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Review Article
Hematology
Thrombosis and severe acute respiratory syndrome coronavirus 2 vaccines: vaccine-induced immune thrombotic thrombocytopenia
Young Shil Park
Clin Exp Pediatr. 2021;64(8):400-405.   Published online June 30, 2021
· Thrombosis and thrombocytopenia occurring within 4–28 days after severe acute respiratory syndrome coronavirus 2 vaccination require attention.
· The terms vaccine-induced immune thrombotic thrombocytopenia (VITT) and thrombosis with thrombocytopenia syndrome (TTS) are used.
· VITT is pathogenetically similar to heparin-induced thrombocytopenia.
· VITT/TTS could be associated with the development of platelet-activating anti-platelet factor 4 antibodies.
· For suspected VITT/TTS, early treatment decisions (intravenous immunoglobulin, non-heparin anticoagulant, and avoidance of platelet transfusions) are important.
Allergy
Food allergies and food-induced anaphylaxis: role of cofactors
Meeyong shin
Clin Exp Pediatr. 2021;64(8):393-399.   Published online November 12, 2020
Question: What are the roles of cofactors in food allergies and food-induced anaphylaxis?
Finding: Cofactors reportedly play a role in approximately 14%–30% of anaphylactic reactions. Cofactors such as exercise, infection, nonsteroidal anti-inflammatory drugs, dehydration, and alcohol can increase intestinal permeability and antigen uptake, thereby causing allergic symptoms.
Meaning: Routine assessment of the possible involvement of cofactors is essential for the management of patients with food-induced anaphylaxis.
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...
Allergy
Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis
Hye Yung Yum, Eun Kyo Ha, Yoon Ho Shin, Man Yong Han
Clin Exp Pediatr. 2021;64(8):373-383.   Published online August 10, 2020
Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%–89% of the chronic rhinitis cases, affecting 1%–50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally...
Letter to the Editor
General Pediatrics
Hyperinflammatory syndrome in children during the coronavirus disease 2019 pandemic in sub-Himalayan region
Seema Sharma, Shikha Verma, Isha Bhatia, Ravinder Singh, Mohit Bajaj, Milap Sharma
Clin Exp Pediatr. 2021;64(7):370-372.   Published online May 11, 2021
Question: Is there an increase in patients with hyperinflammatory syndrome during the coronavirus disease 2019 pandemic?
Finding: We found 10 patients with hyperinflammatory syndrome with poor outcome during a period of 2 months in a single tertiary care centre.
Meaning: Pediatricians who come across patients with muco cutaneous manifestations and multiorgan involvement should consider hyperinflammatory syndrome. Early recognition and prompt treatment of such patients may result in promising outcome.
Original Article
Emergency Medicine
Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center study
Meraj Siddiqui, Ayşe Gültekingil, Oğuz Bakırcı, Nihal Uslu, Esra Baskın
Clin Exp Pediatr. 2021;64(7):364-369.   Published online May 18, 2021
Question: What are the differences between coronavirus disease 2019 (COVID-19) and influenza infections in children?
Finding: Pediatric COVID-19 patients predominantly exhibited respiratory and/or gastrointestinal symptoms, neurological manifestations, olfactory/gustatory dysfunction, elevated monocytes, mildly elevated C-reactive protein, and unilateral or diffuse abnormalities on chest x-ray. Patients with underlying medical conditions had higher intensive care unit admission rates and should be followed closely.
Meaning: The clinical presentations of pediatric COVID-19 patients varied from asymptomatic/mild to severe.
Nephrology (Genitourinary)
Expression profiling of cultured podocytes exposed to nephrotic plasma reveals intrinsic molecular signatures of nephrotic syndrome
Stuti Panigrahi, Varsha Chhotusing Pardeshi, Karthikeyan Chandrasekaran, Karthik Neelakandan, Hari PS, Anil Vasudevan
Clin Exp Pediatr. 2021;64(7):355-363.   Published online November 1, 2020
Question: Is it possible to classify nephrotic syndrome (NS) through gene expression profiling of podocytes exposed to NS plasma?
Finding: Our data showed different expression profiles in podocytes exposed to nephrotic plasma from different clinical groups, suggesting the molecular stratification of patients into intrinsic subtypes.
Meaning: Transcriptome profiling of podocytes treated with NS plasma can stratify patients into intrinsic subtypes and provide insight into the molecular mechanisms of podocyte injury.
Urinary neutrophil gelatinase-associated lipocalin: a marker of urinary tract infection among febrile children
Ji Hyun Moon, Kee Hwan Yoo, Hyung Eun Yim
Clin Exp Pediatr. 2021;64(7):347-354.   Published online October 17, 2020
Question: Reliably diagnosing urinary tract infection (UTI) in febrile children is often difficult. Can urinary neutrophil gelatinase-associated lipocalin (uNGAL) better predict UTI and acute pyelonephritis (APN) than serum C-reactive protein (CRP) and white blood cell (WBC) count?
Finding: uNGAL better facilitated the prediction of UTI and APN, than serum CRP and WBC counts in febrile children.
Meaning: uNGAL is a suitable biomarker for UTI and APN in febrile children.
Developmental and Behavioral Medicine
Is meconium exposure associated with autism spectrum disorders in children?
Ensiyeh Jenabi, Erfan Ayubi, Salman Khazaei, Saeid Bashirian, Mojtaba Khazaei
Clin Exp Pediatr. 2021;64(7):341-346.   Published online October 4, 2020
• Meconium exposure is weakly associated with an increased risk of autism spectrum disorder (ASD) development in children.
• More evidence based on large prospective cohort studies is required to conclude whether meconium exposure is associated with an increased risk of ASD.
Editorial
Neurology
Recent trends in autism spectrum disorder research using text mining of PubMed: importance of early detection
Seung Soo Kim
Clin Exp Pediatr. 2021;64(7):339-340.   Published online November 9, 2020
Behavioral therapy, the most widely proven intervention for the core symptoms of autism spectrum disorder (ASD), is required for life for individuals with ASD. Parent involvement, early detection, and early therapy play important roles. We must organize the risk factors for ASD and develop a screening tool that can be easily applied in the clinical, daycare, or school setting.
Review Article
Infection
Updates on the coronavirus disease 2019 vaccine and consideration in children
Hyun Mi Kang, Eun Hwa Choi, Yae-Jean Kim
Clin Exp Pediatr. 2021;64(7):328-338.   Published online June 21, 2021
· The number of coronavirus disease 2019 cases has exponentially increased worldwide, and children ≤19 years old account for 11.0% of all confirmed cases.
· mRNA vaccines, BNT162b2 and mRNA-1273, and adenoviral vector vaccines, AZD1222 and Ad26.COV2.S, authorized for emergency use in the Emergency Use Listing of the World Health Organization are reviewed.
· Clinical trials of these vaccines have shown that they are safe and serious adverse reactions are rarely observed.
School closures during the coronavirus disease 2019 outbreak
Eun Young Cho, Young June Choe
Clin Exp Pediatr. 2021;64(7):322-327.   Published online May 31, 2021
· Earlier modeling studies of the effects of school closures on severe acute respiratory syndrome coronavirus 2 were largely derived from the pandemic influenza model, resulting in conflicting implications.
· Observational findings suggest no clear effect of school closures on community transmission or overall mortality.
· School closures must be weighed against potential high social costs, which can also negatively affect children’s health.
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.
Clinical note
Neurology
Myelin oligodendrocyte glycoprotein antibody encephalitis following severe acute respiratory syndrome coronavirus 2 in a pediatric patient
Nusrat Ahsan, Saba Jafarpour, Jonathan D. Santoro
Clin Exp Pediatr. 2021;64(6):310-312.   Published online February 1, 2021
Question: Although neurologic complications have been reported during the acute phase of infection in children, less is known about the postinfectious phenomenon associated with the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus.
Finding: We present a case of a 7-year-old female with a prior asymptomatic infection with SARS-CoV-2 who subsequently developed encephalopathy and status epilepticus in association with myelin oligodendrocyte glycoprotein (MOG) antibody positivity.
Meaning: Here we present the first case of postinfectious of a MOG spectrum disorder associated with prior SARS-CoV-2 infection in a pediatric patient.
Original Article
Gastroenterology
Celiac disease in children: Increasing prevalence and changing clinical presentations
Hasan M. Isa, Eman Farid, Jaafar J. Makhlooq, Afaf M. Mohamed, Jumana G. Al-Arayedh, Fawzeya A. Alahmed, Shima Medani
Clin Exp Pediatr. 2021;64(6):301-309.   Published online October 17, 2020
Question: What are the prevalence and clinical characteristics of celiac disease (CD) in children in Bahrain?
Finding: We found a significant increase in CD prevalence over the last decade (P=0.0001). A male predominance was noted. Atypical presentations were common. Most patients had poor adherence to a gluten-free diet.
Meaning: CD is an underdiagnosed condition. Atypical symptoms should be considered to prevent missing patients with CD.
Infection
Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade
Woosuck Suh, Bi Na Kim, Hyun Mi Kang, Eun Ae Yang, Jung-Woo Rhim, Kyung-Yil Lee
Clin Exp Pediatr. 2021;64(6):293-300.   Published online October 14, 2020
Question: How has the antibiotic susceptibility of urinary pathogens changed and what does it imply?
Finding: A yearly increase in multidrug-resistant and extended-spectrum β-lactamase (ESBL)–producing pathogens was observed. A higher recurrence rate was observed in cases of febrile urinary tract infection caused by ESBL producers in patients with underlying vesicoureteral reflux (VUR).
Meaning: The initial empirical antibiotic should reflect the changing susceptibility patterns and underlying VUR status.
Other
Association between pesticide and polychlorinated biphenyl exposure during pregnancy and autism spectrum disorder among children: a meta-analysis
Fereshteh Mehri, Saeid Bashirian, Salman khazaei, Ensiyeh Jenabi
Clin Exp Pediatr. 2021;64(6):286-292.   Published online July 27, 2020
· This meta-analysis analyzed the association between pesticide and polychlorinated biphenyl (PCB) exposure during pregnancy and autism spectrum disorders (ASD) risk among children.
· A significant association was noted between PCB and pesticide exposure during pregnancy and ASD risk among children (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.26–2.34 and OR, 1.20; 95% CI, 1.02–1.39), respectively.
· Pesticide and PCB exposure during pregnancy may affect ASD risk among children.
Editorial
Infection
Should we prescribe carbapenem for treating febrile urinary tract infection caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in children with vesicoureteral reflux?
Ji Young Park
Clin Exp Pediatr. 2021;64(6):284-285.   Published online January 5, 2021
Recent studies are focused on the noninferiority of noncarbapenem therapy for the treatment of extended-spectrum β-lactamases producing Enterobacteriaceae infections to reduce the utilization of carbapenem.
Neurology
Psychogenic nonepileptic seizures; beyond differentiating from epileptic seizures
Sang Ook Nam
Clin Exp Pediatr. 2021;64(6):282-283.   Published online November 12, 2020
Infection
Babies born to mothers positive for SARS-CoV-2 – Are they in danger?
Joon Kee Lee
Clin Exp Pediatr. 2021;64(6):280-281.   Published online May 4, 2021
Concerns have arisen in the coronavirus disease 2019 (COVID-19) pandemic upon pregnancy and postnatal care starting from reproductive decision-making. To the utmost knowledge, reproductive decisions should not be based primarily on health-related COVID-19 concerns, as the possibility of vertical transmission is negligible and the perinatal outcome is generally not poor compared to pregnancies without COVID-19, as long as infection control measures are well kept.
Review Article
Cardiology
Application of CRISPR-Cas9 gene editing for congenital heart disease
Heeyoung Seok, Rui Deng, Douglas B. Cowan, Da-Zhi Wang
Clin Exp Pediatr. 2021;64(6):269-279.   Published online March 2, 2021
Clustered regularly interspaced short palindromic repeats and CRISPR-associated protein 9 (CRISPR-Cas9) system has made a big step in the genome editing which still requires technical developments for the efficient applications in the many fields including congenital heart diseases (CHDs), closely related to the genomic abnormality. In this review, we tried to cover the most updated researches of CRISPR-Cas9 in the CHDs to understand the current technologies, eventually becoming therapeutic bases for the CHD patients.
Gastroenterology
Causes of acute gastroenteritis in Korean children between 2004 and 2019
Eell Ryoo
Clin Exp Pediatr. 2021;64(6):260-268.   Published online September 18, 2020
· Norovirus is the most common virus in Korean children with acute gastroenteritis.
· Escherichia coli and Salmonella spp. are the most common cause of bacterial gastroenteritis in Korean children, with a detection rate of 3%–20%.
· Uncommon bacterial and parasitic gastroenteritis require attention because of increasing international exchange and overseas travel.
Neurology
Myths and truths about pediatric psychogenic nonepileptic seizures
Jung Sook Yeom, Heather Bernard, Sookyong Koh
Clin Exp Pediatr. 2021;64(6):251-259.   Published online October 17, 2020
• Psychogenic non-epileptic seizures (PNES) are events that look like epileptic seizures but are not caused by abnormal electrical discharges.
• PNES are a manifestation of psychological and emotional distress.
• Treatment for PNES does not begin with the psychological intervention but starts with the diagnosis and how the diagnosis is delivered.
• A multifactorial biopsychosocial process and a neurobiological review are both essential components when treating PNES
Clinical note
Infection
Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia
Seyed Kamal Eshagh Hossaini, Zahra Movahedi, Ahmad Hormati, Hosein Heydari, Seyed Jalal Eshagh Hosseini, Fatemeh Khodadust, Mahboubeh Afifian, Sajjad Ahmadpour
Clin Exp Pediatr. 2021;64(5):247-250.   Published online March 8, 2021
Question: What should be considered in an immunocompromised child with coronavirus disease 2019 (COVID-19)?
Finding: Due to the importance of appropriately managing COVID-19 in children with cancer, the possibility of a fatal outcome should be considered in immunocompromised patients who receive chemotherapy agents.
Meaning: In all kinds of infections including COVID-19, disuse management and the development of international guidelines for children with cancer is challenging but important.
Original Article
Neonatology (Perinatology)
Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India
Ritu Sharma, Shikha Seth, Rakhee Sharma, Sanju Yadav, Pinky Mishra, Sujaya Mukhopadhyay
Clin Exp Pediatr. 2021;64(5):239-246.   Published online February 16, 2021
Question: Is there any risk of vertical transmission of coronavirus disease 2019 (COVID-19), and what is its neonatal profile?
Finding: Biological samples for vertical transmission were negative in all deliveries; however, 2 neonates tested positive for nasopharyngeal COVID-19 reverse transcription-polymerase chain reaction. No significant neonatal morbidity was observed.
Meaning: COVID-19 does not increase adverse neonatal outcomes and shows a negligible risk of vertical transmission; however, horizontal transmission cannot be underestimated.
Allergy
Sex-based differences in factors associated with bronchial hyperresponsiveness in adolescents with childhood asthma
Young Hwan Kim, Yoon Young Jang, Jieun Jeong, Hai Lee Chung
Clin Exp Pediatr. 2021;64(5):229-238.   Published online January 14, 2021
Question: What factors are associated with bronchial hyperresponsiveness (BHR) in adolescents with childhood asthma?
Finding: Age, mold sensitization, and increased eosinophil count were associated with BHR in boys versus a reduced forced expiratory volume in 1 second/forced vital capacity ratio in girls. Early mold sensitization was a risk factor for persistent BHR in boys only.
Meaning: Sex-specific differences were observed in the factors associated with BHR in adolescents.
Editorial
Cardiology
When should mechanical circulatory support be considered in pediatric patients with acute fulminant myocarditis?
Hye Won Kwon
Clin Exp Pediatr. 2021;64(5):227-228.   Published online September 22, 2020
Acute fulminant myocarditis is an uncommon syndrome characterized by sudden and severe cardiac inflammation, which leads to cardiogenic shock, ventricular arrhythmia, heart blocks, or multiorgan failure. Despite aggressive clinical course, patients with acute fulminant myocarditis have better outcomes than those with the nonfulminant type when appropriately supported during the acute phase of the disease. Therefore, early recognition of deteriorating myocarditis and timely mechanical circulatory support are crucial to improve outcomes.
Other
Is multisystem inflammatory syndrome related with coronavirus disease 2019, Kawasaki disease, and angiotensin-converting enzyme 2 in children?
Lucy Youngmin Eun
Clin Exp Pediatr. 2021;64(5):225-226.   Published online March 5, 2021
With the coronavirus disease (COVID-19) pandemic, it is important to consider why Kawasaki disease (KD) is prevalent in young children and its symptoms are similar to multisystem inflammatory syndrome in older children. We hypothesized that angiotensin-converting enzyme 2 (ACE2) expression may be related. In fact, this may be an answer why COVID-19 occurs less frequently in children with lower ACE2 expression.
Allergy
Targeting eosinophils: another strategy for asthma treatment
Hye Mi Jee
Clin Exp Pediatr. 2021;64(5):223-224.   Published online March 5, 2021
Identifying phenotypes and endotypes of asthma patients is challenging, and eosinophilic phenotypes are generally characterized by severe or refractory asthma.
Biologicals targeting eosinophils are promising for the control of severe or refractory asthma symptoms.
To ensure proper treatment, increased understanding of the diverse phenotypes of high Th2 inflammation in pediatric asthma is needed.
Review Article
Genetics and Metabolism
Understanding the genetics of systemic lupus erythematosus using Bayesian statistics and gene network analysis
Seoung Wan Nam, Kwang Seob Lee, Jae Won Yang, Younhee Ko, Michael Eisenhut, Keum Hwa Lee, Jae Il Shin, Andreas Kronbichler
Clin Exp Pediatr. 2021;64(5):208-222.   Published online July 15, 2020
Bayesian false-discovery probability and false-positive report probability are the 2 major Bayesian methods used to evaluate noteworthiness of a genetic variant.
Application of stricter P value is needed to confirm statistical significance in meta-analyses.
Gene network analysis of noteworthy genetic variants shows a blueprint of the genetic background in complex diseases.
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