- Perspective
- Neonatology (Perinatology)
- Neonatal care in a low-birthrate society: insights from population-based observations in Japan
- Hirokazu Arai, Hiroshi Miura, Yohei Onodera, Hiroyuki Adachi, Akira Sato, Tomoo Ito, Masaru Mizuno
- Clin Exp Pediatr. 2026;69(8):683-685. Published online July 24, 2026
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Declining birth rates are reshaping neonatal care. In low-birthrate settings, shifts in the underlying causes of neonatal death, including greater use of perinatal palliative care for trisomy 18 and challenges in maintaining expertise in extremely low-birth-weight infants, may contribute to fluctuations in neonatal mortality. These observations highlight the need for a coordinated system-level support.
- Clinical Note
- Neonatology (Perinatology)
- Peters anomaly: a rare etiology of corneal clouding in the newborn
- Gregory Ison, Srividya Naganathan
- Clin Exp Pediatr. 2026;69(8):680-682. Published online July 13, 2026
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- Nephrology (Genitourinary)
- A rare genetically confirmed case of apparent mineralocorticoid excess syndrome due to a homozygous HSD11B2 variant in a 2-year-old child with severe hypertension: response to targeted therapy
- Bashair Alabbasi, Mugahid Elamin, Ghadah Alsallum, Ghada Alzahrany
- Clin Exp Pediatr. 2026;69(8):676-679. Published online July 24, 2026
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- Original Article
- Neurology
- Patient-independent automated pediatric seizure monitoring based on expert-labeled electrographic ictal data as core reference knowledge
- Yoon Gi Chung, Jaeso Cho, Anna Cho, Hunmin Kim, Byung Chan Lim
- Clin Exp Pediatr. 2026;69(8):665-675. Published online July 14, 2026
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Question: Can deep learning models trained on expert-verified electroencephalography segments reliably detect seizures and be applied to single-channel wearable monitoring?
Finding: This technique demonstrated 80.1%–100% sensitivity and low false-alarm rates. On 1,604 expert-labeled segments, the model outperformed previous studies in terms of latency and accuracy across unseen datasets.
Meaning: Expert-labeled data are essential for achieving universal seizure detection. This channel-specific approach enabled efficient and continuous monitoring using wearable devices.
- Neonatology (Perinatology)
- Efficacy and safety of home-based fiberoptic blanket versus hospital-based light-emitting diode phototherapy for neonatal jaundice: a retrospective cohort study from Thailand
- Chayatat Ruangkit, Thanyathorn Thaninjeerawat, Saitarn Klaidangklum, Saowalak Prasopa, Pongsakorn Atiksawedparit, Sasivimon Soonsawad
- Clin Exp Pediatr. 2026;69(8):655-664. Published online July 1, 2026
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Question: Is a home-based fiberoptic phototherapy blanket as effective and safe as hospital-based overhead light-emitting diode phototherapy for the treatment of neonatal jaundice?
Finding: Home phototherapy (HPT) resulted in a slower bilirubin reduction rate than inpatient phototherapy (IPT); however, both modalities achieved the therapeutic targets without phototherapy-related complications.
Meaning: With careful patient selection, structured monitoring, and reliable follow-up, HPT is a safe and feasible alternative to IPT for neonatal jaundice.
- Gastroenterology
- Prognosis of pediatric hepatic Wilson disease with ATP7B loss of function variants
- Amresh Kumar Mishra, Moinak Sen Sarma, Anchal Dubey, Pratik Gadekar, Amita Moirangthem, Anshu Srivastava, Amrita Mathias
- Clin Exp Pediatr. 2026;69(8):646-654. Published online July 13, 2026
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Question: Do the loss of function (LOF) of ATP7B mutated variants affect the severity or outcomes of hepatic Wilson disease (WD)?
Finding: LOF is associated with advanced liver disease, portal hypertension, and extrahepatic involvement. LOF did not determine hepatic or overall outcomes. ATP7B: c.813C>A (truncation variant) has an aggressive course with higher predisposition to acute liver failure. Lower serum exchangeable copper levels and higher disappearance of Kayser-Fleischer ring were observed in ATP7B: c.3809A>G (nontruncation variant) suggesting a better effect of chelation and lesser systemic copper.
Meaning: Truncation of the ATP7B protein determines the severity of the phenotype in WD.
- Other
- Association between sodium content of intravenous immunoglobulin and electrolyte changes and clinical course of Kawasaki disease
- Yoshitaka Watanabe, Naomi Yagi, Toya Hattori, Chisato Oyake, Shota Endo, Maria Yoshimi, Takayoshi Kyoda, Hirokazu Ikeda
- Clin Exp Pediatr. 2026;69(8):639-645. Published online July 1, 2026
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Question: Hyponatremia in Kawasaki disease is associated with inflammation and disease severity. Intravenous immunoglobulin (IVIG) formulations feature various sodium contents. What is the clinical impact of such variations?
Finding: IVIG sodium content was associated with sodium, potassium, and protein level changes.
Meaning: Coronary outcomes were similar but electrolyte changes differed: high-sodium IVIG caused hypokalemia, whereas low-sodium IVIG caused hyponatremia. IVIG preparation requires consideration when interpreting laboratory values.
- Editorial
- Neurology
- Network-based biomarkers in pediatric drug-resistant epilepsy
- Joseph Lim, Jaeso Cho, Hunmin Kim
- Clin Exp Pediatr. 2026;69(8):636-638. Published online July 24, 2026
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Conventional preoperative evaluation in pediatric drug-resistant epilepsy relies on clinical surrogates that quantify seizure exposure but not its impact on brain networks. A newly developed diffusion-weighted imaging connectome biomarker, anchored to intracranial electroencephalography-confirmed seizure onset zones and resolved across 6 neurocognitive domains, addresses this gap. This individualized approach classifies cognitive impairment with high accuracy and may offer a more precise, clinically interpretable tool to inform surgical timing.
- Review Article
- Endocrinology
- Linking pediatric obesity to youth-onset type 2 diabetes: integrated longitudinal and cross-sectional evidence from population-based studies worldwide
- Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Mohamed, Ahmed Elawwa
- Clin Exp Pediatr. 2026;69(8):622-635. Published online July 20, 2026
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Pediatric obesity and youth-onset type 2 diabetes have increased simultaneously across 6 continents over the last 25 years. Approximately 75% of affected youths are obese at diagnosis, beta-cell declines occur rapidly, and microvascular complications occur early. Glucagon-like peptide-1 receptor agonists and bariatric surgery achieve meaningful weight loss and glycemic improvement; however, the primary prevention of childhood obesity remains the most powerful strategy for arresting this epidemic.
- Other
- Virtual reality for managing pain and fear and anxiety during pediatric needle procedures: an umbrella review
- Thomas Saliba, Guillaume Fahrni
- Clin Exp Pediatr. 2026;69(8):609-621. Published online July 14, 2026
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Meta-analyses suggest that virtual reality (VR) reduces self-reported pain, fear, and anxiety in children during needle procedures but has high heterogeneity, high overlap between primary studies, and low methodological quality, leading to a "very weak" GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification. Clinicians should view VR as a promising additional distraction tool; however, VR cannot yet replace current analgesic and anxiolytic strategies. Future research should focus on age-stratified analyses, measurement tool standardization, and modern VR technology
- Clinical Note
- Neurology
- Fulminant early-onset subacute sclerosing panencephalitis masquerading as leukodystrophy: a diagnostic challenge
- Kaushik Ragunathan, Deb Kumar Boruah, Vishnupriya Veeraraghavan, Jaya Shankar Kaushik
- Clin Exp Pediatr. 2026;69(7):604-608. Published online June 18, 2026
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- Original Article
- Pulmonology
- Telomere biology disorders associated with childhood interstitial lung disease
- Maria Greiner-Mai, Christina Katharina Rapp, Katrin Knoflach, Daniel Gräfe, Franz Wolfgang Hirsch, Julia Ley-Zaporozhan, Simone Reu-Hofer, Julia Hentschel, Stefan Zielen, Monika Helena Tedy, Heymut Omran, Ernst Rietschel, Tuğba Sismanlar Eyuboglu, Ayse Tana-Aslan, Nagehan Emiralioglu, Nicola Ullmann, Samuele Naviglio, Massimo Maschio, Fabian Beier, Tuğba Ramaslı Gürsoy, Matthias Griese, Freerk Prenzel
- Clin Exp Pediatr. 2026;69(7):593-603. Published online June 18, 2026
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Question: What are the pulmonary manifestations and clinical characteristics of telomere biology disorders in children with interstitial lung disease?
Finding: Telomere biology disorders are an important but often underrecognized cause of childhood interstitial lung disease and are associated with variable pulmonary, radiologic, and histopathologic findings, frequent multisystem involvement, and often severe disease progression.
Meaning: Early genetic testing and multidisciplinary evaluation are essential for timely diagnosis, optimized management, and improved outcomes in affected children.
- Other
- Did government subsidy program improve quality of care for children with complex chronic conditions in children’s hospitals? A quasi-experimental study in South Korea
- Riyoung Na, Myoung-Hee Kim, Seok-Jun Yoon
- Clin Exp Pediatr. 2026;69(7):582-592. Published online May 28, 2026
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Question: Do government-funded Specialized Public Medical Centers for Children (SPMCCs) improve the quality of care for pediatric patients requiring complex and intensive medical care?
Finding: The SPMCC hospital designation reduced 30-day readmission rates among pediatric patients with severe conditions.
Meaning: Government investments are associated with improved quality of care for children with complex chronic conditions. Therefore, sustained government funding is essential to enhancing pediatric care quality.
- Hematology
- Peripheral blood cell counts of prematurely born, small for gestational age neonates
- Mara O. Zuiderwijk, Sophie Groene, Enrico Lopriore, Vincent Bekker, Michiel H.D. Schoenaker
- Clin Exp Pediatr. 2026;69(7):572-581. Published online May 12, 2026
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Question: As small for gestational age (SGA) neonates are more susceptible to infections, we hypothesized that their complete blood count and leukocyte differentiation might be affected.
Finding: The counts of multiple blood cells of extreme SGA neonates were affected as illustrated by multivariate analyses, which showed significant decreases in neutrophil, monocyte, lymphocyte, and thrombocyte counts.
Meaning: The mechanisms underlying this phenomenon and its clinical effects require further elucidation.
- Gastroenterology
- Distinct age-dependent phenotypes of abnormal liver function tests derived from national Emergency Department data
- Dong-Uk Kim, Shinjie Choi, Yeji Kim, Lia Kim, Jung Ok Shim, Jin Soo Moon, Jong Woo Hahn, Hye Ran Yang, Ju Young Chang, Jae Sung Ko
- Clin Exp Pediatr. 2026;69(7):563-571. Published online May 14, 2026
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Question: What are the clinical phenotypes and pathogen associations of pediatric and adult Emergency Department visits for abnormal liver function tests?
Finding: Pediatric visits showed fever-predominant profiles with temporal correlations with respiratory viruses, whereas adult visits revealed population-level temporal associations between enteric pathogens and infectious gastroenteritis, upper gastrointestinal disorders, and metabolic comorbidity clustering.
Meaning: These findings provide novel population-level evidence of age-specific pathogen associations and support distinct age-stratified clinical diagnostics.
- Neonatology (Perinatology)
- Association between base excess levels and clinical outcomes among very low birth weight infants: a multicenter birth cohort study in South Korea
- Ji Yoo Kim, Hyeon Jin Kim, Heeyoon Choi, Minji Kim, Jinseok Lee, Yong Sung Choi, Dong Keon Yon
- Clin Exp Pediatr. 2026;69(7):555-562. Published online May 21, 2026
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Question: Is metabolic acidosis at birth in very low birth weight infants (VLBWIs) associated with long-term clinical outcomes?
Finding: Metabolic acidosis at birth was associated with increased mortality, adverse respiratory outcomes, neurological morbidities, and infection-related and gastrointestinal outcomes.
Meaning: VLBWIs with metabolic acidosis are at high risk of systemic complications. This finding emphasizes the need for close monitoring and comprehensive care.
- Nephrology (Genitourinary)
- Serum metabolomic profile in children with sepsis-associated acute kidney injury
- Nisha Chaudhary, Praveen Singh, Abhijeet Saha, Shantanu Sengupta
- Clin Exp Pediatr. 2026;69(7):545-554. Published online April 15, 2026
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Question: Can the potential metabolites/pathways involved in the pathogenesis of sepsis-associated acute kidney injury (SA-AKI) be identified using metabolomics?
Finding: We identified 18 novel metabolites involved in the pathogenesis of SA-AKI as well as 31 metabolites that were altered in severe AKI. Linoleic acid, linolenic acid, and phospholipid pathways were altered in SA-AKI.
Meaning: Once validated, these markers may be used to diagnose SA-AKI at an early stage before sufficient kidney injury occurs.
- Editorial
- Pulmonology
- Telomere biology disorders in childhood interstitial lung disease: new insights from the chILD-EU cohort
- Andrew Courtwright
- Clin Exp Pediatr. 2026;69(7):542-544. Published online June 30, 2026
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Greiner-Mai et al. expand recognition of telomere biology disorder (TBD)-associated interstitial lung disease (ILD) in children, demonstrating heterogenous radiographic and ILD subtypes in combination with variable extrapulmonary phenotypes, even in the absence of ultrashort peripheral blood telomere length (TL). While their findings highlight some of the limitations of current TL testing methods, they introduce critical questions regarding family screening and the role of antifibrotic and telomere-directed therapies in children with TBD-related ILD.
- Review Article
- Endocrinology
- Testosterone therapy in boys with constitutional delay of growth and puberty: a PubMed-based systematic review and exploratory meta-analysis
- Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Ahmed, Khaled A. Siddiq, Mohammed Qusad, Mohamed AlKhalaf
- Clin Exp Pediatr. 2026;69(7):531-541. Published online June 18, 2026
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In boys with constitutional delay of growth and puberty, a short course of low-dose testosterone consistently accelerates linear growth and advances pubertal maturation. Long-term follow-up studies do not show a clinically meaningful effect of conservative regimens on near-adult height. As the pooled quantitative evidence represents only 46 boys in 2 controlled studies, treatment should remain individualized, while larger randomized trials using standardized patient-reported outcomes are needed.
- Clinical Note
- Gastroenterology
- Esophagopleural fistula following coin impaction in a female toddler: successful management using through-the-scope clips
- Sarthak Chakrabarti, Nikhil Sonthalia, Kaustabh Chaudhuri, Tamashis Mukherjee, Uday Chand Ghoshal, Mahesh Kumar Goenka
- Clin Exp Pediatr. 2026;69(6):527-530. Published online May 14, 2026
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- Ultrasonographic features of 5-aminosalicylic acid intolerance in pediatric ulcerative colitis
- Hirotoki Murashige, Yasufumi Sakata, Yoshihiro Azuma, Shunji Hasegawa
- Clin Exp Pediatr. 2026;69(6):524-526. Published online May 28, 2026
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- Original Article
- Endocrinology
- Intramuscular and subcutaneous gonadotropin-releasing hormone agonist tests for central precocious puberty in girls: a randomized controlled trial
- Worapimon Lerdrassameethad, Suttipong Wacharasindhu, Vichit Supornsilchai, Khomsak Srilanchakon
- Clin Exp Pediatr. 2026;69(6):518-523. Published online April 15, 2026
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Question: Did the intramuscular (IM) and subcutaneous (SC) administration of gonadotropin-releasing hormone (GnRH) agonists have comparable timing and diagnostic utility for evaluating central precocious puberty in girls?
Finding: Both the IM and SC GnRH stimulation tests demonstrated comparable times to peak luteinizing hormone levels.
Meaning: Clinicians may consider the IM route as a time-efficient alternative, as it offers similar diagnostic utility for central precocious puberty without compromising the detection of hypothalamic-pituitary-gonadal axis activation.
- Anthropometric trajectories of Korean children and adolescents with severe obesity
- Jeongho Han, Hakyung Lee, Dong Jun Ha, Jieun Lee, Yong Hee Hong, Hwa Young Kim, Jaehyun Kim
- Clin Exp Pediatr. 2026;69(6):508-517. Published online April 10, 2026
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Question: How do body mass index (BMI) and metabolic markers change over time in severely obese Korean children and adolescents receiving only lifestyle modifications?
Finding: Among 124 participants, BMI z scores decreased modestly over 2.6 years, primarily in younger prepubertal boys. However, most remained severely obese, with minimal improvement in body composition or metabolic markers.
Meaning: Lifestyle interventions alone have limited efficacy for severe pediatric obesity. Early and more intensive treatments are required.
- Pulmonology
- High-Risk CCL14 lineage drives severe Mycoplasma pneumoniae pneumonia in children: a study in central China
- Chunbo Hao, Zijie Li, Yanjuan Yu, Song Wang, Genhao Wang, Gaijing Jia, Tiantian Sun, Shouhang Chen, Yang Wu, Yu Tang, Fang Wang, Guangcai Duan, Yuefei Jin
- Clin Exp Pediatr. 2026;69(6):497-507. Published online April 10, 2026
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Question: Are the predominant circulating strains of Mycoplasma pneumoniae associated with disease severity and clinical indicators?
Finding: The common cluster label 14 (CCL14) lineage was a high-risk clone circulating in central China that demonstrated a strong association between severe pediatric pneumonia and a distinct hyperinflammatory profile.
Meaning: Targeted molecular surveillance of the CCL14 lineage may facilitate early risk stratification and guide clinical management to reduce the burden of severe disease.
- Endocrinology
- Thyroid peroxidase gene variants and susceptibility to congenital hypothyroidism and autoimmune thyroid disease among Egyptian pediatric cohort
- Hala M. Sakhr, Mohammed H. Hassan, Esraa Abbass Abdallah, Amira Mahmoud Ewis, Mohamed Hesham Mohamed, Shymaa Gaber Rizk
- Clin Exp Pediatr. 2026;69(6):486-496. Published online March 26, 2026
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Question: Which factors influence pediatric thyroid disorder susceptibility and severity?
Finding: Anemia, selenium deficiency, excess copper, and the thyroid peroxidase (TPO) Arg386His polymorphism, especially with the histidine/histidine genotype, are strongly associated with pediatric thyroid disease and high thyroid-stimulating hormone levels.
Meaning: Pediatric thyroid disorders are multifactorial. The TPO Arg386His variant may help identify children at higher risk of severe thyroid dysfunction, enabling earlier diagnosis, improved risk stratification, and more personalized clinical management.
- Editorial
- Cardiology
- Beyond morphometry: the atrial septal defect pressure gradient as a dynamic predictor of mitral valve growth in borderline left hearts
- Han Ki Park
- Clin Exp Pediatr. 2026;69(6):484-485. Published online May 27, 2026
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Traditional morphometric scores often fail to predict the success of biventricular repair of borderline left hearts. Wang et al. demonstrated that a low atrial septal defect (ASD) pressure gradient is a critical functional predictor of mitral valve growth. By integrating ASD hemodynamics with anatomical data, clinicians can better identify candidates for biventricular repair, proving that the "grey zone" is narrower than previously thought and improving outcomes for vulnerable neonates.
- Review Article
- Allergy
- Update on pediatric allergic rhinitis: narrative review based on guideline updates
- Jung Yeon Shim
- Clin Exp Pediatr. 2026;69(6):473-483. Published online May 28, 2026
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Intranasal corticosteroids remain the cornerstone treatment for moderate to severe allergic rhinitis. The 2024–2025 Allergic Rhinitis and its Impact on Asthma guideline update suggests that fixed intranasal antihistamine–intranasal corticosteroid combinations may provide greater symptom control in allergic rhinitis than either agent alone. A control-based patient-centered approach that incorporates real-world evidence is essential for optimizing treatment outcomes in children.
- Nutrition
- Dietary fiber in pediatric gastrointestinal health: a narrative review of evidence and challenges
- Rohit Das, Bipashna Thatal, Buddhiman Tamang
- Clin Exp Pediatr. 2026;69(6):456-472. Published online May 27, 2026
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Dietary fiber plays a critical role in pediatric gastrointestinal health by modulating gut microbiota, improving bowel function, and supporting immune development. Evidence consistently supports its benefit in functional constipation, while effects on abdominal pain, inflammatory bowel disease, and irritable bowel syndrome remain variable due to differences in fiber type, dosage, and study design. Clinically, fiber should be used as an adjunct therapy within individualized dietary and behavioral management strategies for children.
- Erratum: Authour correciton
- Author correction: Bifidobacterium animalis subsp. lactis BLa80 for preventing allergic, respiratory, and gastrointestinal diseases in young children in China: a randomized double-blind placebo-controlled trial
- Ke Chen, Xi Zhang, Kaihong Zeng, Jiayi Zhong, Shanshan Jin, Yang Nie, Ping Yang, Nianyang He, Haixia Chen, Yanmei Cao, Yunrong Fu, Ziji Fang, Wei Jiang, Changqi Lium
- Clin Exp Pediatr. 2026;69(5):455-455. Published online April 28, 2026
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- Original Article
- Neurology
- Classification of neurocognitive impairment in pediatric drug-resistant focal epilepsy by quantifying seizure-affected brain network abnormalities in clinical diffusion-weighted imaging connectome
- Jeong-Won Jeong, Min-Hee Lee, Yoon Ho Hwang, Michael Behen, Aimee Luat, Csaba Juhász, Eishi Asano
- Clin Exp Pediatr. 2026;69(5):443-454. Published online March 13, 2026
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Question: Does epilepsy affect neurocognitive functions in pediatric drug-resistant focal epilepsy?
Finding: Diffusion magnetic resonance imaging (MRI) connectome could identify new imaging markers for seizure-associated structural abnormalities. New markers reflect deviations of local efficiency in neurocognitive networks and provide outstanding discretionary capacity for neurocognitive impairments, achieving an accuracy range of 90%–98% in the independent test patients.
Meaning: Supplementary MRI-driven decisions could be performed for personalized interventions to mitigate long-term neurocognitive effects.
