Clinical and Experimental Pediatrics

Original Article

Neonatology (Perinatology)

Validation of a new Japanese classification for predicting severe bronchopulmonary dysplasia in preterm infants

Masato Ito, Shinya Hirano, Fumihiko Namba

Clin Exp Pediatr. 2026;69(3):274-281. Published online January 20, 2026

Question: Can the revised Japanese classification predict severe bronchopulmonary dysplasia (BPD) early in preterm infants?
Finding: Small for gestational age and bubbly/cystic chest radiographic patterns were independently associated with severe BPD, and subtypes I and III showed particularly strong associations.
Meaning: This classification may facilitate early risk stratification and guide timely supportive strategies to prevent progression to severe BPD.

DOI: https://doi.org/10.3345/cep.2025.02642

Thrombocytopenia in preterm infants born to mothers with systemic lupus erythematosus: a retrospective cohort study

Ru Xue, Guoqing Zhang, Xiafang Chen, Jun Bu, Lanlan Mi, Fei Bei

Clin Exp Pediatr. 2026;69(3):266-273. Published online December 22, 2025

Question: What are the characteristics and clinical implications of thrombocytopenia in preterm neonates born to mothers with systemic lupus erythematosus?
Finding: Nearly one-third of preterm infants developed thrombocytopenia. Key modulators of this risk included gestational age, maternal hypertensive disorders of pregnancy, and hydroxychloroquine use. Thrombocytopenia may be associated with neonatal morbidity.
Meaning: Platelet count should be monitored during the first week of life, and infants should be assessed for potential complications.

DOI: https://doi.org/10.3345/cep.2025.01942

Allergy

Can a basophil activation test of cord blood predict a cow's milk allergy?

Dilara Fatma Kocacik Uygun, Durmuş Burgucu, Vedat Uygun, Gül Alkan Bulbul, Fulden Duyar, Cem Yasar Sahnal, Aysen Bingöl

Clin Exp Pediatr. 2026;69(3):257-265. Published online January 20, 2026

Question: Can a basophil activation test (BAT) of cord blood predict a cow's milk allergy?
Finding: Infants with a high casein-BAT value were more likely to develop food allergy symptoms in the first year, whereas cow’s milk BAT showed no predictive association.
Meaning: Cord blood casein BAT may help identify newborns at increased risk for early-life food allergies, enabling closer monitoring and preventive strategies, although larger studies are needed for validation.

DOI: https://doi.org/10.3345/cep.2025.01697

Other

Improvements in obesity-related measures among Asian patients with severe obesity following a structured lifestyle intervention

Pei-Shan Chen, Shu-Mei Tsai, Chih-Hsuan Chang, Hui-Ru Yang, Yen-Ju Huang, Hsiang-Yin Liu, Kai-Chi Chang, Huey-Ling Chen

Clin Exp Pediatr. 2026;69(3):247-256. Published online December 22, 2025

Question: How does obesity severity affect baseline fitness and improvements in key obesity-related measures following participation in a structured lifestyle modification program?
Finding: Severely obese youth showed poorer baseline physical fitness but greater improvements in key obesity-related measures following lifestyle interventions.
Meaning: Early targeted intervention may help prevent progression to more severe obesity and declines in physical fitness in patients with obesity.

DOI: https://doi.org/10.3345/cep.2025.01774

Hematology

Granulocyte transfusion improves survival in pediatric febrile neutropenia: a 15-year cohort study

Witsanu Phetsai, Kleebsabai Sanpakit, Jassada Buaboonnam, Kamon Phuakpet, Nassawee Vathana, Nattee Narkbunnam, Fon Kladed, Chayamon Takpradit

Clin Exp Pediatr. 2026;69(3):236-246. Published online January 12, 2026

Question: Does granulocyte transfusion improve survival and clinical recovery in pediatric febrile neutropenia?
Finding: In this 15-year real-world cohort, granulocyte transfusion significantly increased 30-day survival (92.3 % vs. 65.4%; adjusted odds ratio, 0.105; P=0.020) and accelerated fever and neutrophil recovery without serious adverse events.
Meaning: Granulocyte transfusion may be an effective adjunctive therapy for severe neutropenic infections in children, particularly in low- and middle-income settings.

DOI: https://doi.org/10.3345/cep.2025.01186

Nephrology (Genitourinary)

Discordance between antibiotic therapy and recurrent urinary tract infections in young children with third-generation cephalosporin-resistant infections

Yusin Kim, Hyun A Lee, Gil Lee, Kyungseok Park, Ye Kyung Kim, Peong Gang Park

Clin Exp Pediatr. 2026;69(3):228-235. Published online November 26, 2025

Question: Does completing a third-generation cephalosporin course, despite in vitro resistance, increase the early urinary tract infection recurrence rate in children?
Finding: Among 989 Korean children, discordant therapy increased the 2-month recurrence risk by 40% compared with concordant or susceptible therapy.
Meaning: Checking isolate susceptibility and switching to an active oral drug may curb recurrence and limit the use of broad-spectrum antibiotics.

DOI: https://doi.org/10.3345/cep.2025.01417

Gastroenterology

Longitudinal analysis of gut microbiota dysbiosis and bacterial signatures predictive of postoperative enterocolitis in children with Hirschsprung disease

Sireekarn Chantakhow, Chanon Kunasol, Jiraporn Khorana, Kanokkan Tepmalai, Nipon Chattipakorn, Siriporn C. Chattipakorn

Clin Exp Pediatr. 2026;69(3):214-227. Published online December 10, 2025

Question: Do gut microbiota differ between patients with Hirschsprung disease (HSCR) and healthy children, and can specific bacterial taxa predict postoperative HSCRassociated enterocolitis (HAEC)?
Finding: Patients with HSCR showed gut dysbiosis with reduced diversity. Postoperative microbial changes included increased alpha diversity. Certain taxa, such as Eubacterium and Collinsella, were associated with recovery or HAEC.
Meaning: Distinct microbial signatures may help identify HAEC risk and guide microbiota-based strategies to improve outcomes.

DOI: https://doi.org/10.3345/cep.2025.01886

Editorial

Neonatology (Perinatology)

Early prediction of bronchopulmonary dysplasia using new classification in high-risk preterm infants

Ga Won Jeon

Clin Exp Pediatr. 2026;69(3):211-213. Published online February 25, 2026

The definition of bronchopulmonary dysplasia (BPD) has continued to evolve. Recently, newer definitions based on respiratory support at 36 weeks’ postmenstrual age better predict long-term outcomes but diagnose BPD relatively late. To address this limitation, the New Japanese Classification uses early postnatal factors, including small for gestational age and bubbly or cystic chest radiographic findings, to predict severe BPD and enable early targeted interventions.

DOI: https://doi.org/10.3345/cep.2026.00143

Review Article

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

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

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

Clinical Note

Genetics and Metabolism

Happle-Tinschert syndrome in an infant: clinical, radiologic and genetic correlation

Belén Rodríguez-Sanchez, Francisco Javier Narbona-Cárceles, Jorge Martín-Nieto-González, Marina de la Puente-Alonso, Luis Zamarro-Díaz, Luis Jiménez-Briones, Julia Suárez-González, Francisco Arias-Lotto, Minia Campos-Domínguez

Clin Exp Pediatr. 2026;69(2):182-185. Published online January 20, 2026

DOI: https://doi.org/10.3345/cep.2025.02614

Original Article

General Pediatrics

Global and regional burden of neonatal disorders (preterm birth, encephalopathy, jaundice, and sepsis), 1990–2021 and projections to 2050

Yuseon Kang, Jeongseon Oh, Dongjin Yeo, Jaeyu Park, Sooji Lee, Na Yun Kim, Jungmin Park, Seung Ha Hwang, Tae Hyeong Kim, Dong Keon Yon

Clin Exp Pediatr. 2026;69(2):171-181. Published online October 30, 2025

Web of Science 1 Crossref 1

This study provides the first comprehensive estimated global burden of neonatal disorders attributable to risk factors in 1990–2021 stratified by sex, cause, sociodemographic index (SDI), and region. We identified persistent disparities across SDI levels, with low birthweight and short gestation contributing most to the age-standardized disability-adjusted life year rate of neonatal disorders. These findings highlight the urgent need for targeted context-specific interventions to reduce infant mortality and improve neonatal health equity.

DOI: https://doi.org/10.3345/cep.2025.01480

Associations of routine breakfast and napping habits with early adiposity rebound by age 3 years: a population-based cohort study in Japan

Toshifumi Yodoshi

Clin Exp Pediatr. 2026;69(2):163-170. Published online October 22, 2025

In a population‑based cohort of 74,466 children, 25% experienced early adiposity rebound (AR) by age 3. Daily breakfast and routine napping at 1.5 years were independently associated with lower odds of AR, while obesity at 1.5 years was a strong predictor. These modifiable routines could help delay AR and enable early identification during routine child health checks.

DOI: https://doi.org/10.3345/cep.2025.01998

Bifidobacterium animalis subsp. lactis BLa80 for preventing allergic, respiratory, and gastrointestinal diseases in young children in China: a randomized double-blind placebo-controlled trial

Ke Chen, Xi Zhang, Kaihong Zeng, Jiayi Zhong, Shanshan Jin, Yang Nie, Ping Yang, Nianyang He, Haixia Chen, Yanmei Cao, Yunrong Fu, Ziji Fang, Wei Jiang, Changqi Lium

Clin Exp Pediatr. 2026;69(2):150-162. Published online October 30, 2025

Question: Can probiotic BLa80 bring long-term benefits to the health of young children?
Finding: This trial demonstrated that the daily administration of s BLa80 at 5×109 colony-forming units for 3 months in children can reduce the risk of eczema, upper respiratory tract infections, and acute tracheitis/bronchitis as well as beneficially improve the gut microbiome without any adverse effect.
Meaning: Bla80 can bring definite health benefits to young children.

DOI: https://doi.org/10.3345/cep.2025.01256

Critical Care Medicine

Telemedicine outcome of mechanically ventilated children in Brazilian pediatric intensive care units

Aristóteles de Almeida Pires, Luciano Remião Guerra, João Ronaldo Mafalda Krauzer, Luciane Gomes da Cunha, Mariana Motta Dias da Silva, Vanessa Cristina Jacovas, Hilda Maria Rodrigues Moleda Constant, Taís de Campos Moreira, Paulo Márcio Pitrez, Felipe Cezar Cabral

Clin Exp Pediatr. 2026;69(2):140-149. Published online October 23, 2025

Question: Telemedicine interventions in Brazilian public pediatric intensive care units effectively address the challenges related to specialized care provision in resource-limited settings.
Finding: The implementation of telemedicine significantly reduced overall mortality rates among mechanically ventilated children (from 20.7% to 10.4%) and increased ventilator-free days from 3 (interquartile range, 0–7) to 4 (interquartile range, 2–8) days.
Meaning: These findings support telemedicine as a viable strategy for enhancing pediatric critical care in public health systems, particularly by improving patient outcomes.

DOI: https://doi.org/10.3345/cep.2025.01270

Nephrology (Genitourinary)

Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices

Nuanpan Penboon, Pornpimol Rianthavorn

Clin Exp Pediatr. 2026;69(2):130-139. Published online October 23, 2025

Question: In children with proliferative lupus nephritis, do National Institutes of Health-modified indices and treatment choices predict long-term kidney function?
Finding: Higher chronicity index scores, especially tubular atrophy and interstitial fibrosis, predicted kidney impairment. Additionally, the use of mycophenolate mofetil (MMF) for maintenance therapy was associated with a lower risk of kidney function decline.
Meaning: The early recognition of chronic lesions and MMF-based maintenance therapy may improve kidney outcomes in childhood-onset lupus nephritis.

DOI: https://doi.org/10.3345/cep.2025.01277

Gastroenterology

Progression from acute to chronic pancreatitis in children: a systematic review and meta-analysis

Endre Botond Gagyi, Mahmoud Obeidat, Edina Tari, Szilárd Váncsa, Dániel Sándor Veres, Peter Banovcin, Péter Jenő Hegyi, Péter Hegyi, Bálint Erőss

Clin Exp Pediatr. 2026;69(2):117-129. Published online December 4, 2025

Approximately 1 in 5 children with acute pancreatitis develops recurrent attacks, and over one-third of such cases progress to chronic pancreatitis. Progression is closely linked to genetic mutations, particularly PRSS1, and anatomical abnormalities, whereas demographic and routine clinical factors lack predictive value. These results support early genetic and anatomical assessments, enabling targeted follow-ups and timely interventions in highrisk pediatric patients.

DOI: https://doi.org/10.3345/cep.2025.01879

Editorial

Neurology

Tocilizumab as a key therapeutic option in high-risk pediatric acute necrotizing encephalopathy

Jon Soo Kim

Clin Exp Pediatr. 2026;69(2):114-116. Published online January 26, 2026

· Acute necrotizing encephalopathy (ANE) is a severe, infection- triggered encephalitis driven primarily by cytokine- mediated immune dysregulation rather than direct viral cytotoxicity.
· Tocilizumab, through targeted inhibition of interleukin-6 signaling, is an important therapeutic option for ANE that may improve survival and neurological outcomes of high-risk pediatric patients.

DOI: https://doi.org/10.3345/cep.2026.00073

Review Article

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

Guideline

Infection

Recommendation for use of 15- and 20-valent pneumococcal conjugate vaccines in Korean infants and children

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

Clin Exp Pediatr. 2026;69(1):76-83. Published online December 30, 2025

Compared to PCV13, PCV15 includes 2 (22F and 33F), and PCV20 includes 7 (8, 10A, 11A, 12F, 15B, 22F, and 33F) additional serotypes. The vaccination schedule remains the same: primary doses at 2, 4, and 6 months, and a booster at 12–15 months. If PCV13 was administered in the primary series, PCV15 and PCV20 may be used to complete it or as a booster.

DOI: https://doi.org/10.3345/cep.2025.01900

Clinical Note

Neonatology (Perinatology)

External tracheal compression and mucosal injury in a neonate with cervical teratoma: a rare airway challenge

Rhodora Guillen, Arijit Lodha, Prashanth Murthy

Clin Exp Pediatr. 2026;69(1):73-75. Published online December 4, 2025

DOI: https://doi.org/10.3345/cep.2025.02299

Original Article

Other

Comparing ethyl chloride and 10% lignocaine spray for pediatric intravenous cannulation pain relief

Susmitha Vellanki, Malavika Kulkarni, H.D. Arun Kumar, Deepali Shetty, Nikhil Karthik B, Mathew Tom

Clin Exp Pediatr. 2026;69(1):65-72. Published online November 21, 2025

Background: Intravenous cannulation (IVC) is a routine yet distressing procedure in pediatric patients, often provoking significant anxiety and procedural pain. Although eutectic mixtures such as eutectic mixture of local anesthetic cream are widely used, their delayed onset limits their applicability in time-sensitive settings. Ethyl chloride vapocoolant spray and 10% lignocaine spray have been proposed as rapid-onset alternatives, yet direct comparative...

DOI: https://doi.org/10.3345/cep.2025.00010

Critical Care Medicine

High-dose methylprednisolone and tocilizumab improve survival of patients with high-risk pediatric acute necrotizing encephalopathy

Chaonan Fan, Fei Li, Kechun Li, Zheng Li, Yiyang Mao, Lijuan Wang, Gang Liu, Yingchao Liu, Quan Wang, Suyun Qian

Clin Exp Pediatr. 2026;69(1):56-64. Published online October 22, 2025

Web of Science 1 Crossref 1

Question: Which immunomodulatory strategies can reduce mortality in children with acute necrotizing encephalopathy (ANE)?
Finding: High-dose methylprednisolone (30 mg/kg/day) significantly improved the survival of high-risk patients, particularly when combined with tocilizumab.
Meaning: These findings support the use of a severity-based immunotherapy approach to optimize the outcomes of pediatric ANE.

DOI: https://doi.org/10.3345/cep.2025.01431

Rheumatology

Recurrent immunoglobulin A vasculitis in children and adolescents: prevalence and associated risk factors

Nootsara Atchariyaphuk, Maynart Sukharomana, Thanaporn Chaiyapak, Sirirat Charuvanij

Clin Exp Pediatr. 2026;69(1):46-55. Published online October 22, 2025

Question: What can predict immunoglobulin A vasculitis (IgAV) recurrence, and when does it occur? How do childhood- and adolescent-onset IgAV compare?
Finding: The IgAV recurrence rate was 35.6%. It usually occurred within 12 months and was associated with corticosteroids treatment.
Meaning: Childhood-onset IgAV more commonly featured gastrointestinal and musculoskeletal manifestations and required hospitalization. Adolescent-onset IgAV more commonly featured renal involvement. Vigilant monitoring for recurrence is necessary, particularly with corticosteroids treatment.

DOI: https://doi.org/10.3345/cep.2025.01158

Allergy

Maternal sleep disorders during pregnancy and subsequent risk of allergic diseases in Japanese children: the TMM BirThree Cohort Study

Ami Uematsu, Masatsugu Orui, Mami Ishikuro, Keiko Murakami, Aoi Noda, Genki Shinoda, Taku Obara, Shinichi Kuriyama

Clin Exp Pediatr. 2026;69(1):36-45. Published online October 22, 2025

Web of Science 1 Crossref 1

Question: Associations have been made between maternal sleep disorders during pregnancy and allergic diseases including bronchial asthma, atopic dermatitis, food allergy, and allergic conjunctivitis/rhinitis/hay fever in their children.
Finding: In the crude model, sleep disorders during pregnancy were associated with all examined allergic diseases in children. After adjustment, significant associations remained for atopic dermatitis and allergic conjunctivitis/rhinitis/hay fever.
Meaning: The study highlights associations between maternal sleep and child allergic diseases.

DOI: https://doi.org/10.3345/cep.2025.01165

Gastroenterology

Gut microbiota and metabolomic alterations in newborns of mothers with gestational diabetes mellitus

Wan-Hsin Su, Yi-Wei Wang, Chien-Chang Chen, Ming-Wei Lai, Hsun-Chin Chao, Ming-Chou Chiang, Ren-Huei Fu, Pai-Jui Yeh

Clin Exp Pediatr. 2026;69(1):26-35. Published online October 22, 2025

Question: Does maternal gestational diabetes mellitus (GDM) affect newborn gut microbiota and metabolomic profiles?
Finding: Neonates born to mothers with diet-controlled GDM exhibited reduced gut microbiota α-diversity, altered β-diversity, and metabolic shifts, including changes in fumarate and succinate levels, with peroxisome proliferator-activated receptor and adipocytokine signaling pathway activation.
Meaning: Maternal GDM affects early microbial colonization and metabolism in newborns and may have long-term health implications.

DOI: https://doi.org/10.3345/cep.2025.01074

Editorial

Allergy

Prioritizing maternal sleep: a public health strategy for preventing childhood allergic diseases

Eunchae Lee, Seohyun Hong, Dong Keon Yon

Clin Exp Pediatr. 2026;69(1):22-25. Published online December 18, 2025

Sleep disorders affect more than half of pregnancies worldwide and can harm maternal health and offspring outcomes. Prioritizing maternal sleep as a public health strategy may help prevent prenatal and pediatric allergic diseases and reduce their burden. Other maternal health strategies may also reduce the burden of offspring allergic diseases, while adequate maternal sleep is associated with other offspring outcomes, underscoring its importance as a key public health strategy.

DOI: https://doi.org/10.3345/cep.2025.01718

Review Article

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

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

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

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