Clinical and Experimental Pediatrics

Original Article

Neonatology (Perinatology)

Differential roles of interleukin-6 and adrenomedullin in early diagnosis and mortality predictions in late-onset neonatal sepsis

Emilly Henrique dos Santos, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Karen Alessandra Rodrigues, Ronaldo Arkader, Thelma Suely Okay

Clin Exp Pediatr. 2025;68(6):463-471. Published online December 23, 2024

Crossref 1

Question: Can adrenomedullin (ADM) or interleukin-6 (IL-6) detect late-onset neonatal sepsis (LOS) at admission (area under the curve [AUC]>0.90) as an early diagnostic marker?
Finding: Only IL-6 consistently distinguished survivors from nonsurvivors (AUC>0.90) on admission and antibiotic treatment days 3 and 7. C-reactive protein level identified infections from day 3 but failed to predict outcomes (AUC<0.70).
Meaning: IL-6 level can improve LOS diagnosis and prognosis.

DOI: https://doi.org/10.3345/cep.2024.01543

Editorial

Neonatology (Perinatology)

Advancements and challenges in neonatal resuscitation: embracing laryngeal mask airways for improved outcomes

Jang Hoon Lee

Clin Exp Pediatr. 2025;68(4):298-299. Published online November 28, 2024

Positive pressure ventilation (PPV) is the most critical intervention provided during delivery room resuscitation. In the new guidelines, this recommendation has been expanded to suggest the use of laryngeal mask airyway (LMA) versus face masks for PPV. Evidence-based information and hands-on training related to this practice will help more healthcare providers become familiar with and appropriately use LMA during delivery room resuscitations.

DOI: https://doi.org/10.3345/cep.2024.01088

Review Article

Neonatology (Perinatology)

Recent advances in understanding pathophysiology of non-nutritional stunting in very preterm infants

Eduardo Cuestas, Alina Rizzotti

Clin Exp Pediatr. 2025;68(4):287-297. Published online December 23, 2024

· Previous reviews of extrauterine growth restriction focused mainly on weight growth restriction caused by nutritional factors or pathological conditions.
· This review summarizes recent developments in the pathophysiology of nonnutritional length growth restriction in very preterm infants with focus on the impact of sustained neonatal inflammation on their short- and long-term outcomes.
· Further research is needed to investigate optimal strategies to improve length growth restriction in very preterm infants.

DOI: https://doi.org/10.3345/cep.2024.01354

Editorial

Neonatology (Perinatology)

The predetermined future: tackling South Korea’s total fertility rate crisis

Jin Kyu Kim

Clin Exp Pediatr. 2025;68(3):225-227. Published online November 6, 2024

· South Korea faces a severe demographic crisis with the lowest global fertility rate. Despite significant investments, the total fertility rate continues to decline.
· It is necessary to fully mobilize national capabilities and execute comprehensive strategies that focus on both intangible and tangible values.
· Immediate and decisive action is essential to addressing these challenges effectively.

DOI: https://doi.org/10.3345/cep.2024.00871

Original Article

Neonatology (Perinatology)

Effect of high-frequency oscillatory ventilation with intermittent sigh breaths on carbon dioxide levels in neonates

Kulthida Baingam, Anucha Thatrimontrichai, Manapat Praditaukrit, Gunlawadee Maneenil, Supaporn Dissaneevate

Clin Exp Pediatr. 2025;68(2):178-184. Published online November 13, 2024

Question: Can sigh breaths (Sighs) application during high-frequency oscillatory ventilation (HFOV) decrease partial pressure of carbon dioxide (PaCO₂) levels?
Finding: The mean PaCO₂ level after Sighs during HFOV was significantly decreased compared to that after HFOV alone (mean difference, -3.6 mmHg).
Meaning: HFOV plus Sighs functionality can reduce PaCO₂ levels. However, further studies are required to conclusively determine the effects of Sighs.

DOI: https://doi.org/10.3345/cep.2024.01011

Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebocontrolled randomized trial

Ameneh Lamsehchi, Maryam Shokouhi Solgi, Mohammad Kazem Sabzehei, Behnaz Basiri, Elahe Talebi Ghane, Kiana Kimiaei Asadi, Sina Azadnajafabad

Clin Exp Pediatr. 2025;68(1):73-79. Published online October 31, 2024

Question: What are the short-term outcomes of oropharyngeal administration of colostrum (OAC) in preterm neonates?
Finding: This study demonstrated the significantly lower rates of necrotizing enterocolitis, clinically suspected sepsis, shorter hospital stay, period to full enteral feeding, and antibiotic therapy period in the OAC group.
Meaning: This trial may further expand the clinical application of OAC in premature infants to reduce their length of hospital stay and complications.

DOI: https://doi.org/10.3345/cep.2024.00591

Review Article

Neonatology (Perinatology)

Need for national guidance regarding proactive care of infants born at 22–23 weeks' gestation

Ga Won Jeon

Clin Exp Pediatr. 2025;68(1):53-61. Published online November 13, 2024

Crossref 1

With advancements in neonatal intensive care, the limit of viability has shifted to 22–23 weeks' gestation, whose survival rates vary across countries and institutions. These rates are not static and can be improved through the proactive and centralized care guided by national protocols, including maternal transfer to high-activity regions with better neonatal intensive care practices before delivery.

DOI: https://doi.org/10.3345/cep.2024.01277

Strategies to support language development in neonatal intensive care unit: a narrative review

Ju Sun Heo, Ee-Kyung Kim

Clin Exp Pediatr. 2024;67(12):651-663. Published online November 6, 2024

· Preterm infants often experience speech and language development delays during early childhood, impacting children's ultimate outcomes.
· Promoting breastfeeding, increasing parent-infant interactions in a single-family room, promoting a nurturing language environment by parental book reading and language interventions, and parent-integrated interventions in the neonatal intensive care unit could potentially enhance children's language development.
· Integrating these strategies through family-centered care is essential.

DOI: https://doi.org/10.3345/cep.2024.00087

Original Article

Neonatology (Perinatology)

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status

Sung-Hoon Chung, Chae Young Kim, Yong-Sung Choi, Myung Hee Lee, Jae Woo Lim, Byong Sop Lee, Ki-Soo Kim; the Korean Neonatal Network

Clin Exp Pediatr. 2024;67(11):619-627. Published online September 12, 2024

Question: How do structural and staffing characteristics of neonatal intensive care units (NICUs) influence the mortality rates of very low birth weight infants (VLBWIs)?
Findings: NICUs with higher staffing levels, particularly with more neonatologists, and those offering advanced care levels were associated with lower mortality rates. Additionally, regional disparities were observed, with some areas demon-strating significantly higher survival rates.
Meaning: Adequate staffing and equitable regional distribution of medical resources are crucial for improving survival outcomes in VLBWIs. Efforts to enhance NICU staffing and address regional healthcare disparities are essential for optimizing care quality and reducing mortality in this vulnerable population.

DOI: https://doi.org/10.3345/cep.2023.01613

Protective effect of recombinant interleukin-10 on newborn rat lungs exposed to short-term sublethal hyperoxia

Hyeon-Soo Lee, Young-Joon Ryu, Min-Jae Lee

Clin Exp Pediatr. 2024;67(10):540-549. Published online September 27, 2024

Lung injury is generated from the early stage of hyperoxia through the biologic effects of cell death and inflammatory response, which eventually leads to evolution of bronchopul-monary dysplasia. Therefore, a protective measure against hyperoxia-induced lung injury is needed. The present study observed that anti-inflammatory cytokine, interleukin-10 had protective effects on newborn rat lungs from injury induced at the early stage of hyperoxia, by preventing cell death and down-regulating inflammatory response.

DOI: https://doi.org/10.3345/cep.2024.01221

Review Article

Neonatology (Perinatology)

Demographic transition in South Korea: implications of falling birth rates

Chae Young Kim, Sung-Hoon Chung

Clin Exp Pediatr. 2024;67(10):498-509. Published online June 27, 2024

Web of Science 2 Crossref 2

· Since 1960, South Korea's TFR decreased from 6.33 to 0.78 in 2022, below the 2.1 replacement level since 1983, with women's average age at first marriage rising to 31.3 in 2022.
· Policies needed: financial incentives, longer parental leave, better childcare.
· The U.S. (15.3% immigrants) and Germany (18.8%) use immigration to maintain demographic stability, a strategy South Korea is considering.

DOI: https://doi.org/10.3345/cep.2023.01599

Quantifying myelin in neonates using magnetic resonance imaging: a systematic literature review

Nabila Hanem Arshad, Hasyma Abu Hassan, Nur Farhayu Omar, Zurina Zainudin

Clin Exp Pediatr. 2024;67(8):371-385. Published online December 6, 2023

Question: This systematic review attempts to discover the best magnetic resonance imaging (MRI) technique for myelin quantification in neonates by evaluating various MRI parameters and their reproducibility.
Finding: Since the benefits of using synthetic MRI for quantifying myelin in neonates outweigh the very minor draw- backs, it is recommended.
Meaning: The findings suggest the importance of identifying noninvasive MRI techniques available to assess myelin tissue in neonates, which aid in diagnosing neurodevelopmental disorders.

DOI: https://doi.org/10.3345/cep.2023.00514

Letter to the Editor

Neonatology (Perinatology)

Pentraxin 3 as a marker of early-onset neonatal sepsis

Safaa ELMeneza, Iman El-Bagoury, Hind Rayes, Amira Hassan

Clin Exp Pediatr. 2024;67(6):312-314. Published online May 23, 2024

Crossref 1

DOI: https://doi.org/10.3345/cep.2024.00409

Original Article

Neonatology (Perinatology)

Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial

Mojtaba Cheraghi, Maziar Nikouei, Majid Mansouri, Siros Hemmatpour, Yousef Moradi

Clin Exp Pediatr. 2024;67(5):249-256. Published online March 26, 2024

Question: Is vitamin E a viable therapeutic option for managing neonatal hyperbilirubinemia?
Finding: This randomized clinical trial examined the effects of oral vitamin E supplementation on bilirubin reduction (primary outcome), phototherapy duration, and length of hospital stay (secondary outcome) in 138 infants.
Meaning: Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and length of hospital stay.

DOI: https://doi.org/10.3345/cep.2023.01312

Editorial

Neonatology (Perinatology)

Exploring the role of laryngeal masks in neonatal resuscitation

Euiseok Jung

Clin Exp Pediatr. 2024;67(5):247-248. Published online December 28, 2023

· Laryngeal masks (LMs) offer stable airway access and skill retention advantages, making them promising alternatives to positive-pressure ventilation in neonatal care.
· The ease of teaching LM insertion techniques to less experienced providers addresses the need for swift intervention and skill retention.
· Careful consideration of the benefits and challenges of LMs is essential in determining their effective integration into enhanced neonatal resuscitation protocols.

DOI: https://doi.org/10.3345/cep.2023.01200

Review Article

Neonatology (Perinatology)

Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks

Eun Song Song, Ga Won Jeon

Clin Exp Pediatr. 2024;67(5):240-246. Published online July 11, 2023

Web of Science 2 Crossref 3

In neonatal resuscitation:
· Laryngeal masks are recommended when endotracheal intubation or positive-pressure ventilation fails.
· Laryngeal masks are useful even during chest compressions.
· Laryngeal masks aid neonates >34 weeks’ gestation and/or with a birth weight >2 kg.
· Main usage barriers include limited experience (81%), preference for endotracheal tubes (57%), and lack of awareness (56%).
· Second-generation laryngeal masks have a built-in esophageal drainage tube that prevents regurgitation into the glottis, and an orogastric tube can be inserted within the esophageal drainage tube to protect against gastric inflation.

DOI: https://doi.org/10.3345/cep.2023.00619

Influence of infant microbiome on health and development

Noelle Younge

Clin Exp Pediatr. 2024;67(5):224-231. Published online August 21, 2023

Web of Science 1 Crossref 2

· The infant gut microbiome is highly dynamic and individualized.
· Microbes are vertically transmitted from mother to infant during delivery and throughout infancy.
· Delivery mode, gestational age, diet, and antibiotic use influence infant microbiome composition and function.
· In animal studies, the microbiome played critical roles in the structural and functional development of the infant gastrointestinal and immune systems.
· Microbiome-targeted therapies have great potential to reduce infant morbidity and mortality.

DOI: https://doi.org/10.3345/cep.2023.00598

Letter to the Editor

Neonatology (Perinatology)

Assessment of iron status and red cell parameters in healthy term small for gestational age neonates at birth

Arif Hossain, Shorna Rahman, Shahana Akter, Ismat Jahan, Sanjoy Kumer Dey, Abdul Mannan, Mohammod Shahidullah

Clin Exp Pediatr. 2024;67(4):221-223. Published online March 19, 2024

DOI: https://doi.org/10.3345/cep.2023.01445

Review Article

Neonatology (Perinatology)

Neonatal family-centered care: evidence and practice models

Juyoung Lee

Clin Exp Pediatr. 2024;67(4):171-177. Published online June 14, 2023

Web of Science 4 Crossref 5

· Concrete evidence exists of early parent-infant attachment supported by family-centered care (FCC) in the neonatal intensive care unit.
· FCC involves the parents’ presence and participation in the infant’s care and decision-making.
· A private and comfortable space should be provided. A single-family room is ideal; however, a quiet space with a recliner can be a good alternative.
· Care culture changes and staff training are required.

DOI: https://doi.org/10.3345/cep.2023.00367

Original Article

Neonatology (Perinatology)

Oral administration of bone marrow-derived mesenchymal stem cells attenuates intestinal injury in necrotizing enterocolitis

Yeong Seok Lee, Yong Hoon Jun, Juyoung Lee

Clin Exp Pediatr. 2024;67(3):152-160. Published online February 19, 2024

Web of Science 1 Crossref 1

Question: What is the optimal dose of bone marrow-derived mesenchymal stem cells (BM-MSCs) for treating necrotizing enterocolitis (NEC), and is orally administered BM-MSC effective?
Findings: High (1×10⁶ cells) or multiple BM-MSC doses showed similar effects as low (1×10⁵ cells) doses of intraperitoneally administered BM-MSCs. Furthermore, orally administered BM-MSCs were as effective as intraperitoneally administered BM-MSCs.
Meaning: Orally administered low-dose BM-MSCs are a potential treatment for NEC.

DOI: https://doi.org/10.3345/cep.2023.01151

Editorial

Neonatology (Perinatology)

Impacts of maternal COVID-19 during pregnancy on neonatal health and epidemiology

Jae Woo Lim

Clin Exp Pediatr. 2024;67(3):149-151. Published online December 28, 2023

Newborns born to mothers infected with coronavirus disease 2019 (COVID-19) should be closely monitored for respiratory disorders, such as transient tachypnea of the newborn, regardless of their COVID-19 test results. Further research is required of the development of infants born to mothers with COVID-19. The trends in Korea's birth rate and infant mortality rates have not been significantly affected by COVID-19.

DOI: https://doi.org/10.3345/cep.2023.01452

Original Article

Neonatology (Perinatology)

Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

Asha P. Shetty, Kurvatteppa Halemani, Alwin Issac, Latha Thimmappa, Sanjay Dhiraaj, Radha K, Prabhaker Mishra, Vijai Datta Upadhyaya

Clin Exp Pediatr. 2024;67(2):104-115. Published online November 14, 2023

Web of Science 10 Crossref 19

Question: What emotions do parents experience when their newborns are admitted to the neonatal intensive care unit (NICU)?
Finding: Mothers experienced more anxiety (51%), depression (31%), and stress (41%) symptoms than fathers (26%, 12%, and 22%, respectively).
Meaning: Parents often experience anxiety, stress, and depression following NICU admission. Healthcare workers are responsible for providing regular parental counseling.

DOI: https://doi.org/10.3345/cep.2023.00486

Letter to the Editor

Neonatology (Perinatology)

Association between feeding intolerance and intestinal dysbiosis in very premature infants

Putri Maharani Tristanita Marsubrin, Agus Firmansyah, Rinawati Rohsiswatmo, Zakiudin Munasir, Saptawati Bardosono, Safarina G. Malik, Yuditiya Purwosunu, Ina S. Timan, Tetty Yuniati, Maya Yulindhini

Clin Exp Pediatr. 2023;66(11):501-503. Published online October 24, 2023

DOI: https://doi.org/10.3345/cep.2023.00829

Original Article

Neonatology (Perinatology)

Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study

Sung Hee Lee, Ju Hyun Jin, Jong Ha Yoo, Shin Won Yoon

Clin Exp Pediatr. 2023;66(11):493-500. Published online October 24, 2023

Web of Science 3 Crossref 3

Question: What are the adverse clinical outcomes of neonates of coronavirus disease 2019 (COVID-19)–infected mothers?
Finding: Infants of mothers with COVID-19 were at significantly increased risk of transient tachypnea of the newborn (TTN), use of noninvasive ventilation, and need for supplemental oxygen (P<0.05).
Meaning: Neonates of mothers with COVID-19 are at risk of TTN and require respiratory support. Close monitoring is essential to ensuring timely intervention if required.

DOI: https://doi.org/10.3345/cep.2023.00563

Review Article

Neonatology (Perinatology)

Treatment of congenital cytomegalovirus infection

Gyu Hong Shim

Clin Exp Pediatr. 2023;66(9):384-394. Published online December 28, 2022

Web of Science 6 Crossref 8

· Congenital cytomegalovirus (CMV) infection is among the most common causes of nongenetic sensorineural hearing loss.
· Congenital CMV is initially treated with intravenous ganciclovir for 2–6 weeks and switched to oral valganciclovir, or with oral valganciclovir for the entire 6-month period.
· Infants with congenital CMV require periodic monitoring of absolute neutrophil count, platelet count, and blood urea nitrogen, creatinine, liver function tests, audiological, ophthalmological, and developmental tests during antiviral medication.

DOI: https://doi.org/10.3345/cep.2022.01032

Neurodevelopmental outcomes of preterm infants

In Gyu Song

Clin Exp Pediatr. 2023;66(7):281-287. Published online December 30, 2022

Web of Science 20 Crossref 25

· Among survivors, 60.9% of infants born at 22 weeks’ gestation had moderate to severe impairments, whereas 50.3% born at 23 weeks’ and 42.2% at 24 weeks’ gestation had moderate to severe impairments.
· Moderate and late preterm infants reportedly have less severe disease than very preterm infants, but they still experience adverse neurodevelopmental outcomes.
· The careful follow-up and early detection of developmental problems in these patients are required.

DOI: https://doi.org/10.3345/cep.2022.00822

Original Article

Neonatology (Perinatology)

Efficacy of body position on gastric residual in preterm infant: a systematic review and meta-analysis

Kurvatteppa Halemani, Alwin Issac, Sanjay Dhiraaj, Prabhaker Mishra

Clin Exp Pediatr. 2023;66(6):262-270. Published online November 30, 2022

Web of Science 6 Crossref 8

Breastfeeding and it's tolerance are the positive indicators for preterm babies. Placing the preterm infant in the right lateral or prone position after feed had lesser gastric residual volume compared to placing them in left lateral or supine positions. The post-feed position is a vital element in enhancing feeding tolerance, mechanical functions of the gastrointestinal tract and the overall development of preterm infants.

DOI: https://doi.org/10.3345/cep.2021.01508

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

Gayoung Lee, Juyoung Lee, Ga Won Jeon, Yong Hoon Jun

Clin Exp Pediatr. 2023;66(1):32-37. Published online December 15, 2022

Web of Science 3 Crossref 3

Question: Is a commercial thickened formula able to alleviate oral feeding-associated desaturation and bradycardia in preterm infants?
Finding: Thickened formula feeding significantly reduced oral feeding-associated desaturation and bradycardia in preterm infants.
Meaning: Thickened formula feeding stabilizes oxygen saturation and heart rate during oral feeding among preterm infants with feeding difficulties.

DOI: https://doi.org/10.3345/cep.2022.00780

Editorial

Neonatology (Perinatology)

Does cord blood cortisol have a mediating effect on maternal prepregnancy body mass index and birth weight?

Gyu Hong Shim

Clin Exp Pediatr. 2023;66(1):24-25. Published online November 30, 2022

· A high prepregnancy body mass index (pre-BMI) is associated with large for gestational age (LGA) and macrosomia, whereas a low pre-BMI is associated with small for gestational age (SGA) and low birth weight (LBW).
· The identification of the role of the hypothalamus-pituitary-adrenal axis in the effect of pre-BMI and maternal gestational weight gain on birth weight could reduce the frequency of LGA, macrosomia, SGA, or LBW through maternal diet optimization.

DOI: https://doi.org/10.3345/cep.2022.00955

Review Article

Neonatology (Perinatology)

Neonatal seizures: stepping outside the comfort zone

Menna Hashish, Mohamed Reda Bassiouny

Clin Exp Pediatr. 2022;65(11):521-528. Published online April 4, 2022

Web of Science 2 Crossref 3

· Use conventional and amplitude-integrated electroencephalography to confirm clinical seizures and screen high-risk newborns.
· Select an explicit clear elective event to be treated with less toxic and more effective antiepileptics.

DOI: https://doi.org/10.3345/cep.2022.00115

Cited By 25	Neurodevelopmental outcomes of preterm infants
Cited By 20	Association of gut microbiota with obesity in children and adolescents
Cited By 20	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 19	Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis
Cited By 18	Nonalcoholic fatty liver disease and insulin resistance in children