Ukrainian Journal of Perinatology and Pediatrics

Features of providingspecialized multidisciplinary care for a newborn with congenital oral tumor and risk of asphyxia diagnosed prenatally, using fetal intervention (clinical case)

2025-12-26T23:53:52+02:00

Congenital granular cell phase or congenital epulis (granular cell myoblastoma, Neumann's end) is a rare benign soft tissue lesion in newborns. Most often, this lesion occurs in isolation, it may not be associated with the congenital absence of the tooth germ in the area of its eruption. It is associated with perinatal complications. The size of the lesions is crucial when planning delivery and subsequent treatment, larger advantages in terms of the size of the composition of the oral cavity can cause airway obstruction in the newborn, and difficulties with intubation contribute to prolonged oxygen starvation and, accordingly, be the cause of further adverse consequences.

Aim - to demonstrate the features of prenatal diagnosis, tactics of pregnant women's management, surgical treatment and postoperative observation of a newborn with a congenital position of the oral cavity and the risk of asphyxia, as well as to emphasize the importance of coordinated interaction of specialists in various areas in ensuring the optimal treatment outcome.

A clinical case of providing specialized multidisciplinary care to a newborn with a congenital clinical oral cavity and the risk of asphyxia, diagnosed prenatally using the EXIT (Ex utero Intrapartum Treatment) procedure, is presented. The provision of multidisciplinary care to a newborn with a prenatally diagnosed congenital complete oral cavity and the risk of asphyxia is demonstrated. Namely, preparation for delivery, the use of the EXIT procedure: delivery by cesarean section with the removal of the fetal head into the wound with repeated intubation of the newborn on a pulsating umbilical cord. Further transportation to the neonatal surgery department and surgical intervention with the removal of this formation.

Conclusions. Timely diagnosis and a multidisciplinary approach are the basis for developing patient-oriented tactics for managing a child with congenital malformations and are the key to a favorable prognosis for the newborn. The presence of a large oral tumor with the risk of airway obstruction and asphyxia requires careful planning of delivery with the possibility of using the EXIT procedure with immediate tracheal intubation on a working umbilical cord to ensure minimal risk of damage to the newborn, and accordingly to reduce possible further complications.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Severe thrombocytopenia and anemia in a child with parvovirus B19 infection (a case report)

2025-12-27T00:13:02+02:00

Parvovirus B19 (PVB19) is a common viral pathogen associated with various hematological disorders, particularly in pediatric patients. This case report highlights a rare presentation of severe thrombocytopenia and anemia in an immunocompetent child after PVB19 infection.

Aim - based on a clinical case, analyze the course of severe thrombocytopenia and anemia in a child with parvovirus infection to raise awareness among physicians about hematological complications associated with PVB19.

Clinical case of severe thrombocytopenia in a 3-month-old Ukrainian boy. The disease began with the appearance of a petechial rash after a mild respiratory illness. Before the boy's illness, his two siblings were diagnosed with PVB19 infection. The child had persistent thrombocytopenia and anemia. In blood PVB19 DNA was revealed, positive immunoglobulin (Ig) G to PVB19 was detected. The child received platelet concentrate transfusions, pulse therapy with prednisolone, and immunoglobulin. There was no stable response to treatment. No immunodeficiency or systemic hematological disease was detected. No genetic predictors of anemia were identified. The final diagnosis was established: Acute parvovirus infection, severe course. Acute thrombocytopenic purpura. Anemia of complex genesis, severe form. Complications: Hypofibrinogenemia. The child was discharged home on day 72 with normal levels of thrombocytes and hemoglobin.

Conclusion. Hematological complications determine the severity of the course and prognosis of PVB19 infection. For these reasons, in young children, considering the likelihood of thrombocytopenia and anemia, for timely diagnosis, it is recommended to determine IgM to PVB19 and verify the diagnosis of PVB19 infection. Severe hematological complications, in particular, transient aplastic crisis, develop after 3-4 weeks, so it is essential to monitor the indicators of a complete blood count in children after PVB19 infection.

The study was conducted according to the principles of the Declaration of Helsinki. Parents’ agreement has been received for it.

The authors declare no conflict of interest.

A modern view of Cornelia de Lange syndrome in children

2025-12-27T00:28:44+02:00

Cornelia de Lange syndrome (CdLS) is a rare multisystemic disease with the involvement of numerous organs and systems.

Aim - based on clinical case of a child to discover modern clinical, diagnostic and rehabilitative principles of CdLS in children.

Clinical case. A clinical case of 37 months old child with classical phenotype CdLS, born with 1400 g of body weight and 36 cm of body length, 5-7 points according to Apgar scale, microcephaly, facial dysmorphism, short trunk and extremities and multiple congenital defects is described in the article. Cytogenetic test has verified CdLS: genotype - gene MTHFR 677 СТ (heterozygote), gene MTRR 66 GG (heterozygote); caryotype 46, XX, G-C - coloration, 1% of chromosomal instability. The child has been hospitalized with physical and psychical development retardation, vomiting, regurgitation, constipations, flabbiness, blepharoptosis and myopia. She is supervised by pediatrician, neurologist, cardiologist, cardiac surgeon and endocrinologist and receives replacement treatment due to somatogenic insufficiency. Laboratory and instrumental findings with no pathological changes. Diagnosis: Psychoverbal and physical development delay (under 3 percentile). Somatotropic insufficiency, Tricuspid regurgitation, I degree. Abnormal chord of the left ventricle. Gastroesophageal reflux. Irritable bowel syndrome with constipation. Myopy of high degree. The child has received symptomatic therapy, growth hormone, nootropic drugs, vitamins and massage. Child’s mother has been as well recommended complex individual program of training with speech therapist, defectologist and psychologist and art-therapy.

Conclusions. Majority of CdLS cases are ones with classical phenotype, however a great number of variants with atypical signs exist, therefore unified clinical diagnostic criteria may be of certain importance for diagnosis verification.

The study is fulfilled according to the Declaration of Helsinki principles. Parents’ agreement has been received for it.

Authors declare no conflict of interests.

Rationale and prospects for infusion therapy in women with pre-eclampsia

2025-12-26T22:22:26+02:00

Pre-eclampsia is a great obstetric syndrome that occurs in the second half of pregnancy and is related to ischemic placenta syndrome or impaired adaptation of the cardiovascular system of a woman. This disease causes short- and long-term consequences for the health of the mother and fetus. Nowadays, some preventive and therapeutic approaches have been introduced among the contingent of women with high risk and manifested pre-eclampsia.

Aim - to find new effective approaches to the prevention and management of women with pre-eclampsia using low-volume infusion therapy.

It is known that the level of amino sugars in the placentas of women with pre-eclampsia is reduced. Epigenetic studies have shown that women with this pathology have a mutation in the sorbitol dehydrogenase gene. The rationale and prospects for the use of sorbitol- and xylitol-based solutions for low-volume infusion therapy were demonstrated. Emphasis is placed on the possibilities of personalized infusion therapy in pre-eclampsia. It is based on the use of combinations of molecules with a high volemic index and solutions close in composition to blood plasma.

Conclusions. Multifunctional hyperosmolar solutions based on xylitol or sorbitol can be used at any stage of the management of pre-eclamptic patients within the framework of a patient-oriented strategy. The use of xylitol is preferred in the presence of carbohydrate intolerance. Further studies will provide an answer to the issue of the dose, duration, and additional monitoring during infusion therapy with sorbitol and xylitol solutions in women with pre-eclampsia.

The author declares no conflict of interest.

A review of fetal megacystis: from diagnosis to long-term prognosis

2025-12-26T22:32:07+02:00

Megacystis is a rare fetal condition characterized by an abnormal enlargement of the bladder, often associated with lower urinary tract obstructions, genetic mutations (e.g., ACTG2 in Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome), or syndromic disorders such as Prune Belly Syndrome.

Aim - to evaluate prenatal diagnostic techniques, assess the effectiveness of prenatal and postnatal interventions, and analyze long-term renal and urological outcomes in neonates diagnosed with megacystis.

This systematic review consolidates available case reports to evaluate prenatal diagnosis, treatment strategies, and long-term outcomes of neonates diagnosed with megacystis. This review was conducted in accordance with the PRISMA 2020 guidelines. Studies were included if they provided prenatal or postnatal diagnoses, genetic findings, interventions, and clinical outcomes. Risk of bias was evaluated by applying the Joanna Briggs Institute Critical Appraisal Checklist. Due to the heterogeneity of case reports, a narrative synthesis was performed, and findings were categorized based on intervention type and prognosis. A total of 20 case reports were included. The mean birth weight of affected neonates was 1152±532 g, with an average gestational age at diagnosis of 28±9.3 weeks. Prenatal interventions (n=5) demonstrated a 60% survival rate but were associated with preterm birth and oligohydramnios. Postnatal surgical management (n=8), including vesicostomy and catheterization, had a 75% survival rate, although some cases required long-term dependency on total parenteral nutrition due to associated comorbidities. Cases where no intervention was performed (n=7) resulted in 100% mortality, with intrauterine demise or termination due to severe structural anomalies. The survival rates were compared across different intervention groups, highlighting that those cases managed postnatally showed significantly better survival outcomes, while fetal intervention success varied based on gestational age and underlying etiology.

This review highlights the need for standardized diagnostic protocols, genetic screening, and prospective cohort studies to improve treatment decision-making and long-term care for affected neonates.

The authors declare they have no conflict of interest.

Psychological, pedagogical and rehabilitation correction of children with autism spectrum disorders

2025-12-26T22:50:59+02:00

Psychological, pedagogical and rehabilitation correction of children with autism spectrum disorders (ASD) requires more effective study and substantiation of the thesis that ASD can be a psychotic component of the entire spectrum of diseases of both children and adults. Differences and deviations in various aspects of the lives of children with autism are the basis of violations of social integration of children in this category.

Aim - to conduct a systematic analysis of scientific sources on psychological, pedagogical and rehabilitation correction of children with ASD.

Psychological, pedagogical and rehabilitation correction of children with ASD is more effective when using game methods in working with children with autism. For children with ASD, it is necessary to create favorable conditions in the educational process. This will improve the development of speech, the formation of social skills and cognitive functions, and will positively affect the regulation of behavior and emotions of a children with autism. An effective correction process helps children with ASD to receive support, guidance, and successfully reveal their potential. And the main thing is to achieve success in communication and social interaction. It is necessary to study psychological, pedagogical, and rehabilitation correction of children with ASD due to insufficient motor control. This aspect significantly complicates the daily life of children with autism. When determining practical rehabilitation skills in the process of correction of children with autism, three basic ones are distinguished: the skill of assessing the functional state of a child with autism (patient); the skill of working with an autistic child (patient) in intensive care; the skill of teamwork with medical and rehabilitation specialists.

The process of inclusive education of children with ASD requires the use of strategies of visual layout, priming, behavioral moment, prompts, or incentives.

The authors declare that there is no conflict of interest.

Social health of ukrainian children and adolescents in conditions of martial arts

2025-12-26T23:15:50+02:00

Аim - to conduct a systematic analysis of scientific sources on the social health of Ukrainian children and adolescents under martial law as a pressing problem of psychology, medicine and social work. Martial law conditions negatively affect the main aspects of the social health of children and adolescents in Ukraine. The level of social health in the aspect of military actions is determined by negative factors that affect the social health of the child. A low level of social health reflects the inability of children and adolescents to socialize.

Social health is not a state of stability. A child, especially in adolescence, cannot have absolute social health. The following components of social health can be defined: interest in the environment; focus on results; empathy; responsibility to others; perception of social reality; adaptation to the environment.

War is a social factor influencing modern society. Psychological resistance to dangerous conditions and the ability to preserve one’s own health and life are being formed in children and adolescents. At the same time, negative social trends include an increase in the percentage of Ukrainian children and adolescents suffering from depression, anxiety, mental disorders, and unbalanced behavior. A small group of adolescents perceives war as a very dangerous psychological and social situation. This leads to reckless actions with negative consequences. The impact of war on the social health of Ukrainian children and adolescents is mainly negative. Preservation of social health requires significant efforts by pediatricians, social workers, and teachers.

The authors declare the absence of a conflict of interest.

Effectiveness of a comprehensive management approach for pelvic congestion syndrome

2025-12-25T14:20:37+02:00

Chronic pelvic pain is a common symptom in obstetric and gynecologic practice; in 15–40% of reproductive-age women it is caused by pelvic congestion syndrome (PCS). This syndrome is considered a form of chronic venous disease; among conservative approaches there is growing interest in venoactive flavonoids (diosmin, hesperidin, anthocyanins, triterpenes of Centella asiatica) with venotonic, anti-inflammatory, and antioxidant effects.

Aim - to investigate the effectiveness of pharmacological treatment with the dietary supplement Flego in women with PCS by comparing changes in venous diameter and quality of life before and after therapy.

Materials and methods. Sixty women aged 25-38 years with PCS were included. All participants received Flego plus lifestyle modification (healthy diet, cessation of harmful habits, increased physical activity, Pilates exercises). Assessments included pelvic vein diameter (ultrasound), quality of life by Pelvic Varicose Vein Questionnaire (PVVQ) and pain by Visual Analogue Scale (VAS) at baseline and at 3 months.

Results. The baseline mean venous diameter was 8.56±1.38 mm (range 6.54-11.65 mm). After 3 months: in 48 (80.0%) patients the diameter decreased to 5.86±1.48 mm; in 10 (16.7%) there was a moderate decrease to 7.12±1.31 mm; in 2 (3.3%) no change was recorded. VAS pain scores decreased from 6.46±1.89 points to 2.62±1.46 points; quality of life by PVVQ improved from 56.32±12.51 points to 27.43±10.11 points.

Conclusions. The combination of Flego with lifestyle modification was associated with a reduction in pelvic vein diameter in 80% of patients, a significant decrease in pain, and improved quality of life. These findings support this approach as a conservative option in early stages of PCS.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution’s local ethics committee. Informed consent was obtained from patients.

The authors declare no conflict of interest.

The effect of the use of compression stockings on stress levels and blood clotting parameters in women who have undergone gynaecological operations

2025-12-25T15:06:49+02:00

Chronic stress significantly contributes to the development of deep vein thrombosis (DVT) and negative surgical outcomes.

Aim - to determine the effectiveness of the use of compression stockings and their effect on stress levels and blood clotting parameters in women who have undergone gynecological operations.

Materials and methods. The examined 40 women who were chronically stressed and underwent gynecological operations were randomly divided into two groups: one used preoperative compression stockings on their legs (group 1; n=20), the other did not use (group 2; n=20). Blood samples were collected to measure prolactin, cortisol and blood clotting parameters (prothrombin time, activated partial thromboplastin time and fibrinogen levels). Participants also completed the Perceived Stress Scale (PSS) and Reader’s Stress Inventory.

Results. The study showed that all indicators were better in the group 1 compared to the group 2: prolactin levels were significantly lower (21.7±3.8 ng/ml versus 25.3±4.7 ng/ml); cortisol levels were also lower (16.4±5.2 μg/dL versus 19.3±6.1 μg/dL); blood clotting parameters indicated faster prothrombin time (11.8±1.2 s versus 14.0±1.1 s), activated partial thromboplastin time (30.2±2.8 s versus 34.5±2.5 s) and lower fibrinogen levels (306.3±35.6 mg/dL versus 347.1±38.4 mg/dL). The level of perceived stress was also lower in the group 1 (26.1±6.3 points) compared to the group 2 (30.4±4.7 points).

Conclusions. Preoperative compression stockings significantly reduce the level of stress hormones, perceived stress and improve blood clotting parameters in women undergoing gynecological surgery (the effectiveness was 98%). It is recommended to include to use of these stockings in the protocols of preoperative preparation for this group of patients.

The study was carried out in accordance with the principles of the Declaration of Helsinki and was approved by the ethics committee of this institution.

The authors declare that there is no conflict of interest.

Serum levels of HSP60 and GroEL as biomarkers of risk for pregnancy loss in women in the first trimester of gestation

2025-12-25T15:26:07+02:00

Pregnancy loss (PL) remains a leading cause of reproductive failure worldwide and in Ukraine. Despite advances in prenatal diagnostics, in 40-50% of cases the etiology of PL remains unidentified, highlighting the need for new biomarkers.

Aim - to evaluate serum levels of Heat Shock Protein 60 (HSP60) and bacterial chaperonin GroEL in women in the I trimester and determine their prognostic value for PL risk.

Materials and methods. A prospective study included 94 pregnant women at 6-12 weeks of gestation. The main group consisted of 61 women with threatened miscarriage and/or a complicated reproductive history; the control group included 33 women with physiological pregnancies. Clinical and ultrasound data (cervical length, chorion localization, retrochorionic hematoma) were recorded. HSP60 and GroEL serum levels were measured using ELISA. Statistical analysis included t-test, χ², correlation analysis, and ROC analysis.

Results. GroEL positively correlated with retrochorionic hematoma presence, whereas HSP60 showed a weak negative association with cervical length. HSP60 concentrations were higher in the main group, and GroEL levels were significantly higher in women the control group. The Area Under the ROC Curve for GroEL was 0.73, indicating satisfactory prognostic value, while HSP60 showed limited diagnostic significance - 0.62.

Conclusions. Increased GroEL levels in the I trimester are associated with PL risk and demonstrate sufficient prognostic accuracy. HSP60 has limited diagnostic value. Combined assessment of biomarkers with clinical and ultrasound parameters improves early PL prediction. Measuring HSP60 and GroEL may be recommended as an additional component of risk assessment algorithms.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee. Informed consent was obtained from the pregnant women participating in the study.

The authors declare no conflict of interest.

Clinical course of long-term consequences of endometritis after cesarean section on the background of hormonal therapy

2025-12-25T15:53:07+02:00

Аim - is to study the features of the clinical course of the long-term consequences of endometritis that occurred after cesarean section, 
depending on the method of restorative treatment.

Materials and methods. 60 women who had endometritis after operative delivery by cesarean section were examined: group I - 40 
women who received rehabilitation measures, group II - 20 women who did not receive them. The complex of rehabilitation measures in group I, 
in addition to traditional therapy, included hormonal correction with combined oral contraceptives. Clinical and laboratory examination was carried out 
for 2 years with an interval of every 6 months.

Results. The rehabilitation treatment carried out in group I patients, 12 months after delivery, contributed to a significant reduction in 
the frequency of pain syndrome from 52.5% to 42.5%; algomenorrhea from 57.5% to 45.0%; menstrual cycle disorders from 47.5% to 42.5%; 
decreased libido - from 52.5% to 47.5% and neuroendocrine disorders from 17.5% to 12.5% of cases.

Conclusions. Comprehensive rehabilitation treatment within 24 months after delivery significantly reduced the average frequency of 
clinical symptoms of "disease of the operated uterus": after 12 months in group I, a significant decrease to 2.3 symptoms versus 4.3 in group II; 
this pattern persisted after 18 months - 1.7 versus 4.6 and after 24 months - 1.5 versus 4.9; it also contributed to a significant decrease 
in the frequency of pathological neuroendocrine symptoms in patients of group I by an average of 15.0%.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved 
by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the study.

The author declares that there is no conflict of interest.

Comparison of approaches to the treatment of postpartum hemorrhage in women after repeat cesarean section

2025-12-25T21:57:01+02:00

The need to reduce maternal mortality and complications associated with postpartum hemorrhage remains relevant today.

Aim - to study the effectiveness of modern methods of prevention and treatment of postpartum hemorrhage in women after repeated cesarean section, including surgical, medical, and combined approaches.

Materials and methods. The study was performed as a retrospective analysis of clinical cases of women with repeated cesarean section in 2019-2024 in specialized institutions of Ukraine. The sample included 200 patients aged 25-40 years, divided into four groups depending on the applied prophylaxis and treatment. The analysis was carried out according to medical histories, taking into account the volume of blood loss (determined by the gravimetric method). Statistical processing of the results was performed using the methods of analysis of variance.

Results. The study showed that the average blood loss was the greatest in patients treated with the combined approach (standard prophylaxis + extended prophylaxis + remodeling of the lower uterine segment + compression sutures according to Bilinch) and the lowest in patients treated with the combined approach; these patients were characterized by the shortest duration of hospitalization (5.8±1.2 days) and the lowest need for additional medications (15.0%). The obtained data confirm the effectiveness of comprehensive prophylaxis in reducing blood loss and improving postoperative recovery.

Conclusions. The effectiveness of preventing postpartum hemorrhage in women after repeated cesarean section directly depends on the tactics used. The best indicators - the least blood loss, lower need for blood transfusion, shorter postoperative period and faster recovery - were recorded in patients who used only the combined approach. The results obtained indicate that this technique is the most optimal and appropriate for preventing bleeding in women with repeated cesarean section and can serve as the basis for improving clinical protocols.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution’s Local Ethics Committee. The informed consent was obtained from patients.

The authors declare no conflict of interest.

A differentiated approach to drug treatment of attention deficit hyperactivity disorder in children

2025-12-25T22:13:09+02:00

Attention deficit hyperactivity disorder (ADHD) is a common and complex neurodevelopmental disorder characterized by persistent manifestations of hyperactivity, inattention, and impulsivity, which leads to negative consequences for the quality of life.

Aim - to conduct a review of current data of ADHD etiopathogenesis, variants of clinical manifestations, and to study a differentiated approach to the pharmacotherapy of ADHD in children, in particular the advantages of using the NIHT approach to the treatment of ADHD in children. Data on the prevalence, etiology, pathogenesis, variants of the clinical course of ADHD in children, current recommendations and manuals for the diagnosis and treatment of ADHD, in particular first-, second-, and third-line drug treatment, as well as a differentiated approach to the use of adjuvant drugs and alternative approaches to the treatment of ADHD were systematized and analyzed. The possibilities of NIHT approach (Non-Individualised Homeopathic Treatment) in the pharmacotherapy of ADHD in children are considered, particularly the use of the drug Kindinorm^® N.

Conclusions. A differentiated approach to the drug treatment of ADHD in children should take into account the variants of the clinical course of ADHD, the characteristics and severity of symptoms, the clinical response to the use of "protocol" drugs, their tolerability and compliance with the regimen, as well as the possibilities of the NIHT approach both in complex treatment and in monotherapy.

The authors declare no conflict of interest.

The role of antimicrobial peptides in the pathogenesis of pneumonia in preterm ınfants with perinatal encephalopathy

2025-12-25T22:31:13+02:00

Aim. In this study, the role of antimicrobial peptides (AMPs) in the pathogenesis of pneumonia in preterm infants with perinatal encephalopathy was investigated.

Materials and methods. For this aim, the concentrations of β1-defensin, lactoferrin, calprotectin, fecal calprotectin, and cathelicidin were analyzed using the enzyme-linked immunosorbent assay (ELISA) in 29 preterm infants with perinatal encephalopathy but without pneumonia or other infectious complications, and in 20 preterm infants with perinatal encephalopathy complicated by pneumonia. The comparison group consisted of 15 practically healthy preterm infants. The control group consisted of 16 full-term, practically healthy infants.

Results. The obtained results demonstrated that, in preterm infants with perinatal encephalopathy complicated by pneumonia, the serum concentration of calprotectin was 4.1-fold higher, β1-defensin - 3.2-fold higher, cathelicidin - 2.0-fold higher, lactoferrin - 4.0-fold higher, and fecal calprotectin - 3.9-fold higher compared to practically healthy preterm infants, with all differences being statistically significant. A negative correlation was found between AMP levels and gestational age, whereas positive correlations were observed with the clinical severity of the disease, the degree of intraventricular hemorrhage in the brain, and indicators of respiratory failure. In addition, positive correlations were identified among lactoferrin, cathelicidin, calprotectin, and defensin levels.

Conclusion. Thus, AMPs play a crucial role in the pathogenesis of postnatal pneumonia developing in the context of perinatal encephalopathy, with their secretion increasing in a compensatory manner to form an essential component of the primary defense line against infection.

The authors declare no conflict of interest.

The associations between urinary neutrophil gelatinase-associated lipocalin, ambulatory blood pressure monitoring, echocardiography, and diabetic kidney disease in children

2025-12-25T22:48:57+02:00

One of the most common microvascular complications of diabetes is diabetic nephropathy, characterized by pathological alterations in the glomeruli leading to albuminuria, hypertension, and progressive loss of renal function.

This study aimed to determine whether type 1 diabetic nephropathy was present in children by evaluating urinary Neutrophil gelatinase-associated lipocalin (uNGAL) and ambulatory blood pressure monitoring (ABPM).

Materials and methods. A cross-sectional study was conducted from July 2023 to July 2024 and included 57 children with type 1 DM who were subdivided into two groups: Group 1 - 36 children without diabetic kidney disease (non-DKD), and Group 2 - 21 children with DKD. All participants underwent history taking, clinical examination, and laboratory investigations, including CBC, urea, creatinine, HbA1c, albumin/creatinine ratio, NGAL, echocardiography, and ABPM.

Results. The mean uNGAL level was significantly higher in Group 2 (10.43±18.71 pg/ml) compared with Group 1 (1.56±1.31 pg/ml) (P=0.006). The mean overall and daytime systolic and diastolic blood pressures were also significantly higher in Group 2 (DKD) compared with Group 1 (non-DKD) (P<0.01), as measured by ABPM. In addition, Group 2 had significantly lower LVESD (P=0.008), indicating left ventricular systolic dysfunction.

Conclusion. As NGAL is an early indicator of DKD, our findings highlight its predictive importance. In addition, the significantly higher systolic and diastolic blood pressures, along with left ventricular systolic dysfunction in the DKD group, underscore the importance of ABPM and echocardiography in the assessment and follow-up of children with type 1 DM.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution’s local ethics committee. The informed consent was obtained from patients.

The authors declare no conflict of interest.

Cytokine profile as a marker for predicting the development of infectious and inflammatory diseases in pregnant women with asymptomatic bacteriuria

2025-12-25T23:05:11+02:00

Aim - to determine the informativeness of the cytokine profile in predicting the development of infectious and inflammatory diseases in the mother and infant in the presence of asymptomatic bacteriuria (АB) in pregnant women.

Materials and methods. A study of the cytokine profile was conducted in 142 pregnant women in the third trimester of pregnancy: I (main) group - 45 patients with АB at a concentration of 105 CFU/ml and more, who received antibacterial therapy (ABT) according to the clinical protocol II group (comparison) - 52 pregnant women with АB at a concentration of 102-104 CFU/ml, who did not receive ABT; control group (CG) - 45 pregnant women without АB. The levels of tumor necrosis factor α (TNFα), interferon γ (IFNγ) and interleukin 4 (IL-4) were studied in peripheral blood and urine.

Results. The average values of TNFα in serum in pregnant women in the CG were significantly lower (to 0.61±0.05 pg/ml) than in pregnant women with АB (in the I group - 42.1±7.59 pg/ml; in the ІI group - 45.19±11.6 pg/ml). The level of IFNγ in the blood serum of pregnant women of the CG was 52.9±12.4 pg/ml. In pregnant women of the II group, a significant decrease in its level to 6.33±0.03 pg/ml was found. In pregnant women of the I group, the level of IFNγ in the blood serum was significantly higher compared to the II group - 35.17±4.5 pg/ml versus 6.33±0.03, but was significantly lower compared to the CG - 52.9±12.4 pg/ml. The level of IL-4 in the blood serum was on average 213.7±56.1 pg/ml in the I group and 139.6±25.2 pg/ml in the II group, which significantly distinguished them from the CG - 98.7±14.9 pg/ml.

Conclusions. In case of АB, pregnant women have a significantly high level of TNFα, IL-4 in blood serum and urine, and a significantly low level of IFNγ in blood serum (p<0.05), which can be considered a marker for predicting the development of infectious and inflammatory diseases in them.

The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. An informed sonsennt was collected in order to carry out the research.

Authors declare no conflict of interests.

Effectiveness of ultrasound screening for pathological placentation in women with a uterine scar after cesarean section based on standard sonographic criteria

2025-12-25T23:17:42+02:00

Pathological placentation, including placenta previa (PP) and placenta accreta spectrum (PAS), is a major pregnancy complication in women with a cesarean section (CS) scar compared to normal placentation. Ultrasound with standardized sonographic criteria remains a key tool for timely detection of these conditions.

Aim - to assess the effectiveness of ultrasound screening for pathological placentation in women with a CS scar compared to NP using standard sonographic markers for early identification of PP and PAS.

Materials and methods. Between January 2020 and January 2023, 284 pregnant women with PP delivered at the Kyiv Perinatal Center. Among them, 145 had a CS scar, and 66 were suspected of PAS. Ultrasound examinations were performed using a Voluson 10 system in grayscale and color Doppler modes.

Results. In normal placentation, the “clear zone” was preserved, whereas in pathological placentation it was absent or irregular, serving as an early PAS marker. PP showed mild myometrial thinning and lacunae without abnormal blood flow, while PAS was associated with marked myometrial thinning (<1 mm), asymmetric “torn” lacunae, and turbulent blood flow. Uterine contour deformation and vesicouterine hypervascularization with bridging vessels were key indicators of deep invasion and critical for cesarean delivery planning.

Conclusions. PAS and PP features may coexist in the same placental bed, complicating differential diagnosis. Ultrasound screening in women with a CS scar is informative when standard markers are assessed comprehensively: myometrial thinning, loss of the “clear zone”, and vascular changes allow early detection, while exophytic masses and uterine protrusion toward the bladder identify severe PAS forms, including placenta percreta.

The investigation is consistent with the principles of the Declaration of Helsinki. The patient's information was withheld from the investigation.

The authors declare that there is a conflict of interest.

Subclinical intrauterine inflammation as a determinant of extremely early preterm birth: integrated analysis of systemic biomarkers. original study

2025-12-25T23:49:55+02:00

Aim - to determine the predictive value of integrating clinical, laboratory, ultrasound and psychometric markers for assessing the risk of extremely early preterm birth (EEPB) associated with intrauterine infection.

Materials and methods. A prospective cohort study included 223 pregnant women at 22-28 weeks’ gestation, of whom 130 were assigned to the risk group (clinical signs of threatened preterm birth) and 93 to the control group. Systemic inflammatory markers (C-reactive protein, leukocyte count, interleukin-6, procalcitonin), bacterial stress proteins (HSP60, GroEL), cortisol levels, psychometric status (Edinburgh Postnatal Depression Scale ≥13), and transvaginal cervical length were analyzed. A nine-factor predictive model was developed and evaluated using ROC analysis.

Results. The most significant predictors of EEPB included short cervical length (≤25 mm), elevated C-reactive protein (>10 mg/L), increased interleukin-6 (>2 pg/mL), procalcitonin (≥0.046 ng/mL), high GroEL levels (254.99±106.78 ng/mL), hypercortisolemia (6.17±3.64 µg/dL), leukocytosis (>11×10⁹/L), and Edinburgh score ≥13. The integrated model demonstrated an AUC of 0.80, sensitivity of 78.9%, and specificity of 76.3%.

Conclusions. Integration of systemic inflammatory, bacterial, hormonal, and psychometric indicators provides high predictive accuracy for subclinical intrauterine inflammation and EEPB. The availability and reproducibility of these biomarkers make the proposed model applicable to routine practice in perinatal care settings.

This study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution involved. Informed consent was obtained from all participants.

The authors declare no conflicts of interest.

Assessment of postpartum depression in refugee women from Ukraine who gave birth abroad after the the beginning of large-scale war

2025-12-26T20:04:31+02:00

The Russian military aggression against Ukraine in February 2022 became the cause of biggest humanitarian crime. Postpartum depression (PPD) is a type of mood disorder of pregnant and postpartum women. It was earlier reported that depression of pregnant women is increased in a combatant zone, while effects of war on pregnant refugee and displaced women are less studied.

Aim - to determine the features of the emotional state of temporarily displaced Ukrainian women who gave birth in Lithuania in spring-autumn 2022, and compare it with the state of Lithuanian women who were not directly affected by war.

Materials and methods. The study was conducted by surveying Ukrainian refugee women (UG) and Lithuanian women (LG) who gave birth in maternity units of Lithuania, using Edinburgh Postpartum Depression Scale (EPDS), the questionnaire elaborated for evaluation of social and medical peculiarities of mother-child pair in early postpartum period as well as medical records of maternity unit.

Results. The average mean scores of EPDS in UG were significantly higher compared to LG. 42.0% of UG exceeded the threshold for the high risk of PPD (≥13). UG, who arrived in Lithuania during the war because of close relatives legally working in Lithuania, had lower EPDS scores to compare to UG who came from combatant zones and who did not have close relatives.

Conclusions. Support of closest relatives and convenient surrounding is important for women’s emotional state during the vulnerable period of maternity and especially during the crisis time.

No conflict of interests was declared by the authors.

Clinical and immunological differences of infectious mononucleosis in children with acute and prolonged course of the disease

2025-12-26T20:36:00+02:00

The basis for conducting the study was the absence in the scientific literature of works devoted to the study of clinical and immunological differences of infectious mononucleosis (IM) in children with an acute and protracted course of the disease.

The aim - to determine the clinical and immunological differences of IM in children with acute and prolonged courses in order to improve therapy and rehabilitation of patients.

Materials and methods. A total of 102 children were under clinical and laboratory-instrumental supervision, of which 65 children (group 1) had acute IM, and 37 (group 2) had a prolonged course.

Results. The severity of lymphoproliferative and hepatosplenic syndromes at the onset of IM can be used as one of the criteria for the probable development of a prolonged course of the disease. The formation of a protracted course is accompanied by a decrease in the content of CD3 less than 50%; CD4 less than 31% and CD8 less than 15%, as well as an increase in the levels of interleukin 1 (IL1) over 20.0 pg/ml (3.5 times more often compared to the group 1), tumor necrosis factor α (TNFα) up to 20.0 pg/ml (1.9 times more often) and a very high level of interleukin 4 (IL4) - over 30.1 pg/ml. Patients of the group 2 were characterized by increased CD22 levels, low levels of immunoglobulins (Ig) IgA, IgM (less than 1.1 g/l), and IgG (less than 10.0 g/l).

Conclusions. Indicators of cellular and humoral immunity influence the course of IM. The formation of the acute course of IM in children is accompanied by activation of both cellular and humoral immunity at the onset of the disease. The prolonged course of IM is characterized by depression of the T-cell link of immunity, as well as inhibition of antibody genesis. The prolonged course of the disease is formed against the background of weak activation of pro-inflammatory interleukins (IL1, TNFα) and significant - anti-inflammatory IL4.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Differential diagnosis algorithm for infantile inflammatory bowel disease

2025-12-26T20:48:43+02:00

Diagnosis of infantile inflammatory bowel disease (IBD) with onset in the first 2 years of life is extremely difficult and requires not only identification of typical signs of ulcerative colitis and Crohn's disease, but also recognition of atypical phenotypes, differentiation from allergic diseases of the gastrointestinal tract and IBD-like monogenic diseases.

Aim - to develop an algorithm for differential diagnosis of infantile IBD.

Materials and methods. The study involved 47 children aged from birth to 2 years. The selection of children was based on the phenotype of the infantile form of IBD. The examined children were divided into 3 groups: 1^st - 20 children with the infantile form of IBD; 2^nd - 6 children with primary immunodeficiency associated with an IBD-like phenotype; 3^rd - 21 children with protein-induced enterocolitis. The control group consisted of 12 practically healthy children of a similar age. Clinical examination included analysis of individual and family history, patient complaints, gastroenterological and extraintestinal symptoms of the disease, assessment of physical and somatic status, nature and frequency of bowel movements, data from clinical and biochemical blood tests, and investigation of pathogens of intestinal infections. The level of interleukin-17A (IL-17A) in the blood, the level of fecal calprotectin, and the patient's immunological status were also determined. Ultrasound examination (US) of the abdominal cavity and intestines, endoscopic and morphological examination of the gastrointestinal tract were performed. The study was performed in accordance with the principles of the Declaration of Helsinki.

Results. An algorithm for differential diagnosis of infantile IBD has been developed to facilitate the diagnostic search. For children of the first two years of life with suspected IBD, it is important to analyze the history and clinical predictors of the disease, laboratory and instrumental examination with the involvement of clinical, biochemical blood tests, US of the abdominal cavity and intestines, determination of the blood IL-17A level and fecal calprotectin level, assessment of the patient's immunological status, and, if necessary, endoscopic and morphological examination of the gastrointestinal tract.

Conclusions. The developed algorithm can be applied in healthcare institutions to improve diagnostic measures and timely prescription of appropriate therapy in patients with infantile IBD.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

The authors declare that there is no conflict of interest.

The efficiency of tissues oxygen providing in acute pneumonia in children

2025-12-26T21:12:30+02:00

Inflammatory respiratory diseases are among the most common causes of medical visits in children, with acute pneumonia (AP) remaining the most serious. Hospitalization often depends not only on infectious symptoms but also on cardiorespiratory disturbances with hypoxia. Vital signs - temperature, pulse, respiratory rate, blood pressure - and since the COVID-19 pandemic, arterial hemoglobin oxygen saturation (SaO₂), are key bedside indicators

Aim - to assess peripheral gas exchange parameters based on pulse oximetry in children with AP and to determine their correlations with standard vital signs.

Materials and methods. Capillary blood oxygen saturation was evaluated in 43 children with AP (mean age 10.8±0.4 years). Pulse rate, respiratory rate, blood pressure, and SaO₂ were measured and statistically analyzed.

Results. The disease course was mild in 14 children (32.5%), moderate in 27 (62.8%), and severe in 2 (4.6%). SaO₂ values ranged from 88% to 99% (mean - 96.3±0.38%). Increasing AP severity significantly correlated with higher respiratory rate, dullness on percussion in affected lung areas, elevated leukocyte count, and prolonged capillary refill time. A weak correlation was found between passive smoking exposure and oxygen saturation. Short-term instability of gas exchange was noted, with SaO₂ fluctuations between 88% and 99% within brief intervals.

Conclusions. AP in children involves inflammatory lung changes, ventilation impairment, and unstable gas exchange. Compensatory mechanisms aimed at maintaining tissue oxygenation - primarily increased heart rate - are accompanied by slowed capillary blood flow, contributing to unstable peripheral oxygen saturation. Pulse oximetry provides valuable insight into these dynamics and may assist in early identification of deterioration in hospitalized children with AP.

No conflict of interests was declared by the authors.

Fetal anatomy of the connections of the median and ulnar nerves on the palm of the hand

2025-12-26T21:23:44+02:00

In traumatic injuries of brachial plexus branches, one of the important compensatory mechanisms of peripheral innervation is the connections between nerves.

Аim - to determine the connections between the median and ulnar nerves in the hand in human fetuses and to clarify the projection of these connections to the skin of the palm for timely diagnosis and treatment of damage to these nerves.

Materials and methods. We studied 48 hand preparations using macro-microscopic dissection and morphometry of human fetuses aged 4-10 months.

Results. In 37 cases, connections were found in the palm area between the median and ulnar nerves that were variable in shape. Our study gives us the right to consider inaccurate the indications of anatomical manuals that 3.5 fingers on the palm are innervated by the median nerve and 1.5 fingers by the ulnar nerve. The innervation of the skin of the palmar surface of 3.5 fingers by the median nerve and 1.5 fingers by the ulnar nerve can be said to be the case only if there is no connection between the median and ulnar nerves in the palm, which happens in 22.9% of cases.

Conclusions. In fetuses, a branch of the ulnar nerve to the median nerve can be found on the palm in 77.1% of cases. There are four types of connections between the median and ulnar nerves: straight (62.2%), Y-shaped (21.6%), X-shaped (10.8%), and T-shaped (5.4%). In human fetuses, due to almost constant connections in the form of connecting branches between the median and ulnar nerves, the palm of the hand has clearly defined areas of overlap of one nerve with branches of the other nerve. The palmar area of the skin from the radial edge of the index finger to the radial edge of the little finger inclusive is an "overlapping zone" because of the dual innervation within it.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper.

No conflict of interests was declared by the authors.

Evaluation of surgical correction of biliary atresia in infants depending on the method

2025-12-26T21:44:48+02:00

Aim - comparison of the results of Kasai operation (KO), performed laparoscopically and laparotomically, according to the main clinical and laboratory indicators 6 months after the intervention. To justify the rational choice of priority access as the standard of surgical treatment of biliary atresia (BA), taking into account technical, anatomical and prognostic aspects, based on the study of clinical and laboratory features of the course of BA in infants.

Materials and methods. A retrospective analysis of 64 cases of BA in children under 6 months of age is presented. The main method of primary treatment in all patients was KO. This allowed to partially or completely restore bile outflow and stabilize the patient's condition before liver transplantation (LT) in 43 patients. The remaining 21 patients have a satisfactory state of bile outflow after undergoing KO and have not had indications for LT to date. All patients underwent comprehensive diagnostics, including clinical and biochemical studies, ultrasound diagnostics, endoscopy, liver biopsy and genetic studies. Laparoscopic KO was performed only in 4 children (type 1 BA), while laparotomic OC was performed in 60 patients (types 2a and 3).

The results of surgical interventions were evaluated in the early postoperative period and 6 months after surgery according to clinical (assessment of physical and neuropsychiatric development, stool color, restoration of skin and mucous membrane color), biochemical parameters (levels of direct bilirubin, alanineaminotransferase, aspartateaminotransferase, fibrinogen, platelets, body mass index). Re-evaluation of these parameters was carried out after 6 months.

Conclusions. Laparotomic approach to KO is considered the optimal method of intervention due to the anatomical conditions of the intervention area, technical features of the technique and its precision, tightness of the anastomosis formation, and duration of the operation. Laparoscopic KO did not show significant advantages in the short-term prognosis in the effectiveness of normalization of clinical and laboratory indicators. The importance of early diagnosis, multidisciplinary approach, and timely surgical intervention as key factors in the successful treatment of BA is emphasized.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.

The author declares no conflict of interest.