Clinical and Experimental Pediatrics

Original Article

Fecal microbiome profiles in infants with biliary atresia versus nonbiliary atresia cholestasis: a pilot study

Nur Azizah, Fadilah Fadilah, Silvia Werdhy Lestari, Muzal Kadim, Fithriyah Sjatha, Hanifah Oswari

Background: Cholestasis is characterized by disrupted bile flow and can lead to severe liver disease in newborns, of which biliary atresia (BA) is a common cause. The gut microbiome plays a crucial role in aggravating liver injury in BA and non-BA cholestasis. However, information is lacking regarding the differences in gut microbiome composition between patients with BA and non-BA cholestasis.
Purpose:...

DOI: https://doi.org/10.3345/cep.2025.00563 [Accepted]

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Evolving treatment strategies for invasive Streptococcus pyogenes in children in the postpandemic era

Laura Buricchi, Giuseppe Indolfi, Marco Renni, Elisabetta Venturini, Luisa Galli, Elena Chiappini

Background: Streptococcus pyogenes (group A Streptococcus [GAS]) is a common cause of bacterial pharyngitis and skin infections in children that can lead to severe and invasive GAS (iGAS) infections. The sudden acute respiratory syndrome coronavirus 2 pandemic coincided with an increase in iGAS cases, with emerging serotypes and risk factors like age, reduced postpandemic immunity, and viral coinfections. The treatment...

DOI: https://doi.org/10.3345/cep.2025.00479 [Accepted]

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Gastroenterology

Dual-strain probiotics Bifidobacterium bifidum and Lactobacillus acidophilus reverse gut dysbiosis in preterm neonates: a randomized controlled trial

Setthawut Sittiwong, Pornthep Tanpowpong, Pisut Pongchaikul, Pracha Nuntnarumit

Clin Exp Pediatr. 2025;68(10):763-771. Published online August 6, 2025

Question: Can probiotics BB/LA reverse gut dysbiosis in preterm neonates?
Finding: BB/LA supplementation induced more diverse beta diversity and increased relative abundances of Bifidobacterium, Lactobacillus and decreased relative abundance Clostridium.
Meaning: Early BB/LA supplementation could reverse gut dysbiosis in preterm neonates.

DOI: https://doi.org/10.3345/cep.2025.00374

Cardiology

Unsustainable and overworked: unpacking the challenges faced by pediatric cardiologists and cardiac surgeons in Korea

Soo In Jeong, GI Beom Kim, Sung Hye Kim, Jae Yoon Na, Hong Ju Shin, Sin Weon Yun, Lucy Youngmin Eun, Sang Yun Lee, Chang-Ha Lee, Kwang Ho Choi, Seul Gi Cha, Mi Young Han

Clin Exp Pediatr. 2025;68(9):732-741. Published online August 6, 2025

Question: What are the key challenges affecting pediatric cardiologists and cardiac surgeons in Korea?
Finding: Excessive workloads, low procedural volumes, and legal risks contribute to high burnout. Regional disparities limit skill maintenance and threaten workforce sustainability.
Meaning: Targeted policies ensuring fair workloads, legal protections, and regional support are essential to stabilizing the pediatric cardiac workforce and maintaining high-quality care.

DOI: https://doi.org/10.3345/cep.2025.01123

Vasovagal syncope and postural orthostatic tachycardia syndrome in adolescents: transcranial doppler versus autonomic function test results

Dong Won Lee

Clin Exp Pediatr. 2025;68(9):673-679. Published online August 6, 2025

Question: Vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) are representative forms of neurally mediated syncope. What influences the occurrence of each?
Finding: Autonomic function test results did not differ, but cerebral blood flow during diastole on transcranial doppler differed between VVS and POTS.
Meaning: Differences in diastolic cerebral blood flow velocity play an important role in VVS and POTS.

DOI: https://doi.org/10.3345/cep.2025.00927

Evaluation of Bak and Bcl-Xl gene expression among pediatric patients with acute primary immune thrombocytopenia

Amira Zaki Badawy, Samia Hassan Kandel, Iman Aly Ahmedy, Mahmoud Ahmed Elhawy, Sally Mohamed El-Hefnawy, Dina Fouad Sief El-Nasr Zidan, Hanan Hassan El-sheity

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet counts and an increased risk of bleeding. Moreover, the apoptotic mechanisms of platelets may influence their production and lifespan.
Purpose: To assess the involvement of apoptotic markers—specifically the B-cell lymphoma protein 2 family proteins Bak and Bcl-Xl in the pathogenesis of acute primary ITP in pediatric patients, and...

DOI: https://doi.org/10.3345/cep.2025.00997 [Accepted]

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Serum copper and ceruloplasmin levels as biomarkers reflecting liver fibrosis in children with autoimmune hepatitis

Salma Abdel Megeed Nagi, Mai Ibrahim Elashmawy, Amany E. Elashkar, Mohamed Zaeim Hafez, Ashraf A.E. Emara, Osama Mohammad Abdelhay, Albayoumi A.B. Fouda, Mohamed AbdelAziz Doma, Ahmad Mohamed Awad, Ahmed Mohammed Saba, Hesham Abdelrahman Ahmed, Ahmed Mohamed Gad Allah, Fatma Mahmoud Abdelraheem, Mohamed A. Gad, Mohamad A. Soliman, Tamer I. Abdalrhman, Khaled Hassaan Awad, Ismael A.K.M. El-lebedy, Mostafa M. Abdelnaser, Mohammed Z. Abdel Kareem, Marwa Fekry Hassan, Shymaa Sobhy Menshawy Khalifa

Background: Clinical, biochemical, histological, and immunological indicators are frequently used to diagnose autoimmune hepatitis (AIH), a chronic inflammatory liver disease affecting children. Wilson disease, which resembles AIH, is mainly evaluated using serum ceruloplasmin and copper levels. However, changes in these biomarkers have also been observed in AIH, raising the question of whether they could be useful for evaluating children with...

DOI: https://doi.org/10.3345/cep.2025.01011 [Accepted]

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Success rates of conservative treatment and optimal surgical timing for pediatric chylothorax

Pakwan Kaewchusen, Narumon Densupsoontorn, Supaluck Kanjanauthai, Puthita Saengpanit

Background: Pediatric chylothorax poses management challenges, with conservative treatment as the first-line approach and surgery reserved for persistent cases. However, data remain limited on factors related to conservative treatment success and optimal surgical timing.
Purpose: This study aimed to evaluate the success rate of conservative treatment, identify the associated factors, and determine the optimal timing for surgical intervention. Methods: We retrospectively reviewed...

DOI: https://doi.org/10.3345/cep.2025.00598 [Accepted]

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Correspondence

Nephrology (Genitourinary)

Authors' reply: a commentary on “COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus”

Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn

Clin Exp Pediatr. 2025;68(8):626-627. Published online July 18, 2025

DOI: https://doi.org/10.3345/cep.2025.01200

Original Article

General Pediatrics

Liposomal SunActive versus conventional iron for treatment of iron-deficiency anemia in children aged 2–12 years: a prospective randomized controlled trial

Wael A. Bahbah, Yasmin A.H.S. Younis, Hanan Salama Elbelouny, Asmaa A. Mahmoud

Clin Exp Pediatr. 2025;68(8):608-615. Published online July 18, 2025

Background: Liposomal iron, a novel oral formulation of ferric pyrophosphate that demonstrates improved gastrointestinal absorption and bioavailability with fewer side effects than conventional iron, represents a significant advancement in the treatment of iron-deficiency anemia (IDA).
Purpose: To conduct an in-depth comparative study of liposomal SunActive and conventional iron supplements (iron polymaltose complex) for treating IDA in children aged 2–12 years Methods: This...

DOI: https://doi.org/10.3345/cep.2025.00262

Editorial

Other

Beyond the eye: a multidisciplinary perspective on managing pediatric myopia

Eoi Jong Seo

Clin Exp Pediatr. 2025;68(8):566-568. Published online July 18, 2025

Myopia is a growing global public health concern because of its association with irreversible vision loss such as myopic traction maculopathy, rhegmatogenous retinal detachment, and glaucoma. The effective prevention of myopia in childhood requires a multidisciplinary approach that integrates ophthalmologic care with lifestyle, nutrition, and sleep interventions. Early detection through regular visual screening in schools and primary care settings and timely ophthalmology referrals are critical to preventing high myopia.

DOI: https://doi.org/10.3345/cep.2025.00955

Original Article

Hematology

Hyperhomocysteinemia in pediatric β-thalassemia: links to vitamin cofactor deficiencies and oxidative stress

Arzu Dadashova, Gunay Aliyeva, Rana Rahimova, Gulnara Azizova, Khayala Mammadova

Clin Exp Pediatr. 2025;68(10):819-830. Published online July 8, 2025

Question: What are the biochemical and clinical correlates of hyperhomocysteinemia in pediatric β-thalassemia, and how does it relate to vitamin status, oxidative stress, and splenectomy?
Finding: Most pediatric β-thalassemia patients exhibited severe hyperhomocysteinemia, which was strongly associated with folate and B₁₂ deficiencies and influenced oxidative stress patterns, particularly in splenectomized individuals.
Meaning: These findings suggest that routine monitoring and correction of B-vitamin deficiencies may mitigate hyperhomocysteinemia-related risks in pediatric thalassemia.

DOI: https://doi.org/10.3345/cep.2025.00556

Neonatology (Perinatology)

Respiratory severity score-guided postnatal systemic corticosteroid therapy for bronchopulmonary dysplasia in extremely preterm infants

Gyeong Eun Yeom, Ju Sun Heo, Baek Sup Shin, Seh Hyun Kim, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim

Clin Exp Pediatr. 2025;68(9):656-665. Published online July 8, 2025

Question: Does a respiratory severity score (RSS)-guided postnatal corticosteroid protocol improve respiratory outcomes of extremely preterm (EP) infants without worsening neurodevelopmental outcomes?
Finding: The protocol enabled targeted and early steroid use, thereby reducing severe bronchopulmonary dysplasia without affecting mortality or causing neurodevelopmental impairments.
Meaning: The RSS-guided protocol may offer a more precise and individualized postnatal corticosteroid therapy for EP infants.

DOI: https://doi.org/10.3345/cep.2025.00514

General Pediatrics

Trends and determinants in breastfeeding among Korean infants (2007–2021): a nationwide study using the National Health Screening Program for Infants and Children

Minwoong Kang, Eui Kyung Choi, Jeung Min Lee, Hye-Jung Shin, Woo Ryoung Lee, Son Moon Shin; Korean Society of Breastfeeding Medicine

Clin Exp Pediatr. 2025;68(10):772-780. Published online July 4, 2025

Question: What are the recent trends and determinants of breastfeeding in South Korea?
Finding: Breastfeeding rates in South Korea declined significantly from 2007 to 2021, with lower rates observed in preterm, low-birthweight, and multiple-birth infants as well as rural or lower-income households.
Meaning: Targeted interventions, including prenatal education, postnatal support, and community-based programs, are required to address disparities and improve breastfeeding rates.

DOI: https://doi.org/10.3345/cep.2025.00857

Oncology

Allogeneic stem-cell transplantation following chimeric antigen receptor T-cell therapy for treatment of relapsed/refractory hematologic malignancy in children and young adults: a systematic review and meta-analysis

Ghea Mangkuliguna, Edi Setiawan Tehuteru, Reganedgary Jonlean, Nicholas Adrianto, Stella Kallista

Clin Exp Pediatr. 2025;68(9):712-721. Published online July 4, 2025

Question: Does consolidative allogeneic stem cell transplantation (allo-SCT) after chimeric antigen receptor (CAR) T-cell therapy improve outcomes of children and young adult patients with relapsed/refractory hematologic malignancies?
Finding: The meta-analysis showed reduced relapse rates and favorable survival trends with allo-SCT despite low evidence quality.
Meaning: Consolidative allo-SCT after CAR T-cell therapy may enhance survival; however, further clinical studies are needed.

DOI: https://doi.org/10.3345/cep.2025.00031

Review Article

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 1 Crossref 1

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

Original Article

Other

Role of neutrophil elastase in predicting infection among children with chemotherapy-induced febrile neutropenia

Mahmoud A. El-Hawy, Doaa M. Elian, Mai El-Sayad Abd El-Hamid, Esraa T. Allam, Mariam S. Kandeel, Asmaa A. Mahmoud

Clin Exp Pediatr. 2025;68(10):801-807. Published online June 10, 2025

Question: Can neutrophil elastase (NE) levels predict infection— the primary cause of mortality—among children with hematological malignancies and febrile neutropenia (FN)?
Finding: Elevated levels of NE were found in children with chemotherapy-induced FN and a bacterial infection.
Meaning: Increased NE levels and prolonged FN are important factors associated with mortality risk.

DOI: https://doi.org/10.3345/cep.2025.00318

Gastroenterology

Treatment targeting pediatric inflammatory bowel disease-associated anemia: experience from a single tertiary center

Ana S.C. Fernandes, Sara Azevedo, Ana Rita Martins, Ana Isabel Lopes

Clin Exp Pediatr. 2025;68(9):722-731. Published online June 10, 2025

Question: Does treating iron deficiency (ID) using intravenous iron in pediatric inflammatory bowel disease (IBD) feature long-term safety and efficacy?
Finding: Intravenous iron supplementation was safe and effective. However, the ID recurrence rate was higher than expected.
Meaning: Proactive screening and treatment of ID in pediatric IBD are essential. The Ganzoni formula likely underestimates the iron requirements of pediatric patients. Prospective trials are needed to optimize iron treatment dosing.

DOI: https://doi.org/10.3345/cep.2025.00640

Critical Care Medicine

Effect of postoperative enteral protein supplementation on nitrogen balance in critically ill children

Irene Yuniar, Kadek Apik Lestari, Antonius Hocky Pudjiadi, Fatima Safira Alatas, Yoga Devaera

Clin Exp Pediatr. 2025;68(10):790-800. Published online May 30, 2025

Question: Does high-protein enteral nutrition better increase the average nitrogen balance (NB) and decrease the intestinal fatty acid-binding protein (I-FABP) level of critically ill postoperative children than standard-protein enteral nutrition?
Finding: The study demonstrated a significant increase in average NB but no significant decrease in I-FABP levels in the high- versus low-protein group.
Meaning: These findings suggest that high-protein enteral nutrition can improve NB in critically ill postoperative children, thereby supporting their recovery.

DOI: https://doi.org/10.3345/cep.2025.00227

Gastroenterology

Adenosine deaminase and interleukin-1 receptor antagonist genetic polymorphisms among obese children with versus without metabolic dysfunction-associated fatty liver disease

Hala M. Sakhr, Mohammed H. Hassan, Azza Mohamed Taha, Ali Helmi Bakri

Clin Exp Pediatr. 2025;68(10):808-818. Published online May 29, 2025

Question: Is there an association between adenosine deaminase (ADA) G22A and interleukin-1 receptor antagonist (IL-1RN) genetic polymorphisms and pediatric metabolic dysfunction-associated fatty liver disease (MAFLD)?
Finding: The GG genotype and G allele of ADA G22A were significantly associated with obesity but not pediatric MAFLD, while the *1/*2 genotype of the IL-1RN gene was significantly associated with obesity and pediatric MAFLD.
Meaning: The IL-1RN gene may contribute to pediatric MAFLD.

DOI: https://doi.org/10.3345/cep.2025.00731

Perspective

General Pediatrics

Navigating the complex behavioral landscape of children in foster care and adopted families

Anisha Choi, Sandhya J. Kadam

Clin Exp Pediatr. 2025;68(8):620-623. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00822

Clinical Note

Genetics and Metabolism

Expanding genotype-phenotype correlation of Kenny-Caffey syndrome type 1

Manuela Lo Bianco, Federica Sipala, Xena Giada Pappalardo, Gaia Fusto, Roberta Rizzo, Federico Favata, Carla Cimino, Silvia Marino, Martino Ruggieri, Agnese Suppiej, Simone Ronsisvalle, Raffaele Falsaperla

Clin Exp Pediatr. 2025;68(8):616-619. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00360

Perspective

Gastroenterology

Metabolic dysfunction-associated steatotic liver disease in children: a practical update based on Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN) 2024 guidelines

Ankit Agrawal, Arghya Samanta

Clin Exp Pediatr. 2025;68(7):546-550. Published online May 12, 2025

DOI: https://doi.org/10.3345/cep.2025.00157

Review Article

Allergy

Global burden of asthma among children and adolescents with projections to 2050: a comprehensive review and forecasted modeling study

Tae Hyeon Kim, Hyunjee Kim, Jiyeon Oh, Soeun Kim, Michael Miligkos, Dong Keon Yon, Nikolaos G Papadopoulos

Clin Exp Pediatr. 2025;68(5):329-343. Published online April 22, 2025

Web of Science 4 Crossref 4

Pediatric asthma can persist to adulthood and must be effectively managed. This review examined the prevalence of asthma among individuals younger than 20 years and revealed a decline from 1990 to 2021, higher rates in males, and a peak in children aged 5–9 years. Despite a projected continued decrease in prevalence by 2050, asthma will remain a significant health concern for children and adolescents.

DOI: https://doi.org/10.3345/cep.2025.00423

Original Article

Nutrition

Factors associated with thiamin deficiency in pediatric patients with heart disease and receiving diuretics: a single-center study

Phakwan Laohathai, Rathaporn Sumboonnanonda, Puthita Saengpanit, Chodchanok Vijarnsorn, Chatchawan Srisawat, Kwanjai Chotipanang, Sarawut Junnu, Supawan Kunnangja, Hathaichanok Rukprayoon, Phakkanan Phuangphan, Sompong Liammongkolkul, Arthima Phaokong, Narumon Densupsoontorn

Clin Exp Pediatr. 2025;68(9):666-672. Published online April 16, 2025

Question: Are pediatric patients with heart disease who are receiving diuretics at risk of thiamin deficiency (TD)?
Finding: Fifteen percent of the patients had TD. TD was associated with inadequate dietary thiamin intake and increasing age.
Meaning: The thiamin pyrophosphate effect should be assessed in those with high risk of TD. Dietary counseling should be emphasized to ensure adequate dietary thiamin intake.

DOI: https://doi.org/10.3345/cep.2024.01893

Review Article

Other

Cost-effectiveness of newborn screening for severe combined immunodeficiency: a systematic review

Rezwanul Rana, Syed Afroz Keramat, Moin Ahmed

Clin Exp Pediatr. 2025;68(9):628-640. Published online April 16, 2025

Universal newborn screening for severe combined immunodeficiency (SCID) demonstrates robust cost-effectiveness across diverse high-income healthcare systems, both from healthcare and societal standpoints. Early detection yields substantial savings. While uncertainties persist, impacting precise cost-effectiveness, the overall finding is positive. Future research must prioritize enhanced data collection and statistical rigor to refine our understanding of SCID's economic impact within the Australian context.

DOI: https://doi.org/10.3345/cep.2025.00052

Correspondence

Infection

A commentary on "COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus"

Hinpetch Daungsupawong, Viroj Wiwanitkit

Clin Exp Pediatr. 2025;68(8):624-625. Published online April 16, 2025

DOI: https://doi.org/10.3345/cep.2025.00304

Original Article

Hematology

Treatment and clinical outcomes of pediatric autoimmune hemolytic anemia: real-world single-center data from Korea

Young Dai Kwon, Eun Sun Jung, Yeon Jung Lim

Clin Exp Pediatr. 2025;68(7):522-529. Published online April 16, 2025

Question: Can pediatric autoimmune hemolytic anemia (AIHA) be effectively managed using first-line steroids?
Finding: In this single-center study, pediatric patients with AIHA achieved normal hemoglobin levels within 16.5 days (range, 9.0–22.0 days) of first-line steroid treatment and maintained effective responses for 2 months.
Meaning: These outcomes highlight the efficacy of steroid treatment in pediatric versus adult AIHA and underscore the need for multicenter trials to establish standardized treatment guidelines.

DOI: https://doi.org/10.3345/cep.2024.02026

Editorial

Neonatology (Perinatology)

Intermittent sigh breaths during high-frequency oscillatory ventilation among newborn infants

Ga Won Jeon

Clin Exp Pediatr. 2025;68(7):486-488. Published online April 16, 2025

Intermittent sigh breaths during high-frequency oscillatory ventilation can improve ventilation and oxygenation by enhancing lung recruitment. Although research on this approach in newborn infants is limited, some published studies suggest that sigh breaths are generally applied at a rate of 2–3 breaths/min with an inspiratory time of 0.5–1 second and pressure of current mean airway pressure + 5 cmH₂O (maximum, 30 cmH₂O).

DOI: https://doi.org/10.3345/cep.2025.00549

Original Article

Infection

Role of miRNA-146a and miRNA-125b in Helicobacter pylori

Nashwa Farouk Mohamed, Ola G.A. Behairy, Manal S. EL-Defrawy, Mona Mahmoud Elsayed, Naglaa F. Alhusseini

Clin Exp Pediatr. 2025;68(10):781-789. Published online April 1, 2025

Crossref 1

Question: Why is the early detection of Helicobacter pylori-associated gastritis in children important?
Finding: The early detection of H. pylori-related gastritis is crucial for its effective management, especially in pediatric patients with dyspepsia.
Meaning: The use of miRNA signatures could detect early gastritis, enabling timely H. pylori eradication treatment to mitigate growth delays and cancer risk.

DOI: https://doi.org/10.3345/cep.2025.00192

Cited By 31	Neurodevelopmental outcomes of preterm infants
Cited By 29	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 27	Gut microbiota affects brain development and behavior
Cited By 24	Association of gut microbiota with obesity in children and adolescents
Cited By 24	Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

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