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Review Article
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
· 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.
DOI: https://doi.org/10.3345/cep.2023.00528    [Epub ahead of print]
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.
Critical Care Medicine
Timing of parenteral nutrition initiation in critically ill children: a randomized clinical trial
Nagwan Y. Saleh, Hesham M. Aboelghar, Nehad B. Abdelaty, Mohamed I. Garib, Asmaa A. Mahmoud
Clin Exp Pediatr. 2023;66(9):403-411.   Published online June 14, 2023
Question: What is the ideal initiation timing of parenteral nutrition for critically ill children?
Finding: This randomized clinical trial of 140 children examined the effects of an early or late start of parenteral nutrition on mechanical ventilation need (primary outcome) and length of stay and mortality (secondary outcomes).
Meaning: Children who received early versus late parenteral nutrition had lower mechanical ventilation need and duration.
Review Article
Other
Epidemiology of pediatric fractures before versus during the coronavirus disease 2019 pandemic
Chi Hoon Oh, Siyeong Yoon, Kyung Rae Ko, Young Woo Kwon, Kyeong Mi Kim, Hyun Seo Park, Hogyeong Kang, Inseok Jang, Soonchul Lee
Clin Exp Pediatr. 2022;65(7):330-336.   Published online June 3, 2022
∙ The novel coronavirus disease 2019 (COVID-19) was first reported in December 2019 as a cluster outbreak in Wuhan, since then, national lockdowns have included school closures, stay-at-home orders.
∙ The characteristics of adolescent fractures were often related to physical activity such as sports-related injury.
∙ During the COVID-19 pandemic, both in the East and the West, the incidence of fractures in children and adolescents is showing a decreasing trend worldwide.
∙ Fractures in children and adolescents were significantly reduced in the proportion of relatively low-energy damage, and the incidence of fractures in adolescents with greater activity compared to children was reduced.
∙ If COVID-19 pandemic ends, normal academic and sports activities increase due to the easing of lockdown policies, the number of trauma patients related to increased activity may increase rapidly, and clinics should prepare for this change.
Original Article
Gastroenterology
Noninvasive markers for esophageal varices in children with cirrhosis
Parisa Rahmani, Fatemeh Farahmand, Ghobad Heidari, Azadeh Sayarifard
Clin Exp Pediatr. 2021;64(1):31-36.   Published online July 21, 2020
Question: Can noninvasive biomarkers identify esophageal varices among children with esophageal cirrhosis?
Finding: The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index, platelet count to spleen size ratio, and risk score differed significantly between the patients with and those without esophageal varices.
Meaning: These biological parameters can predict esophageal varices among pediatric patients and indicate the need for esophagogastroduodenoscopy.
Critical Care Medicine
Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?
Chanapai Chaiyakulsil, Onsuthi Pharadornuwat
Clin Exp Pediatr. 2021;64(3):123-129.   Published online July 14, 2020
Question: Can central line bundles and feedback reduce central line-associated complications in pediatric patients?
Finding: The central line-related bloodstream infection rate decreased from 10.0 catheter-days to 1.4/1,000 catheter-days at 6-month postintervention. The central line occlusion rate was also decreased.
Meaning: Reinforcing central line care bundles with direct feedback can significantly decrease central line-associated complications in pediatric patients.
Assessment of interhospital transport care for pediatric patients
Krittiya Chaichotjinda, Marut Chantra, Uthen Pandee
Clin Exp Pediatr. 2020;63(5):184-188.   Published online August 29, 2019
Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur.
Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications...
Review Article
General Pediatrics
Quality improvement in pediatric care
Moon Sung Park
Clin Exp Pediatr. 2018;61(1):1-5.   Published online January 22, 2018

We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite...

Case Report
Neurology
A pediatric case of idiopathic Harlequin syndrome
Ju Young Kim, Moon Souk Lee, Seung Yeon Kim, Hyun Jung Kim, Soo Jin Lee, Chur Woo You, Jon Soo Kim, Ju Hyung Kang
Clin Exp Pediatr. 2016;59(Suppl 1):S125-S128.   Published online November 30, 2016

Harlequin syndrome, which is a rare disorder caused by dysfunction of the autonomic system, manifests as asymmetric facial flushing and sweating in response to heat, exercise, or emotional factors. The syndrome may be primary (idiopathic) with a benign course, or can occur secondary to structural abnormalities or iatrogenic factors. The precise mechanism underlying idiopathic harlequin syndrome remains unclear. Here, we...

Gastroenterology
Granular cell tumor of the esophagus in an adolescent
Ji Sun Lee, Kyung Ok Ko, Jae Woo Lim, Eun Jeong Cheon, Young Jin Kim, Jang Sin Son, Jung Min Yoon
Clin Exp Pediatr. 2016;59(Suppl 1):S88-S91.   Published online November 30, 2016

Esophageal granular cell tumor (GCT) is a rare neoplasm originating from the Schwann cells of the submucosal neuronal plexus. Histology is the gold standard for its diagnosis. Endoscopic resection or surgical excision should be considered, depending on the potential for malignancy. Here, we report a case of an esophageal GCT in an adolescent. A 12-year-old boy presented with a 1-year...

Original Article
Infection
Pneumocystis jirovecii pneumonia in pediatric patients: an analysis of 15 confirmed consecutive cases during 14 years
Kyung-Ran Kim, Jong Min Kim, Ji-Man Kang, Yae-Jean Kim
Clin Exp Pediatr. 2016;59(6):252-255.   Published online June 30, 2016
Purpose

Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center.

Methods

We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review...

Review Article
Gastroenterology
Nutritional concerns in pediatric inflammatory bowel disease
Yong Joo Kim
Clin Exp Pediatr. 2016;59(6):247-251.   Published online June 30, 2016

The pathophysiology and fundamental etiologic mechanism of inflammatory bowel disease (IBD) is not well understood even though therapeutic regimens and drugs are rapidly evolutionary. IBD has complicated connections with genetic, immunologic, gut microbial, environmental, and nutritional factors. It is not clearly well known to the physicians how to feed, what nutrients are more helpful, and what food to be avoided....

Original Article
Gastroenterology
Recent viral pathogen in acute gastroenteritis: a retrospective study at a tertiary hospital for 1 year
Hye Il Jin, Yoo Mi Lee, You Jin Choi, Su Jin Jeong
Clin Exp Pediatr. 2016;59(3):120-125.   Published online March 31, 2016
Purpose

Viral gastroenteritis among children is mainly caused by rotavirus, norovirus, astrovirus, or adenovirus strains. However, changing socioeconomic conditions and a rotavirus vaccination program may be affecting the prevalence of these viral infections. Therefore, we aimed to elucidate the season-specific trends in viral infections for facilitating prophylaxis and surveillance in our region.

Methods

We evaluated 345 pediatric patients (203 males, 142 females; age,...

Case Report
The first pediatric case of tularemia in Korea: manifested with pneumonia and possible infective endocarditis
Jung Sook Yeom, Kyuyol Rhie, Ji Sook Park, Ji-Hyun Seo, Eun Sil Park, Jae-Young Lim, Chan-Hoo Park, Hyang-Ok Woo, Hee-Shang Youn
Clin Exp Pediatr. 2015;58(10):398-401.   Published online October 21, 2015

Tularemia is a potentially severe zoonotic disease caused by Francisella tularensis. A lack of awareness about tularemia can be embarrassing and could result in delayed treatment because of improper diagnosis. The diagnosis of tularemia is difficult, because the infections are rare and the clinical spectrum is broad. As only 1 adult case has been reported in Korea thus far, pediatricians...

Development of multifocal nodular lesions of a liver mimicking hepatic metastasis, following resection of an insulinoma in a child
Sook Young Jung, Ben Kang, Yoon Mee Choi, Jun Mee Kim, Soon Ki Kim, Young Se Kwon, Ji Eun Lee
Clin Exp Pediatr. 2015;58(2):69-72.   Published online February 28, 2015

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia....

Original Article
The relationship between primary headache and constipation in children and adolescents
Mi-Na Park, Min-Gyu Choi, Su Jeong You
Clin Exp Pediatr. 2015;58(2):60-63.   Published online February 28, 2015
Purpose

Many patients presenting with headache also complain of constipation; the relationship between these two symptoms has not been explored in detail. The aim of this study was to investigate the association between primary headache and constipation.

Methods

This retrospective study included all children who attended the Inje University Sanggye Paik Hospital complaining of headache, and who had been followed up for at...

Review Article
Advancements in the treatment of pediatric acute leukemia and brain tumor - continuous efforts for 100% cure
Hee Young Ju, Che Ry Hong, Hee Young Shin
Clin Exp Pediatr. 2014;57(10):434-439.   Published online October 31, 2014

Treatment outcomes of pediatric cancers have improved greatly with the development of improved treatment protocols, new drugs, and better supportive measures, resulting in overall survival rates greater than 70%. Survival rates are highest in acute lymphoblastic leukemia, reaching more than 90%, owing to risk-based treatment through multicenter clinical trials and protocols developed to prevent central nervous system relapse and testicular...

Original Article
Clinical outcome of acute necrotizing encephalopathy in related to involving the brain stem of single institution in Korea
Cha Gon Lee, Ji Hye Kim, Munhyang Lee, Jeehun Lee
Clin Exp Pediatr. 2014;57(6):264-270.   Published online June 30, 2014
Purpose

Acute necrotizing encephalopathy (ANE) is a fulminant disease of the brain characterized by bilateral thalamic lesions, and is prevalent among children in East Asia. The prognosis of ANE is usually poor with a high mortality rate and neurological sequelae. This study aimed to delineate the clinical characteristics and prognostic factors of ANE.

Methods

We retrospectively analyzed clinical data of 399 pediatric patients...

Review Article
Magnetoencephalography in pediatric epilepsy
Hunmin Kim, Chun Kee Chung, Hee Hwang
Clin Exp Pediatr. 2013;56(10):431-438.   Published online October 31, 2013

Magnetoencephalography (MEG) records the magnetic field generated by electrical activity of cortical neurons. The signal is not distorted or attenuated, and it is contactless recording that can be performed comfortably even for longer than an hour. It has excellent and decent temporal resolution, especially when it is combined with the patient's own brain magnetic resonance imaging (magnetic source imaging). Data...

Original Article
Intravenous fluid prescription practices among pediatric residents in Korea
Jiwon M. Lee, Younghwa Jung, Se Eun Lee, Jun Ho Lee, Kee Hyuck Kim, Ja Wook Koo, Young Seo Park, Hae Il Cheong, Il-Soo Ha, Yong Choi, Hee Gyung Kang
Clin Exp Pediatr. 2013;56(7):282-285.   Published online July 19, 2013
Purpose

Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children. The present paper investigated the pattern of current practice in intravenous fluid prescription among Korean pediatric residents, to underscore the need for updated education.

Methods

A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each...

Effect of hyperglycemia on mortality rates in critically ill children
Seongkuk Kim, Bo Eun Kim, Eun Ju Ha, Mi Young Moon, Seong Jong Park
Clin Exp Pediatr. 2010;53(3):323-328.   Published online March 15, 2010
Purpose : To verify the effect of hyperglycemia on mortality rates in critically ill children and to identify the blood glucose level that influences prognosis. Methods : From July 2006 to June 2008, a total of 206 patients who were admitted to the pediatric intensive care unit (PICU) at Asan Medical Center and who survived for more than 7 days...
Erratum
Changes related term alteration of pediatrics and roles of pediatrician
Yong Kyu Sohn
Clin Exp Pediatr. 2008;51(11):1133-1135.   Published online November 15, 2008
The ultimate goal of the term alteration to pediatrics is that not only infants and children but also adlescents are subjet to pediatrics. At 27, June, 2007 the term pediatrics was altered to pediatrics (children and aoldescent medicine). From now on the roles of pediatricians for adolescents are needed and adolescent medicine should be reorganized in Korea. Although the numbers...
Original Article
Normal antistreptolysin O titers of children by age group in the Gyeonggi-Incheon region
Jihun Lee, Yoo Jung Kim, Joong Hyun Bin, Ja Young Hwang, Seong Hoon Hahn, So Young Kim, Hyun Hee Kim, Wonbae Lee
Clin Exp Pediatr. 2007;50(10):965-969.   Published online October 15, 2007
Purpose : Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. Methods...
Clinical characteristics of deep neck abscess in children; 15 year experience in a university hospital
Min-Ji Goo, Jeong-Suk Yeom, Eo-Jin Kim, Jung-Je Park, Ji-Hyun Seo, Eun-Sil Park, Jae-Young Lim, Chan-Hoo Park, Hyang-Ok Woo, Hee-Shang Youn
Clin Exp Pediatr. 2007;50(7):649-654.   Published online July 15, 2007
Purpose : The objective of this study was to clarify the presentation, associated preceding illness, pathologic organisms, treatment and outcome of deep neck abscess in children according to age and location. Methods : We retrospectively reviewed the in-patient charts of children treated at our hospital for deep neck abscess. Thirty-five such patients were identified as having been treated...
An analysis of one-year experience of pediatric observation unit: The first report in Korea
Jee Young Lee, Ui-Yoon Choi, Soo Young Lee, Ji-Young Lee, Byong Chan Lee, Hui Sung Hwang, Hye Rin Mok, Dae Chul Jeong, Seung Yun Chung, Jin Han Kang
Clin Exp Pediatr. 2007;50(7):622-628.   Published online July 15, 2007
Purpose : While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. Methods : All children admitted from...
Quantitative Assessment of Myocardial Tissue Velocity in Normal Children with Doppler Tissue Imaging : Reference Values, Growth and Heart Rate Related Change
Se Young Kim, Myung Chul Hyun, Sang Bum Lee
Clin Exp Pediatr. 2005;48(8):846-856.   Published online August 15, 2005
Purpose : To measure the peak myocardial tissue velocities and patterns of longitudinal motion of atrioventricular(AV) annuli and assess body weight and heart rates-related changes in normal children. Methods : Using pulsed wave Tissue Doppler Imaging(TDI), we measurpeak systolic, early and late diastolic myocardial velocities in 72 normal children at six different sites in apical-4 chamber (A4C) view and at...
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