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Original Article
Cardiology
Assessment of cardiac function in syncopal children without organic causes
Heoungjin Kim, Lucy Youngmin Eun
Clin Exp Pediatr. 2021;64(11):582-587.   Published online March 10, 2021
Question: Does a subtle deterioration in cardiac function affect the severity of syncope in patients without underlying disease?
Finding: For syncope patients with reasonable cardiac function but without underlying disease, tissue Doppler imaging (TDI) measurements helped reveal subtle differences in cardiac function with syncope and predicted the severity of syncope or a potential recurrent event.
Meaning: TDI measurements might be a useful indicator for predicting the severity of syncope.
Original article
Infection
The global prevalence of Toxocara spp. in pediatrics: a systematic review and meta-analysis
Behnam Abedi, Mehran Akbari, Sahar KhodaShenas, Alireza Tabibzadeh, Ali Abedi, Reza Ghasemikhah, Marzieh Soheili, Shnoo Bayazidi, Yousef Moradi
Clin Exp Pediatr. 2021;64(11):575-581.   Published online February 5, 2021
Is the global prevalence of toxocariasis high among children? The prevalence of toxocariasis is high in pediatric patients. Asian children are more susceptible to the disease than other children. Its virulence varies among different socioeconomic classes in various countries. Hand washing after soil contact, routine pet deworming, and appropriate disposal of pet feces in households with Asian pediatrics are needed to prevent toxocariasis.
Editorial
Oncology
Infantile hemangioma: timely diagnosis and treatment
Meerim Park
Clin Exp Pediatr. 2021;64(11):573-574.   Published online July 22, 2021
While the majority of infantile hemangiomas (IHs) do not require therapy and regress spontaneously, about 10%–15% develop complications such as ulceration, obstruction, or disfigurement. Early intervention is recommended for infants with potentially problematic IHs. Oral propranolol 2–3 mg/kg/day is currently the treatment of choice.
Review Article
Oncology
Update on infantile hemangioma
Hye Lim Jung
Clin Exp Pediatr. 2021;64(11):559-572.   Published online May 26, 2021
· Infantile hemangiomas (IHs) are the most common benign vascular tumors, occurring in 5%–10% of infants.
· IHs are characteristically not present at birth but are usually diagnosed at 1–4 weeks of age, rapidly proliferate until 5 months of age, and then spontaneously involute.
· High-risk IHs (10%) require early treatment from 1 month of age.
· Oral propranolol, a nonselective beta-blocker, is the first-line treatment for IHs.
Nutrition
Changes in health status of North Korean children and emerging health challenges of North Korean refugee children
Seong-Woo Choi
Clin Exp Pediatr. 2021;64(11):552-558.   Published online May 17, 2021
· Among North Korean refugee (NKR) children under 5 years, 61% and 9.3% were underweight in 1998 and 2017, respectively.
· The immunization rate of NKR children exceeded 90% since 2006.
· For NKR children, protein-energy malnutrition was the #1 cause of death in 2009 versus #17 in 2019.
· In 2020, stunting affected 5.4% and 0.9% and obesity affected 10.7% and 2.7% of NKR versus South Korean children, respectively.
Infection
Effects of nasopharyngeal microbiota in respiratory infections and allergies
Hyun Mi Kang, Jin Han Kang
Clin Exp Pediatr. 2021;64(11):543-551.   Published online April 15, 2021
· The nasal microbiota varies with age and is shaped by various factors in healthy individuals.
· The pathological condition of the respiratory tract appears to be associated with reduced nasal microbiota biodiversity, while dysbiosis is involved in the pathophysiology of many respiratory diseases, including otitis, sinusitis, allergic diseases, and lower respiratory infections.
Original Article
Neurobehavior
Association between small for gestational age and risk of autism spectrum disorders: a meta-analysis
Ensiyeh Jenabi, Saeid Bashirian, Zahra Asali, Mahdieh Seyedi
Clin Exp Pediatr. 2021;64(10):538-542.   Published online January 28, 2021
• The relationship between small for gestational age (SGA) and autism spectrum disorders (ASDs) and remains conflicting.
• We showed based on odds ratio reports in epidemiological studies that SGA can increase the risk of ASD and SGA is a risk factor for ASD.
• The association between SGA and the risk of ASD has further momentum to the current public health emphasis on appropriate prepregnancy weight and weight gain during pregnancy
Other
Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital
Muruganantham Balagurunathan, Thrilok Natarajan, Jothilakshmi Karthikeyan, Venkateshwaran Palanisamy
Clin Exp Pediatr. 2021;64(10):531-537.   Published online August 4, 2021
Question: What are the clinical spectrum, course, and short-term outcomes of multisystem inflammatory syndrome in children (MIS-C)?
Finding: MIS-C can have variable clinical manifestations. Fever is most common, followed by gastrointestinal and cardiovascular symptoms. Early identification and appropriate management lead to favorable outcomes.
Meaning: MIS-C can present in a myriad of ways and severities. High suspicion is necessary to ensure its early identification and appropriate management and favorable patient outcomes.
Endocrinology
Correlation between total air pollutant emissions and incidence of type 1 diabetes in the Russian Federation
Hoon Sung Choi, Jin Taek Kim, Ji-Young Seo, Faina Linkov, Evgeniy Shubnikov, Hong Kyu Lee
Clin Exp Pediatr. 2021;64(10):525-530.   Published online January 18, 2021
Question: Is there a quantitative relationship between air pollutant emissions and the incidence of type 1 diabetes (T1D)?
Finding: The incidence of T1D in each region of the Russian Federation correlated with the total air pollutants emitted each year.
Meaning: These findings suggest that air pollution contributes to the development of T1D.
Editorial
Endocrinology
Ambient air pollution and pediatric diabetes
Jae Hyun Kim
Clin Exp Pediatr. 2021;64(10):523-534.   Published online March 12, 2021
· Epidemiological studies have shown that ambient air pollution is associated with diabetes mellitus in children and adults.
· The mechanism of ambient air pollution causing diabetes mellitus is unclear.
· A study of the association between diabetes and air pollution in Korean pediatric populations is required.
Nephrology (Genitourinary)
Obesity and chronic kidney disease: what should pediatric nephrologists know?
Jung Won Lee
Clin Exp Pediatr. 2021;64(10):521-522.   Published online June 1, 2021
• Obesity is not only a comorbidity of hypertension, it may be a riskfactorfor chronickidneydisease.
• Renal impairment associated with obesity is believed to start early in childhood and continue into adulthood, implying a higher risk of adverse cardiovascular events.
• The identification of kidney injury, implementation of preventive strategies, and prompt treatment are essential to improving clinical outcomes in obese children with early kidney disease.
Immunology
Importance of neonatal screening for primary immunodeficiencies
Jung Woo Rhim
Clin Exp Pediatr. 2021;64(10):519-520.   Published online May 4, 2021
· Early detection of asymptomatic infants with primary immunodeficiencies before the onset of infections enables effective treatment and intervention to prevent serious sequelae.
· T-cell receptor excision circles and kappa-deleting recombination excision circles have recently been used to detect T- or B-cell lymphopenia in neonates.
Review Article
Nephrology (Genitourinary)
Obesity and chronic kidney disease: prevalence, mechanism, and management
Hyung Eun Yim, Kee Hwan Yoo
Clin Exp Pediatr. 2021;64(10):511-518.   Published online April 6, 2021
· Obesity is strongly associated with the development and progression of chronic kidney disease.
· Altered renal hemodynamics, metabolic effects, and lipid nephrotoxicity may play a key role in the development of obesity-related kidney disease.
· Children born to obese mothers are at increased risk of developing obesity and chronic kidney disease later in life.
· A multilevel approach is needed to prevent obesity and related chronic diseases.
Immunology
Modern diagnostic capabilities of neonatal screening for primary immunodeficiencies in newborns
Evgenia Olegovna Khalturina, Natalia Dmitrievna Degtyareva, Anastasiia Vasi’evna Bairashevskaia, Alena Valerievna Mulenkova, Anna Vladimirovna Degtyareva
Clin Exp Pediatr. 2021;64(10):504-510.   Published online March 25, 2021
· Neonatal screening for primary immunodeficiency diseases (PIDs) enables early diagnosis and subsequent initiation of therapy.
· Excision of T-cell receptors and kappa-recombination excision circles are cheaper alternative PID screening methods.
· Sanger DNA sequencing remains the reference method for detecting PID; however, next-generation sequencing technology is increasingly used to diagnose it.
· Here we developed a graphical algorithm for diagnosing primary immunodeficiency syndrome based on modern methods of screening for primary immunodeficiencies in newborns.
Neurology
Recent update on reading disability (dyslexia) focused on neurobiology
Sung Koo Kim
Clin Exp Pediatr. 2021;64(10):497-503.   Published online March 2, 2021
·Neurobiological studies using functional brain imaging have uncovered the reading pathways, brain regions involved in reading, and neurobiological abnormalities of dyslexia.
·An accurate diagnosis and timely specialized intervention are important in children with dyslexia. When national infant development screening tests have been conducted as in Korea, if a language developmental delay and early predictors of dyslexia are detected, the progression to dyslexia should be carefully observed and early intervention provided.
Letters to the Editor
Gastroenterology
Functional gastrointestinal disorders and smartphone use in adolescents
Mauro Cinquetti, Marco Biasin, Marco Ventimiglia, Linda Balanzoni, Denise Signorelli, Angelo Pietrobelli
Clin Exp Pediatr. 2021;64(9):494-496.   Published online November 9, 2020
Question: Are functional gastrointestinal disorders (FGIDs) common in Italy? If so, what are the associated risk factors?
Finding: In this cross-sectional study of 1,594 adolescents, the prevalence of FGIDs was 30.9% and was mainly associated with smartphone addiction.
Meaning: Smartphone use and dietary habits should be monitored in children with FGIDs.
Original Article
Neurobehavior
Is there an association between labor induction and attention-deficit/hyperactivity disorder among children?
Ensiyeh Jenabi, Mahdieh Seyedi, Saeid Bashirian, Bita Fereidooni
Clin Exp Pediatr. 2021;64(9):489-493.   Published online February 5, 2021
· This meta-analysis pooled all observational (case-control and cohort) studies to obtain the association between labor induction and the risk of attention-deficit/hyperactivity disorder (ADHD) among children.
· The findings showed that labor induction is not associated with increased risk of ADHD among children.
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.
Nutrition
Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery
Nehal El Koofy, Hadeer Mohamed Nasr Eldin, Wesam Mohamed, Mostafa Gad, Sara Tarek, Gamal El Tagy
Clin Exp Pediatr. 2021;64(9):473-479.   Published online November 16, 2020
Question: Is malnutrition a risk factor for postoperative complications in pediatric surgical patients?
Finding: There is a high incidence of malnutrition in pediatric surgical patients. Stunting increases the risks of postoperative complications and extended hospital stays, while underweight status contributes to extended hospital stays.
Meaning: Preoperative nutritional assessments are crucial to improving postoperative outcomes. Anemia increases the risk of postoperative complications and should be corrected preoperatively.
Editorial
Gastroenterology
Does smartphone overuse affect functional gastrointestinal disorders?
Jee Hyun Lee
Clin Exp Pediatr. 2021;64(9):471-472.   Published online December 28, 2020
Functional gastrointestinal disorders are common disorders characterized by persistent and recurrent gastrointestinal symptoms. Pathophysiological mechanisms have been suggested, including intestinal microbiota, altered intestinal permeability and motility, dietary effects, sensory abnormalities, and brain-gut dysregulation. Lifestyle factors such as diet, sleep, affect, and physical activity might function as moderators.
Nutrition
Advantages and limitations of using national survey datasets in child and adolescent research
Yoon Lee
Clin Exp Pediatr. 2021;64(9):468-470.   Published online January 26, 2021
The Korean National Health and Nutrition Examination Survey and the Korea Youth Risk Behavior Web-based Survey are major nationwide health and nutrition surveys in Korea. Although these surveys have some limitations of cross-sectional sample surveys, the accumulated data are valuable and provide new prospects for understanding public health depending on the interpretation method.
Review Article
Infection
Consideration in treatment decisions for refractory Mycoplasma pneumoniae pneumonia
Hye-Kyung Cho
Clin Exp Pediatr. 2021;64(9):459-467.   Published online February 10, 2021
• To avoid unnecessary exposure to secondary antibiotics, it is needed to diagnose Mycoplasma pneumoniae (MP) pneumonia carefully, especially when unresponsiveness to macrolide is suspected.
• Serologic and molecular tests for MP infection and excluding respiratory infection caused by other pathogens might be considered.
• It is necessary to continuously monitor antibiotic susceptibility of MP, and efforts to lower antibiotic pressure are required.
Nutrition
Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data
Minji Kang, So Yoon Choi, Minyoung Jung
Clin Exp Pediatr. 2021;64(9):443-458.   Published online December 28, 2020
In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk...
Critical Care Medicine
Pediatric postintensive care syndrome: high burden and a gap in evaluation tools for limited-resource settings
Chanapai Chaiyakulsil, Rapee Opasatian, Paweethida Tippayawong
Clin Exp Pediatr. 2021;64(9):436-442.   Published online December 18, 2020
Pediatric postintensive care syndrome has high impact and burden and can affect a child’s life for decades. The early evaluation and detection of such problems require a simple and less time-consuming surveillance tool. Current evaluation tools can be difficult and strenuous for areas with limited resources. Thus, a new simple tool is required for the early detection and intervention of postintensive care syndrome in critically ill children
Letter to the Editor
General Pediatrics
Skipping breakfast is associated with lifestyle habits among Japanese pupils
Jun Kohyama
Clin Exp Pediatr. 2021;64(8):433-435.   Published online November 4, 2020
Question: Breakfast is important; however, adolescents are increasingly skipping it.
Finding: Skipping breakfast is independently associated with sleepiness, physical inactivity, dinner irregularity, screen time on school days, poor academic performance, after-school activity, and decreased sleep duration before school day.
Meaning: Reducing screen time on school days, after-school activity, and irregular dinner habits might decrease breakfast skipping, resulting in decreased sleepiness and improved academic performance.
Clinical note
Nephrology (Genitourinary)
Extracorporeal membrane oxygenation with systemic heparinization as a rescue therapy for acute life-threatening pulmonary thromboembolism complicating nephrotic syndrome
Kyusang You, So Mi Kim, Dongmin Kim, Kyoungmin Ryu, Mee Jeong Lee
Clin Exp Pediatr. 2021;64(8):430-432.   Published online November 16, 2020
Question: How would you treat acute life-threatening pulmonary thromboembolism occurring in nephrotic patients?
Finding: A 16-year-old woman with minimal change-associated nephrotic syndrome presented with cardiac arrest caused by an acute bilateral pulmonary thromboembolism. Her hemodynamics stabilized with resolution of thrombi while on venoarterial extracorporeal membrane oxygenation (ECMO) and systemic heparinization.
Meaning: In selected cases, ECMO with systemic heparinization may rescue patients from acute life-threatening pulmonary thromboembolism even without reperfusion therapy.
Original Article
Neonatology (Perinatology)
Effects of carnosine and hypothermia combination therapy on hypoxic-ischemic brain injury in neonatal rats
Jun Chul Byun, Seong Ryong Lee, Chun Soo Kim
Clin Exp Pediatr. 2021;64(8):422-428.   Published online February 24, 2021
Question: How can we further improve the neuroprotective effects of hypothermia in newborns with hypoxic-ischemic (HI) brain injury?
Finding: Combination carnosine and hypothermia therapy effectively reduced brain damage in neonatal rats. The in situ zymography, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, and immunofluorescence study results showed that neuroprotective effects were achieved with combination therapy only.
Meaning: Carnosine and hypothermia have synergistic neuroprotective effects against brain damage following HI injury
Infection
Prevalence of methicillin-resistant Staphylococcus aureus in Iranian children: a systematic review and meta-analysis
Farhad Sarrafzadeh, Seyed Mojtaba Sohrevardi, Hamid Abousaidi, Hossein Mirzaei
Clin Exp Pediatr. 2021;64(8):415-421.   Published online November 20, 2020
The pooled prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 42% among culture-positive cases of S. aureus, 51% in hospitalized children, and 14% in healthy children. The high prevalence of MRSA in Iranian children may be due to insufficient infection control measures in hospitals, inappropriate use of methicillin, inadequate staff training, and over-prescription of antibiotics in Iran.
Allergy
Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1–3 years
Jihyun Lee, Meeyong Shin, Bora Lee
Clin Exp Pediatr. 2021;64(8):408-414.   Published online November 1, 2020
Question: Is age at the time of complementary food introduction associated with asthma and atopic dermatitis (AD) in early childhood?
Finding: We found no significant association between age at the time of complementary food introduction and the incidence of AD and asthma in Koreans aged 1–3 years.
Meaning: Our findings suggest that the influence of individual allergenic foods on the development of AD and asthma should be clarified.
Editorial
Nephrology (Genitourinary)
Pulmonary thromboembolism: a rare but life-threatening complication of nephrotic syndrome
Heeyeon Cho
Clin Exp Pediatr. 2021;64(8):406-407.   Published online February 4, 2021
Pulmonary thromboembolism (PTE) is often diagnosed in children with nephrotic syndrome. Massive PTE can cause hemodynamic instability, right ventricular failure, and circulatory collapse. Extracorporeal membrane oxygenation can be used for massive PTE as a method of hemodynamic support and adjunct to surgical embolectomy.
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