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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.
Influence of infant microbiome on health and development
Noelle Younge
The microbiome is a complex ecosystem comprising microbes, their genomes, and the surrounding environment. The microbiome plays a critical role in early human development, including maturation of the host immune system and gastrointestinal tract. Multiple factors, including diet, antibiotic use, and other environmental exposures, influence the establishment of the microbiome during infancy. Numerous studies have identified associations between the microbiome...
Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks
Eun Song Song, Ga Won Jeon
Though positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation has a high failure rate in delivering PPV due to mask leaks, airway obstruction, or gastric inflation. Further, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%....
Original Article
Neurology
Need for palliative care from birth to infancy in pediatric patients with neurological diseases
Raffaele Falsaperla, Silvia Marino, Carla Moscheo, Lucia Giovanna Tardino, Simona Domenica Marino, Concetta Sciuto, Piero Pavone, Giovanna Vitaliti, Federica Sullo, Martino Ruggieri
Clin Exp Pediatr. 2023;66(8):350-356.   Published online June 14, 2023
Question: What are the current palliative care protocols, palliative course, and implementable palliative care programs for hospitalized pediatric patients with neurological diseases in Italy?
Finding: We studied 34 newborns with nervous system diseases, all of whom had a poor prognosis.
Meaning: Despite current legislation in Italy, no palliative care network has been implemented. Given the vast number of patients with neurological conditions, standardized palliative care guidelines and protocols are required.
Review Article
Neonatal family-centered care: evidences and practice models
Juyoung Lee
Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or premature infants have been exposed to more intensive monitoring and painful procedures, and lengthy hospitalization leading to prolonged separation from their parents. Over recent decades, the importance of parent-infant closeness early in an infant’s life has become more apparent, especially for preterm infants who are...
Original Article
Developmental and Behavioral Medicine
Parenting stress and interactive engagement behaviors in children with developmental delay
Jung Sook Yeom, Rock Bum Kim, Jae Young Cho, Ji Sook Park, Eun Sil Park, Ji-Hyun Seo, Jae-Young Lim, Hyang-Ok Woo
Clin Exp Pediatr. 2023;66(6):252-261.   Published online May 19, 2023
· Question: What level of parenting stress is experienced by parents of children with developmental delays (DDs) without autism spectrum disorder, and what factors contribute to it?
· Findings: Parents of children with DDs experienced high parenting stress that were significantly mediated by their children’s low interactive behaviors.
· Meaning: The interactive behaviors of children with DDs mediate parenting stress.
Review Article
Other
Hearing loss in neonates and infants
Goun Choe, Su-Kyoung Park, Bong Jik Kim
Clin Exp Pediatr. 2023;66(9):369-376.   Published online January 9, 2023
· Congenital hearing loss is common, with an approximate incidence of 1.5 per 1,000 newborns and affecting 1.2%–11% of preterm and 1.6%–13.7% of neonatal intensive care unit neonates.
· Etiologies vary, and up to 80% of cases are genetic.
· Newborn hearing screenings follow the 1-3-6 rule, and babies at high risk of hearing loss should be referred to otolaryngology for early detection and timely intervention.
Neonatology (Perinatology)
Neurodevelopmental outcomes of preterm infants
In Gyu Song
Clin Exp Pediatr. 2023;66(7):281-287.   Published online December 30, 2022
· Among survivors, 60.9% of infants born at 22 weeks’ gestation had moderate to severe impairments, whereas 50.3% born at 23 weeks’ and 42.2% at 24 weeks’ gestation had moderate to severe impairments.
· Moderate and late preterm infants reportedly have less severe disease than very preterm infants, but they still experience adverse neurodevelopmental outcomes.
· The careful follow-up and early detection of developmental problems in these patients are required.
Original Article
Neonatology (Perinatology)
A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants
Gayoung Lee, Juyoung Lee, Ga Won Jeon, Yong Hoon Jun
Clin Exp Pediatr. 2023;66(1):32-37.   Published online December 15, 2022
Question: Is a commercial thickened formula able to alleviate oral feeding-associated desaturation and bradycardia in preterm infants?
Finding: Thickened formula feeding significantly reduced oral feeding-associated desaturation and bradycardia in preterm infants.
Meaning: Thickened formula feeding stabilizes oxygen saturation and heart rate during oral feeding among preterm infants with feeding difficulties.
Gastroenterology
Probiotics added to maternal nutrition affect ınfantile colic symptoms and fecal microbiota profile: a single-blind randomized controlled study
Aysu Yıldız Karaahmet, Gülümser Dolgun, Metehan Özen
Clin Exp Pediatr. 2022;65(11):547-554.   Published online September 23, 2022
Question: Do probiotics added to maternal nutrition affect infantile colic symptoms and intestinal microbiota?
Finding: Infants whose mothers ingested probiotics demonstrated decreased crying frequency and intensity and significantly increased bacterial diversity in the stools. The bacterial variety was substantially affected by the added probiotic product.
Meaning: The addition of probiotics to maternal nutrition in early infancy could play an important role in preventing infantile colic.
Review Article
Nephrology (Genitourinary)
Neonatal hypertension: concerns within and beyond the neonatal intensive care unit
Kathleen Altemose, Janis M. Dionne
Clin Exp Pediatr. 2022;65(8):367-376.   Published online May 30, 2022
Some neonates, especially those who are premature, may experience hypertension while in the neonatal intensive care unit (NICU). The most common causes are prematurity-related and the hypertension usually resolves over the first 1–2 years of life. Unfortunately, the increasing population of NICU graduates is at risk for later cardiovascular and kidney disease in childhood and adulthood. This population requires careful attention to blood pressure and weight throughout their life course.
Original Article
Other
Plastic bottle feeding produces changes in biochemical parameters in human infants – A pilot study
Mahendra K. Pant, Abul. H. Ahmad, Manisha Naithani, Jayanti Pant
Clin Exp Pediatr. 2022;65(9):459-465.   Published online May 19, 2022
Question: Plastic feeding bottles are used commonly to feed infants who cannot be breastfeed. Does plastic bottle feeding produce biochemical changes in infants?
Finding: The plastic bottles leach out endocrine disruptors and affects bodily functions in terms of biochemical alterations like increased blood urea, raised creatine-kinase–MB levels, and altered lipid profile in infants exposed to bottle feeding.
Meaning: Plastic bottles feeding alters bodily functions in infants.
Review Article
Gastroenterology
Clinical importance of immunonutrition in infants: a review of the recent literature
Ji Sook Park
Clin Exp Pediatr. 2022;65(7):337-343.   Published online February 17, 2022
Nutrients are important in the developing immune system. Human milk supplies diverse bioactives to prevent acute infection or chronic inflammation. Immunoglobulins, lactoferrin, and glutamine in human milk decrease gastrointestinal and respiratory infection. Human milk oligosaccharides promote the growth of intestinal microbiota, the gut barrier, and antimicrobial or antiviral activity. Micronutrients act as anti-inflammatory immunonutrients, too. However, the toxicity of some nutrients from an overdose should be considered.
Factors influencing development of the infant microbiota: from prenatal period to early infancy
Sujin Jeong
Clin Exp Pediatr. 2022;65(9):439-447.   Published online December 23, 2021
∙ Microbial colonization primarily occurs after birth but there may be some colonization in utero, although this remains highly controversial.
∙ Maternal factors during pregnancy affect the infant microbiota: diet, weight, gestational weight gain, and antibiotic usage.
∙ Microbes are passed from mother-to-infant during and after birth. Delivery mode, breastfeeding, early life antibiotic, and proton pump inhibitor treatment have the largest effects on microbial composition in early life.
∙ The early life gut microbiome plays an important role in the development of the immune system and metabolism.
Neonatology (Perinatology)
Breastfeeding and vitamin D
Ju Sun Heo, Young Min Ahn, Ai-Rhan Ellen Kim, Son Moon Shin; for the Korean Society of Breastfeeding Medicine
Clin Exp Pediatr. 2022;65(9):418-429.   Published online December 14, 2021
∙ Exclusively breastfed infants are at risk of developing vitamin D deficiency associated with hypocalcemia, rickets, and various health outcomes.
∙ The prevalence of vitamin D deficiency in breastfed infants differs vastly between studies and nations at 0.6%–91.1%.
∙ The vitamin D content of breast milk does not meet the requirements of exclusively breastfed infants.
∙ Most international guidelines recommend that breastfed infants be supplemented with 400 IU/day of vitamin D during the first year of life.
∙ Vitamin D intake (milk+supplements) of 800 IU/day can be considered in preterm infants along with biochemical monitoring.
Original Article
Other
Risk factors and screening timing for developmental dysplasia of the hip in preterm infants
Ga Won Jeon, Hye Jung Choo, Yong Uk Kwon
Clin Exp Pediatr. 2022;65(5):262-268.   Published online November 5, 2021
Question: When is the best screening timing and what is the risk factor for developmental dysplasia of the hip (DDH) in preterm infants?
Finding: Ultrasonography performed earlier than 38 weeks of postmenstrual age caused unnecessary subsequent ultrasonography. DDH did not occur predominantly on the left side or in breech infants.
Meaning: The screening timing, etiology, and risk factors for DDH in preterm infants are somewhat different from those in term infants.
Review Article
Neonatology (Perinatology)
Pathophysiology, classification, and complications of common asymptomatic thrombocytosis in newborn infants
Ga Won Jeon
Clin Exp Pediatr. 2022;65(4):182-187.   Published online October 18, 2021
· Thrombocytosis, common in newborns and infants (<2 years) (3%–13%), is caused by elevated thrombopoietin (TPO) concentrations.
· Serum TPO levels are significantly higher immediately to 1 month postnatal and decrease with age.
· Platelet counts are positively correlated with gestational age at birth and postnatal age.
· Thrombocytosis is more common in preterm than in term infants.
· Thrombocytosis in newborns is reactive and resolves spontaneously without complications.
Original Article
Neonatology (Perinatology)
Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial
Mohammad Kazem Sabzehei, Behnaz Basiri, Maryam Shokouhi, Sajad Ghahremani, Ali Moradi
Clin Exp Pediatr. 2022;65(4):188-193.   Published online July 28, 2021
Question: Are the short-term outcomes of minimally invasive surfactant therapy (MIST) relatively superior to those of INtubation, SURfactant administration, and Extubation (INSURE) in preterm infants with respiratory distress syndrome (RDS)?
Finding: MIST could be an appropriate substitution for INSURE in preterm infants with RDS since it reduced hospitalization time and number of side effects.
Meaning: MIST is recommended for surfactant administration for its proven advantages over the INSURE technique.
Review Article
Neonatology (Perinatology)
Growth patterns of preterm infants in Korea
Joohee Lim, So Jin Yoon, Soon Min Lee
Clin Exp Pediatr. 2022;65(1):1-9.   Published online July 8, 2021
∙ The growth of preterm infants is a main focus of neonatology.
∙ Preterm infants in Korea, especially those with a very low birth weight, achieve retarded growth.
∙ Careful growth monitoring and early intervention will contribute to better development outcomes and quality of life for preterm infants and improve public health.
Infection
Recommendation for use of diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b conjugate, and hepatitis B vaccine in infants
Hye-Kyung Cho, Su Eun Park, Yae-Jean Kim, Dae Sun Jo, Yun-Kyung Kim, Byung-Wook Eun, Taek-Jin Lee, Jina Lee, Hyunju Lee, Ki Hwan Kim, Eun Young Cho, Jong Gyun Ahn, Eun Hwa Choi; The Committee on Infectious Diseases of the Korean Pediatric Society
Clin Exp Pediatr. 2021;64(12):602-607.   Published online June 8, 2021
∙ Diphtheria and tetanus toxoids and acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b-hepatitis B (DTaP-IPV-Hib-HepB) was licensed in Korea in April 2020.
∙ DTaP-IPV-Hib-HepB is indicated as a 3-dose primary series for infants aged 2, 4, and 6 months who received the standalone HepB vaccine at birth.
∙ Infants born to HepB surface antigen-positive mothers are currently recommended to be immunized with HepB immunoglobulin at birth and then monovalent HepB vaccine at 0, 1, and 6 months.
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
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.
Allergy
Cohort profile: National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008)
Ju Hee Kim, Jung Eun Lee, So Min Shim, Eun Kyo Ha, Dong Keon Yon, Ok Hyang Kim, Ji Hyeon Baek, Hyun Yong Koh, Kyu Young Chae, Seung Won Lee, Man Yong Han
Clin Exp Pediatr. 2021;64(9):480-488.   Published online January 5, 2021
This national cohort study included all Korean children born in 2008 and 2009 observed over a period of more than 10 years. Our findings demonstrate that it is possible to analyze disease onset prior to hospitalization based on information such as lifestyle, eating habits, and risk factors by integrating National Health Insurance System data with national health screening data.
Review Article
Neonatology (Perinatology)
Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up
Yumi Kono; on behalf of the Neonatal Research Network of Japan
Clin Exp Pediatr. 2021;64(7):313-321.   Published online November 9, 2020
· Very low birth weight infants remain at high risk of developing neurodevelopmental impairments in early childhood.
· It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.
· All possible strategies should be employed to maintain good compliance after neonatal intensive care unit discharge.
Neurology
Is it really a seizure? The challenge of paroxysmal nonepileptic events in young infants
Seung Yeon Jung, Joon Won Kang
Clin Exp Pediatr. 2021;64(8):384-392.   Published online September 18, 2020
Paroxysmal nonepileptic events (PNE) comprise of a variety of nonepileptic behaviors and are divided into various types. A more accurate diagnosis is possible by examining the video clip provided by the caregiver. In infants, physiologic PNE accounts for the majority of the PNE. It is important to exclude epilepsy, for which blood tests, electroencephalography, and imaging tests can facilitate differential...
Original Article
General Pediatrics
Significance of the tethered maxillary frenulum: a questionnaire-based observational cohort study
Sody A. Naimer, Ariel Israel, Aviezer Gabbay
Clin Exp Pediatr. 2021;64(3):130-135.   Published online September 7, 2020
Question: Does a tethered maxillary frenulum in the newborn result in breastfeeding difficulty or other oral symptomatology?
Finding: The analysis of subjects with a tethered maxillary frenulum surveyed beyond a mean 5-year follow-up did not reveal an increase in oral issues versus those of a random agematched control group.
Meaning: These data demonstrate no need to intervene upon the diagnosis of a tethered maxillary frenulum.
Neonatology (Perinatology)
Predictive factors of death in neonates with hypoxic-ischemic encephalopathy receiving selective head cooling
Behnaz Basiri, Mohammadkazem Sabzehei, Mohammadmahdi sabahi
Clin Exp Pediatr. 2021;64(4):180-187.   Published online August 27, 2020
Question: What is the most important factor that increases mortality in infants with hypoxic-ischemic encephalopathy (HIE) who receive selective head cooling?
Finding: All cases of neonatal mortality were severe HIE (stage 3), and a severely abnormal amplitude-integrated electroencephalography and mortality were increased with the need for advanced neonatal resuscitation upon delivery.
Meaning: Advanced neonatal resuscitation affects HIE outcomes, and medical personnel should be prepared to provide the best intervention.
Review Article
Other
Review of epidemiological studies on air pollution and health effects in children
Jong-Tae Lee
Clin Exp Pediatr. 2021;64(1):3-11.   Published online June 10, 2020
This review summarized the accumulated epidemiologic evidence with emphasis on studies conducted in Korea and heterogeneity in the literature. Based on systematic reviews and meta-analyses, there is consistent evidence on the association between exposure to ambient air pollution and children’s health, especially respiratory health and adverse birth outcomes, and growing evidence on neurodevelopmental outcomes.
Original Article
Neonatology (Perinatology)
Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis
Mahmoud Robati Anaraki, Masoud Nouri-Vaskeh, Shahram Abdoli Oskoei
Clin Exp Pediatr. 2021;64(4):172-179.   Published online May 14, 2020
· Mortality is decreased significantly in meta-analysis of studies in different regimen of fluconazole prophylaxis.
· Significant decrease was seen in incidence of invasive candidiasis-associated mortality in extremely low birth weight infants in same schedules of prophylaxis.
· More studies required to relief the concerns.
Developmental and Behavioral Medicine
Development of the Korean Developmental Screening Test for Infants and Children (K-DST)
Hee Jung Chung, Donghwa Yang, Gun-Ha Kim, Sung Koo Kim, Seoung Woo Kim, Young Key Kim, Young Ah Kim, Joon Sik Kim, Jin Kyung Kim, Cheongtag Kim, In-Kyung Sung, Son Moon Shin, Kyung Ja Oh, Hee-Jeong Yoo, Hee Joon Yu, Seoung-Joon Lim, Jeehun Lee, Hae-Ik Jeong, Jieun Choi, Jeong-Yi Kwon, Baik-Lin Eun
Clin Exp Pediatr. 2020;63(11):438-446.   Published online May 14, 2020
Question: Can the Korean Developmental Screening Test for Infants and Children (K-DST) be a useful screening tool for infants and children in Korea?
Finding: The K-DST has high reliability (internal consistency of 0.73–0.93, test-retest reliability of 0.77–0.88) and a high discriminatory ability with a sensitivity of 0.833 and specificity of 0.979.
Meaning: The K-DST is an effective and reliable screening tool for infants and children with neurodevelopmental disorders in Korea.
Review Article
Infection
Epidemiology and clinical features of coronavirus disease 2019 in children
Soo-Han Choi, Han Wool Kim, Ji-Man Kang, Dong Hyun Kim, Eun Young Cho
Clin Exp Pediatr. 2020;63(4):125-132.   Published online April 6, 2020
Coronavirus disease-2019 (COVID-19), which started in Wuhan, China, in December 2019 and declared a worldwide pandemic on March 11, 2020, is a novel infectious disease that causes respiratory illness and death. Pediatric COVID-19 accounts for a small percentage of patients and is often milder than that in adults; however, it can progress to severe disease in some cases. Even neonates...
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