Clinical and Experimental Pediatrics

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Endocrinology

Gut microbiota profiles in Korean children with growth hormone deficiency: a case-control study

So Yoon Choi, Seom Gim Kong, Gyu Min Yeon, Yoo Rha Hong, Minyoung Jung, Jung Hyun Lee

Clin Exp Pediatr. 2026;69(10):797-805. Published online August 19, 2026

Question: Is gut microbiota composition altered in children with growth hormone deficiency (GHD)?
Finding: Children with GHD exhibited altered gut microbiota composition and predicted microbial functional pathways despite similar overall microbial diversity.
Meaning: These preliminary findings suggest a potential association between gut microbiota and pediatric GHD and warrant validation in larger prospective studies.

DOI: https://doi.org/10.3345/cep.2026.00493

Gastroenterology

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

Clin Exp Pediatr. 2026;69(10):788-796. Published online July 24, 2026

Question: Are bacterial infections associated with lower native liver survival in children with biliary atresia (BA)?
Finding: Children with BA and proven/suspected bacterial infections, including cholangitis, had significantly lower native liver survival and higher rates of liver transplantation or death.
Meaning: Early recognition, appropriate management, and prevention of bacterial infections may improve native liver survival in children with BA-related cirrhosis.

DOI: https://doi.org/10.3345/cep.2026.00388

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

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

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

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

Letter to the Editor

Pulmonology

Telomere biology disorders in childhood interstitial lung disease: from genetic diagnosis to bedside suspicion – A commentary on “Telomere biology disorders associated with childhood interstitial lung disease”

Weerapong Lilitwat

Clin Exp Pediatr. 2026;69(9):751-752. Published online August 19, 2026

DOI: https://doi.org/10.3345/cep.2026.01760

Clinical Note

Nephrology (Genitourinary)

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

Clin Exp Pediatr. 2026;69(9):748-750. Published online July 20, 2026

Web of Science 1 Crossref 1

DOI: https://doi.org/10.3345/cep.2026.00563

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

Original Article

Endocrinology

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

Pattara Wiromrat, Preamrudee Poomthavorn, Ratikorn Chaisiwamongkol, Chaiyawat Suppasilp, Ouyporn Panamonta, Ratchaneewan Sinitkul

Clin Exp Pediatr. 2026;69(9):733-742. Published online August 19, 2026

Web of Science 1 Crossref 1

Question: Did the incidence of central precocious puberty (CPP) and premature thelarche (PT) among Thai children change during 2018–2024?
Finding: CPP incidence in girls more than doubled during the COVID-19 pandemic and remained elevated thereafter, primarily at age 8 to <9 years. PT incidence increased progressively, particularly in girls aged 7 to <8 years.
Meaning: In peripubertal age groups, CPP and PT incidence increases may reflect pandemic-related factors, obesity, awareness, or earlier pubertal onset.

DOI: https://doi.org/10.3345/cep.2026.00983

Basic Research

Longitudinal changes in serum soluble C5b-9 levels following immunomodulatory therapy for multisystem inflammatory syndrome in children

Amrita Pattanaik, Prasad Varamballi, Srilatha Marate, Sushma Bhandarkar B., Shrikiran Aroor, Somashekar A.R., Suchetha S. Rao, Chiranjay Mukhopadhyay

Clin Exp Pediatr. 2026;69(9):726-732. Published online August 19, 2026

Question: Do serum soluble C5b-9 (sC5b-9) levels change following immunomodulatory therapy in children with multisystem inflammatory syndrome in children (MIS- C)?
Finding: In this longitudinal multicentric study of 100 children with MIS-C, serum sC5b-9 concentrations significantly decreased following treatment, although some patients showed persistently elevated levels at discharge.
Meaning: Serial sC5b-9 measurements may indicate treatment-associated immune activity and recovery in MIS-C.

DOI: https://doi.org/10.3345/cep.2026.01179

Oncology

Pediatric patients with cancer exhibit increased neutrophil extracellular traps and reduced active deoxyribonuclease I: diagnostic, prognostic, and therapeutic opportunities

Nuria Benavent, Julia Oto, Patricia Verger, Alejandro Herreros-Pomares, Raquel Herranz, Bienvenida Argilés, Julia Balaguer, Antonio Juan-Ribelles, Santiago Bonanad, Pilar Medina, Adela Cañete

Clin Exp Pediatr. 2026;69(9):713-725. Published online August 19, 2026

· Circulating neutrophil extracellular trap (NET) markers are increased in pediatric cancer and correlate with disease risk and outcomes.
· Cell-free DNA and calprotectin levels show diagnostic and prognostic value, whereas impaired deoxyribonuclease I activity identifies a targetable mechanism.
· NETs are promising biomarkers and therapeutic targets for high-risk pediatric tumors.

DOI: https://doi.org/10.3345/cep.2026.01004

Cardiology

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

Clin Exp Pediatr. 2026;69(9):706-712. Published online July 29, 2026

Question: Are red cell distribution width (RDW) and reticulocyte hemoglobin content (CHr) reliable alternative markers for detecting iron depletion in children with cyanotic congenital heart disease, whose status is often masked by compensatory polycythemia?
Finding: Multivariate analysis demonstrated that RDW (≥18.8%) and CHr (<28 pg) are strong independent predictors of iron depletion in this vulnerable population.
Meaning: Combined use of these accessible markers facilitates earlier diagnosis and improves clinical management in resource-limited healthcare facilities.

DOI: https://doi.org/10.3345/cep.2026.00241

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