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Letter to the Editor
Neonatology (Perinatology)
Association between feeding intolerance and intestinal dysbiosis in very premature infants
Putri Maharani Tristanita Marsubrin, Agus Firmansyah, Rinawati Rohsiswatmo, Zakiudin Munasir, Saptawati Bardosono, Safarina G. Malik, Yuditiya Purwosunu, Ina S. Timan, Tetty Yuniati, Maya Yulindhini
Clin Exp Pediatr. 2023;66(11):501-503.   Published online October 24, 2023
Original Article
Neonatology (Perinatology)
Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study
Sung Hee Lee, Ju Hyun Jin, Jong Ha Yoo, Shin Won Yoon
Clin Exp Pediatr. 2023;66(11):493-500.   Published online October 24, 2023
Question: What are the adverse clinical outcomes of neonates of coronavirus disease 2019 (COVID-19)–infected mothers?
Finding: Infants of mothers with COVID-19 were at significantly increased risk of transient tachypnea of the newborn (TTN), use of noninvasive ventilation, and need for supplemental oxygen (P<0.05).
Meaning: Neonates of mothers with COVID-19 are at risk of TTN and require respiratory support. Close monitoring is essential to ensuring timely intervention if required.
Developmental and Behavioral Medicine
Attention-deficit/hyperactive-impulsive disorder symptoms among grade 1 students with reading disorder in Thailand
Patcharapun Sarisuta, Issarapa Chunsuwan, Tippawan Hansakunachai, Paskorn Sritipsukho
Clin Exp Pediatr. 2023;66(11):485-492.   Published online October 24, 2023
Question: Would students with reading disorder have a significantly higher prevalence of attention-deficit/hyperactiveimpulsive disorder (ADHD) symptoms than neurotypical students?
Finding: Students at risk of reading disorder exhibited significant ADHD symptoms compared with those not at risk of reading disorder according to all presentations of teacher assessments versus only for predominantly inattentive presentations of the parental assessments.
Meaning: Students with reading disorder have a significantly higher prevalence of ADHD symptoms than neurotypical students. Sex, parental education level, average family income, and children’s school affiliation significantly influenced reading disorder prevalence.
Letter to the Editor
Allergy
Increased serum eosinophilic cationic protein in children with nonspecific chronic cough
Young Hwan Kim, Yoon Young Jang, Jieun Jeong, Hai Lee Chung
Clin Exp Pediatr. 2023;66(10):455-457.   Published online September 14, 2023
Original Article
Developmental and Behavioral Medicine
Impact of short and intensive art-based intervention on symptomatology and social interactions among children with autism spectrum disorder
Deldar Morad Abdulah, Bayar Mohammed Omar Abdulla, Pranee Liamputtong
Clin Exp Pediatr. 2023;66(10):447-454.   Published online September 14, 2023
Question: Does a short and intensive art-based intervention affect symptoms and social interactions among children with autism spectrum disorder (ASD)?
Finding: The short and intensive art-based intervention did not affect symptoms in children with ASD level 2 or 3, including social awareness, social cognition, social communication, social motivation, and autistic mannerisms.
Meaning: The short and intensive art-based intervention did not improve the symptoms of patients with ASD.
Editorial
Infection
COVID-19 infection and vaccination among children
Amnuay Kleebayoon, Viroj Wiwanitkit
Clin Exp Pediatr. 2023;66(12):531-532.   Published online August 30, 2023
· Coronavirus disease 2019 (OVID-19) infection and immunization have been linked with kidney problems; however, causality has not been proven.
· Concern about confounders is usually needed.
· Correspondence about a published article on the COVID-19 vaccine
Review Article
Other
Children’s health affected by parent’s behavioral characteristics: a review
Sung Eun Kim, Jongin Lee
Clin Exp Pediatr. 2024;67(5):232-239.   Published online August 21, 2023
· Parents’ occupational hazards, long working hours, and smoking behaviors should be modified adequately to minimize adverse health effects on their children.
· As of 2023, several diseases from fetal exposure to occupational hazards can be compensated with Industrial Accident Compensation Insurance in South Korea.
· A directed acyclic graph is recommended for medical research to control the effects of parents’ behaviors on children’s health.
Neonatology (Perinatology)
Influence of infant microbiome on health and development
Noelle Younge
Clin Exp Pediatr. 2024;67(5):224-231.   Published online August 21, 2023
· The infant gut microbiome is highly dynamic and individualized.
· Microbes are vertically transmitted from mother to infant during delivery and throughout infancy.
· Delivery mode, gestational age, diet, and antibiotic use influence infant microbiome composition and function.
· In animal studies, the microbiome played critical roles in the structural and functional development of the infant gastrointestinal and immune systems.
· Microbiome-targeted therapies have great potential to reduce infant morbidity and mortality.
Gastroenterology
Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children
Yu Kyung Cho, Jin Lee, Chang Nyol Paik
Clin Exp Pediatr. 2023;66(9):377-383.   Published online August 21, 2023
· 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.
Original Article
Developmental and Behavioral Medicine
Neonatal risk factors associated with attention-deficit/hyperactivity disorder: an umbrella review
Ensiyeh Jenabi, Erfan Ayubi, Sajjad Farashi, Saeid Bashirian, Fereshteh Mehri
Clin Exp Pediatr. 2023;66(10):441-446.   Published online July 14, 2023
Question: The risk factors for attention deficit hyperactivity disorder (ADHD), such as breastfeeding, congenital heart disease, and low birth weight, in neonates are not well understood.
Finding: This umbrella review obtained significant effect sizes for ADHD for congenital heart disease (odds ratio [OR], 3.04), low birth weight (OR, 2.25), never breastfed (OR, 1.55), and Apgar score (OR, 1.30).
Meaning: Congenital heart disease, low birth weight, lack of breastfeeding, and Apgar scores were significant factors for ADHD.
Review Article
Neonatology (Perinatology)
Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks
Eun Song Song, Ga Won Jeon
Clin Exp Pediatr. 2024;67(5):240-246.   Published online July 11, 2023
In neonatal resuscitation:
· Laryngeal masks are recommended when endotracheal intubation or positive-pressure ventilation fails.
· Laryngeal masks are useful even during chest compressions.
· Laryngeal masks aid neonates >34 weeks’ gestation and/or with a birth weight >2 kg.
· Main usage barriers include limited experience (81%), preference for endotracheal tubes (57%), and lack of awareness (56%).
· Second-generation laryngeal masks have a built-in esophageal drainage tube that prevents regurgitation into the glottis, and an orogastric tube can be inserted within the esophageal drainage tube to protect against gastric inflation.
Nutrition
Macronutrients modified dietary intervention in the management of overweight/obese children and adolescents: a systematic review
Jihyun Park, Oh Yoen Kim
Clin Exp Pediatr. 2024;67(4):191-200.   Published online July 11, 2023
· Dietary macronutrient modifications affect the body composition of and metabolic markers in children and adolescents.
· Hypocaloric diets, regardless of macronutrient composition, are reportedly effective for weight loss in obese children.
· Future interventional studies with meta-analyses that include Korean children and adolescents are needed to provide basic information applicable to this population.
Editorial
Gastroenterology
Noninvasive and simple, but accurate? Meta-analysis of evidence-based point-of-care ultrasound for assessing dehydration in children
Jin-Hee Oh
Clin Exp Pediatr. 2023;66(11):475-476.   Published online July 11, 2023
· Point-of-care ultrasound imaging, including measurement of the inferior vena cava/aorta ratio, is powerful for evaluating the hemodynamic status of pediatric patients.
· Owing to the limited feasibility of randomized clinical trials and insufficient data in children, imaging tools require validation.
· Objective validity meta-analyses of imaging studies can affect clinical decision-making and serve as a cornerstone for evidence-based practice in pediatrics.
Immunology
Systemic autoinflammatory disorders: autoinflammatory and autoimmune disorders
Young Dae Kim
Clin Exp Pediatr. 2023;66(10):439-440.   Published online July 4, 2023
· Systemic autoinflammatory disorders (SAIDs) typically have an early onset in life, and may have close relatives may have similar disease.
· SAIDs should be suspected in any patient, especially children, who experience persistent or recurrent inflammatory episodes that fail to fit the pattern of other established diseases.
· Advancements in the understanding of autoinflammation will provide novel diagnostic and therapeutic options for SAIDs patients.
Review Article
Genetics and Metabolism
Development of orphan drugs for rare diseases
Han-Wook Yoo
Clin Exp Pediatr. 2024;67(7):315-327.   Published online June 28, 2023
· Orphan disease is a rare disease, primarily affecting newborn and children. Vast majority of orphan diseases has genetic background.
· Orphan disease is individually rare. But as a whole, it is not rare, becoming a great socioeconomic burden.
· The diagnosis of rare genetic disease has been problematic, but recent progress of genome analysis technologies makes it faster and more precise.
· There are many unmet needs as to the curative treatment. However, the number of treatable rare diseases is growingly increasing owing to the development of biotechnology.
· Most orphan drugs are extremely expensive because of numer ous hurdles during the process of drug development as well as small number of patients.
Nephrology (Genitourinary)
Kidney complications associated with COVID-19 infection and vaccination in children and adolescents: a brief review
Hee Sun Baek, Min Hyun Cho
Clin Exp Pediatr. 2023;66(10):424-431.   Published online June 28, 2023
Several observational studies have shown that acute kidney injury affects up to 46% of children and adolescents who develop severe postinflammatory responses, such as multisystem inflammatory syndrome in childhood, due to coronavirus disease 2019 (COVID-19). Although causality has not been established, some cases of glomerulopathy or nephrotic syndrome occurring after COVID-19 infection or vaccination have been reported. Therefore, kidney complications associated with these conditions in children and adolescents warrant attention.
Cardiology
Heart failure in children and adolescents: an update on diagnostic approaches and management
Amit Agrawal, Dalwinder Janjua, Abdulrahman Ahmed Alsayed Ali Zeyada, Ahmed Taher Elsheikh
Clin Exp Pediatr. 2024;67(4):178-190.   Published online June 19, 2023
· Pediatric heart failure (PHF) is a clinical syndrome featuring various symptoms (shortness of breath, ankle swelling, fatigue) and signs (pulmonary crackles, peripheral edema).
· Congenital heart diseases are the most common underlying etiology of PHF, whereas myocarditis and primary cardio-myopathies are common in children without structural ab-normalities.
· PHF pathophysiology is complex and multifactorial and varies by etiology and age.
· PHF management includes decongestive therapy, treatment of underlying causes, preventing progression, and managing pulmonary or systemic obstructions.
· Drugs should be chosen based on pharmacodynamics, clinical manifestations, hemodynamic state, and renal function.
Allergy
Practical issues of oral immunotherapy for egg or milk allergy
Sukyung Kim, Kangmo Ahn, Jihyun Kim
Clin Exp Pediatr. 2024;67(3):140-148.   Published online June 19, 2023
· 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.
Pulmonology
Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies
Eun Kyo Ha, Ju Hee Kim, Man Yong Han
Clin Exp Pediatr. 2023;66(11):465-474.   Published online June 19, 2023
· 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.
Allergy
Skin and oral intervention for food allergy prevention based on dual allergen exposure hypothesis
Kiwako Yamamoto-Hanada, Yukihiro Ohya
Clin Exp Pediatr. 2024;67(10):477-485.   Published online June 14, 2023
To prevent food allergy in infants, based on the dual allergen exposure hypothesis, we recommend a personalized approach consisting of both skin intervention (eczema treatment to achieve early remission and well-controlled skin without eczema to prevent percutaneous immunoglobulin E sensitization) and oral intervention (early allergenic food introduction).
Neonatology (Perinatology)
Neonatal family-centered care: evidence and practice models
Juyoung Lee
Clin Exp Pediatr. 2024;67(4):171-177.   Published online June 14, 2023
· Concrete evidence exists of early parent-infant attachment supported by family-centered care (FCC) in the neonatal intensive care unit.
· FCC involves the parents’ presence and participation in the infant’s care and decision-making.
· A private and comfortable space should be provided. A single-family room is ideal; however, a quiet space with a recliner can be a good alternative.
· Care culture changes and staff training are required.
Other
Acetaminophen causes neurodevelopmental injury in susceptible babies and children: no valid rationale for controversy
Lisa Zhao, John P. Jones, Lauren G. Anderson, Zacharoula Konsoula, Cynthia D. Nevison, Kathryn J. Reissner, William Parker
Clin Exp Pediatr. 2024;67(3):126-139.   Published online June 14, 2023
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.
Infection
Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment
Ki Wook Yun
Clin Exp Pediatr. 2024;67(2):80-89.   Published online June 14, 2023
· 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.
Allergy
Moderate to severe atopic dermatitis in children: focus on systemic Th2 cytokine receptor antagonists and Janus kinase inhibitors
Jeong Hee Kim, Mona Salem Samra
Clin Exp Pediatr. 2024;67(2):64-79.   Published online June 14, 2023
· 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.
Gastroenterology
High-resolution anorectal manometry in children
Yogesh Waikar
Clin Exp Pediatr. 2024;67(2):57-63.   Published online June 14, 2023
· 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
Developmental and Behavioral Medicine
Clinical practice guidelines for attention-deficit/hyperactivity disorder: recent updates
Tae Hoon Eom, Young-Hoon Kim
Clin Exp Pediatr. 2024;67(1):26-34.   Published online June 14, 2023
· 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.
Nephrology (Genitourinary)
X-linked hypophosphatemic rickets: from diagnosis to management
Eujin Park, Hee Gyung Kang
Clin Exp Pediatr. 2024;67(1):17-25.   Published online June 14, 2023
· 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.
Original Article
General Pediatrics
Virtual reality for pain reduction during intravenous injection in pediatrics: a systematic review and meta-analysis of controlled clinical trials
Ensiyeh Jenabi, Saeid Bashirian, Amir Mohammad Salehi, Masoud Rafiee, Mozhdeh Bashirian
Clin Exp Pediatr. 2023;66(12):533-537.   Published online June 14, 2023
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.
Review Article
Endocrinology
Applications of genomic research in pediatric endocrine diseases
Ja Hye Kim, Jin-Ho Choi
Clin Exp Pediatr. 2023;66(12):520-530.   Published online June 14, 2023
· Recent advances in molecular genetics have improved our understanding of pediatric endocrine disorders and are now used in mainstream medical practice.
· Genome-wide association studies can increase our understanding of the biological mechanisms of disease and inform new therapeutic options.
· The identification of founder mutations leads to the efficient localization of the genes underlying Mendelian disorders.
· Next-generation sequencing technologies benefit clinical practice and research of pediatric endocrinology.
Allergy
Natural course of IgE-mediated food allergy in children
Kyunguk Jeong, Sooyoung Lee
Clin Exp Pediatr. 2023;66(12):504-511.   Published online June 14, 2023
· 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.
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