Clinical and Experimental Pediatrics

Editorial

Neurobehavior

Importance of pediatrician’s role in preventing positional plagiocephaly

Hee-Jeong Kang

Clin Exp Pediatr. 2024;67(6):294-295. Published online May 21, 2024

· Plagiocephaly is characterized by the asymmetrical shape of a baby’s head.
· Since positional plagiocephaly is associated with developmental delay and further musculoskeletal problems, early detection allows for timely intervention and prevents worsening of the condition.
· Pediatricians can educate parents about proper head positioning and encourage supervised tummy time during awake hours.

DOI: https://doi.org/10.3345/cep.2023.01025

Review Article

Hematology

Iron deficiency in children with a focus on inflammatory conditions

Na Hee Lee

Clin Exp Pediatr. 2024;67(6):283-293. Published online May 21, 2024

Web of Science 3 Crossref 3

· Iron deficiency has important effects on neurodevelopment and the immune system in children.
· Hepcidine plays an important role in iron homeostasis.
· Diagnosis and treatment of iron deficiency in chronic inflammatory disease are important for patients' quality of life and disease course.

DOI: https://doi.org/10.3345/cep.2023.00521

Other

Use of virtual reality in children in a broad range of medical settings: a systematic narrative review of recent meta-analyses

Emily Antonovics, Grammatina Boitsios, Thomas Saliba

Clin Exp Pediatr. 2024;67(6):274-282. Published online May 21, 2024

Web of Science 3 Crossref 5

· Virtual reality (VR) is becoming increasingly common for entertainment and in medical settings.
· VR is useful for treating children with cerebral palsy.
· VR can help with attention deficit/hyperactivity disorder symptoms.
· VR can decrease pain perception in children undergoing burn wound care.
· VR can reduce preoperative anxiety.
· VR can reduce fear and pain during needle-involving procedures.

DOI: https://doi.org/10.3345/cep.2023.00388

Allergy

Action-plan and as-needed therapy in allergic rhinitis

Hyeon-Jong Yang

Clin Exp Pediatr. 2024;67(6):267-273. Published online May 21, 2024

Web of Science 3 Crossref 2

· The guidelines may not work in the real world.
· An action-plan reflecting patient’s severity and variable of symptoms, values and preferences as well as the benefits and harms of treatment, may be a useful alternative.
· The action plan and as-needed therapy must include the following elements: when, what, how, and why.
· Action plan and as-needed therapy can help patients manage their symptoms more effectively.

DOI: https://doi.org/10.3345/cep.2023.00654

Editorial

Infection

Preventing bloodstream infections in children after liver transplantation

Young June Choe

Clin Exp Pediatr. 2024;67(11):599-600. Published online April 18, 2024

Liver transplantation (LT) is crucial for children with end-stage liver diseases, yet bloodstream infections (BSI) pose significant risks, despite medical advancements. Immunosuppressants, essential for preventing organ rejection, heighten infection susceptibility. Understanding BSI organisms is vital due to antimicrobial resistance. Pediatric LT recipients have unique risk factors, demanding tailored preventive measures. This systematic review on bacterial BSI emphasizes the urgency of effective prevention strategies, considering the high incidence and distinct organism profile. Further research is vital for optimizing antibiotic management and improving outcomes for this vulnerable population.

DOI: https://doi.org/10.3345/cep.2024.00045

Immunology

Utility of eosinophil granule proteins in management of pediatric chronic cough

Chang-Keun Kim

Clin Exp Pediatr. 2024;67(10):519-520. Published online April 17, 2024

· Pediatric chronic cough often involves eosinophilic inflammation; however, objective measurements are not routinely used in treatment decisions.
· Accurate biomarkers of eosinophil activity, such as eosinophil-derived neurotoxin (EDN) and cationic proteins (ECP), should be used. EDN, which overcomes the shortcomings of ECP, recently received approval for use in Korean healthcare settings.
· EDN and ECP can play a role in treatment period and drug selection decisions.

DOI: https://doi.org/10.3345/cep.2023.01431

Original Article

Pulmonology

Oligohydramnios affects pulmonary functional/structural abnormalities in school-aged children with bronchopulmonary dysplasia

Jeong Eun Shin, Soon Min Lee, Mi-Jung Lee, Jungho Han, Joohee Lim, Haerin Jang, Ho Seon Eun, Min Soo Park, Soo Yeon Kim, Myung Hyun Sohn, Ji Ye Jung, Kyung Won Kim

Clin Exp Pediatr. 2024;67(5):257-266. Published online April 16, 2024

Web of Science 3 Crossref 4

Question: Is bronchopulmonary dysplasia (BPD) associated with functional/structural abnormalities later in life?
Finding: School-aged children with severe BPD had abnormalities on pulmonary function tests and lung computed tomography despite no subjective respiratory symptoms; however, only prenatal oligohydramnios and prolonged ventilator use were associated with abnormal lung function.
Meaning: Long-term monitoring of preterm infants’ lung health is essential, especially for those with prenatal oligohydramnios or prolonged ventilator use.

DOI: https://doi.org/10.3345/cep.2023.01053

Review Article

Infection

Incidence, causative organisms, and risk factors of bloodstream infections in pediatric liver transplant patients: a systematic review

Mohamad Shieb, Rand Hasanain, Zara Arshad, Faisal A. Nawaz, Rahul Kashyap, Eric J. Stern

Clin Exp Pediatr. 2024;67(9):427-434. Published online April 5, 2024

Web of Science 1 Crossref 1

The overall incidence of bloodstream infections was 23.5%. Gram-negative organisms occur at a much higher rate in pediatric liver transplant recipients then that the general pediatric population. However, when comparing pediatric and adult liver transplant recipients Gram-positive organisms occur with a much higher rate in the pediatric population highlighting the importance of early and broad spectrum antimicrobial coverage when bloodstream infections are suspected.

DOI: https://doi.org/10.3345/cep.2023.01466

Original Article

Neonatology (Perinatology)

Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial

Mojtaba Cheraghi, Maziar Nikouei, Majid Mansouri, Siros Hemmatpour, Yousef Moradi

Clin Exp Pediatr. 2024;67(5):249-256. Published online March 26, 2024

Question: Is vitamin E a viable therapeutic option for managing neonatal hyperbilirubinemia?
Finding: This randomized clinical trial examined the effects of oral vitamin E supplementation on bilirubin reduction (primary outcome), phototherapy duration, and length of hospital stay (secondary outcome) in 138 infants.
Meaning: Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and length of hospital stay.

DOI: https://doi.org/10.3345/cep.2023.01312

Editorial

Neurology

Impact of COVID-19 pandemic on clinical features of benign convulsions with mild gastroenteritis

Jon Soo Kim

Clin Exp Pediatr. 2024;67(9):456-458. Published online March 25, 2024

· The frequency of benign convulsions with mild gastroenteritis (CwG) was not significantly influenced by the pandemic.
· The coronavirus disease 2019 pandemic has further diversified the etiologic enteric viral pathogens of CwG.

DOI: https://doi.org/10.3345/cep.2024.00108

Letter to the Editor

Neonatology (Perinatology)

Assessment of iron status and red cell parameters in healthy term small for gestational age neonates at birth

Arif Hossain, Shorna Rahman, Shahana Akter, Ismat Jahan, Sanjoy Kumer Dey, Abdul Mannan, Mohammod Shahidullah

Clin Exp Pediatr. 2024;67(4):221-223. Published online March 19, 2024

DOI: https://doi.org/10.3345/cep.2023.01445

Original Article

Neurology

Changes in frequency of benign convulsions with mild gastroenteritis and their viral causes before and during the COVID-19 pandemic: a single-center study

Hyejin Na, Sanghoon Lee, Seo Hee Kim, Young Ok Kim

Clin Exp Pediatr. 2024;67(4):213-220. Published online March 19, 2024

Web of Science 2 Crossref 2

Question: Did coronavirus disease 2019 (COVID-19) affect the frequency, seasonal variation, or virus type of benign convulsions with mild gastroenteritis (CwG)?
Findings: We compared 41 cases of CwG before and during the COVID-19 pandemic. After March 2020, frequency did not change significantly (18 patients vs. 23 patients), seasonal variation was lost, and number of cases of enteric adenovirus-associated CwG increased (1 cases vs. 7 cases).
Meaning: The COVID-19 pandemic affected CwG.

DOI: https://doi.org/10.3345/cep.2023.01137

Nutrition

Effect of probiotics plus zinc supplementation on clinical outcomes of infants and children with acute infectious diarrhea: a randomized controlled trial

Deldar Morad Abdulah, Saad Jbraeil Sulaiman, Zaid Waad Ahmed

Clin Exp Pediatr. 2024;67(4):203-212. Published online February 19, 2024

Web of Science 3 Crossref 4

Question: Does zinc supplementation along with probiotics affect disease severity or clinical outcomes of children with acute diarrhea?
Findings: This study indicated that zinc supplementation and probiotics had no effect on clinical improvement or disease severity among pediatric patients with acute diarrhea.
Meaning: Children who received probiotics plus zinc recovered faster than those who received probiotics only.

DOI: https://doi.org/10.3345/cep.2023.01340

Letter to the Editor

Pulmonology

Metabolic syndrome and pulmonary dysfunction in asthmatic children during the COVID-19 pandemic

Jue Seong Lee, Sang Hyun Park, Yoon Lee, Seunghyun Kim, Wonsuck Yoon, Young Yoo

Clin Exp Pediatr. 2024;67(3):168-170. Published online February 19, 2024

Web of Science 1 Crossref 1

DOI: https://doi.org/10.3345/cep.2023.01480

Original Article

Neonatology (Perinatology)

Oral administration of bone marrow-derived mesenchymal stem cells attenuates intestinal injury in necrotizing enterocolitis

Yeong Seok Lee, Yong Hoon Jun, Juyoung Lee

Clin Exp Pediatr. 2024;67(3):152-160. Published online February 19, 2024

Web of Science 1 Crossref 1

Question: What is the optimal dose of bone marrow-derived mesenchymal stem cells (BM-MSCs) for treating necrotizing enterocolitis (NEC), and is orally administered BM-MSC effective?
Findings: High (1×10⁶ cells) or multiple BM-MSC doses showed similar effects as low (1×10⁵ cells) doses of intraperitoneally administered BM-MSCs. Furthermore, orally administered BM-MSCs were as effective as intraperitoneally administered BM-MSCs.
Meaning: Orally administered low-dose BM-MSCs are a potential treatment for NEC.

DOI: https://doi.org/10.3345/cep.2023.01151

Editorial

Critical Care Medicine

Is it possible to provide palliative care to pediatric patients with neurological diseases?

Young-Hoon Kim

Clin Exp Pediatr. 2024;67(8):403-404. Published online February 15, 2024

· Patients with neurological diseases often require external mechanical support to maintain mechanical ventilation or supply.
· Little has been done to help the families of affected children make difficult decisions that carry significant physical and psychological consequences.
· The establishment of a department that provides pediatric palliative care for neurological patients should be considered.

DOI: https://doi.org/10.3345/cep.2023.01032

Letter to the Editor

General Pediatrics

Vitamin B₁₂ deficiency in anemic children before versus after age 2 years: a form of hidden hunger in India

Sahil Goel, Ruchika Bhatnagar, Anita Kumari, Brig Prem Lochan Prasad, Lahar Sahai

Clin Exp Pediatr. 2024;67(2):116-118. Published online January 24, 2024

DOI: https://doi.org/10.3345/cep.2023.01347

Editorial

Endocrinology

Nonalcoholic fatty liver disease in children and adolescents

Hae Sang Lee

Clin Exp Pediatr. 2024;67(2):90-91. Published online January 24, 2024

Web of Science 2 Crossref 2

· With the increase in childhood obesity, nonalcoholic fatty liver disease (NAFLD) has become a concern in recent years.
· NAFLD is strongly associated with insulin resistance.
· Lifestyle modifications are the mainstay treatment for NAFLD.

DOI: https://doi.org/10.3345/cep.2023.00752

Review Article

Pulmonology

Evidence-based management guidelines for noncystic fibrosis bronchiectasis in children and adolescents

Eun Lee, Kyunghoon Kim, You Hoon Jeon, In Suk Sol, Jong Deok Kim, Taek Ki Min, Yoon Ha Hwang, Hyun-Ju Cho, Dong In Suh, Hwan Soo Kim, Yoon Hee Kim, Sung-Il Woo, Yong Ju Lee, Sungsu Jung, Hyeon-Jong Yang, Gwang Cheon Jang

Clin Exp Pediatr. 2024;67(9):418-426. Published online January 23, 2024

· We suggest offering long-term macrolides to children with noncystic fibrosis bronchiectasis with frequent exacerbations (conditional recommendation, moderate quality of evidence).
· We do not recommend the routine use of mucolytic agents, inhaled corticosteroids, or nonsteroidal anti-inflammatory drugs to prevent exacerbation of bronchiectasis in children (inconclusive, very low quality of evidence).
· We recommend the use of nebulized hypertonic saline to prevent exacerbations and improve the lung function of children with noncystic fibrosis bronchiectasis (weak recommendation, moderate quality of evidence).

DOI: https://doi.org/10.3345/cep.2023.00871

Original Article

Cardiology

Effect of face mask on pulmonary artery pressure during echocardiography in children and adolescents

Alireza Ahmadi, Mohammad Reza Sabri, Zohreh Sadat Navabi

Clin Exp Pediatr. 2024;67(3):161-167. Published online January 23, 2024

Question: Can face masks alter pulmonary pressure in children and adolescents with and without congenital heart disease?
Findings: Mask removal during echocardiography (ECHO) reduced pulmonary pressure.
Meaning: These findings suggest that face masks should be removed during ECHO in children and adolescents.

DOI: https://doi.org/10.3345/cep.2023.01172

Review Article

Nephrology (Genitourinary)

Effects of diethylene glycol contamination of pharmaceutical products on unexplained acute kidney injury in children: a systematic review

Sani Rachman Soleman, Muhammad Luthfi Adnan, Hilmi Ardian Sudiarto, Satria Bintang Mahathma, Alya Ayu Tazkia, Hana Afifah Firdaus, Alfreda Amelia Khotijah, Miranti Dewi Pramaningtyas, Emi Azmi Choironi

Clin Exp Pediatr. 2024;67(8):395-402. Published online January 4, 2024

A recent unexplained acute kidney injury (AKI) outbreak due to pharmaceutical product contamination with diethylene glycol (DEG) raises public attention. Our study revealed that DEG-contaminated paracetamol causes unexplained AKI in children. However, paracetamol is not the only contaminated drug. Other drugs, such as cough expectorants, antihistamines, and sedatives, can also be affected. Other chemicals, such as ethylene glycol and propylene glycol, can also contribute to poisonings.

DOI: https://doi.org/10.3345/cep.2023.01039

Editorial

Neonatology (Perinatology)

Exploring the role of laryngeal masks in neonatal resuscitation

Euiseok Jung

Clin Exp Pediatr. 2024;67(5):247-248. Published online December 28, 2023

· Laryngeal masks (LMs) offer stable airway access and skill retention advantages, making them promising alternatives to positive-pressure ventilation in neonatal care.
· The ease of teaching LM insertion techniques to less experienced providers addresses the need for swift intervention and skill retention.
· Careful consideration of the benefits and challenges of LMs is essential in determining their effective integration into enhanced neonatal resuscitation protocols.

DOI: https://doi.org/10.3345/cep.2023.01200

Impacts of maternal COVID-19 during pregnancy on neonatal health and epidemiology

Jae Woo Lim

Clin Exp Pediatr. 2024;67(3):149-151. Published online December 28, 2023

Newborns born to mothers infected with coronavirus disease 2019 (COVID-19) should be closely monitored for respiratory disorders, such as transient tachypnea of the newborn, regardless of their COVID-19 test results. Further research is required of the development of infants born to mothers with COVID-19. The trends in Korea's birth rate and infant mortality rates have not been significantly affected by COVID-19.

DOI: https://doi.org/10.3345/cep.2023.01452

Clinical Note

Neurology

Expanding association between BICD2 variants and brain malformations and associated lissencephaly

Jaeso Cho, Haeryung Kim, Seoungbok Lee, Jihoon G Yoon, HyeJin Kim, Minhye Kim, Seoyun Jang, Woojoong Kim, Soo Yeon Kim, Jong Hee Chae

Clin Exp Pediatr. 2024;67(1):54-56. Published online December 21, 2023

DOI: https://doi.org/10.3345/cep.2023.01095

Original Article

Adolescence Medicine

Relationship between inflammatory biomarkers and insulin resistance in excess-weight Latin children

Mariano Nicolás Aleman, María Constanza Luciardi, Emilce Romina Albornoz, María Cristina Bazán, Adela Victoria Abregú

Clin Exp Pediatr. 2024;67(1):37-45. Published online December 21, 2023

Web of Science 3 Crossref 3

Question: What is the prevalence of insulin resistance (IR) in excess-weight Latin children, and can proinflammatory biomarkers predict it?
Finding: IR prevalence was elevated and tumor necrosis factor- α, interleukin-6, monocyte chemoattractant protein- 1, soluble CD40 ligand, and high-sensitivity C-reactive protein levels were increased in excess-weight Latin children. However, none predicted IR status.
Meaning: These inflammatory biomarkers were unable to predict IR status. Therefore, further investigations are necessary.

DOI: https://doi.org/10.3345/cep.2022.01382

Review Article

Allergy

Recent advances in food allergen immunotherapy

You Hoon Jeon, Edwin H. Kim

Clin Exp Pediatr. 2024;67(8):386-394. Published online December 7, 2023

Web of Science 1 Crossref 1

· To enhance the safety of food allergen immunotherapy, alternative approaches such as sublingual immunotherapy, epicutaneous immunotherapy, low-dose oral immunotherapy (OIT), and omalizumab with OIT are being explored.
· Factors such as causative allergen type, natural outgrowth, symptom severity, and patient age should be considered.
· Individualized food allergen immunotherapy plans should be established to determine the most beneficial treatment for each patient.

DOI: https://doi.org/10.3345/cep.2023.01004

Neonatology (Perinatology)

Quantifying myelin in neonates using magnetic resonance imaging: a systematic literature review

Nabila Hanem Arshad, Hasyma Abu Hassan, Nur Farhayu Omar, Zurina Zainudin

Clin Exp Pediatr. 2024;67(8):371-385. Published online December 6, 2023

Question: This systematic review attempts to discover the best magnetic resonance imaging (MRI) technique for myelin quantification in neonates by evaluating various MRI parameters and their reproducibility.
Finding: Since the benefits of using synthetic MRI for quantifying myelin in neonates outweigh the very minor draw- backs, it is recommended.
Meaning: The findings suggest the importance of identifying noninvasive MRI techniques available to assess myelin tissue in neonates, which aid in diagnosing neurodevelopmental disorders.

DOI: https://doi.org/10.3345/cep.2023.00514

Original Article

Neurology

Effectiveness of Helmet therapy for infants with moderate to severe positional plagiocephaly

Jeongho Kim, Jina Kim, Kyu Young Chae

Clin Exp Pediatr. 2024;67(1):46-53. Published online December 5, 2023

Web of Science 1 Crossref 1

Question: Is helmet therapy effective for positional plagiocephaly? What factors influence helmet therapy efficacy for positional plagiocephaly?
Finding: Helmet therapy is effective for infants with moderate to severe positional plagiocephaly, and its effectiveness is influenced by age at treatment initiation, severity of head asymmetry, and daily duration of helmet wear.
Meaning: Pediatricians should initiate helmet therapy for positional plagiocephaly sooner, ideally before 9 months of age, to maximize treatment efficacy.

DOI: https://doi.org/10.3345/cep.2023.00626

Review Article

Infection

COVID-19 among infants: key clinical features and remaining controversies

Nevio Cimolai

Clin Exp Pediatr. 2024;67(1):1-16. Published online November 27, 2023

Web of Science 5 Crossref 5

· 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.

DOI: https://doi.org/10.3345/cep.2023.00794

Editorial

Allergy

Trends in food allergen immunotherapy in Korea after changed national regulations

Tae Won Song

Clin Exp Pediatr. 2024;67(4):201-202. Published online November 21, 2023

National regulations, academic guidelines, and clinical trends in food allergen immunotherapies (FA-AIT) differ among countries and have changed rapidly. Current officially approved FA-AIT are oral immunotherapy (OIT) using heated milk/egg in Korea and peanut OIT using standardized products in the United States and Europe. FA-AIT should be administered by specialist physicians with experience administering oral food challenge tests and managing severe allergic reactions inside and outside research settings.

DOI: https://doi.org/10.3345/cep.2023.01123

Cited By 21	Neurodevelopmental outcomes of preterm infants
Cited By 19	Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Cited By 17	Association of gut microbiota with obesity in children and adolescents
Cited By 16	Nonalcoholic fatty liver disease and insulin resistance in children
Cited By 16	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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