Clinical and Experimental Pediatrics

Letter to the Editor

Other

Adolescent hypertension and carotid intima-media thickness: significance of submillimetric differences

Christian Saleh

Clin Exp Pediatr. 2025;68(1):104-105. Published online November 28, 2024

DOI: https://doi.org/10.3345/cep.2024.01466

Original Article

Neurology

Instability of revised Korean Developmental Screening Test classification in first year of life

Ji Eun Jeong, You Min Kim, Na Won Lee, Gyeong Nam Kim, Jisuk Bae, Jin Kyung Kim

Clin Exp Pediatr. 2025;68(1):97-103. Published online November 11, 2024

Question: How stable are the revised Korean Developmental Screening Test score classifications in early infancy?
Finding: A significant number of infants improved into the peer and high-level group (≥-1 standard deviations), especially in the gross motor area.
Meaning: The early detection of developmental delay requires a comprehensive medical history, physical and neurological examinations, and repeated developmental screenings.

DOI: https://doi.org/10.3345/cep.2024.00619

Endocrinology

Efficacy of leuprolide acetate versus triptorelin pamoate administered every 3 months for treatment of central precocious puberty

Thanaporn Thaneetrakool, Suphab Aroonparkmongkol, Nattakarn Numsriskulrat, Vichit Supornsilchai, Suttipong Wacharasindhu, Khomsak Srilanchakon

Clin Exp Pediatr. 2025;68(1):91-96. Published online November 6, 2024

Question: What are the differences in efficacy between leuprolide acetate and triptorelin pamoate administered every 3 months for the treatment of central precocious puberty (CPP)?
Finding: There were no significant intergroup differences in luteinizing hormone suppression or predicted adult height at the end of treatment in girls with CPP.
Meaning: Leuprolide acetate and triptorelin pamoate have comparable efficacy for treating CPP.

DOI: https://doi.org/10.3345/cep.2024.00822

Pulmonology

Polysomnographic features of children with obesity: body mass index predict severe obstructive sleep apnea in obese children?

Rungrat Sukharom, Prakarn Tovichien, Kanokporn Udomittipong, Pinyapach Tiamduangtawan, Wattanachai Chotinaiwattarakul

Clin Exp Pediatr. 2025;68(1):80-90. Published online November 6, 2024

Question: How Common is obstructive sleep apnea (OSA) in obese children? OSA is common in obese children, even without habitual snoring.
Finding: Among the subjects, 60.6% had positional OSA, 40.2% had rapid eye movement-related OSA, 59.8% had desaturation, 20.5% had sleep-related hypoventilation, and 5.0% had obesity hypoventilation syndrome. Body mass index (BMI) and neck and waist circumferences were significantly associated with severe OSA.
Meaning: We recommend screening obese children (BMI > 29.2 kg/m²) for OSA.

DOI: https://doi.org/10.3345/cep.2024.00066

Neonatology (Perinatology)

Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebocontrolled randomized trial

Ameneh Lamsehchi, Maryam Shokouhi Solgi, Mohammad Kazem Sabzehei, Behnaz Basiri, Elahe Talebi Ghane, Kiana Kimiaei Asadi, Sina Azadnajafabad

Clin Exp Pediatr. 2025;68(1):73-79. Published online October 31, 2024

Question: What are the short-term outcomes of oropharyngeal administration of colostrum (OAC) in preterm neonates?
Finding: This study demonstrated the significantly lower rates of necrotizing enterocolitis, clinically suspected sepsis, shorter hospital stay, period to full enteral feeding, and antibiotic therapy period in the OAC group.
Meaning: This trial may further expand the clinical application of OAC in premature infants to reduce their length of hospital stay and complications.

DOI: https://doi.org/10.3345/cep.2024.00591

Infection

Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes

Setareh Mamishi, Reihaneh Hosseinpour Sadeghi, Sadaf Sajedi Moghaddam, Babak Pourakbari, Shiva Poormohammadi, Maryam Sotoudeh Anvari, Shima Mahmoudi

Clin Exp Pediatr. 2025;68(1):65-72. Published online October 31, 2024

Question: What is the prevalence of carbapenem resistance in gram-negative bacteria and associated carbapenemase genes?
Findings: This study identified a notable prevalence of carbapenem-resistant gram-negative isolates, with Escherichia coli being the predominant contributor, follow ed by Klebsiella pneumoniae, Acinetobacter baumannii, while bla _OXA48 was the most prevalent carbapenemase gene.
Meaning: These findings highlight the urgent need for proactive measures including the rapid detection of carbapenemase- producing isolates and effective infection control.

DOI: https://doi.org/10.3345/cep.2023.01774

Editorial

Cardiology

What we should know about pediatric heart failure: children are not small adults

Ja-Kyoung Yoon

Clin Exp Pediatr. 2025;68(1):62-64. Published online November 6, 2024

· Pediatric heart failure (PHF) features high morbidity and mortality rates.
· Although adults and children can share a common diagnosis of heart failure, the underlying causes can differ significantly and require distinct therapeutic approaches.
· Treatments designed for adults are often applied to PHF despite the fundamental physiological and developmental differences between them.
· Child-specific data are vital for the development of tailored treatments to meet the unique needs of patients with PHF.

DOI: https://doi.org/10.3345/cep.2023.01130

Review Article

Neonatology (Perinatology)

Need for national guidance regarding proactive care of infants born at 22–23 weeks' gestation

Ga Won Jeon

Clin Exp Pediatr. 2025;68(1):53-61. Published online November 13, 2024

With advancements in neonatal intensive care, the limit of viability has shifted to 22–23 weeks' gestation, whose survival rates vary across countries and institutions. These rates are not static and can be improved through the proactive and centralized care guided by national protocols, including maternal transfer to high-activity regions with better neonatal intensive care practices before delivery.

DOI: https://doi.org/10.3345/cep.2024.01277

Endocrinology

A review of vitamin D deficiency and vitamin D receptor polymorphisms in endocrine-related disorders

Nur Faten Hafizah Rosli, Noor Shafina Mohd Nor, Rose Adzrianee Adnan, Siti Hamimah Sheikh Abdul Kadir

Clin Exp Pediatr. 2025;68(1):30-52. Published online November 6, 2024

Crossref 1

· The prevalence of vitamin D deficiency is high among children and adolescents and mainly attributed to changes in environmental factors.
· Vitamin D hormone-like properties are associated with many endocrine-related disorders.
· The effect of vitamin D is modulated by the vitamin D receptor, polymorphisms of which are reportedly associated with an increased risk of disease development in children and adolescents.

DOI: https://doi.org/10.3345/cep.2024.00227

Other

Global trends in importance of 24-hour movement behaviors to pediatric health: implications for South Korea

Eun-Young Lee, Reyana Jayawardena, Seiyeong Park, Justin Y Jeon, Yeon-Soo Kim, Mark S. Tremblay

Clin Exp Pediatr. 2025;68(1):16-29. Published online November 11, 2024

· The 24-hour movement behavior paradigm provides an important framework for future pediatric health promotion efforts.
· Policy priorities should include advancing surveillance and monitoring assessments related to 24-hour movement behaviors, evaluating their implementation in school and government policies, and building preparedness for future pandemics and natural disasters, including climate change, by promoting healthy 24-hour movement behaviors.
· Future research should advocate for the promotion of 24- hour movement behaviors.

DOI: https://doi.org/10.3345/cep.2024.00178

Microplastic and human health with focus on pediatric well-being: a comprehensive review and call for future studies

Rogers Wainkwa Chia, Ntegang Venant Atem, Jin-Yong Lee, Jihye Cha

Clin Exp Pediatr. 2025;68(1):1-15. Published online November 6, 2024

· Milk and formula are common sources of microplastic in infants.
· Water and air are the most common sources of microplastic pollution from infancy to adolescence.
· Microplastic use by children of all ages can cause cell damage and affect their health.
· Microplastics present in children can be quantified using a stereomicroscope and characterized using micro- Fourier transform infrared spectroscopy.

DOI: https://doi.org/10.3345/cep.2023.01739

Clinical Note

Oncology

Right ventricular mass in a 10-year-old girl with osteosarcoma: an unusual case of asymptomatic cardiac metastasis

Jun Ah Lee, Hyun-Ju Lim, Jong Woong Park, Sang-Hoon Shin, Mi Hyang Kwak

Clin Exp Pediatr. 2024;67(12):725-727. Published online November 26, 2024

DOI: https://doi.org/10.3345/cep.2024.00857

Original Article

Other

Balance assessment with decreased base of support for children with disabilities

Guilherme M. Cesar, Madison Giebler, Thad W. Buster, Judith M. Burnfield

Clin Exp Pediatr. 2024;67(12):718-724. Published online November 11, 2024

Question: Can a balance task with narrowed base of support indicate overall functional balance control in children with disabilities?
Finding: While single-limb standing could explain overall balance control for children with disabilities, it was unrelated with balance control for typically developing children.
Meaning: One balance task with narrowed base of support can be used as practical assessment of balance abilities for children with disabilities when allocated session time is of concern.

DOI: https://doi.org/10.3345/cep.2024.00780

Infection

Clinical, biochemical, and genetic study of TACE/TNF-α/ACE signaling pathway in pediatric COVID-19 infection

Ahmed El-Abd Ahmed, Sawsan M.A. Abuhamdah, Mohammed H. Hassan, Nagwan I. Rashwan, Eman A. Abd-Elmawgood, Haggagy Mansour, Hoda S. Sherkawy, Shymaa G. Rizk

Clin Exp Pediatr. 2024;67(12):704-717. Published online November 27, 2024

Question: Is the tumor necrosis factor (TNF) signaling pathway (TNF-α-converting enzyme [TACE]/TNF-α/angiotensin converting enzyme [ACE]) involved in pediatric coronavirus disease 2019 (COVID-19) infection?
Finding: Significantly increased circulating TACE/TNF-α and decreased ACE2 levels were noted. TNF-α-308G/A plays a significant role in susceptibility to COVID-19 infection among children. The ACE (I/D) (rs4646994) and ACE2 (rs2285666) single nucleotide polymorphisms lack significant associations with pediatric COVID-19 infection.
Meaning: The TNF signaling pathway participates in pediatric COVID-19 infection.

DOI: https://doi.org/10.3345/cep.2024.00941

Cardiology

Comparative analysis of adolescent hypertension definitions for predicting early adulthood carotid artery intima-media thickness: Tehran lipid and glucose study

Maryam Barzin, Shirin Yaghoobpoor, Maryam Mahdavi, Behnaz Abiri, Majid Valizadeh, Fereidoun Azizi, Pooneh Dehghan, Farhad Hosseinpanah

Clin Exp Pediatr. 2024;67(12):694-703. Published online September 12, 2024

Crossref 1

Question: What is the prevalence of HTN among adolescents enrolled in the TLGS according to 3 different accepted definitions (4th report, ESH, and AAP-CPG). Also, what is the ability of each of these definitions in predicting early adulthood CIMT, as a surrogate for cardiovascular disease events?
Finding: The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. The highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively.
Meaning: Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG.

DOI: https://doi.org/10.3345/cep.2024.00248

General Pediatrics

Role of proper postnatal care in continued exclusive breastfeeding among young Indonesian mothers

Wahyu Triadmajani, Shinta Prawitasari, Abdul Wahab

Clin Exp Pediatr. 2024;67(12):686-693. Published online September 12, 2024

Question: Is proper postnatal care (PNC) associated with exclusive breastfeeding (EBF) practice among young Indonesian mothers?
Finding: Proper PNC elevates the likelihood of EBF among Indonesian adolescent mothers aged 15–19 years.
Meaning: Breastfeeding services should be provided during the early postnatal period to support EBF practice among adolescent mothers. High-quality PNC is a tailored intervention for vulnerable populations.

DOI: https://doi.org/10.3345/cep.2024.00815

Nonpharmacological interventions for managing postoperative pain and anxiety in children: a randomized controlled trial

Edlin Glane Mathias, Mamatha Shivananda Pai, Vijay Kumar, Dinesh Narayanakurup, Malavika Kulkarni, Vasudeva Guddattu, Ann-Cathrine Bramhagen, Baby S Nayak, Anice George

Clin Exp Pediatr. 2024;67(12):677-685. Published online October 31, 2024

Question: What is the effect of nonpharmacological interventions on postoperative pain and anxiety among children.
Finding: Nurse-provided distraction interventions reduce pain and anxiety among pediatric surgical patients.
Meaning: The findings suggest that nonpharmacological interventions provided postoperatively to children reduce their pain and anxiety levels.

DOI: https://doi.org/10.3345/cep.2023.01690

Editorial

Allergy

Comorbidities of allergic rhinitis in children

Yong Ju Lee

Clin Exp Pediatr. 2024;67(12):675-676. Published online July 31, 2024

· Allergic rhinitis in children often goes undiagnosed or untreated, with significant systemic complications like sleep disorders, growth issues, and gastrointestinal symptoms linked to nasal obstruction.
· A patient-centered action plan that considers symptom severity, preferences, and comprehensive management of associated complications is essential for effective treatment.

DOI: https://doi.org/10.3345/cep.2024.00164

Advancements in food allergen immunotherapy: improving quality of life and reducing risks

Jihyun Kim

Clin Exp Pediatr. 2024;67(12):672-674. Published online July 31, 2024

· Pediatric food allergies considerably impair patient and family quality of life, particularly those with persistent allergies to common food allergens.
· Recent research has focused on developing diverse approaches to food allergen immunotherapy, showing promising outcomes of oral, sublingual, and epicutaneous immuno therapies.
· Critical considerations in immunotherapy candidate selection underscore the need for personalized approaches and reliable biomarkers in future studies to improve treatment outcomes.

DOI: https://doi.org/10.3345/cep.2023.01718

Review Article

Adolescence Medicine

Ji-Hyun Seo, Sochung Chung

Clin Exp Pediatr. 2024;67(12):664-671. Published online October 31, 2024

· Diet behaviors in children and adolescents are influenced by environmental and sociocultural factors.
· Unhealthy diet behaviors and poor diet quality are the main contributing factors to noncommunicable diseases and mental health problems during childhood and adolescence.
· Smoking and alcohol drinking in children and adolescents may be associated with unhealthy diet behavior or poor diet quality.

DOI: https://doi.org/10.3345/cep.2023.01634

Neonatology (Perinatology)

Strategies to support language development in neonatal intensive care unit: a narrative review

Ju Sun Heo, Ee-Kyung Kim

Clin Exp Pediatr. 2024;67(12):651-663. Published online November 6, 2024

· Preterm infants often experience speech and language development delays during early childhood, impacting children's ultimate outcomes.
· Promoting breastfeeding, increasing parent-infant interactions in a single-family room, promoting a nurturing language environment by parental book reading and language interventions, and parent-integrated interventions in the neonatal intensive care unit could potentially enhance children's language development.
· Integrating these strategies through family-centered care is essential.

DOI: https://doi.org/10.3345/cep.2024.00087

Developmental and Behavioral Medicine

Screen time among preschoolers: exploring individual, familial, and environmental factors

Sangha Lee, Donghee Kim, Yunmi Shin

Clin Exp Pediatr. 2024;67(12):641-650. Published online September 12, 2024

This systematic review examined the correlation between screen time and various factors in preschoolers. Findings suggest that media parenting, including setting appropriate media limits, is crucial in protecting against excessive screen exposure. However, limited research has been done on the impact of family and personal factors, particularly with the increasing use of portable devices among young children.

DOI: https://doi.org/10.3345/cep.2023.01746

Rheumatology

Double-negative T cells in pediatric rheumatic diseases

Dimitri Poddighe, Tilektes Maulenkul, Kuanysh Dossybayeva, Gulsamal Zhubanova, Zaure Mukusheva, Lyudmila Akhmaltdinova

Clin Exp Pediatr. 2024;67(12):632-640. Published online September 12, 2024

Crossref 1

Double-negative T (DNT) cells appear to be increased in several pediatric rheumatic diseases and this finding may be correlated with disease activity to some extent. However, due to significant heterogeneity in several methodological aspects, further investigations in rheumatic children are needed to assess the potential relevance of DNT cells as biomarkers and clarify their immunopathological role.

DOI: https://doi.org/10.3345/cep.2023.01760

Letter to the editor

Nephrology (Genitourinary)

Impact of COVID-19 pandemic on healthcare provision in youth with systemic lupus erythematosus

Punchita Apisrinitirath, Nuanpan Siripen, Pornpimol Rianthavorn

Clin Exp Pediatr. 2024;67(11):628-631. Published online October 28, 2024

DOI: https://doi.org/10.3345/cep.2024.00689

Original Article

Neonatology (Perinatology)

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status

Sung-Hoon Chung, Chae Young Kim, Yong-Sung Choi, Myung Hee Lee, Jae Woo Lim, Byong Sop Lee, Ki-Soo Kim; the Korean Neonatal Network

Clin Exp Pediatr. 2024;67(11):619-627. Published online September 12, 2024

Question: How do structural and staffing characteristics of neonatal intensive care units (NICUs) influence the mortality rates of very low birth weight infants (VLBWIs)?
Findings: NICUs with higher staffing levels, particularly with more neonatologists, and those offering advanced care levels were associated with lower mortality rates. Additionally, regional disparities were observed, with some areas demon-strating significantly higher survival rates.
Meaning: Adequate staffing and equitable regional distribution of medical resources are crucial for improving survival outcomes in VLBWIs. Efforts to enhance NICU staffing and address regional healthcare disparities are essential for optimizing care quality and reducing mortality in this vulnerable population.

DOI: https://doi.org/10.3345/cep.2023.01613

Pulmonology

Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

Hyeri Jeong, Dawon Park, Eun Kyo Ha, Ju Hee Kim, Jeewon Shin, Hey-Sung Baek, Hyunsoo Hwang, Youn Ho Shin, Hye Mi Jee, Man Yong Han

Clin Exp Pediatr. 2024;67(11):608-618. Published online October 28, 2024

· This study analyzed 45 randomized controlled trials (5,061 participants, 13 interventions) of the comparative efficacies of treatments for acute bronchiolitis in infants.
· Inhalation therapy with epinephrine and hypertonic saline significantly reduced the length of hospital stay compared with normal saline.
· Hypertonic saline had the greatest ability to improve the clinical severity score of bronchiolitis in infants younger than 2 years of age.

DOI: https://doi.org/10.3345/cep.2023.01676

Allergy

Regional differences in diagnosis and management of cow's milk allergy

Fabian Hendricx, Emma Robert, Jaime A. Ramirez-Mayans, Karen Rubi Ignorosa Arellano, Erick M. Toro Monjaraz, Yvan Vandenplas

Clin Exp Pediatr. 2024;67(11):601-607. Published online October 28, 2024

· Although there is broad consensus on many aspects regarding the symptoms, diagnosis, and treatment of cow's milk allergy, the impact of geographical, cultural, and socioeconomic factors remains unestablished.
· Availability and cost of formula for the management of cow's milk allergy have a major impact on the therapeutic choice.
· Region-specific guidelines for the treatment of cow's milk allergy are required.

DOI: https://doi.org/10.3345/cep.2023.01550

Editorial

Infection

Preventing bloodstream infections in children after liver transplantation

Young June Choe

Clin Exp Pediatr. 2024;67(11):599-600. Published online April 18, 2024

Liver transplantation (LT) is crucial for children with end-stage liver diseases, yet bloodstream infections (BSI) pose significant risks, despite medical advancements. Immunosuppressants, essential for preventing organ rejection, heighten infection susceptibility. Understanding BSI organisms is vital due to antimicrobial resistance. Pediatric LT recipients have unique risk factors, demanding tailored preventive measures. This systematic review on bacterial BSI emphasizes the urgency of effective prevention strategies, considering the high incidence and distinct organism profile. Further research is vital for optimizing antibiotic management and improving outcomes for this vulnerable population.

DOI: https://doi.org/10.3345/cep.2024.00045

Review Article

General Pediatrics

Protecting our future: environmental hazards and children’s health in the face of environmental threats: a comprehensive overview

Jungha Lee, Hyo-Bin Kim, Hun-Jong Jung, Myunghee Chung, So Eun Park, Kon-Hee Lee, Won Seop Kim, Jin-Hwa Moon, Jung Won Lee, Jae Won Shim, Sang Soo Lee, Yunkoo Kang, Young Yoo; The Environmental Health Committee of the Korean Pediatric Society

Clin Exp Pediatr. 2024;67(11):589-598. Published online October 31, 2024

· Exposure to air pollutants cause allergic and respiratory diseases as well as chronic kidney disease.
· Adequate physical activity and proper nutrition are essential for children to maintain good health.
· We must educate people about the harmful effects of noise, blue light, heavy metals and smoke.
· Government and society must actively decrease environ-mental hazards.

DOI: https://doi.org/10.3345/cep.2023.01578

Critical Care Medicine

Recent updates on systemic treatment of atopic dermatitis

Jiyoung Ahn

Clin Exp Pediatr. 2024;67(11):580-588. Published online November 1, 2024

Atopic dermatitis (AD) is a complex disease with multifactorial pathogenesis and variable clinical presentation. Up to one-fifth of patients with AD develop moderate to severe disease that is often refractory to classical therapies and can compromise quality of life. This review summarizes recent clinical evidence on biological agents and small-molecule immunotherapies for the treatment of AD.

DOI: https://doi.org/10.3345/cep.2024.00339

Cited By 17	Neurodevelopmental outcomes of preterm infants
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