"Most downloaded" Articles are from the articles published in 2022 during the last six months.
· Most commonly confirmed causes of community-acquired pneumonia (CAP) in children are Mycoplasma pneumoniae (8%–40%) and respiratory syncytial virus (15%–20%). · Pyogenic bacteria, most commonly Streptococcus pneumoniae (40%–50%) and Streptococcus pyogenes (10%–25%), are detected in 2%–5% of children hospitalized with CAP. · CAP should be diagnosed conservatively according to clinical and radiological criteria. · The etiology should be identified via appropriate test result interpretation. |
· Neonatal seizures are often electrographic-only seizures without clinical signs; therefore, the identification of electrical seizure activity on electroencephalography is the gold standard for diagnosis. · Clinical signs of neonatal seizures are divided into motor or nonmotor seizures, and motor seizures are mostly focal or multifocal. · Most neonatal seizures are caused by acute symptomatic etiologies, but in cases of intractable seizures, structural, genetic, or metabolic etiologies should be investigated. |
· Dendritic, regulatory T, and regulatory B cells significantly contribute to the natural course of food allergy. · Cow’s milk and hen’s egg allergies tend to resolve in earlier childhood but recent studies show that 50% of patients still persist into school age. · The potential factors affecting the natural course of food allergy are age at diagnosis, symptom severity, sensitization status and its change rate, and external factors such as diet and interventions. · There is a considerable possibility of food allergy outgrow if specific IgE levels are 2–5 kUA/L or less, but other factors such as age and recent symptoms should be considered together. · With a clear understanding of the natural course of food allergy, pediatricians can provide appropriate assessment and interventions to our patients, and consequently can help patients overcome their food allergy and improve the social safety net. |
· Inflammatory responses accompanying fever increase neuronal excitability in the central nervous system, which in turn provokes seizures. · Fever in children with febrile seizures is usually caused by common respiratory viruses, the distributions of which match those of seasonal community-acquired respiratory tract infections. · Several genetic variations in ion channels seem associated with neuronal hyperexcitability in children with febrile seizures. |
· Primary pediatricians should play a key role in the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). · The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has lowered the diagnostic threshold for older teens and adults and a comorbid diagnosis with autism is now allowed. · The American Academy of Pediatrics had added recommendation-related comorbid conditions in its guideline and the Society of Developmental and Behavioral Pediatrics recently developed a complex ADHD guideline. · The European ADHD Guideline Group recently developed a guideline for managing ADHD during the coronavirus disease 2019 pandemic. |
· 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. |
SpO2/FiO2 ratio ≤166, pediatric respiratory rate-oxygenation index <132, and clinical respiratory score ≥6 at 12 hours after high-flow nasal cannula (HFNC) initiation were useful bedside predictors for HFNC failure in pediatric patients. |
· Oral immunotherapy should be supervised by pediatricians with experience administering oral food challenge tests and managing allergic reactions. · Food allergen intake is gradually increased and maintained for years. · Patients may experience allergic reactions and psychological problems. · Adjunctive therapies (biologics, antihistamines, and leukotriene receptor antagonists) may improve efficacy and safety. · Contraindications include uncontrolled asthma, malignancy, active autoimmune disorders, and beta-blocker usage. |
· Congenital hearing loss is common, with an approximate incidence of 1.5 per 1,000 newborns and affecting 1.2%–11% of preterm and 1.6%–13.7% of neonatal intensive care unit neonates. · Etiologies vary, and up to 80% of cases are genetic. · Newborn hearing screenings follow the 1-3-6 rule, and babies at high risk of hearing loss should be referred to otolaryngology for early detection and timely intervention. |
Despite worldwide acceptance of acetaminophen (paracetamol) in pediatric medicine, careful examination reveals no valid objections to the conclusion that early exposure to acetaminophen causes neurodevelopmental injury in susceptible babies and children. Nevertheless, debate that early exposure to acetaminophen causes neurodevelopmental injury has centered around the prenatal period, evidence of which is relatively limited compared to that in the postnatal period, which is the time of greatest absolute and relative risk. |
· X-linked hypophosphatemia (XLH), the most common cause of hypophosphatemic rickets, affects 1/20,000 people. · XLH is caused by a loss-of-function mutation of the PHEX gene. · Its main pathogenesis is elevated fibroblast growth factor-23 (FGF23) level. · Burosumab, an FGF23 inhibitor, was developed in the early 2000s. · Burosumab was approved in Korea in 2020 for XLH patients aged 1+ years with radiographic evidence of bone disease. |
· Current definitions of long coronavirus disease (COVID) in children and adolescents vary in duration, ranging from 4 to 12 weeks or more. · The clinical spectrum of long COVID in children and adolescents comprises a wide range of symptoms and might be a multisystem disorder. · Persistent health problems with a prevalence of 1%–66.5% were reported in children and adolescents after COVID-19, with a higher incidence of persistent single or multiple symptoms. |
The identification of the causative pathogens of community-acquired pneumonia and appropriate treatment and prevention can reduce mortality and the socioeconomic burden by reducing the medical expenses. The world has been in the coronavirus disease 2019 pandemic since 2020, and there is always a risk of continuous emergence and epidemic of new respiratory infectious diseases. Therefore, it is important to sustain a monitoring system for respiratory infectious diseases including pneumonia. |
An accurate diagnosis depends on correct history taking and its interpretation. An in-depth understanding of the symptoms of syncope in connection with its pathophysiology can lead to avoiding critical pitfalls in the diagnostic process of history taking. |
· Anorectal manometry is safe in children. · Defecation Dyssynergia is one of the commonest cause of chronic constipation. · Positive Rectoanal inhibiory reflex rules out Hirschsprung's Disease |
· Pediatric small intestinal bacterial overgrowth (SIBO) manifestations range from nonspecific abdominal symptoms to malabsorption or malnutrition. · SIBO is prevalent in children and adolescents with functional abdominal pain disorders. · Predisposing factors include disturbed intestinal motility, altered anatomy, and/or abnormal body defense systems against intestinal bacteria. · Breath tests are safe and noninvasive. · Treatment principles include managing predisposing conditions, nutritional support, symptom control, and antibiotics. |
· Eosinophilic gastrointestinal disease (EGID) is uncommon, with a prevalence of 1–30/100,000 in the general population; however, it is increasing worldwide. · The diagnosis of EGID is based on histopathological findings of endoscopic mucosal biopsy in which tissue eosinophils are counted in each gastrointestinal tract segment of patients with chronic or recurrent gastrointestinal symptoms. · Individualized treatment strategies, including adequate dietary and pharmacological therapy, may help improve outcomes of children with EGID. |
· Spontaneous movements can be useful to evaluate neuronal integrity in preterm infants. · In General Movements Assessment, continuous cramped synchronized movements and absent fidgety movements can indicate high-risk infants for cerebral palsy. · Recent advances in machine learning techniques have led to the automated prediction of cerebral palsy based on infantile spontaneous movements. |
· Atopic dermatitis (AD) is characterized by a strong T helper (Th)2 response, although the extents of Th22, Th17/ interleukin (IL)-23, and Th1 responses vary among disease subtypes. · Children with moderate to severe AD may require early systemic therapy to reduce the systemic inflammation caused by increased Th2 cytokine levels. · Dupilumab, which blocks IL-4/IL-13 receptor, has equivalent efficacy for extrinsic and intrinsic AD and a favorable safety profile in infants and children aged 6 months and older. |
Question: What is the ideal initiation timing of parenteral nutrition for critically ill children? Finding: This randomized clinical trial of 140 children examined the effects of an early or late start of parenteral nutrition on mechanical ventilation need (primary outcome) and length of stay and mortality (secondary outcomes). Meaning: Children who received early versus late parenteral nutrition had lower mechanical ventilation need and duration. |
· Chronic liver diseases in children are heterogenous but converge in the common pathway of fibrosis. · Much of the literature on mechanisms of fibrogenesis focus on adults but pediatric physiology has documented differences. · Understanding of these distinctions are necessary to define, treat, and prevent fibrosis. · Current management of liver fibrosis relies heavily on liver biopsy. Multiple tools have shown high diagnostic performance in pediatric and adult populations. Large, multicenter studies are needed for validation. |
∙ The main pathogen for benign convulsions with mild gastroenteritis (CwG) was previously rotavirus; however, cases associated with norovirus are increasing. ∙ CwG is characterized by clustered generalized seizures. Electroencephalography and magnetic resonance imaging show transiently abnormal findings in the acute phase that eventually normalize with progression. Its prognosis is good, and long-term treatment is unnecessary. ∙ There are many reports on the pathophysiological mechanism of CwG, which remains unclear. |
· Clinical studies of coronavirus disease 2019 (COVID-19) in infants should be supported by rigorous laboratory diagnostic criteria. · Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads to infants similarly to other viral respiratory infections. · Among infants ≤1 year of age beyond the immediate postpartum period, COVID-19 is relatively mild, but even the low risk of severe disease requires prevention. · Comorbidities increase infection vulnerability and complications in infants. · Clinical and laboratory data do not sufficiently distinguish COVID-19 from other respiratory viral infections. · Coinfection with SARS-CoV-2 is uncommon among infants. · Unique infection sequelae, including multi-inflammatory syndrome in children and neonates and long COVID require further study and refinement of diagnostic criteria. · Infection control standards applied to mother-infant dyads should be tempered by standard preventive strategies, maternal input, accommodation potential, and overall safety. · Maternal vaccination prevents disease in early infancy. |
· Systemic autoinflammatory disorders (SAID) are disorders caused by dysregulation of the innate immunity with genetic background, leading to recurrent episodes of systemic inflammation. · SAID is characterized by recurrent acute inflammatory responses including fever or skin manifestations, unrelated with infection or malignancy. · Diagnosis is based on family and long-term history with detailed clinical and laboratory manifestations during febrile periods. |
There have been global tri-phasic epidemic periods of retinopathy of prematurity (ROP). In recent years, its incidence has reportedly been 10%–40% depending on country and study population. Current treatment strategies for ROP include laser photocoagulation, surgical treatment, and anti-vascular endothelial growth factor treatment, the role of which has drawn attention in recent years. |
Question: What are the risk factors for prolonged diarrhea in children under 2 years old? Finding: History of antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin levels were the main risk factors of prolonged diarrhea in children under 2 years old with acute diarrhea. Meaning: Rational antibiotic usage is necessary as well as thorough testing of serum zinc level and fecal alpha-1 antitrypsin levels. |
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. |
· 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. |
· Intussusception, the most common cause of small bowel obstruction in young children, has an overall incidence in Korea of 28.3 cases per 100,000 person-years. · Its cause is idiopathic inmost cases, although viral or bacterial gastroenteritis has beenpostulated as a cause. Approximately 4% of children have pathological lead points for intussusception, and Meckel’s diverticulum is the most common cause. · Intussusception in preterm infants is extremely rare. Older children (>5 years of age) are at increased risk of pathological lead points. |
Question: This is the first meta-analysis to examine published evidence of the effectiveness of virtual reality at reducing pain during pediatric intravenous injections. Finding: Our results suggest that virtual reality effectively reduces pain associated with intravenous injections in pediatric patients. Meaning: These findings suggest the importance of virtual reality in decreasing the pain of intravenous injections among children. |