Clinical and Experimental Pediatrics最新文献

{"title":"Sarcopenia in pediatric gastroenterology and hepatology: an updated review.","authors":"Toshifumi Yodoshi","doi":"10.3345/cep.2026.00234","DOIUrl":"10.3345/cep.2026.00234","url":null,"abstract":"<p><p>Sarcopenia-the pathologic loss of skeletal muscle mass and strength-is increasingly recognized in pediatric gastroenterology and hepatology as an important determinant of clinical outcomes. Although historically linked to aging, secondary sarcopenia in children arises from chronic inflammation, malnutrition, physical inactivity, corticosteroid exposure, endocrine disturbances, and anabolic resistance. Unlike adult medicine, where diagnostic frameworks are more established, pediatric definitions remain heterogeneous because growth and puberty substantially influence body composition and muscle function. Diagnosis therefore relies on size-adjusted muscle indices, usually normalized to height squared, interpreted against age- and sex-specific reference curves. Body mass index alone is insufficient because muscle depletion and abnormal fat distribution may be present despite normal or elevated body weight, particularly in children with sarcopenic obesity and metabolic dysfunction-associated steatotic liver disease. Accumulating evidence suggests that pediatric sarcopenia is not simply a marker of frailty but a clinically meaningful predictor of adverse outcomes. In pediatric liver transplantation and cirrhosis, sarcopenia is associated with higher waitlist mortality, longer intensive care stays, and more posttransplant infections. In pediatric inflammatory bowel disease, reduced muscle mass correlates with aggressive disease, earlier biologic escalation, and increased surgical risk. This review summarizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of pediatric sarcopenia in gastrointestinal and liver diseases. We discuss available diagnostic tools, including computed tomography/magnetic resonance imaging, dual-energy x-ray absorptiometry, bioelectrical impedance analysis, and grip strength, highlighting their practical advantages and limitations. We also propose a pragmatic diagnostic algoririthm and outline management strategies that extend beyond caloric supplementation, emphasizing adequate protein intake, resistance exercise, and optimization of underlying disease. Early recognition of sarcopenia may improve risk stratification, functional outcomes, and long-term prognosis in children with chronic gastrointestinal and liver diseases.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"366-383"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context-dependent features of transcriptomic landscapes in pregnant mother-neonate dyads of preeclampsia.","authors":"Yu-Chun Cheng, Yun-Ju Lai, Wei-Shiung Lian, Ching-Chang Tsai, Hsin-Hsin Cheng, Hong-Ren Yu, Mao-Meng Tiao, Jiunn-Ming Sheen, Ying-Lun Hsu, Feng-Sheng Wang, I-Chun Lin","doi":"10.3345/cep.2025.02565","DOIUrl":"10.3345/cep.2025.02565","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia (PE) is a serious complication of pregnancy that affects the offspring and mothers. Those with a history of PE are at higher risk of future cardiometabolic diseases, the etiology of which remains uncertain.</p><p><strong>Purpose: </strong>To investigate the transcriptomic profiles of mothers and neonates to determine whether certain genes are commonly affected after shared exposure to PE.</p><p><strong>Methods: </strong>In this observational study, pregnant mother-neonate dyads with PE and healthy normotensive mothers were prospectively recruited. We used RNA sequencing and bioinformatics analysis to characterize the transcriptomic profiles of maternal blood leukocytes (MBLs), cord blood leukocytes (CBLs), and umbilical arterial and venous endothelial cells (UAECs and UVECs, respectively). These results were further validated using real-time reverse transcription polymerase chain reaction.</p><p><strong>Results: </strong>Gene expression during the perinatal/peripartum period was context-dependent in patients with PE and involved various signaling pathways. Inflammation- and immune-related signaling pathways in maternal blood and coagulation-related signaling pathways in cord blood were upregulated in the PE group compared to those in the control group. Ten differentially expressed genes were commonly affected in MBLs and CBLs. Maternal LMNA and CBL levels of MAST4 differentiated those with PE from those with normotension in a gestational-age-adjusted model. Maternal levels of ADAMTS2 and CBL levels of ADAMTS2, GABRE, and MMP8 independently determined neonatal gestational age and birth weight. CBL MMP8 levels independently determined maternal blood pressure. However, the transcriptomic profiles of endothelial cells differ from those of blood leukocytes. Heart morphogenesis-related signaling pathways in UAECs and leukocyte cell-cell adhesion-related signaling pathways in UVECs were more involved in PE. The messenger RNA levels of FAT3 and SLC25A18 in the UAECs were higher in the PE group than in the control group.</p><p><strong>Conclusion: </strong>Perinatal and peripartum genes in PE are expressed in a context-dependent manner via diverse signaling pathways, with little overlap between mothers and neonates.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"394-406"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of induction-phase acute kidney injury and age at diagnosis on chronic kidney disease in pediatric acute lymphoblastic leukemia: a time-to-event cohort study.","authors":"Pongpak Phongphiew, Nuanpan Penboon, Kanhatai Chiengthong, Pornpimol Rianthavorn","doi":"10.3345/cep.2025.02327","DOIUrl":"10.3345/cep.2025.02327","url":null,"abstract":"<p><strong>Background: </strong>The survival rate of pediatric acute lymphoblastic leukemia (ALL) currently exceeds 90% in high-income settings, shifting the focus to its long-term effects. Kidney injury, acute kidney injury (AKI), and chronic kidney disease (CKD) are increasingly recognized associated conditions; however, the determinants of CKD in pediatric ALL remain poorly defined.</p><p><strong>Purpose: </strong>To quantify the burden of AKI during induction and CKD in children with ALL, estimate CKD-free survival, and identify clinical predictors of CKD.</p><p><strong>Methods: </strong>This retrospective cohort at a single university-affiliated tertiary center included patients aged 2-18 years with ALL who completed ≥3 months of follow-up. AKI was classified by Kidney Disease: Improving Global Outcomes serum-creatinine criteria, while CKD was defined as a glomerular filtration rate <90 mL/min/1.73 m2 for ≥3 months. CKD-free survival was estimated using the Kaplan-Meier method. Associations with time to CKD were assessed using the Cox proportional hazards model.</p><p><strong>Results: </strong>Of 113 children (median age, 5.6; interquartile range [IQR], 3.8-9.4 years), AKI occurred during induction in 49 (43.4%). Leukemic kidney infiltration (LKI) was more frequently noted in patients with versus without AKI (P=0.01). Over 644 patient-years of follow-up (median, 5.1; IQR, 2.9-8.3 years), 15 (13.3%) developed CKD (stage 2 [n=12], stage 3 [n=3]). The 1-, 3-, and 5-year CKD-free survival rates were 99.1%, 95.3%, and 94.1%, respectively. In multivariate models, age was independently associated with CKD (adjusted hazard ratio [aHR], 1.28 per year; 95% confidence interval [CI], 1.04-1.57; P=0.02), whereas the incidence of LKI did not reach significance (aHR, 2.93; 95% CI, 0.87-9.89; P=0.08).</p><p><strong>Conclusion: </strong>AKI commonly developed during induction. An older age at diagnosis was the principal independent predictor of CKD development. The age effect demonstrated a linear risk gradient rather than a conventional dichotomous ≥10-year threshold. A LKI was associated with AKI and suggestive of subsequent CKD. These results suggest that older children may benefit from intensive kidney surveillance and supportive care. Multicenter prospective studies are warranted to refine the prevention strategies.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"407-416"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limited improvement in outcomes of infantile epileptic spasms syndrome despite therapeutic advances.","authors":"Donghwa Yang","doi":"10.3345/cep.2026.00745","DOIUrl":"10.3345/cep.2026.00745","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"384-385"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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.","authors":"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","doi":"10.3345/cep.2026.err01","DOIUrl":"10.3345/cep.2026.err01","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":"69 5","pages":"455"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics and cerebral oxygenation in the neonatal transition: a prospective pilot study.","authors":"Daniel Pfurtscheller, Christoph Schlatzer, Nina Höller, Bernhard Schwaberger, Lukas P Mileder, Nariae Baik-Schneditz, Magdalena Holter, Gerhard Pichler","doi":"10.3345/cep.2025.02572","DOIUrl":"10.3345/cep.2025.02572","url":null,"abstract":"<p><strong>Background: </strong>The impact of arterial blood pressure on cerebral oxygenation during immediate postnatal transition is poorly understood.</p><p><strong>Purpose: </strong>Here we investigated the association between arterial blood pressure (BP), cerebral tissue oxygenation index (cTOI), and cerebral fractional tissue oxygen extraction (cFTOE) during the immediate postnatal transition in preterm and full-term neonates.</p><p><strong>Methods: </strong>This prospective observational study included preterm and term neonates who did versus did not require respiratory support. Oscillometric BP was measured at 5, 10, and 15 minutes after birth. cTOI was continuously monitored using near-infrared spectroscopy, while arterial oxygen saturation (SpO2) was recorded using pulse oximetry. cFTOE was calculated from cTOI and SpO. cTOI and cFTOE values were correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at all time points. Correlation and mixed-model analyses were then performed.</p><p><strong>Results: </strong>A total of 102 neonates were enrolled: 51 preterm (33 with, 18 without respiratory support) and 51 term (14 with, 37 without respiratory support). In preterm neonates requiring respiratory support, cTOI was positively correlated with DABP at all time points and with MABP at 15 minutes. cFTOE was negatively correlated with MABP and DABP throughout the experiment and with SABP at 5 minutes. No significant correlations were observedamong the other groups. A mixed-model analysis showed that MABP and DABP were significantly associated with cFTOE but not cTOI independent of gestational age or respiratory support.</p><p><strong>Conclusion: </strong>Among preterm neonates requiring respiratory support, cTOI and cFTOE were associated with arterial BP during the immediate neonatal transition. Only cFTOE showed a slight association with BP among stable preterm and full-term neonates. These findings suggest impaired cerebral autoregulation in compromised preterm infants during the immediate postnatal transition.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"330-339"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adiposity rebound in early childhood: understanding body mass index percentiles and monitoring on growth charts to be healthy.","authors":"Sochung Chung","doi":"10.3345/cep.2026.00668","DOIUrl":"10.3345/cep.2026.00668","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":"69 4","pages":"301-303"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on \"Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices\".","authors":"Yanlan Ma, Yunyun Zhu","doi":"10.3345/cep.2025.02712","DOIUrl":"10.3345/cep.2025.02712","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"362-363"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of hematopoietic stem cell transplantation for pediatric patients with transfusion-dependent thalassemia in Thailand.","authors":"Kleebsabai Sanpakit, Kamala Laohverapanich, Bunchoo Pongtanakul, Nattee Narkbunnam, Chayamon Takpradit, Usanarat Anurathapan, Samart Pakakasama, Supanun Lauhasurayotin, Kanhatai Chiengthong, Thirachit Chotsampancharoen, Pornpun Sripornsawan, Piya Rujkijyanont, Duantida Songdej, Nongnuch Sirachainan, Suradej Hongeng","doi":"10.3345/cep.2025.02173","DOIUrl":"10.3345/cep.2025.02173","url":null,"abstract":"<p><strong>Background: </strong>Hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with transfusion-dependent thalassemia (TDT), and the outcomes are influenced by multiple factors.</p><p><strong>Purpose: </strong>We retrospectively evaluated the clinical characteristics, risk factors, complications, and treatment outcomes in Thai patients aged <20 years using 30-year multicenter HSCT data. This study sought to evaluate the contributing factors affecting survival outcomes and complications, provide insights into the evolution of HSCT for TDT, and inform practice guidelines in developing countries.</p><p><strong>Methods: </strong>The outcomes of 266 HSCT procedures from related and unrelated donors in 249 Thai patients with TDT performed from 1988 to 2016 (median follow-up, 102 months) were analyzed.</p><p><strong>Results: </strong>The median age at HSCT was 6.9 years (range, 1-19 years). Most HSCT procedures used human leukocyte antigen-matched related donors (MRDs; 71.8%), with bone marrow serving as the primary graft source (69.5%). The thalassemia recurrence rate was 11.6%, whereas the mortality rate was 9.0%, primarily due to Gram-negative sepsis. The 5-year overall (OS) and event-free survival (EFS) were 91.3% and 81.0%, respectively. The outcomes did not differ significantly between MRDs and matched unrelated donors (MUDs: OS rate, 91.5% vs. 88.0%, P=0.52; EFS rate, 82.0% vs. 76.2%, P=0.45). Since 2000, advances in pre-HSCT transfusion, iron chelation, graft-versus-host disease prophylaxis, and supportive care have been implemented, with intravenous busulfan adopted after 2009. Over three periods (1988-1999, 2000-2009, and 2010-2016), the OS rate rose from 89.4% to 93.0% (P=0.74), and the EFS rate rose from 67.7% to 87.2% (P=0.01). Age ≤10 years was associated with better overall OS and EFS, although significance was limited to the earliest period. A multivariate analysis identified a pre-HSCT ferritin level >2,500 ng/mL, low CD34+ doses, and the use of oral busulfan conditioning as factors associated with unfavorable survival. Long-term complications, primarily endocrine disorders, affected 22.7% of survivors.</p><p><strong>Conclusion: </strong>Our results broaden the donor pool by demonstrating comparable outcomes between MRD and MUD transplantation. Optimizing pretransplant care, such as regular pre-HSCT transfusion, adjusting conditioning intensity, and improving posttransplant supportive care, may mitigate age-related risks in older recipients.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"340-352"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal postnatal corticosteroid regimens to prevent bronchopulmonary dysplasia with minimal adverse effects.","authors":"Ga Won Jeon","doi":"10.3345/cep.2026.00108","DOIUrl":"10.3345/cep.2026.00108","url":null,"abstract":"<p><p>Postnatal corticosteroids can facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD); therefore, they are commonly used to prevent or treat BPD in preterm infants, particularly those born extremely preterm. Despite their frequent use in high-risk infants with severe BPD, no clear guidelines have been established for the optimal timing of administration, dosage, corticosteroid type, route of delivery, and indication based on the infant's baseline risk of BPD. Early systemic corticosteroid administration, particularly dexamethasone within the first week of life, appears to be associated with adverse neurodevelopmental outcomes and is generally not recommended. Dexamethasone and hydrocortisone exhibit distinct biological and clinical effects, yet evidence from direct comparative studies is limited. Dexamethasone may improve cerebral palsy-free survival of infants at high risk of BPD but poses potential harm in those at low risk, highlighting the need for individualized risk-based decision-making. Optimal dosing remains unclear: lower doses may reduce systemic side effects despite the uncertainty of their neurodevelopmental safety, whereas higher doses may be more effective in selected high-risk infants. Inhaled corticosteroids have inconclusive benefits compared with systemic therapy. The intratracheal administration of corticosteroids with surfactant improves distal airway delivery and reduces death or BPD rates; however, short- and long-term safety data remain limited. Overall, postnatal corticosteroids should be used cautiously and selectively in high-risk, ventilator-dependent infants with severe BPD. Future high-quality trials are needed to evaluate long-term survival free of neurodevelopmental impairments.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":"69 4","pages":"293-300"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}