Clinical and Experimental Pediatrics

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

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

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

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

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

Web of Science 1 Crossref 2

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

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

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

Web of Science 3 Crossref 3

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

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

Web of Science 1 Crossref 1

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

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

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

Web of Science 2 Crossref 2

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

Neonatology (Perinatology)

Optimal postnatal corticosteroid regimens to prevent bronchopulmonary dysplasia with minimal adverse effects

Ga Won Jeon

Clin Exp Pediatr. 2026;69(4):293-300. Published online March 27, 2026

Postnatal corticosteroids facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD). Despite being commonly used in high-risk infants, administration guidelines have not been established. Early dexamethasone may cause neurodevelopmental harm, and the optimal dosing remains uncertain. Inhaled corticosteroids show inconclusive benefits, whereas intratracheal administration with surfactant appears promising. Thus, corticosteroids should be used cautiously in high-risk, ventilator-dependent infants with severe BPD, and further high-quality trials are needed.

DOI: https://doi.org/10.3345/cep.2026.00108

Moving toward meaningful shared decision-making in neonatal care: clinical practice and policy implications in Korea

In Gyu Song, Trisha M. Prentice, Lynn Gillam

Clin Exp Pediatr. 2026;69(4):282-292. Published online March 13, 2026

Web of Science 1 Crossref 1

Shared decision-making (SDM) offers an ethically grounded, relational approach to making difficult decisions in neonatal care. Its effective use depends on recognizing when its use is appropriate and enacted in clinical conversations. In Korea, while parents are often involved in decision-making, SDM is not yet consistently articulated or evaluated as a structured practice. Culturally grounded research, education, and institutional support are needed to strengthen family-centered neonatal care.

DOI: https://doi.org/10.3345/cep.2025.02929

Immunology

Multiomics approaches in Kawasaki disease: insights into pathogenesis and emerging directions for diagnosis and treatment

Jong Gyun Ahn, Insoo Kang

Clin Exp Pediatr. 2026;69(3):197-210. Published online February 25, 2026

Web of Science 1 Crossref 2

Kawasaki disease (KD) is an acute febrile vasculitis and the leading cause of acquired heart disease in children. Despite decades of research, the etiology remains unknown and key mechanisms linking systemic inflammation to coronary artery lesions are incompletely defined. High-throughput technologies—including genomics, transcriptomics, proteomics, metabolomics, epigenomics, and immunomics—have enabled systems-level profiling of KD and highlighted reproducible inflammatory and vascular pathways....

DOI: https://doi.org/10.3345/cep.2025.02901

Gastroenterology

Balancing therapeutic benefits and hidden risks of proton pump inhibitors in pediatric practice: a narrative review and update

Maria Rogalidou, Alexandra Papadopoulou

Clin Exp Pediatr. 2026;69(3):186-196. Published online February 25, 2026

Web of Science 1 Crossref 1

Proton pump inhibitors (PPIs) effectively treat acid-related disorders, including gastroesophageal reflux disease, eosinophilic esophagitis, peptic ulcers, and Zollinger-Ellison syndrome. Long-term use, particularly in children, may lead to microbiome alterations, nutrient deficiencies, infections, renal injury, osteoporosis, fractures, and other gastrointestinal changes. PPI therapy should be guided by clear clinical indications, prescribed at the lowest effective dose for the shortest necessary duration, and regularly reassessed to minimize risks in young children.

DOI: https://doi.org/10.3345/cep.2025.02761

Neurology

Sacral dimple: clinical perspectives of lesions hidden beneath the skin

Jin Eun, Kwan Sung Lee, Seung Ho Yang

Clin Exp Pediatr. 2026;69(2):103-113. Published online November 26, 2025

· Most sacral dimples are benign, but atypical features may indicate occult spinal dysraphism.
· Simple dimples meeting strict criteria require no imaging, whereas atypical dimples require targeted ultrasonography or magnetic resonance imaging.
· The early diagnosis and surgical management of highrisk cases prevents irreversible neurological, orthopedic, and urological deficits.

DOI: https://doi.org/10.3345/cep.2025.01802

General Pediatrics

Systematic review of influence of ethnicity on efficacy and safety of pharmacotherapy for childhood and adolescent obesity

Surendra Gupta, Purushottam Lal, Abhishek Gupta, Brajesh Raj Chaudhary

Clin Exp Pediatr. 2026;69(2):84-102. Published online January 26, 2026

Ethnic variations may influence the response of children and adolescents to obesity pharmacotherapy. Current evidence does not show consistent differences in efficacy or safety among ethnic groups; however, available data are limited. Larger, ethnically diverse trials are needed to develop personalized obesity treatment strategies.

DOI: https://doi.org/10.3345/cep.2025.02838

Gastroenterology

Ingestion of foreign bodies and caustic substances in children: a narrative review on clinical evaluation and management update

Maria Rogalidou

Clin Exp Pediatr. 2026;69(1):11-21. Published online December 10, 2025

Web of Science 4 Crossref 5

Foreign body and caustic substance ingestion in children aged 1–5 years can feature to severe and, sometimes life-threatening complications. High-risk items include batteries, magnets, and corrosive chemicals. Severity depends on object type, location, and ingestion timing. Prompt diagnosis and early endoscopic intervention are crucial. Individualized management, high clinical suspicion, and parental education are essential to improving outcomes and preventing immediate and long-term complications affecting a child’s quality of life.

DOI: https://doi.org/10.3345/cep.2025.01823

Endocrinology

Pubertal induction in prepubertal males with hypogonadotropic hypogonadism: testosterone or gonadotropins?

Paolo Cavarzere, Riccardo Battiston, Valentina Lupieri, Valentina Mancioppi, Claudio Maffeis

Clin Exp Pediatr. 2026;69(1):1-10. Published online December 18, 2025

Web of Science 1 Crossref 1

The pubertal induction process in males still poses a challenge for pediatric endocrinologists. The existing literature is limited, and it is not yet possible to make definitive recommendations. We described the various treatment for this condition and tried to analyze the unresolved questions to address the question posed in the title of our manuscript.

DOI: https://doi.org/10.3345/cep.2025.02355

Nutrition

Exploring nutritional screening tools for hospitalized children: a narrative review

Pankaj Soni, Amit Agrawal, Gaurav Jadon

Clin Exp Pediatr. 2025;68(12):963-970. Published online October 22, 2025

Web of Science 4 Crossref 4

Malnutrition is frequently identified in hospitalized children, and the use of nutritional screening tools is crucial for assessing their nutritional status during their hospital admission and stay. Common tools include the Pediatric Yorkhill Malnutrition Score, Screening Tool for Assessment of Malnutrition in Pediatrics, and Screening Tool for Risk of Nutritional Status and Growth. However, these tools have varying sensitivities and specificities, and none is recommended for all hospitalized children.

DOI: https://doi.org/10.3345/cep.2025.00633

Oncology

Breaking the barrier: a guidelines-based review of antiangiogenesis drug resistance in pediatric cancer therapy

Nader Shakibazad, Mahdi Shahriari, Mani Ramzi

Clin Exp Pediatr. 2025;68(12):952-962. Published online November 24, 2025

Web of Science 2 Crossref 1

Antiangiogenic therapy resistance in pediatric cancers involves alternative angiogenic pathways, microenvironmental support, hypoxia-driven signaling, metabolic reprogramming, and structural adaptations such as vascular co-option. Metabolic adaptation highlights tumor plasticity. Effective treatments combine immunotherapy with biomarkers. To address vascular endothelial growth factor limitations, emerging targets include hypoxia-inducible factor-2α, endoglin, CXCR4, angiopoietin/Tie2, and bispecific antibodies. In resource-constrained settings, the guidelines recommend low-dose chemotherapy plus oral multiantiangiogenic agents to ensure improved accessibility and treatment outcomes.

DOI: https://doi.org/10.3345/cep.2025.01809

Gastroenterology

Neonatal ichthyosis-sclerosing cholangitis syndrome caused by a novel CLDN1 mutation: a case report and literature review

Upasana Ghosh, Ankit Agrawal, Varunvenkat M. Srinivasan, Rani Manisha, Umesh Shukla, Vikas Jain, Mayank Nilay, Harish Kumar

Clin Exp Pediatr. 2025;68(11):858-867. Published online October 2, 2025

Crossref 2

· Neonatal ichthyosis-sclerosing cholangitis (NISCH) syndrome is a rare autosomal recessive disorder characterized by cholestasis and manifestations such as generalized ichthyosis, alopecia, and dental anomalies.
· The clinical features of NISCH syndrome are distinct and necessitate an early genetic diagnosis.
· The disease phenotype can vary significantly, ranging from no liver involvement and transient neonatal cholestasis to end-stage liver disease.
· Management requires a multidisciplinary approach with long-term follow-up.

DOI: https://doi.org/10.3345/cep.2025.00906

General Pediatrics

Bridging the gap: autism spectrum disorder in children in the United States and worldwide: a narrative review

Sandhya J. Kadam, Malika Goel

Clin Exp Pediatr. 2025;68(11):852-857. Published online October 2, 2025

Web of Science 2 Crossref 4

The prevalence of autism is increasing worldwide. The United States has the highest numbers, likely due to the availability of better treatment options. However, global disparities exist, especially in low-resource settings in which stigma, underdiagnosis, and limited services hinder care. A coordinated international approach emphasizing early screening, inclusive policies, and culturally sensitive support systems can bridge this gap and improve the outcomes for children with autism and their families worldwide.

DOI: https://doi.org/10.3345/cep.2025.00969

Endocrinology

Continuous glucose monitoring in Korean pediatric patients with type 1 diabetes: current landscape and clinical implications

Hwa Young Kim, Jaehyun Kim

Clin Exp Pediatr. 2025;68(11):842-851. Published online October 2, 2025

Web of Science 5 Crossref 5

Continuous glucose monitoring (CGM) has transformed pediatric type 1 diabetes care by facilitating tighter glycemic control, reducing hypoglycemia, and improving quality of life.
Recent advances in CGM technology and the expansion of insurance coverage in Korea have led to its broader adoption.
Emerging metrics such as time in tight range offer refined tools for individualized glycemic assessment, highlighting CGM’s evolving role in personalized pediatric diabetes management.

DOI: https://doi.org/10.3345/cep.2025.01522

General Pediatrics

Impact of screen exposure during pediatric ages including multifaceted aggravating factors: a literature review

Daniel González-Pérez, David Sebastián Huertas-Moreno, Manuela Granados-Pinilla, Sofía Hernandez-Rojas, Laura González-Rincon, Geraldine Hurtado-Garcia, Simón Grisales-Calle, María José González-Mariño, Luz Dary Gutierrez-Castañeda, Jhon Camacho-Cruz

Clin Exp Pediatr. 2025;68(10):751-760. Published online September 24, 2025

Web of Science 3 Crossref 2

Excessive screen time in children is linked to obesity, overweight, sedentary behavior, depression and mood disorders, myopia, behavioral changes, sleep disturbances, attention deficit hyperactivity disorder, among others. Polymorphisms in genes like FTO, CACNA1D, and DRD2 could further increase these risks. Implementing strategies such as limiting screen use, creating screen-free zones, and monitoring content is essential to mitigate adverse physical and mental health effects in the pediatric population.

DOI: https://doi.org/10.3345/cep.2025.00178

Infection

Recommendation for use of a long-acting monoclonal antibody to prevent respiratory syncytial virus infection in infants and young children

Soo-Han Choi, Dong Hyun Kim, Jong Gyun Ahn, Ki Wook Yun, Byung-Wook Eun, Jin Lee, Jina Lee, Taek-Jin Lee, Hyunju Lee, Dae Sun Jo, Eun Young Cho, Hye-Kyung Cho, Young June Choe, Ui Yoon Choi, Yun-Kyung Kim; The Committee on Infectious Diseases of the Korean Pediatric Society

Clin Exp Pediatr. 2025;68(10):742-750. Published online September 3, 2025

Web of Science 1 Crossref 2

To prevent respiratory syncytial virus (RSV)-associated lower respiratory tract infections, a single dose of nirsevimab, a long-acting monoclonal antibody, is recommended for all neonates born during the RSV season (October to March) and all infants younger than 6 months old at the start of the RSV season. Nirsevimab should be administered shortly after birth to neonates and just before or early in the season to infants entering their first RSV season.

DOI: https://doi.org/10.3345/cep.2025.01067

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 21 Crossref 32

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

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Review article