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Original Article
Enteric pathogens implicated in acute infectious diarrhea among young children in resource-limited region with rapidly growing population: a hospital-based cross-sectional study
Aseel Al-Mashahedah, Randa Dhahi
Background: Acute infectious diarrhea is among the leading causes of morbidity and mortality worldwide, particularly in developing countries and among children younger than 5 years of age.
Purpose: To determine the causative microorganisms in diarrhea and elucidate their epidemiological trajectory among children younger than 5 years of age to establish successful preventive measures. Methods: This cross-sectional study was conducted in Al-Musayyib...
C3 glomerulopathy in children: experience at a resource-limited center
Soumya Reddy, Abhishek Ghante, Mahesha Vankalakunti, Anil Vasudevan
Background: In children, C3 glomerulopathy (C3G) is a heterogeneous disease characterized by diverse clinicopathological profiles and kidney outcomes. However, diagnostic work-up in resource-limited settings is challenging because of the unavailability of complement assays and limited access to electron microscopy or genetic testing.
Purpose: This study aimed to describe the clinicopathological features and response to immunosuppression and evaluate renal outcomes among...
Review Article
Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and meta-analysis
Duc Long Tran, Phu Nguyen Trong Tran, Paweena Susantitaphong, Phichayut Phinyo, Palittiya Sintusek
Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD...
DOI: https://doi.org/10.3345/cep.2024.00927    [Epub ahead of print]
Practical concepts and strategies for early diagnosis and management of eosinophilic gastrointestinal disorders in East-Asian children
Byung-Ho Choe
Eosinophilic gastrointestinal disorders (EGIDs) are emerging as significant concerns in the Korean pediatric population and transitioning from rare to more commonly diagnosed conditions. This review discusses the increasing prevalence of EGID among children and adolescents and highlights the complexities involved in its diagnosis and management. This review begins with a thorough examination of the diverse clinical presentations of EGIDs in...
Original Article
Occurrence of stroke in children and young adults in Indonesia: a multicenter private hospital study
Jeanne Leman, Veli Sungono, Yosua Timotius Haryono, Muhammad Adam Mudzakir, Dewi Lestari Rahmawati, Callistus Bruce Henfry Sulay, Gilbert Sterling Octavius
Background: Most studies that estimate the occurrence of childhood stroke use heterogeneous methods and rely on International Classification of Diseases codes, a strategy that may be unreliable.
Purpose: This study aimed to estimate the occurrence of childhood stroke in Indonesia using imaging and clinical data from a private hospital network. Methods: This cross-sectional study used consecutive retrospective multi-center data samples...
Review Article
Other
Global trends in importance of 24-hour movement behaviors to pediatric health: implications for South Korea
Eun-Young Lee, Reyana Jayawardena, Seiyeong Park, Justin Y Jeon, Yeon-Soo Kim, Mark S. Tremblay
Clin Exp Pediatr. 2025;68(1):16-29.   Published online November 11, 2024
· The 24-hour movement behavior paradigm provides an important framework for future pediatric health promotion efforts.
· Policy priorities should include advancing surveillance and monitoring assessments related to 24-hour movement behaviors, evaluating their implementation in school and government policies, and building preparedness for future pandemics and natural disasters, including climate change, by promoting healthy 24-hour movement behaviors.
· Future research should advocate for the promotion of 24- hour movement behaviors.
Original Article
Evaluation of pediatric migraine triggers: a single-center study
Hey-Joon Son, Joo-Ok Jin, Kon-Hee Lee
Question: What are the primary triggers for pediatric migraines, and how do they impact clinical management?
Finding: Common triggers for pediatric migraines include sleep disturbances, academic stress, and motion sickness, with academic stress identified as the most intense.
Meaning: Recognizing and addressing specific triggers like sleep disturbance and academic stress is crucial to effectively managing pediatric migraines with emphasis on personalized care to improve outcomes.
DOI: https://doi.org/10.3345/cep.2024.00738    [Epub ahead of print]
General Pediatrics
Nonpharmacological interventions for managing postoperative pain and anxiety in children: a randomized controlled trial
Edlin Glane Mathias, Mamatha Shivananda Pai, Vijay Kumar, Dinesh Narayanakurup, Malavika Kulkarni, Vasudeva Guddattu, Ann-Cathrine Bramhagen, Baby S Nayak, Anice George
Clin Exp Pediatr. 2024;67(12):677-685.   Published online October 31, 2024
Question: What is the effect of nonpharmacological interventions on postoperative pain and anxiety among children.
Finding: Nurse-provided distraction interventions reduce pain and anxiety among pediatric surgical patients.
Meaning: The findings suggest that nonpharmacological interventions provided postoperatively to children reduce their pain and anxiety levels.
Review Article
General Pediatrics
Protecting our future: environmental hazards and children’s health in the face of environmental threats: a comprehensive overview
Jungha Lee, Hyo-Bin Kim, Hun-Jong Jung, Myunghee Chung, So Eun Park, Kon-Hee Lee, Won Seop Kim, Jin-Hwa Moon, Jung Won Lee, Jae Won Shim, Sang Soo Lee, Yunkoo Kang, Young Yoo; The Environmental Health Committee of the Korean Pediatric Society
Clin Exp Pediatr. 2024;67(11):589-598.   Published online October 31, 2024
· Exposure to air pollutants cause allergic and respiratory diseases as well as chronic kidney disease.
· Adequate physical activity and proper nutrition are essential for children to maintain good health.
· We must educate people about the harmful effects of noise, blue light, heavy metals and smoke.
· Government and society must actively decrease environ-mental hazards.
Original Article
Pulmonology
Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis
Hyeri Jeong, Dawon Park, Eun Kyo Ha, Ju Hee Kim, Jeewon Shin, Hey-Sung Baek, Hyunsoo Hwang, Youn Ho Shin, Hye Mi Jee, Man Yong Han
Clin Exp Pediatr. 2024;67(11):608-618.   Published online October 28, 2024
· This study analyzed 45 randomized controlled trials (5,061 participants, 13 interventions) of the comparative efficacies of treatments for acute bronchiolitis in infants.
· Inhalation therapy with epinephrine and hypertonic saline significantly reduced the length of hospital stay compared with normal saline.
· Hypertonic saline had the greatest ability to improve the clinical severity score of bronchiolitis in infants younger than 2 years of age.
Review Article
Developmental and Behavioral Medicine
Effect of pesticide exposure on stunting incidence: a systematic review and meta-analysis
Sani Rachman Soleman, Yaltafit Abror Jeem, Muhammad Fathi Banna Al Faruqi, Mahdea Kasyiva, Vita Widyasari, Kuswati Kuswati, Nur Aini Djunet, Muflihah Rizkawati, Ety Sari Handayani
Clin Exp Pediatr. 2024;67(10):510-518.   Published online September 24, 2024
This review aimed to determine whether pesticide exposure is associated with stunting in children. The 13 included studies agree that pesticide exposure is not correlated with stunting incidence regardless of substance type (organophosphate and pyrethroid). Heterogeneity appeared with age covariate as potential confounding. The evidence of this study is challeng-ing, as the adverse effects of pesticides grossly occurred. The protection of children is warranted for preventing future neurodevelopment issues.
Original Article
Cardiology
Comparative analysis of adolescent hypertension definitions for predicting early adulthood carotid artery intima-media thickness: Tehran lipid and glucose study
Maryam Barzin, Shirin Yaghoobpoor, Maryam Mahdavi, Behnaz Abiri, Majid Valizadeh, Fereidoun Azizi, Pooneh Dehghan, Farhad Hosseinpanah
Clin Exp Pediatr. 2024;67(12):694-703.   Published online September 12, 2024
Question: What is the prevalence of HTN among adolescents enrolled in the TLGS according to 3 different accepted definitions (4th report, ESH, and AAP-CPG). Also, what is the ability of each of these definitions in predicting early adulthood CIMT, as a surrogate for cardiovascular disease events?
Finding: The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. The highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively.
Meaning: Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG.
Review Article
Developmental and Behavioral Medicine
Screen time among preschoolers: exploring individual, familial, and environmental factors
Sangha Lee, Donghee Kim, Yunmi Shin
Clin Exp Pediatr. 2024;67(12):641-650.   Published online September 12, 2024
This systematic review examined the correlation between screen time and various factors in preschoolers. Findings suggest that media parenting, including setting appropriate media limits, is crucial in protecting against excessive screen exposure. However, limited research has been done on the impact of family and personal factors, particularly with the increasing use of portable devices among young children.
Rheumatology
Double-negative T cells in pediatric rheumatic diseases
Dimitri Poddighe, Tilektes Maulenkul, Kuanysh Dossybayeva, Gulsamal Zhubanova, Zaure Mukusheva, Lyudmila Akhmaltdinova
Clin Exp Pediatr. 2024;67(12):632-640.   Published online September 12, 2024
Double-negative T (DNT) cells appear to be increased in several pediatric rheumatic diseases and this finding may be correlated with disease activity to some extent. However, due to significant heterogeneity in several methodological aspects, further investigations in rheumatic children are needed to assess the potential relevance of DNT cells as biomarkers and clarify their immunopathological role.
Allergy
Comparison and review of international guidelines for treating asthma in children
Eui Jeong Roh
Clin Exp Pediatr. 2024;67(9):447-455.   Published online August 20, 2024
Asthma is the most common chronic disease among children. Although asthma in children may spontaneously improve, it continues into adulthood in many cases. Therefore, appropriate disease management and medication are essential. Consistent and objective guidelines are needed to manage pediatric asthma and related adverse reactions.
Original Article
Genetics and Metabolism
Interleukin (IL)-1B and IL-1 receptor antagonist gene polymorphisms in children with primary immune thrombocytopenia
Seham Mohamed Ragab, Wafaa Moustafa Abo ElFotoh, Mahmoud Ahmed El-Hawy, Eman Abdelfatah Badr, Saara Khairat Ali Mostafa, Mai El-Sayad Abd El-Hamid
Clin Exp Pediatr. 2024;67(9):465-473.   Published online July 24, 2024
· Polymorphisms in interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonists may significantly affect the pathogenesis of immune thrombocytopenia (ITP).
· IL-1B and IL-1R antagonist gene polymorphisms are correlated with severity and susceptibility to primary ITP in children.
Review Article
Developmental and Behavioral Medicine
Comprehensive evaluation of the child with global developmental delays or intellectual disability
Abdullah Nasser Aldosari, T. Saeed Aldosari
Clin Exp Pediatr. 2024;67(9):435-446.   Published online May 29, 2024
· A detailed history and comprehensive physical examination remain the cornerstones for establishing a diagnosis of global developmental delay/intellectual disability (GDD/ID).
· Comprehensive surveillance and screening programs play a significant role in the early detection of GDD.
· Whole-exome sequencing is highly recommended as first- or second-line testing for individuals with idiopathic GDD/ID.
· Early intervention by a well-versed multidisciplinary team can significantly improve the outcomes and prognosis of GDD/ID.
Original Article
Developmental and Behavioral Medicine
Effectiveness of online responsive teaching in young children with developmental disabilities: a pilot study
Jung Sook Yeom, Jeongmee Kim
Clin Exp Pediatr. 2024;67(6):303-311.   Published online May 21, 2024
Question: Does online responsive teaching (RT) impact children's and parents’ emotions and behaviors, and do parents find it satisfactory?
Finding: Online RT significantly improved children's pivotal and problem behaviors, decreased parenting stress, and enhanced parental interactive styles with high satisfaction.
Meaning: This pilot study's findings suggest that online RT can enhance child outcomes, offering accessible interventions amid challenges such as limited access and pandemics.
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).
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.
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.
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
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.
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
· 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.
Original Article
Gastroenterology
Risk factors of prolonged diarrhea in children under 2 years old
Dedy Rahmat, Agus Firmansyah, Ina S. Timan, Saptawati Bardosono, Joedo Prihartono, Pramita Gayatri
Clin Exp Pediatr. 2023;66(12):538-544.   Published online November 16, 2023
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.
Review Article
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.
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.
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.
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.
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