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Letter to the Editor
General Pediatrics
Debate around and impact of digital screen time and media parenting on children’s development
Gowda Parameshwara Prashanth
Clin Exp Pediatr. 2025;68(7):551-553.   Published online March 11, 2025
Original Article
Neonatology (Perinatology)
Evaluation of total serum bilirubin thresholds for discontinuing phototherapy in jaundiced neonates: a randomized study
Ajay Kumar, Nidhi Jain
Clin Exp Pediatr. 2025;68(7):539-545.   Published online February 26, 2025
Question: What are the outcomes of jaundiced neonates when phototherapy is discontinued at 2 different total serum bilirubin (TSB) thresholds?
Findings: The study involved 80 neonates, comparing a recommended TSB threshold and a lower threshold for phototherapy discontinuation. Results showed a 14.3% reinstitution rate of treatment, with no adverse outcomes.
Meaning: Careful posttreatment monitoring is essential when discontinuing phototherapy, and future research should consider updated guidelines like those from the American Academy of Pediatrics.
Incidence of neural tube defects in tertiary care university hospital in Bangladesh
Ismat Jahan, Arif Hossain, Shah Nizam Uddin Shaon, Sadeka Choudhury Moni, Mohammad Kamrul Hassan Shabuj, Sanjoy Kumer Dey, Mohammad Abdul Mannan, Mohammod Shahidullah
Clin Exp Pediatr. 2025;68(7):530-538.   Published online April 1, 2025
Question: What is the burden of neural tube defects (NTDs) in a tertiary care neonatal intensive care unit in Bangladesh?
Finding: The overall incidence of NTD was 6.4 (range, 4.59–11.2) per 1,000 live births, and the meningomyelocele complex was the most frequent location.
Meaning: The high incidence of NTD found in a leading tertiary care multidisciplinary referral hospital in Bangladesh may not reflect that of the wider population.
Hematology
Treatment and clinical outcomes of pediatric autoimmune hemolytic anemia: real-world single-center data from Korea
Young Dai Kwon, Eun Sun Jung, Yeon Jung Lim
Clin Exp Pediatr. 2025;68(7):522-529.   Published online April 16, 2025
Question: Can pediatric autoimmune hemolytic anemia (AIHA) be effectively managed using first-line steroids?
Finding: In this single-center study, pediatric patients with AIHA achieved normal hemoglobin levels within 16.5 days (range, 9.0–22.0 days) of first-line steroid treatment and maintained effective responses for 2 months.
Meaning: These outcomes highlight the efficacy of steroid treatment in pediatric versus adult AIHA and underscore the need for multicenter trials to establish standardized treatment guidelines.
Genetics and Metabolism
Role of microRNA-498 and microRNA-410 in neonatal hypoxic-ischemic encephalopathy
Eman Salah Eldeen Arafat, Hasnaa Hesham Abotaleb, Dina Abdel Razek Midan, Abdel Hamid Abdo Ismail, Zeinab Sabri Abouzouna
Clin Exp Pediatr. 2025;68(7):512-521.   Published online February 26, 2025
Question: Is it role of microRNA-410 (miRNA-410) and microRNA-498 (miRNA-498) in neonatal hypoxic-ischemic encephalopathy (HIE)?
Findings: miRNA-498 and miRNA-410 can be auxiliary diagnostic and prognostic tools for neonatal HIE.
Meaning: we can use miRNA-498 and miRNA-410 as markers and indicator for HIE.
Neonatology (Perinatology)
Characterization of gut microbiota in very low birth weight infants with versus without bronchopulmonary dysplasia
Anucha Thatrimontrichai, Manapat Praditaukrit, Gunlawadee Maneenil, Supaporn Dissaneevate, Kamonnut Singkhamanan, Komwit Surachat
Clin Exp Pediatr. 2025;68(7):503-511.   Published online February 26, 2025
Question: Does the gut microbiota differ between very low birth weight (VLBW) infants with versus without bronchopulmonary dysplasia (BPD)?
Finding: Common respiratory pathogens were notably elevated in the BPD group, whereas anaerobic and butyrate-producing taxa, key components of postbiotics, were dominant in the non-BPD group.
Meaning: In gut-lung communication, the interplay between the intestinal and respiratory systems may implicate pro- and postbiotics in VLBW infants with BPD.
Pulmonology
Clinical course of children with postinfectious bronchiolitis obliterans with versus without comorbid bronchopulmonary dysplasia
Lamia Medghoul, Julien Grosjean, Christophe Marguet, Hortense Petat
Clin Exp Pediatr. 2025;68(7):497-502.   Published online April 1, 2025
Question: Postinfectious bronchiolitis obliterans (PIBO) is a chronic respiratory disease that typically develops in children after a severe respiratory infection. Bronchopulmonary dysplasia (BPD) is often comorbid in patients with PIBO.
Finding: Corticosteroid pulse therapy effectively manages PIBO with or without comorbid BPD, significantly reducing exacerbations and decreasing the daily requirement for inhaled corticosteroids.
Meaning: Therapeutic effects of corticosteroid pulses are rapid and sustained over time, in both groups.
Nonlinear association between neutrophil-to-lymphocyte ratio and asthma in children and adolescents in the United States: a cross-sectional study
Chuhan Cheng, Liyan Zhang
Clin Exp Pediatr. 2025;68(7):489-496.   Published online March 11, 2025
Question: Is there a nonlinear relationship between neutrophil-to-lymphocyte ratio (NLR) and asthma in children and adolescents?
Finding: NLR showed a nonlinear association with asthma, with an NLR threshold of 2.23 identifying individuals at higher risk.
Meaning: An NLR<2.23 may serve as a potential biomarker for asthma risk assessment and management in pediatric populations, thereby offering a simple tool for the early identification of at-risk individuals.
Editorial
Neonatology (Perinatology)
Intermittent sigh breaths during high-frequency oscillatory ventilation among newborn infants
Ga Won Jeon
Clin Exp Pediatr. 2025;68(7):486-488.   Published online April 16, 2025
Intermittent sigh breaths during high-frequency oscillatory ventilation can improve ventilation and oxygenation by enhancing lung recruitment. Although research on this approach in newborn infants is limited, some published studies suggest that sigh breaths are generally applied at a rate of 2–3 breaths/min with an inspiratory time of 0.5–1 second and pressure of current mean airway pressure + 5 cmH2O (maximum, 30 cmH2O).
Review Article
Immunology
NLRP3 inflammasome: a key player in neonatal brain injury
Cagla Kiser, Ilkcan Ercan, Defne Engur, Sermin Genc
Clin Exp Pediatr. 2025;68(7):475-485.   Published online April 1, 2025
Hypoxic-ischemic encephalopathy is the major cause of neonatal brain injury. NOD-like receptor family pyrin domain containing 3 inflammasome activation leads to neuroinflammation, which significantly affects newborn mortality. The establishment of preventive and therapeutic strategies against brain damage requires a thorough understanding of the mechanisms underlying neuroinflammation and inflammasome activation in the neonatal brain.
Clinical Note
General Pediatrics
Aplasia cutis congenita with unique vascular malformation and cranial hypoplasia: a case in a preterm infant
Yasufumi Sakata, Natsumi Fujii, Sadahiro Nomura, Yoshihiro Azuma, Hiroki Hamano, Hidenobu Kaneyasu, Seigo Okada, Kazumasa Takahashi, Shunji Hasegawa
Clin Exp Pediatr. 2025;68(6):472-474.   Published online March 11, 2025
Original Article
Neonatology (Perinatology)
Differential roles of interleukin-6 and adrenomedullin in early diagnosis and mortality predictions in late-onset neonatal sepsis
Emilly Henrique dos Santos, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Karen Alessandra Rodrigues, Ronaldo Arkader, Thelma Suely Okay
Clin Exp Pediatr. 2025;68(6):463-471.   Published online December 23, 2024
Question: Can adrenomedullin (ADM) or interleukin-6 (IL-6) detect late-onset neonatal sepsis (LOS) at admission (area under the curve [AUC]>0.90) as an early diagnostic marker?
Finding: Only IL-6 consistently distinguished survivors from nonsurvivors (AUC>0.90) on admission and antibiotic treatment days 3 and 7. C-reactive protein level identified infections from day 3 but failed to predict outcomes (AUC<0.70).
Meaning: IL-6 level can improve LOS diagnosis and prognosis.
Nephrology (Genitourinary)
COVID-19 vaccine hesitancy among parents of children with systemic lupus erythematosus
Karnchanit Sausukpaiboon, Nuanpan Penboon, Pornpimol Rianthavorn
Clin Exp Pediatr. 2025;68(6):454-462.   Published online February 3, 2025
Question: What is the acceptance rate for coronavirus disease 2019 vaccination among parents of children with systemic lupus erythematosus (SLE)?
Finding: One-third of parents were hesitant to vaccinate their child. Parental willingness to vaccinate themselves, older patient age, and belief in the vaccine's potency were associated with vaccine acceptance.
Meaning: These findings highlight the need for targeted interventions to improve vaccine acceptance among parents of children with SLE.
Oncology
Prognostic role of mid-regional pro-adrenomedullin in predicting infection in pediatric cancer with febrile neutropenia
Seham M. Ragab, Sara Mahmoud El-Deeb, Ahmed Saeed, Asmaa A. Mahmoud
Clin Exp Pediatr. 2025;68(6):445-453.   Published online January 13, 2025
· Infection remains a leading cause of death in febrile neutropenia (FN).
· Mid-regional pro-adrenomedullin (MR-ProADM) levels are higher among patients with FN and a bacterial infection.
· A longer FN duration and hospital stay length as well as elevated C-reactive protein, procalcitonin, and MR-ProADM levels are significant risk factors for mortality.
Hematology
Impact of Xmn1 polymorphism on hydroxyurea therapy in children with HbE-β non-transfusion dependent thalassemia: a cohort study
Saheli Roy, Paramita Bhattacharya, Atanu Kumar Dutta, Mrinal Kanti Das
Clin Exp Pediatr. 2025;68(6):437-444.   Published online February 3, 2025
Question: Does the T allele of Xmn1 polymorphism favorably influence hydroxyurea efficacy in children of Eastern descent with fetal hemoglobin (HbE)-β nontransfusion dependent thalassemia (NTDT)?
Finding: Decrease in transfusion requirement and increase in height following hydroxyurea therapy was noted in both groups, however, change in CT was more critical than that in CC genotype.
Meaning: T allele of Xmn1 polymorphism favorably influences hydroxyurea efficacy in children with HbE-β NTDT.
Editorial
Neurology
Screen time and neurodevelopment in preschoolers: addressing a growing concern in pediatric practice
Soongang Park, Hyewon Woo
Clin Exp Pediatr. 2025;68(6):434-436.   Published online January 13, 2025
· Excessive screen time in preschoolers is associated with neurodevelopmental delays, particularly during the early years of life.
· Parental supervision and national guidelines are critical in mitigating the negative impacts of excessive screen time and fostering healthy media habits in preschoolers.
Review Article
Other
Peripheral nerve sheath tumors in the head and neck in patients with APC gene deletion mutations: a case report and scoping review of the literature
Koral M. Blunt, Monirah Albathi, Miriam Conces, Tendy Chiang
Clin Exp Pediatr. 2025;68(6):428-433.   Published online January 13, 2025
In this report, we describe our experience with a patient with an APC-related genetic syndrome who presented with a rare palatal lesion with characteristics of a schwannoma. We discuss the role of immunohistochemical staining in discerning the differential diagnosis.
Endocrinology
Impact of hematopoietic stem cell transplantation on growth outcomes in mucopolysaccharidosis: a systematic review
Farzaneh Abbasi, Asal Khalili Dehkordi, Reihaneh Mohsenipour
Clin Exp Pediatr. 2025;68(6):417-427.   Published online March 11, 2025
Hematopoietic stem cell transplantation (HSCT) enhances the growth outcomes of pediatric patients with mucopolysaccharidosis, with early intervention leading to improved height, weight, and body mass index. However, achieving a standard adult height remains uncommon among these patients, even in cases of early HSCT. Growth hormone therapy provides short-term benefits but does not address long-term height deficits. Pubertal development is generally normal; however, precocious puberty and pubertal arrest may occur.
Critical Care Medicine
Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis
Ambrus Szemere, Alíz Fazekas, Anna Réka Sebestyén, Rani Ezzeddine, Veronika Upor, Marie Anne Engh, Péter Hegyi, Zsolt Molnár, Klára Horváth
Clin Exp Pediatr. 2025;68(6):406-416.   Published online February 19, 2025
Protocolized sedation may reduce ventilation requirements, pediatric intensive care unit length of stay, and sedative exposure. However, it may increase the likelihood of unplanned extubation, highlighting the importance of incorporating preventive measures to mitigate this risk.
Allergy
Eosinophil-derived neurotoxin levels can predict allergic disease development and atopic march in children
Zak Callaway, Chang-Keun Kim
Clin Exp Pediatr. 2025;68(6):398-405.   Published online February 3, 2025
· Allergic march occurs in a subset of children, beginning with atopic dermatitis and progressing to food allergies, allergic rhinitis, and/or asthma. Its early diagnosis is important to slowing its progression.
· Eosinophil-derived neurotoxin (EDN), an excellent biomarker of eosinophil activity, is often elevated in allergic diseases.
· EDN levels have been used to predict allergic disease development and diagnose, treat, and monitor allergic diseases.
Clinical Note
Gastroenterology
Abdominal pain in a young girl: a twist in the tale
Upasana Ghosh, Ankit Agrawal, Umesh Shukla, Vikas Jain, Deeksha Bhalla
Clin Exp Pediatr. 2025;68(5):395-397.   Published online March 11, 2025
· Chronic abdominal pain caused by a gastric trichobezoar is extremely rare among children.
· An indentable epigastric mass is characteristic and upper gastrointestinal endoscopy is diagnostic of a gastric trichobezoar.
· Symptomatic large trichobezoars usually require surgery.
· Neuropsychiatric disorders are often associated with gastric trichobezoar, making a psychiatric evaluation of paramount importance.
Original Article
General Pediatrics
The role of serum zinc and selenium levels in etiology of febrile seizures
Yavuz Ataş, Hatice Gamze Poyrazoğlu
Clin Exp Pediatr. 2025;68(5):388-394.   Published online January 13, 2025
Zinc may play a key role in preventing febrile seizures by increasing the seizure threshold and reducing oxidative stress. Incorporating zinc supplements into treatment could help protect children from the adverse effects of febrile seizures and improve their overall outcomes.
Infection
Enteric pathogens implicated in acute infectious diarrhea among young children in resource-limited region with rapidly growing population: a hospital-based cross-sectional study
Aseel Mahmood Ibrahim Al-Mashahedah, Randa Mohammed Dhahi
Clin Exp Pediatr. 2025;68(5):379-387.   Published online December 23, 2024
Question: What are the most common enteric pathogens in acute diarrhea among children younger than 5 years of age, and which age group is most susceptible?
Finding: Bacteria were the most common causative microorganisms of diarrhea, followed by viruses, parasites, and fungi. The 1–2-year age group was the most commonly affected.
Meaning: There is a need to formulate preventive strategies targeting children exposed to enteric pathogens to limit diarrhea.
Nutrition
Differential effects of dietary and physical activity interventions on adiposity of children with obesity
Anekchoke Tangtongsoong, Chonnikant Visuthranukul, Yuda Chongpison, Sirinuch Chomtho
Clin Exp Pediatr. 2025;68(5):370-378.   Published online February 3, 2025
Question: How do dietary intake and physical activity affect body mass index (BMI) z scores and adiposity among children with obesity?
Finding: Higher dietary protein and fiber intakes were significantly associated with a decrease in BMI z scores and adiposity among children with obesity.
Meaning: Optimizing dietary interventions by focusing on protein and fiber intakes could be an effective strategy for managing childhood obesity.
Immunology
Serum bactericidal activity against meningococcus in patients with systemic lupus erythematosus
Soyoung Lee, Kyung-Hyo Kim, Ji Hyen Lee, Han Wool Kim
Clin Exp Pediatr. 2025;68(5):362-369.   Published online January 13, 2025
Question: What is the level of immunity against meningococcal infections in patients with systemic lupus erythematosus (SLE) under the age of 19, and is vaccination against meningococcus necessary for these patients, given their susceptibility to infections due to immunosuppressive treatments and disease characteristics?
Finding: Although some of our study patients exhibited serum bactericidal activity against meningococci, most remained seronegative.
Meaning: These findings suggest that patients with SLE who are at risk of meningococcal infection receive appropriate vaccinations.
Editorial
Other
Further research on impact of microplastics on children's health is essential to protecting future generations
Jongin Lee, Dong-Wook Lee
Clin Exp Pediatr. 2025;68(5):359-361.   Published online November 13, 2024
· The ecological impacts of microplastics have been documented. It was recently recognized that they can directly or indirectly cause diseases in humans.
· There are few established methods for assessing human exposure to microplastics.
· Standardization of exposure assessments and large-scale epidemiological studies are required to explore the human effects of microplastics.
Review Article
Nutrition
The Korea Infant Physical Growth Examination Survey (KIPGroS): a study protocol
Jong Woo Hahn, MinSoo Shin, Jin Gyu Lim, Yoon-Joo Kim, Ki Soo Kang, Narae Lee, Seong Hee Jeong, Mun Hui Jeong, Yeoun Joo Lee, Eui Kyung Choi, Jung Ok Shim, Jee Yoon Park, Chan-Wook Park, Joo Young Kim, Su Jin Jeong, Young Hwa Jung, Jaehyun Kim, Chang Won Choi, Ju Whi Kim, Seung Han Shin, Yun Jeong Lee, Young Ah Lee, Choong-Ho Shin, Seung-sik Hwang, Young Eun Kim, Youn Ha Kang, Kyungwon Oh, Sungha Yun, Jae Sung Ko, Jin Soo Moon
Clin Exp Pediatr. 2025;68(5):352-358.   Published online February 13, 2025
The suitability of World Health Organization (WHO) growth charts for assessing the growth of children under 3 years of age in all countries remains controversial, and their applicability must be evaluated based on country-specific growth data. The Korea Infant Physical Growth Examination Survey evaluated the suitability of WHO growth charts to contribute to the next revision of growth charts in Korea.
Gastroenterology
Anxiety disorders presenting as gastrointestinal symptoms in children – a scoping review
Anjali Kumar, Pramodh Vallabhaneni
Clin Exp Pediatr. 2025;68(5):344-351.   Published online January 13, 2025
A positive bidirectional relationship between gastrointestinal disorders and anxiety, but with no clear aetiology, was identified. Factors such as somatisation and pain catastrophising resulted in poorer pain-related outcomes in children. Further studies are required to understand this relationship in order to have targeted treatments and ensure better long term outcomes.
Allergy
Global burden of asthma among children and adolescents with projections to 2050: a comprehensive review and forecasted modeling study
Tae Hyeon Kim, Hyunjee Kim, Jiyeon Oh, Soeun Kim, Michael Miligkos, Dong Keon Yon, Nikolaos G Papadopoulos
Clin Exp Pediatr. 2025;68(5):329-343.   Published online April 22, 2025
Pediatric asthma can persist to adulthood and must be effectively managed. This review examined the prevalence of asthma among individuals younger than 20 years and revealed a decline from 1990 to 2021, higher rates in males, and a peak in children aged 5–9 years. Despite a projected continued decrease in prevalence by 2050, asthma will remain a significant health concern for children and adolescents.

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