Clinical and Experimental Pediatrics

Original Article

Cardiology

Vasovagal syncope with mild versus moderate autonomic dysfunction: a 13-year single-center experience

Han Eoul Lee, Dong Won Lee

Clin Exp Pediatr. 2022;65(1):47-52. Published online June 1, 2021

Question: It is well known that autonomic dysfunction contributes to vasovagal syncope (VVS). Does the degree of autonomic dysfunction contribute to clinical manifestations, diagnostic methods, treatment, and prognosis?
Finding: The clinical manifestations, diagnostic methods, treatment, and prognosis differ between patients with mild and moderate degrees of autonomic dysfunction.
Meaning: VVS is caused by autonomic dysfunction, but autonomic dysfunction severity need not be classified.

DOI: https://doi.org/10.3345/cep.2021.00052

Editorial

Nephrology (Genitourinary)

Obesity and chronic kidney disease: what should pediatric nephrologists know?

Jung Won Lee

Clin Exp Pediatr. 2021;64(10):521-522. Published online June 1, 2021

Web of Science 1 Crossref 1

• Obesity is not only a comorbidity of hypertension, it may be a riskfactorfor chronickidneydisease.
• Renal impairment associated with obesity is believed to start early in childhood and continue into adulthood, implying a higher risk of adverse cardiovascular events.
• The identification of kidney injury, implementation of preventive strategies, and prompt treatment are essential to improving clinical outcomes in obese children with early kidney disease.

DOI: https://doi.org/10.3345/cep.2021.00556

Review Article

Infection

School closures during the coronavirus disease 2019 outbreak

Eun Young Cho, Young June Choe

Clin Exp Pediatr. 2021;64(7):322-327. Published online May 31, 2021

Web of Science 4 Crossref 6

· Earlier modeling studies of the effects of school closures on severe acute respiratory syndrome coronavirus 2 were largely derived from the pandemic influenza model, resulting in conflicting implications.
· Observational findings suggest no clear effect of school closures on community transmission or overall mortality.
· School closures must be weighed against potential high social costs, which can also negatively affect children’s health.

DOI: https://doi.org/10.3345/cep.2021.00353

Oncology

Update on infantile hemangioma

Hye Lim Jung

Clin Exp Pediatr. 2021;64(11):559-572. Published online May 26, 2021

Web of Science 38 Crossref 40

· Infantile hemangiomas (IHs) are the most common benign vascular tumors, occurring in 5%–10% of infants.
· IHs are characteristically not present at birth but are usually diagnosed at 1–4 weeks of age, rapidly proliferate until 5 months of age, and then spontaneously involute.
· High-risk IHs (10%) require early treatment from 1 month of age.
· Oral propranolol, a nonselective beta-blocker, is the first-line treatment for IHs.

DOI: https://doi.org/10.3345/cep.2020.02061

Original Article

Pulmonology

Modified high-flow nasal cannula for children with respiratory distress

Sarocha Itdhiamornkulchai, Aroonwan Preutthipan, Jarin Vaewpanich, Nattachai Anantasit

Clin Exp Pediatr. 2022;65(3):136-141. Published online May 24, 2021

Question: Can the modified high-flow nasal cannula (HFNC) provide alternative respiratory support for children with acute respiratory distress?
Finding: A total of 74 patients were assigned to the modified or commercial HFNC groups. The intubation rate, length of hospital stay, and adverse events did not differ between the 2 groups.
Meaning: The modified HFNC can provide alternative respiratory support for pediatric respiratory distress.

DOI: https://doi.org/10.3345/cep.2020.01403

Review Article

Neurology

Cognitive outcomes in late childhood and adolescence of neonatal hypoxic-ischemic encephalopathy

Bo Lyun Lee, Hannah C. Glass

Clin Exp Pediatr. 2021;64(12):608-618. Published online May 24, 2021

Web of Science 42 Crossref 42

∙ Cognitive impairments occur in children with hypoxic-ischemic encephalopathy (HIE) even without neuromotor deficits.
∙ Therapeutic hypothermia has improved neurodevelopmental outcomes of children with HIE; however, 40% of children remain at risk of death/disability or cognitive impairments necessitating the development of adjunctive neuroprotective therapies.
∙ Long-term follow-up until adolescence is required to identify cognitive dysfunction.
∙ A pattern of watershed injury on brain imaging is associated with poor cognitive outcomes.

DOI: https://doi.org/10.3345/cep.2021.00164

Original Article

Emergency Medicine

Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center study

Meraj Siddiqui, Ayşe Gültekingil, Oğuz Bakırcı, Nihal Uslu, Esra Baskın

Clin Exp Pediatr. 2021;64(7):364-369. Published online May 18, 2021

Web of Science 12 Crossref 10

Question: What are the differences between coronavirus disease 2019 (COVID-19) and influenza infections in children?
Finding: Pediatric COVID-19 patients predominantly exhibited respiratory and/or gastrointestinal symptoms, neurological manifestations, olfactory/gustatory dysfunction, elevated monocytes, mildly elevated C-reactive protein, and unilateral or diffuse abnormalities on chest x-ray. Patients with underlying medical conditions had higher intensive care unit admission rates and should be followed closely.
Meaning: The clinical presentations of pediatric COVID-19 patients varied from asymptomatic/mild to severe.

DOI: https://doi.org/10.3345/cep.2021.00066

Review Article

Nutrition

Changes in health status of North Korean children and emerging health challenges of North Korean refugee children

Seong-Woo Choi

Clin Exp Pediatr. 2021;64(11):552-558. Published online May 17, 2021

Web of Science 2 Crossref 2

· Among North Korean refugee (NKR) children under 5 years, 61% and 9.3% were underweight in 1998 and 2017, respectively.
· The immunization rate of NKR children exceeded 90% since 2006.
· For NKR children, protein-energy malnutrition was the #1 cause of death in 2009 versus #17 in 2019.
· In 2020, stunting affected 5.4% and 0.9% and obesity affected 10.7% and 2.7% of NKR versus South Korean children, respectively.

DOI: https://doi.org/10.3345/cep.2021.00192

Letter to the Editor

General Pediatrics

Hyperinflammatory syndrome in children during the coronavirus disease 2019 pandemic in sub-Himalayan region

Seema Sharma, Shikha Verma, Isha Bhatia, Ravinder Singh, Mohit Bajaj, Milap Sharma

Clin Exp Pediatr. 2021;64(7):370-372. Published online May 11, 2021

Question: Is there an increase in patients with hyperinflammatory syndrome during the coronavirus disease 2019 pandemic?
Finding: We found 10 patients with hyperinflammatory syndrome with poor outcome during a period of 2 months in a single tertiary care centre.
Meaning: Pediatricians who come across patients with muco cutaneous manifestations and multiorgan involvement should consider hyperinflammatory syndrome. Early recognition and prompt treatment of such patients may result in promising outcome.

DOI: https://doi.org/10.3345/cep.2020.02040

Original Article

General Pediatrics

Effect of maternal and child factors on stunting: partial least squares structural equation modeling

Agus Santosa, Essa Novanda Arif, Dinal Abdul Ghoni

Clin Exp Pediatr. 2022;65(2):90-97. Published online May 4, 2021

Web of Science 18 Crossref 24

Question: What effects do maternal and child factors have on stunting? Are there significant indicators of stunting?
Finding: Child and maternal factors had 49.8% and 30.3% effects on stunting, respectively. The primary child factor was infant formula dose, while the primary maternal factor was nutritional status.
Meaning: More attention to nutritional status during pregnancy and ensuring the appropriate dose of infant formula at ages 6–24 months can prevent stunting.

DOI: https://doi.org/10.3345/cep.2021.00094

Editorial

Immunology

Importance of neonatal screening for primary immunodeficiencies

Jung Woo Rhim

Clin Exp Pediatr. 2021;64(10):519-520. Published online May 4, 2021

Web of Science 4 Crossref 4

· Early detection of asymptomatic infants with primary immunodeficiencies before the onset of infections enables effective treatment and intervention to prevent serious sequelae.
· T-cell receptor excision circles and kappa-deleting recombination excision circles have recently been used to detect T- or B-cell lymphopenia in neonates.

DOI: https://doi.org/10.3345/cep.2021.00283

Infection

Babies born to mothers positive for SARS-CoV-2 – Are they in danger?

Joon Kee Lee

Clin Exp Pediatr. 2021;64(6):280-281. Published online May 4, 2021

Concerns have arisen in the coronavirus disease 2019 (COVID-19) pandemic upon pregnancy and postnatal care starting from reproductive decision-making. To the utmost knowledge, reproductive decisions should not be based primarily on health-related COVID-19 concerns, as the possibility of vertical transmission is negligible and the perinatal outcome is generally not poor compared to pregnancies without COVID-19, as long as infection control measures are well kept.

DOI: https://doi.org/10.3345/cep.2021.00276

Endocrinology

Pediatricians must consider familial environment when diagnosing and managing childhood obesity

Young Suk Shim

Clin Exp Pediatr. 2022;65(1):31-32. Published online April 19, 2021

•The prevalence of childhood obesity is increasing worldwide, including in the Republic of Korea, creating a major public healthissue.
•Accumulated evidence indicates a strong relationship between parentalandchildobesity.
•A family-based approach is indicated to prevent and manage childhoodandadultobesity.

DOI: https://doi.org/10.3345/cep.2021.00318

Original Article

Endocrinology

Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis

Azam Maleki, Saeid Bashirian, Ali Reza Soltanian, Ensiyeh Jenabi, Abdollah Farhadinasab

Clin Exp Pediatr. 2022;65(2):85-89. Published online April 15, 2021

Web of Science 8 Crossref 9

Question: Have polycystic ovary syndrome (PCOS) increased risk of having an offspring with attention-deficit/hyperactivity disorder (ADHD)?
Finding: Six articles (3 cohort and 3 case-control studies; 401,413 total ADHD cases) met the study criteria. Maternal PCOS was associated with an increased risk of ADHD in the offspring based on odds ratio (OR) and relative ratio (RR) (OR, 1.42; 95% confidence interval [CI], 1.27–1.57) and (RR, 1.43; 95% CI, 1.35–1.51), respectively.
Meaning: Our study showed that maternal PCOS is a risk factor for ADHD.

DOI: https://doi.org/10.3345/cep.2021.00178

Review Article

Infection

Effects of nasopharyngeal microbiota in respiratory infections and allergies

Hyun Mi Kang, Jin Han Kang

Clin Exp Pediatr. 2021;64(11):543-551. Published online April 15, 2021

Web of Science 17 Crossref 17

· The nasal microbiota varies with age and is shaped by various factors in healthy individuals.
· The pathological condition of the respiratory tract appears to be associated with reduced nasal microbiota biodiversity, while dysbiosis is involved in the pathophysiology of many respiratory diseases, including otitis, sinusitis, allergic diseases, and lower respiratory infections.

DOI: https://doi.org/10.3345/cep.2020.01452

Original Article

General Pediatrics

Efficacy of probiotics for managing infantile colic due to their anti-inflammatory properties: a meta-analysis and systematic review

Reza Shirazinia, Ali Akbar Golabchifar, Mohammad Reza Fazeli

Clin Exp Pediatr. 2021;64(12):642-651. Published online April 12, 2021

Web of Science 7 Crossref 8

Question: Do probiotics reduce colic symptoms?
Finding: Probiotics reduced colic symptoms in colicky infants probably due to the anti-inflammatory properties.
Meaning: Probiotics may be an effective and less noxious way to manage infantile colic.

DOI: https://doi.org/10.3345/cep.2020.01676

Review Article

Nephrology (Genitourinary)

Obesity and chronic kidney disease: prevalence, mechanism, and management

Hyung Eun Yim, Kee Hwan Yoo

Clin Exp Pediatr. 2021;64(10):511-518. Published online April 6, 2021

Web of Science 28 Crossref 28

· Obesity is strongly associated with the development and progression of chronic kidney disease.
· Altered renal hemodynamics, metabolic effects, and lipid nephrotoxicity may play a key role in the development of obesity-related kidney disease.
· Children born to obese mothers are at increased risk of developing obesity and chronic kidney disease later in life.
· A multilevel approach is needed to prevent obesity and related chronic diseases.

DOI: https://doi.org/10.3345/cep.2021.00108

Original Article

General Pediatrics

Global relationship between parent and child obesity: a systematic review and meta-analysis

Ju Suk Lee, Mi Hyeon Jin, Hae Jeong Lee

Clin Exp Pediatr. 2022;65(1):35-46. Published online March 29, 2021

Web of Science 40 Crossref 48

Question: Are parent and child obesity correlated worldwide?
Finding: Overweight and obese status of parents and children were significantly associated worldwide. The association between parent and child obesity was stronger in Asia than in Europe and the Middle East, and in high-income than in middle- and low-income countries.
Meaning: Childhood obesity is highly influenced by parental weight status, indicating that parents could play an important role in its prevention.

DOI: https://doi.org/10.3345/cep.2020.01620

Review Article

Immunology

Modern diagnostic capabilities of neonatal screening for primary immunodeficiencies in newborns

Evgenia Olegovna Khalturina, Natalia Dmitrievna Degtyareva, Anastasiia Vasi’evna Bairashevskaia, Alena Valerievna Mulenkova, Anna Vladimirovna Degtyareva

Clin Exp Pediatr. 2021;64(10):504-510. Published online March 25, 2021

Web of Science 3 Crossref 3

· Neonatal screening for primary immunodeficiency diseases (PIDs) enables early diagnosis and subsequent initiation of therapy.
· Excision of T-cell receptors and kappa-recombination excision circles are cheaper alternative PID screening methods.
· Sanger DNA sequencing remains the reference method for detecting PID; however, next-generation sequencing technology is increasingly used to diagnose it.
· Here we developed a graphical algorithm for diagnosing primary immunodeficiency syndrome based on modern methods of screening for primary immunodeficiencies in newborns.

DOI: https://doi.org/10.3345/cep.2020.01270

Original Article

Other

Spatial modeling of mortality from acute lower respiratory infections in children under 5 years of age in 2000–2017: a global study

Ali Almasi, Sohyla Reshadat, Alireza Zangeneh, Mehdi Khezeli, Raziyeh Teimouri, Samira Rahimi Naderi, Shahram Saeidi

Clin Exp Pediatr. 2021;64(12):632-641. Published online March 19, 2021

Crossref 2

Question: We assessed the spatial modeling of mortality from acute lower respiratory infections in children under 5 years old during 2000–2017 using a global data.
Finding: The total number of child deaths during the study period decreased, while the number of hot spots increased among countries.
Meaning: Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot formed in Europe over the study period.

DOI: https://doi.org/10.3345/cep.2020.01438

General Pediatrics

Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia

Vivi Ninda Sutriana, Mei Neni Sitaresmi, Abdul Wahab

Clin Exp Pediatr. 2021;64(11):588-595. Published online March 15, 2021

Web of Science 16 Crossref 24

Question: Is the incidence of childhood pneumonia influenced by breastfeeding and basic immunization status?
Finding: Exclusive breastfeeding and complete basic immunization status have an effect in limiting the incidence of childhood pneumonia.
Meaning: While exclusive breastfeeding and complete basic immunization the Expanded Program on Immunization status are important factors for reducing the incidence of childhood pneumonia, indoor air pollution was also a significant risk factor.

DOI: https://doi.org/10.3345/cep.2020.00339

Editorial

Endocrinology

Ambient air pollution and pediatric diabetes

Jae Hyun Kim

Clin Exp Pediatr. 2021;64(10):523-534. Published online March 12, 2021

Web of Science 2 Crossref 2

· Epidemiological studies have shown that ambient air pollution is associated with diabetes mellitus in children and adults.
· The mechanism of ambient air pollution causing diabetes mellitus is unclear.
· A study of the association between diabetes and air pollution in Korean pediatric populations is required.

DOI: https://doi.org/10.3345/cep.2021.00122

Original Article

Cardiology

Assessment of cardiac function in syncopal children without organic causes

Heoungjin Kim, Lucy Youngmin Eun

Clin Exp Pediatr. 2021;64(11):582-587. Published online March 10, 2021

Crossref 1

Question: Does a subtle deterioration in cardiac function affect the severity of syncope in patients without underlying disease?
Finding: For syncope patients with reasonable cardiac function but without underlying disease, tissue Doppler imaging (TDI) measurements helped reveal subtle differences in cardiac function with syncope and predicted the severity of syncope or a potential recurrent event.
Meaning: TDI measurements might be a useful indicator for predicting the severity of syncope.

DOI: https://doi.org/10.3345/cep.2019.01046

Clinical note

Infection

Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia

Seyed Kamal Eshagh Hossaini, Zahra Movahedi, Ahmad Hormati, Hosein Heydari, Seyed Jalal Eshagh Hosseini, Fatemeh Khodadust, Mahboubeh Afifian, Sajjad Ahmadpour

Clin Exp Pediatr. 2021;64(5):247-250. Published online March 8, 2021

Crossref 1

Question: What should be considered in an immunocompromised child with coronavirus disease 2019 (COVID-19)?
Finding: Due to the importance of appropriately managing COVID-19 in children with cancer, the possibility of a fatal outcome should be considered in immunocompromised patients who receive chemotherapy agents.
Meaning: In all kinds of infections including COVID-19, disuse management and the development of international guidelines for children with cancer is challenging but important.

DOI: https://doi.org/10.3345/cep.2020.01711

Editorial

Other

Is multisystem inflammatory syndrome related with coronavirus disease 2019, Kawasaki disease, and angiotensin-converting enzyme 2 in children?

Lucy Youngmin Eun

Clin Exp Pediatr. 2021;64(5):225-226. Published online March 5, 2021

Web of Science 1 Crossref 2

With the coronavirus disease (COVID-19) pandemic, it is important to consider why Kawasaki disease (KD) is prevalent in young children and its symptoms are similar to multisystem inflammatory syndrome in older children. We hypothesized that angiotensin-converting enzyme 2 (ACE2) expression may be related. In fact, this may be an answer why COVID-19 occurs less frequently in children with lower ACE2 expression.

DOI: https://doi.org/10.3345/cep.2021.00031

Allergy

Targeting eosinophils: another strategy for asthma treatment

Hye Mi Jee

Clin Exp Pediatr. 2021;64(5):223-224. Published online March 5, 2021

Web of Science 1 Crossref 1

Identifying phenotypes and endotypes of asthma patients is challenging, and eosinophilic phenotypes are generally characterized by severe or refractory asthma.
Biologicals targeting eosinophils are promising for the control of severe or refractory asthma symptoms.
To ensure proper treatment, increased understanding of the diverse phenotypes of high Th2 inflammation in pediatric asthma is needed.

DOI: https://doi.org/10.3345/cep.2021.00017

Review Article

Neurology

Recent update on reading disability (dyslexia) focused on neurobiology

Sung Koo Kim

Clin Exp Pediatr. 2021;64(10):497-503. Published online March 2, 2021

Web of Science 5 Crossref 6

·Neurobiological studies using functional brain imaging have uncovered the reading pathways, brain regions involved in reading, and neurobiological abnormalities of dyslexia.
·An accurate diagnosis and timely specialized intervention are important in children with dyslexia. When national infant development screening tests have been conducted as in Korea, if a language developmental delay and early predictors of dyslexia are detected, the progression to dyslexia should be carefully observed and early intervention provided.

DOI: https://doi.org/10.3345/cep.2020.01543

Cardiology

Application of CRISPR-Cas9 gene editing for congenital heart disease

Heeyoung Seok, Rui Deng, Douglas B. Cowan, Da-Zhi Wang

Clin Exp Pediatr. 2021;64(6):269-279. Published online March 2, 2021

Web of Science 9 Crossref 12

Clustered regularly interspaced short palindromic repeats and CRISPR-associated protein 9 (CRISPR-Cas9) system has made a big step in the genome editing which still requires technical developments for the efficient applications in the many fields including congenital heart diseases (CHDs), closely related to the genomic abnormality. In this review, we tried to cover the most updated researches of CRISPR-Cas9 in the CHDs to understand the current technologies, eventually becoming therapeutic bases for the CHD patients.

DOI: https://doi.org/10.3345/cep.2020.02096

Original Article

Neonatology (Perinatology)

Effects of carnosine and hypothermia combination therapy on hypoxic-ischemic brain injury in neonatal rats

Jun Chul Byun, Seong Ryong Lee, Chun Soo Kim

Clin Exp Pediatr. 2021;64(8):422-428. Published online February 24, 2021

Web of Science 5 Crossref 6

Question: How can we further improve the neuroprotective effects of hypothermia in newborns with hypoxic-ischemic (HI) brain injury?
Finding: Combination carnosine and hypothermia therapy effectively reduced brain damage in neonatal rats. The in situ zymography, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, and immunofluorescence study results showed that neuroprotective effects were achieved with combination therapy only.
Meaning: Carnosine and hypothermia have synergistic neuroprotective effects against brain damage following HI injury

DOI: https://doi.org/10.3345/cep.2020.01837

Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India

Ritu Sharma, Shikha Seth, Rakhee Sharma, Sanju Yadav, Pinky Mishra, Sujaya Mukhopadhyay

Clin Exp Pediatr. 2021;64(5):239-246. Published online February 16, 2021

Web of Science 15 Crossref 16

Question: Is there any risk of vertical transmission of coronavirus disease 2019 (COVID-19), and what is its neonatal profile?
Finding: Biological samples for vertical transmission were negative in all deliveries; however, 2 neonates tested positive for nasopharyngeal COVID-19 reverse transcription-polymerase chain reaction. No significant neonatal morbidity was observed.
Meaning: COVID-19 does not increase adverse neonatal outcomes and shows a negligible risk of vertical transmission; however, horizontal transmission cannot be underestimated.

DOI: https://doi.org/10.3345/cep.2020.01704

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