassan Sayed, Ahmed Alamir Mahmoud Abdallah, Eman Ahmed Abd-Elmawgood

Clin Exp Pediatr. 2025;68(9):680-689. Published online April 1, 2025

Question: Do macrophage migration-inhibitory factor (MIF) and growth differentiation factor-15 (GDF-15) levels and their gene polymorphisms affect RDS among preterm babies?
Finding: Significantly higher serum MIF and GDF-15 levels were observed in patients with severe respiratory distress syndrome (RDS). The mutant G- and C-alleles of GDF-15 rs4808793 C>G single nucleotide polymorphism (SNP) and MIF rs755622 G>C SNP were present at significantly higher frequencies in preterm neonates with RDS.
Meaning: MIF and GDF-15 play a significant role in neonatal RDS and its severity.

DOI: https://doi.org/10.3345/cep.2025.00416

Cardiology

Vasovagal syncope and postural orthostatic tachycardia syndrome in adolescents: transcranial doppler versus autonomic function test results

Dong Won Lee

Clin Exp Pediatr. 2025;68(9):673-679. Published online August 6, 2025

Question: Vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) are representative forms of neurally mediated syncope. What influences the occurrence of each?
Finding: Autonomic function test results did not differ, but cerebral blood flow during diastole on transcranial doppler differed between VVS and POTS.
Meaning: Differences in diastolic cerebral blood flow velocity play an important role in VVS and POTS.

DOI: https://doi.org/10.3345/cep.2025.00927

Nutrition

Factors associated with thiamin deficiency in pediatric patients with heart disease and receiving diuretics: a single-center study

Phakwan Laohathai, Rathaporn Sumboonnanonda, Puthita Saengpanit, Chodchanok Vijarnsorn, Chatchawan Srisawat, Kwanjai Chotipanang, Sarawut Junnu, Supawan Kunnangja, Hathaichanok Rukprayoon, Phakkanan Phuangphan, Sompong Liammongkolkul, Arthima Phaokong, Narumon Densupsoontorn

Clin Exp Pediatr. 2025;68(9):666-672. Published online April 16, 2025

Question: Are pediatric patients with heart disease who are receiving diuretics at risk of thiamin deficiency (TD)?
Finding: Fifteen percent of the patients had TD. TD was associated with inadequate dietary thiamin intake and increasing age.
Meaning: The thiamin pyrophosphate effect should be assessed in those with high risk of TD. Dietary counseling should be emphasized to ensure adequate dietary thiamin intake.

DOI: https://doi.org/10.3345/cep.2024.01893

Neonatology (Perinatology)

Respiratory severity score-guided postnatal systemic corticosteroid therapy for bronchopulmonary dysplasia in extremely preterm infants

Gyeong Eun Yeom, Ju Sun Heo, Baek Sup Shin, Seh Hyun Kim, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim

Clin Exp Pediatr. 2025;68(9):656-665. Published online July 8, 2025

Question: Does a respiratory severity score (RSS)-guided postnatal corticosteroid protocol improve respiratory outcomes of extremely preterm (EP) infants without worsening neurodevelopmental outcomes?
Finding: The protocol enabled targeted and early steroid use, thereby reducing severe bronchopulmonary dysplasia without affecting mortality or causing neurodevelopmental impairments.
Meaning: The RSS-guided protocol may offer a more precise and individualized postnatal corticosteroid therapy for EP infants.

DOI: https://doi.org/10.3345/cep.2025.00514

Editorial

General Pediatrics

Artificial intelligence in pediatric healthcare: bridging potential, clinical practice, and ethical considerations

Yoon Lee, Seohyun Hong, Dong Keon Yon

Clin Exp Pediatr. 2025;68(9):652-655. Published online August 28, 2025

· Artificial intelligence (AI) holds transformative potential for pediatric healthcare, with applications spanning prevention, diagnosis, treatment, and follow-up across diverse subspecialties; however, ethical concerns, scarcity of pediatric- specific data, and limited funding remain significant challenges.
· International consensus on pediatric AI guidelines, expanding child-specific datasets, and incorporating explainable AI are essential to ensure safety and trust.
· Multicenter collaboration and increased investment can address these gaps, enabling equitable, reliable, and pediatric- centered AI solutions.

DOI: https://doi.org/10.3345/cep.2025.01844

Review Article

Other

Artificial intelligence in pediatric healthcare: current applications, potential, and implementation considerations

Taejin Park, In-Hee Lee, Seung Wook Lee, Sek Won Kong

Clin Exp Pediatr. 2025;68(9):641-651. Published online June 25, 2025

Web of Science 1 Crossref 1

Artificial intelligence (AI) offers potential benefits in pediatric care, but its real-world adoption requires clinician literacy, ethical and legal safeguards, and cautious implementation. Large language models are emerging across healthcare, but their use in pediatric clinical practice remains premature. Thus, the cautious and accountable implementation of AI is crucial to preventing unintended harm and realizing its potential.

DOI: https://doi.org/10.3345/cep.2025.00962

Cost-effectiveness of newborn screening for severe combined immunodeficiency: a systematic review

Rezwanul Rana, Syed Afroz Keramat, Moin Ahmed

Clin Exp Pediatr. 2025;68(9):628-640. Published online April 16, 2025

Universal newborn screening for severe combined immunodeficiency (SCID) demonstrates robust cost-effectiveness across diverse high-income healthcare systems, both from healthcare and societal standpoints. Early detection yields substantial savings. While uncertainties persist, impacting precise cost-effectiveness, the overall finding is positive. Future research must prioritize enhanced data collection and statistical rigor to refine our understanding of SCID's economic impact within the Australian context.

DOI: https://doi.org/10.3345/cep.2025.00052

Correspondence

Nephrology (Genitourinary)

Authors' reply: a commentary on “COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus”

Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn

Clin Exp Pediatr. 2025;68(8):626-627. Published online July 18, 2025

DOI: https://doi.org/10.3345/cep.2025.01200

Infection

A commentary on "COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus"

Hinpetch Daungsupawong, Viroj Wiwanitkit

Clin Exp Pediatr. 2025;68(8):624-625. Published online April 16, 2025

DOI: https://doi.org/10.3345/cep.2025.00304

Perspective

General Pediatrics

Navigating the complex behavioral landscape of children in foster care and adopted families

Anisha Choi, Sandhya J. Kadam

Clin Exp Pediatr. 2025;68(8):620-623. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00822

Clinical Note

Genetics and Metabolism

Expanding genotype-phenotype correlation of Kenny-Caffey syndrome type 1

Manuela Lo Bianco, Federica Sipala, Xena Giada Pappalardo, Gaia Fusto, Roberta Rizzo, Federico Favata, Carla Cimino, Silvia Marino, Martino Ruggieri, Agnese Suppiej, Simone Ronsisvalle, Raffaele Falsaperla

Clin Exp Pediatr. 2025;68(8):616-619. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00360

Original Article

General Pediatrics

Liposomal SunActive versus conventional iron for treatment of iron-deficiency anemia in children aged 2–12 years: a prospective randomized controlled trial

Wael A. Bahbah, Yasmin A.H.S. Younis, Hanan Salama Elbelouny, Asmaa A. Mahmoud

Clin Exp Pediatr. 2025;68(8):608-615. Published online July 18, 2025

Background: Liposomal iron, a novel oral formulation of ferric pyrophosphate that demonstrates improved gastrointestinal absorption and bioavailability with fewer side effects than conventional iron, represents a significant advancement in the treatment of iron-deficiency anemia (IDA).
Purpose: To conduct an in-depth comparative study of liposomal SunActive and conventional iron supplements (iron polymaltose complex) for treating IDA in children aged 2–12 years Methods: This...

DOI: https://doi.org/10.3345/cep.2025.00262

Hematology

Hematopoietic stem cell transplantation in pediatric patients with type VI mucopolysaccharidosis

Vedat Uygun, Koray Yalçın, Hayriye Daloğlu, Seda Öztürkmen, Suna Çelen, Suleimen Zhumatayev, Gülsün Karasu, Akif Yeşilipek

Clin Exp Pediatr. 2025;68(8):601-607. Published online March 11, 2025

Question: Could hematopoietic stem cell transplantation (HSCT) be an alternative to enzyme replacement therapy (ERT) for type VI mucopolysaccharidosis (MPS VI)?
Finding: HSCT is generally not offered due to reports of high toxicity and mortality. However, we detected fewer complications and graft-versus-host disease cases and no deaths with HSCT.
Meaning: HSCT is both less expensive than ERT and permanent; thus, it should be considered an alternative treatment for MPS VI.

DOI: https://doi.org/10.3345/cep.2024.02033

Gastroenterology

Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial

Ajay Aravind, Ujjal Poddar, Anshu Srivastava, Moinak Sen Sarma

Clin Exp Pediatr. 2025;68(8):594-600. Published online March 11, 2025

CO₂ insufflation has been used instead of air insufflation to reduce postprocedure pain and discomfort in adults; however, adequately powered studies in children are scarce. This randomized controlled trial of 200 children showed that CO₂ insufflation reduces postprocedure pain and discomfort during pediatric colonoscopy with no signs of CO₂ retention. CO₂ insufflation is safe and causes less pain in children.

DOI: https://doi.org/10.3345/cep.2024.02012

Somatic symptom severity during acute illnesses among children with functional gastrointestinal disorders

Rattanachart Sirinil, Anundorn Wongteerasut

Clin Exp Pediatr. 2025;68(8):587-593. Published online March 11, 2025

Functional gastrointestinal disorders (FGIDs) are associated with various somatic symptoms measured using a visual analogue scale and the Children’s Somatic Symptoms Inventory-24 questionnaire. Children with FGIDs exhibited more significant somatic symptoms than controls during acute illnesses. Gastrointestinal (GI) and non-GI manifestations are significantly more common in children with FGIDs.

DOI: https://doi.org/10.3345/cep.2024.01795

Critical Care Medicine

Serum amyloid A and proadrenomedullin as early markers in critically ill children with sepsis

Nagwan Y. Saleh, Wafaa M. Abo El Fotoh, Mona S. Habib, Salem E. Deraz

Clin Exp Pediatr. 2025;68(8):578-586. Published online February 26, 2025

Question: Are serum amyloid A (SAA) and proadrenomedullin (proADM) levels early markers in critically ill children with sepsis?
Finding: This prospective case-control study included 65 critically ill children with sepsis admitted to the pediatric intensive care unit and 31 controls. SAA and proADM levels were significantly higher in patients versus controls.
Meaning: SAA and proADM are promising biomarkers for diagnosing and predicting outcomes in pediatric sepsis.

DOI: https://doi.org/10.3345/cep.2024.01928

Neurology

Establishing an induced pluripotent stem cell bank using urine cells from pediatric patients with neurogenetic diseases

Hien Bao Dieu Thai, WonWoo Jung, Sol Choi, Woo Joong Kim, JangSup Moon, ByungChan Lim

Clin Exp Pediatr. 2025;68(8):569-577. Published online April 1, 2025

Question: What can be used to create a reliable supply of somatic cells for induced pluripotent stem cells (iPSCs) generation and standardize procedures for building an iPSC bank for researching pediatric neurogenetic disorders?
Findings: Noninvasively acquired urine cells are a desirable cell source for iPSC reprogramming.
Meaning: An iPSC bank can be created from diverse patient cell sources and offer a useful resource for translating research results into clinical therapy for pediatric neurogenetic disorders.

DOI: https://doi.org/10.3345/cep.2024.01830

Editorial

Other

Beyond the eye: a multidisciplinary perspective on managing pediatric myopia

Eoi Jong Seo

Clin Exp Pediatr. 2025;68(8):566-568. Published online July 18, 2025

Myopia is a growing global public health concern because of its association with irreversible vision loss such as myopic traction maculopathy, rhegmatogenous retinal detachment, and glaucoma. The effective prevention of myopia in childhood requires a multidisciplinary approach that integrates ophthalmologic care with lifestyle, nutrition, and sleep interventions. Early detection through regular visual screening in schools and primary care settings and timely ophthalmology referrals are critical to preventing high myopia.

DOI: https://doi.org/10.3345/cep.2025.00955

Review Article

Other

Myopia: a review of current concepts, association with nonophthalmological conditions, and treatment strategy in children and adolescents

Yeon Woong Chung

Clin Exp Pediatr. 2025;68(8):554-565. Published online April 1, 2025

Crossref 1

Myopia is a major ophthalmological disorder with increasing prevalence worldwide, particularly in East Asia. Evidence indicates that its development involves complex interactions between genetic and environmental factors. Body stature, sleep patterns, and nutritional status significantly influence the progression of myopia during childhood and adolescence. Its treatment and prevention strategies include optical correction, atropine therapy, increased outdoor activity, decreased near work, and regular retinal monitoring.

DOI: https://doi.org/10.3345/cep.2025.00115

Letter to the Editor

General Pediatrics

Debate around and impact of digital screen time and media parenting on children’s development

Gowda Parameshwara Prashanth

Clin Exp Pediatr. 2025;68(7):551-553. Published online March 11, 2025

DOI: https://doi.org/10.3345/cep.2025.00073

Perspective

Gastroenterology

Metabolic dysfunction-associated steatotic liver disease in children: a practical update based on Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN) 2024 guidelines

Ankit Agrawal, Arghya Samanta

Clin Exp Pediatr. 2025;68(7):546-550. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00157

Original Article

Neonatology (Perinatology)

Evaluation of total serum bilirubin thresholds for discontinuing phototherapy in jaundiced neonates: a randomized study

Ajay Kumar, Nidhi Jain

Clin Exp Pediatr. 2025;68(7):539-545. Published online February 26, 2025

Question: What are the outcomes of jaundiced neonates when phototherapy is discontinued at 2 different total serum bilirubin (TSB) thresholds?
Findings: The study involved 80 neonates, comparing a recommended TSB threshold and a lower threshold for phototherapy discontinuation. Results showed a 14.3% reinstitution rate of treatment, with no adverse outcomes.
Meaning: Careful posttreatment monitoring is essential when discontinuing phototherapy, and future research should consider updated guidelines like those from the American Academy of Pediatrics.

DOI: https://doi.org/10.3345/cep.2024.01249

Incidence of neural tube defects in tertiary care university hospital in Bangladesh

Ismat Jahan, Arif Hossain, Shah Nizam Uddin Shaon, Sadeka Choudhury Moni, Mohammad Kamrul Hassan Shabuj, Sanjoy Kumer Dey, Mohammad Abdul Mannan, Mohammod Shahidullah

Clin Exp Pediatr. 2025;68(7):530-538. Published online April 1, 2025

Question: What is the burden of neural tube defects (NTDs) in a tertiary care neonatal intensive care unit in Bangladesh?
Finding: The overall incidence of NTD was 6.4 (range, 4.59–11.2) per 1,000 live births, and the meningomyelocele complex was the most frequent location.
Meaning: The high incidence of NTD found in a leading tertiary care multidisciplinary referral hospital in Bangladesh may not reflect that of the wider population.

DOI: https://doi.org/10.3345/cep.2024.01578

Hematology

Treatment and clinical outcomes of pediatric autoimmune hemolytic anemia: real-world single-center data from Korea

Young Dai Kwon, Eun Sun Jung, Yeon Jung Lim

Clin Exp Pediatr. 2025;68(7):522-529. Published online April 16, 2025

Question: Can pediatric autoimmune hemolytic anemia (AIHA) be effectively managed using first-line steroids?
Finding: In this single-center study, pediatric patients with AIHA achieved normal hemoglobin levels within 16.5 days (range, 9.0–22.0 days) of first-line steroid treatment and maintained effective responses for 2 months.
Meaning: These outcomes highlight the efficacy of steroid treatment in pediatric versus adult AIHA and underscore the need for multicenter trials to establish standardized treatment guidelines.

DOI: https://doi.org/10.3345/cep.2024.02026

Genetics and Metabolism

Role of microRNA-498 and microRNA-410 in neonatal hypoxic-ischemic encephalopathy

Eman Salah Eldeen Arafat, Hasnaa Hesham Abotaleb, Dina Abdel Razek Midan, Abdel Hamid Abdo Ismail, Zeinab Sabri Abouzouna

Clin Exp Pediatr. 2025;68(7):512-521. Published online February 26, 2025

Question: Is it role of microRNA-410 (miRNA-410) and microRNA-498 (miRNA-498) in neonatal hypoxic-ischemic encephalopathy (HIE)?
Findings: miRNA-498 and miRNA-410 can be auxiliary diagnostic and prognostic tools for neonatal HIE.
Meaning: we can use miRNA-498 and miRNA-410 as markers and indicator for HIE.

DOI: https://doi.org/10.3345/cep.2024.01669

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