Clinical and Experimental Pediatrics

Review Article

Infection

Antibiotic pretreatment and culture yield in pediatric osteoarticular infection: a systematic review and meta-analysis

Mohamad Shieb, Caroline Decesare, Guyu Li, Elizabeth Ristagno

Clin Exp Pediatr. 2026;69(11):825-832. Published online September 14, 2026

In this systematic review and meta-analysis of 9 studies comprising 1,704 tissue culture specimens from children with osteoarticular infection, antibiotic pretreatment was not associated with reduced tissue culture yield (odds ratio, 1.60; 95% confidence interval, 1.23–2.08). Empiric antibiotic therapy should not be withheld to preserve culture yield in suspected osteoarticular infection; invasive cultures should be obtained at the earliest safe opportunity without delaying treatment.

DOI: https://doi.org/10.3345/cep.2026.01634

Pulmonology

Health literacy and emergency preparedness in pediatric tracheostomy and home ventilation: a practical review

Megan Pilcher, Weerapong Lilitwat

Clin Exp Pediatr. 2026;69(11):833-843. Published online September 7, 2026

For children with tracheostomy and home ventilation, health literacy is a safety capacity, not merely reading ability. Existing guidelines define what a safe discharge system should contain; clinicians must also verify what caregivers can understand, demonstrate, and retain. An author-derived six-domain framework, staged multimodal teaching, teach-back, show-back, simulation, and longitudinal reassessment can translate recommendations into emergency action, while long-term outcome evidence remains limited.

DOI: https://doi.org/10.3345/cep.2026.01802

Neonatology (Perinatology)

Association between surgical repair timing and mortality in neonates with congenital diaphragmatic hernia: a systematic review and meta-analysis

Veerabhadra Radhakrishna, Bharathi Balachander, Sanjana Hansoge Somanath, Hejmady Aneesh Shenoy, Srinivas Balachander

Clin Exp Pediatr. 2026;69(11):844-854. Published online September 17, 2026

Preoperative stabilization is critical for the management of congenital diaphragmatic hernias. Surgical repair within 24 hours of life significantly increases mortality risk. A 24- to 48-hour stabilization window optimizes survival and resource utilization. Delaying surgery beyond 48 hours offers no additional survival benefits and increases morbidity. In neonates requiring extracorporeal membrane oxygenation, the exact surgical timing does not independently predict mortality.

DOI: https://doi.org/10.3345/cep.2026.01837

Editorial

Infection

A commentary on “Effect of varicella vaccine introduction on chickenpox incidence in Kingdom of Bahrain”

Ui Yoon Choi

Clin Exp Pediatr. 2026;69(11):855-857. Published online October 29, 2026

Bahrain’s experience suggests that routine varicella vaccination using a 2-dose schedule can substantially reduce the disease burden. In Korea, where a single-dose schedule has been used since 2005, breakthrough varicella remains common, and 1-dose vaccine effectiveness declines to approximately 50% by 6 years after vaccination. Findings from Bahrain, together with experiences from Germany and the United States, support the consideration of a routine second dose in Korea.

DOI: https://doi.org/10.3345/cep.2026.03202

Original Article

Neurology

Prenatal stress via chronic immobilization amplifies N-methyl-D-aspartate-induced spasm-like seizure susceptibility and neuroinflammation in neonatal rats

Hyeok Hee Kwon, Seungyeon Bin, Seung Gyu Choi, Hyo Jung Shin, Joon Won Kang

Clin Exp Pediatr. 2026;69(11):858-867. Published online September 8, 2026

Question: Does chronic prenatal immobilization stress increase an offspring's susceptibility to spasms, and is this associated with altered glial activation and gamma-aminobutyric acid (GABA)ergic signaling in the developing brain?
Finding: Prolonged prenatal stress increases susceptibility to N-methyl-D-aspartate-induced spasms, enhanced glial activation, and impaired GABAergic signaling.
Meaning: Long-term prenatal stress may promote early life epileptogenesis associated with neuroinflammation as well as disrupted inhibitory neurotransmission, although a causal role remains to be established.

DOI: https://doi.org/10.3345/cep.2026.01403

General Pediatrics

Effect of varicella vaccine introduction on chickenpox incidence in Kingdom of Bahrain

Afaf Merza Mohamed, Hasan M. Isa, Malak Husain Hasan, Maram Husain Hasan, Ali K. Moosa, Janan Husain Radhi, Basma Al Saffar, Adel Al Sayyad

Clin Exp Pediatr. 2026;69(11):868-877. Published online September 14, 2026

Question: What was the effect of varicella vaccine introduction on chickenpox incidence in Bahrain?
Finding: Postvaccine introduction in May 2015, new varicella cases declined substantially, particularly among children aged 0–9 years. Most cases are managed in primary healthcare settings, with rare hospitalizations and no reported deaths.
Meaning: Routine varicella vaccination is associated with reduced disease burden, demonstrating sustained high coverage, continued surveillance, and protection of susceptible groups.

DOI: https://doi.org/10.3345/cep.2026.01326

Developmental and Behavioral Medicine

Association between maternal traumatic stress related to Great East Japan Earthquake and behavioral problems in offspring

Shun Tanabe, Masatsugu Orui, Chikana Kawaguchi, Genki Shinoda, Aoi Noda, Mami Ishikuro, Taku Obara, Shinichi Kuriyama

Clin Exp Pediatr. 2026;69(11):878-890. Published online October 22, 2026

Association between maternal traumatic stress related to Great East Japan Earthquake and behavioral problems in offspringQuestion: Does prepregnancy maternal traumatic stress influence behavioral outcomes in early childhood?
Finding: Children born to mothers who reported greater disaster-related traumatic stress showed higher risks of internalizing, externalizing, and total behavioral problems at ages 2 and 3 years consistent with a dose-response relationship.
Meaning: Long-term maternal mental health support covering the broader reproductive period may play a role in addressing intergenerational behavioral problems after large-scale disasters.

DOI: https://doi.org/10.3345/cep.2026.00843

Hematology

Hematological alterations in adolescent girls with restrictive anorexia nervosa and secondary amenorrhea at the time of diagnosis

Katarína Šebeková, Alexandra Gaál Kovalčíková, Ľubica Tichá, Ľudmila Podracká

Clin Exp Pediatr. 2026;69(11):891-901. Published online October 19, 2026

Question: Do adolescent girls with restrictive anorexia nervosa and secondary amenorrhea have low blood counts at diagnosis?
Finding: Patients, even those with bone mineral density z scores similar to those of controls and adequate micronutrient levels, exhibited lower blood counts and suppressed bone formation and endocrine parameters compared with healthy age-matched controls.
Meaning: Hematological alterations may occur early in the disease course and complement routine clinical assessments.

DOI: https://doi.org/10.3345/cep.2026.00808

Clinical Note

Cardiology

First biallelic CASQ2 variant in a Korean child with catecholaminergic polymorphic ventricular tachycardia

Sang Hun Jung, Shin Hyeung Kwak, Gwang Jun Choi, Ja-Kyoung Yoon, Jin Young Song, I Seok Kang, June Huh

Clin Exp Pediatr. 2026;69(11):902-905. Published online September 1, 2026

DOI: https://doi.org/10.3345/cep.2026.01158

Correspondence

Endocrinology

A commentary on “Linking pediatric obesity to youth-onset type 2 diabetes: integrated longitudinal and cross-sectional evidence from population-based studies worldwide” – Parallel trends are not causal evidence: methodological caution regarding the pediatric obesity–youth-onset type 2 diabetes link

Ercan Yılmaz, Zeynep Yamancan Yılmaz

Clin Exp Pediatr. 2026;69(11):906-907. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.02768

Author's reply to “Parallel trends are not causal evidence: methodological caution regarding the pediatric obesity–youth-onset type 2 diabetes link”

Ashraf T. Soliman

Clin Exp Pediatr. 2026;69(11):908-911. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.02831

Guideline

Oncology

Evidence-based clinical practice guidelines for pediatric hepatoblastoma: a systematic review and expert recommendations from Korea

Jin Kyung Suh, Jisun Hwang, Hee Mang Yoon, Kyong Ihn, Jung-Man Namgoong, Jeong A. Park, Jung-Sun Kim, Hyoung Soo Choi, Sung Hye Park, Dong Ah Park, Kyung-Nam Koh

Clin Exp Pediatr. 2026;69(11):912-924. Published online October 23, 2026

This is the first Korean evidence-based clinical practice guideline for pediatric hepatoblastoma. Key recommendations include computed tomography and magnetic resonance imaging for PRETEXT (PRE-Treatment EXTent of disease) staging, cisplatin monotherapy for standard-risk disease, upfront surgery for resectable tumors, metastasectomy for residual lung lesions, and sodium thiosulfate for otoprotection. Well-differentiated fetal histology carries a favorable prognosis, whereas the small cell undifferentiated pattern requires immunohistochemical and molecular testing to exclude malignant rhabdoid tumor.

DOI: https://doi.org/10.3345/cep.2026.02691

Correction

Author Correction: 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(11):925-926. Published online October 22, 2026

DOI: https://doi.org/10.3345/cep.2026.01228.e1

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