Modern Pediatrics. Ukraine

Neonatal hearing screening in children: international recommendations and Ukrainian realities

Yu.V. Marushko, І.V. Kondratenko, O.V. Khomych, S.P. Khodakivska — Sun, 28 Dec 2025 00:00:00 +0200

Hearing impairment in newborns and infants is one of the most serious factors negatively affecting speech development, cognitive functions, socio-emotional formation, and the child's adaptation in society. An effective system of neonatal audiological screening (NAS) enables the detection of hearing loss within the first weeks of life.

Aim – to systematize international approaches to neonatal hearing screening in children and to describe the experience of their practical implementation at the «St. Michael's Clinical Hospital of Kyiv» and its department of hearing and speech pathology «SUVAG».

This publication is a review and analytical article based on content analysis and statistical description of secondary data. The study involved a comprehensive analysis of scientific sources covering approaches to neonatal hearing screening in children over the past five years (data from PubMed, Scopus, and Web of Science). Additionally, data from the department of hearing and speech pathology «SUVAG» were examined within the scope of the work. The issue of early detection of hearing impairments in newborns is one of the key challenges in modern pediatric audiology. The study analyzes current international and national approaches to screening organization, clinical guidelines, and statistical reports. Particular attention is given to the data obtained from the department of hearing and speech pathology «SUVAG», which is a leading specialized institution for the diagnosis, counseling, and early rehabilitation of children with hearing disorders. The dynamics of two key screening indicators over recent years were assessed, allowing the identification of referral trends and the effectiveness of existing diagnostic pathways in the city of Kyiv.

Conclusions. Neonatal hearing screening is a key component of the early detection system for hearing impairments, and the high rates of referrals to the department of hearing and speech pathology “SUVAG” following non-completion of the primary screening in maternity hospitals demonstrate the effectiveness of patient routing, ensuring timely in-depth diagnostics and early intervention, which is crucial for the child’s speech and cognitive development.

The authors declare no conflict of interest.

Respiratory tract infections in children (literature review)

Sun, 28 Dec 2025 00:00:00 +0200

Respiratory tract infections are among the most frequent disorders in the clinical practice of every pediatrician and pediatric otolaryngologist, and are also associated with significant morbidity and mortality. They are considered the second most important cause of death of children under the age of five and are the leading cause of global child mortality, which is an urgent problem for pediatrics and pediatric otolaryngology.

Aim - based on an analysis of modern literary data, systematize information about respiratory tract infections in the context of the characteristics of their manifestation and the severity of their course.

Data from the scientific literature on modern etiopathogenesis, problems of diagnosis and treatment of respiratory tract infections, their impact on the quality of life and burden on the health care system were analyzed.

In the world of modern ideas, respiratory tract infections are the most frequent disorders in the clinical practice of every pediatrician and pediatric otolaryngologist, and acute lower respiratory tract infections, such as pneumonia and bronchiolitis, are the main cause of morbidity and mortality among young children. They lead to serious medical costs, significantly affect the quality of life and require effective prevention strategies to reduce the burden on the health care system.

Conclusions. The analysis of modern literary sources showed that data on the characteristics of respiratory tract infections in children are insufficient due to the limited role of clinical, laboratory and radiological characteristics, which leads to multiple visits to the doctor and affects the quality of life. Acute respiratory tract infections lead to serious medical costs, and this economic burden tends to increase. In this regard, to reduce morbidity and mortality, recommendations on clinical management and diagnostic issues, research to identify epidemiological and clinical features, effective prevention strategies to reduce the burden on the health care system are needed.

The authors declare no conflict of interest.

Modern infectious and immune-mediated causes of acute encephalitis in children

Sun, 28 Dec 2025 00:00:00 +0200

Acute encephalitis in children is a heterogeneous clinical syndrome with diverse infectious and immune-mediated causes. Despite the availability of diagnostic criteria proposed by the International Encephalitis Consortium, establishing the etiology remains challenging in many cases, as clinical manifestations often overlap across different etiological groups. Recent epidemiological changes, including the emergence of SARS-CoV-2 and the rise in recognized autoimmune encephalitides, have further expanded the spectrum of potential triggers in pediatric populations.

Aim - to summarize current evidence on the etiological structure of acute encephalitis in children and analyze the contribution of infectious, autoimmune, and post-infectious mechanisms over the past decade.

A structured literature review was conducted using publications from 2015-2025, focusing on epidemiology, pathogen distribution, diagnostic approaches, and the evolving role of advanced molecular technologies in etiology determination. Despite comprehensive diagnostic work-up, the etiological agent can be identified in only about half of pediatric encephalitis cases. Viral pathogens, particularly HSV-1, enteroviruses, HHV-6, influenza, and emerging infections such as SARS-CoV-2, remain the leading causes. However, autoimmune encephalitides, including anti-NMDAR, MOG-associated disease, and AQP4-IgG-positive neuromyelitis optica spectrum disorders, are increasingly recognized, accounting for a substantial proportion of previously unexplained cases. Novel diagnostic tools such as metagenomic next-generation sequencing, phage immunoprecipitation sequencing (PhIP-Seq), and rapid multiplex PCR panels significantly improve detection rates. The growing number of reported co-infections and virus-triggered immune dysregulation highlights the importance of considering both infectious and immune-mediated etiologies in every child with acute encephalitis.

Conclusions. The etiological landscape of pediatric acute encephalitis is dynamic and continues to evolve in response to emerging pathogens and expanding diagnostic capabilities. Integrating modern molecular methods with standardized clinical and immunologic assessment is essential to increase the proportion of etiologically confirmed cases. The development and implementation of a unified, stepwise diagnostic algorithm will facilitate the earlier identification of the underlying cause, the timely initiation of targeted therapy, and improved outcomes in affected children.

The authors declare no conflict of interest.

Cow’s milk protein allergy in children: a contemporary approach to diagnosis and management (literature review)

O.M. Shulhai, K.T. Hlushko, O.M. Mochulska, I.Y. Shostak — Sun, 28 Dec 2025 00:00:00 +0200

Cow’s milk protein allergy (CMPA) is an allergic reaction to the proteins found in cow’s milk. Diagnosing this condition can be challenging, as it is primarily based on clinical history and physical examination. It is important for physicians to differentiate between milk allergy and milk intolerance, as the approaches to diagnosis and treatment of these two conditions differ.

Aim - to summarize the literature on the epidemiology, clinical manifestations, diagnostic methods, and treatment of cow’s milk allergy.

Immune-mediated adverse food reactions are classified as IgE-mediated, non-IgE-mediated (with the latter being most commonly responsible for CMPA), and mixed forms (involving both IgE- and non-IgE-mediated mechanisms). CMPA should be suspected in children who develop immediate symptoms such as anaphylaxis, laryngeal edema, acute urticaria or angioedema, as well as acute asthma with severe respiratory distress. Delayed reactions may include blood in stools, atopic dermatitis, chronic diarrhea, iron deficiency anemia, gastroesophageal reflux disease, chronic vomiting, colic, constipation, failure to thrive, food refusal, enterocolitis syndrome, enteropathy with hypoalbuminemia, and eosinophilic esophagogastroenteritis. The Cow’s Milk-related Symptom Score (CoMiSS™) is a modern clinical screening tool developed to aid healthcare professionals in the early diagnosis of CMPA and to raise awareness about this condition. The use of food antigen-specific IgG testing panels should be avoided, as they are not evidence-based and may lead to overdiagnosis of presumed food intolerance.

Conclusions. CMPA should not be confused with cow’s milk intolerance, which is relatively rare in infants. For breastfed infants, formula supplementation during the first 24 hours of life is not recommended, as it increases the risk of developing CMPA. Mothers and healthcare providers should be aware of the benefits of exclusive breastfeeding and be supported with appropriate resources to avoid unnecessary formula supplementation and reduce the risk of CMPA.

The authors declare no conflict of interest.

Methods of blood pressure measurement in children: problematic issues and ways to address them

Sun, 28 Dec 2025 00:00:00 +0200

Arterial hypertension in children is a relevant medical and social problem, characterized by a growing prevalence and a high risk of developing cardiovascular complications in adulthood. The specific features of its clinical course in childhood, often asymptomatic presentation, as well as difficulties in interpreting blood pressure values, lead to delayed diagnosis of the disease. The correct choice of blood pressure measurement method and proper interpretation of the obtained results are key elements in disease diagnosis.

Aim - to analyze and compare modern methods of blood pressure measurement in children, assess their advantages and limitations, and determine their significance in the clinical management of patients with arterial hypertension syndrome.

A systematic analysis of scientific publications, clinical guidelines, and conference materials indexed in the Cochrane Library, PubMed, and Google Scholar databases over the past 10 years was conducted. The auscultatory method remains the “gold standard” for confirming elevated blood pressure in children, while oscillometric devices are convenient for screening and home monitoring. Office blood pressure measurement is the basic diagnostic tool; however, it has limitations due to the “white coat” effect and the risk of missing masked hypertension. Automated office blood pressure measurement shows promise in reducing psychological influence and achieving better agreement with ambulatory readings. Ambulatory blood pressure monitoring is identified as the most informative method for detecting hypertension phenotypes, assessing circadian rhythms, and identifying target organ damage. Home blood pressure monitoring complements office-based methods and contributes to improved disease control and treatment adherence.

Conclusions. No single method of blood pressure measurement is universal. A rational combination of office and ambulatory methods increases the accuracy of diagnosing arterial hypertension in children, enables timely detection of hidden forms of the disease, optimizes treatment strategies, and reduces the risk of future cardiovascular complications.

The authors declare no conflict of interest.

The psychological and pedagogical characteristics of children with autism spectrum disorders

S.V. Hryshchenko — Sun, 28 Dec 2025 00:00:00 +0200

Autistic spectrum disorders are a set of disorders with a deficit in communication and social interaction. The impact on various aspects of the lives of children with autism is noted. The psychological and pedagogical characteristics of children with autism spectrum disorders depend on the need to study the causes of autism spectrum disorders in more depth, as well as violations of the social integration of children with autism.

Aim - to conduct a systematic analysis of scientific sources on the psychological and pedagogical characteristics of children with autism spectrum disorders.

The psychological and pedagogical characteristics of children with autism spectrum disorders prove the presence of special behavioral states associated with disorders of the child's brain functioning. It is necessary to form in autistic people the ability to orient their behavior to the social environment: how to speak or act, how not to. The characteristics prove that children with autism spectrum disorders try to repeat those actions for which they received positive attention and approval. The interests of people with autism spectrum disorders are limited. There are unusual reactions to sensory stimuli. There is a need to form socially positive value orientations in children with autism, which is necessary for their development. There is inadequate behavior in children with autism spectrum disorders in a mild form (such as: shouting in the classroom, rocking on a chair, can interfere with the teacher in class), or in a more severe form (aggression or autoaggression).

Children with autism are more anxious than normotypical children. This category of children has problems with pragmatics: correct use of speech, with semantics: they have a limited vocabulary, as well as impaired sensory perception. There is a need to improve the system for preventing tantrums and stressful conditions in children with autism spectrum disorders. Parents, guardians and medical and social specialists need to remain calm when working with autistic people.

The author declares that there is no conflict of interest.

Development of the motivational sphere of adolescents aged 15-16 years in conditions of martial law

Sun, 28 Dec 2025 00:00:00 +0200

Aim - to conduct a systematic analysis of scientific sources that study and analyze the features of the development of the motivational sphere of adolescents aged 15-16 years in conditions of martial law.

The motivational sphere of adolescents aged 15-16 years is currently being formed, transformed and functioning in conditions of martial law. The structure of adolescents' motives changes under the influence of military events. The motivational sphere requires determining the role of the family, educational and social environment in order to clarify the psychological conditions that contribute to the preservation of the internal activity of an adolescent child. The features of the development of the motivational sphere of adolescents aged 15-16 years in conditions of martial law depend on the modern socio-psychological environment. Factors influencing motivational processes and the transformation of the system of motives are feelings of anxiety, uncertainty of the future, disruption of social ties, loss of a sense of security. In conditions of stress and instability during military events, there is a decrease in the educational motivation of adolescents. Socially significant motives are strengthened: the desire to help, show responsibility, support others. The motivational sphere of adolescents is a holistic system of internal motivations that ensure activity and stability of behavior. Adolescence is a sensitive period for the formation of personal values and self-awareness. In conditions of martial law, it is necessary to create conditions for the development of positive internal motivation, support of the emotional balance of an adolescent child. The development of the motivational sphere of adolescents 15-16 years old in conditions of martial law is complex. Internal resources (cognitive interest, self-esteem, need for recognition) are combined with the support of the social environment (family, school, peers). This is a decisive factor in maintaining and strengthening motivation for learning, self-development and life activity. Effective psychological and pedagogical support for adolescents 15-16 years old should be based on the principles of humanism, partnership and trust. The development of the motivational sphere of adolescents 15-16 years old in conditions of martial law is a psychological and socially significant direction.

The authors declare the absence of a conflict of interest.

Diagnostic markers of kidney damage in children with post-COVID-19 syndrome

N.A. Petritsa, N.S. Luk’yanenko, N.R. Kech — Sun, 28 Dec 2025 00:00:00 +0200

The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) has been showin to adversely affect kidney tissue, causing inflammatory, autoimmune, and metabolic disorders, which pose a risk of developing acute and chronic nephropathies. The lack of clear diagnostic criteria for kidney damage in children with post-COVID-19 syndrome (condition after recovering from COVID-19) complicates timely treatment and prevention of complications. Identifying early diagnostic markers of kidney damage is important for early detection of pathology, which would improve medical surveillance and timely treatment.

Aim - to identify early diagnostic markers of kidney injury in children with post-COVID-19 syndrome.

Materials and methods. This observational study included 30 children under the age of 18 diagnosed with post-COVID-19 syndrome who had documented urinary abnormalities during the acute phase of SARS-CoV-2 infection and were hospitalized between January 2023 and July 2024. The source of information was the "Medical Record of an Inpatient". The study was conducted using a targeted selective screening method. All children underwent comprehensive clinical and laboratory examinations according to generally accepted pediatric standards. The following indicators of kidney functional status were assessed: anti-crystallization capacity of urine (ACCU), daily salt excretion, lipid peroxidation (LPO) products, polar lipids (PL), and a series of urinalysis tests. The study results were compared with data from 40 children in the control group. Statistical analysis was performed using the EZR package (R-statistics).

Results. It was found that the intensity of tissue hypoxia and dysfunction of the proximal nephron segments directly correlates with SARS-CoV-2-induced damage. This is evidenced by a decrease in ACCU towards calcium phosphates, reduced phosphate excretion, increased excretion of LPO products and appearance of PL, as well as a higher frequency of proteinuria and calciuria in urine compared to the control group.

Conclusions. The possibility of predicting and diagnosing post-COVID-19 syndrome in children with urinary tract damage using non-invasive biochemical markers of tissue hypoxia and renal parenchymal membranolysis in children's daily urine has been confirmed.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the study. Informed consent was obtained from the parents and children.

The authors declare no conflict of interest.

Prognostic significance of clinical and laboratory markers for assessing the quality of life of children with type 1 Gaucher disease

O.V. Zozulia — Sun, 28 Dec 2025 00:00:00 +0200

Type 1 Gaucher disease (GD1) is a rare genetic disorder that disrupts lipid metabolism and has a wide range of clinical manifestations. An important aspect of treatment is monitoring changes in the quality of life of patients, especially children, during enzyme replacement therapy. Therefore, studying the correlations between laboratory markers and quality of life indicators is necessary to improve therapeutic strategies.

Aim - to evaluate the relationship between laboratory markers (hemoglobin, erythrocytes, platelets, spleen volume, Lyso-GL1) and quality of life indicators (sleep, general fatigue, cognitive fatigue) in children with GD1 during a five-year course of enzyme replacement therapy.

Materials and methods. The study included 27 children under the age of 18 with clinically and molecularly confirmed diagnosis of GD1. Laboratory indicators and quality of life parameters were assessed using a visual analog scale (VAS). Measurements were taken before the start of treatment and annually for five years.

Results. A statistically significant correlation was found between hemoglobin levels and general and cognitive fatigue. Low platelet levels were associated with poor sleep quality. In addition, spleen size and Lyso-GL1 concentration were important indicators of the impact on general fatigue in children with GD1.

Conclusions. Laboratory markers such as hemoglobin level, platelet count, Lyso-GL1 concentration, and spleen size are important predictors of quality of life parameters in children with GD1. This allows predicting the effectiveness of therapy and adjusting treatment in a timely manner. Further research should focus on a more in-depth analysis of the mechanisms underlying the relationship between these indicators.

The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the local ethics committee. Written informed consent was obtained from the children’s legal guardians.

The author declares no conflict of interest.

Fetal topography of the common palmar digital nerves and arteries

I.G. Biryuk, T.V. Khmara, Ye.Ye. Osypenko, I.L. Kukovska, L.P. Yurchuk — Sun, 28 Dec 2025 00:00:00 +0200

To date, the data on the variability, the site of branching of the common palmar digital nerves into the proper palmar digital nerves and their relationship with the corresponding arteries remain discussable and fragmentary.

Aim - to determine the peculiarities of the topography of the common palmar digiti nerves and arteries in human fetuses of 4-10 months of age.

Materials and methods. We studied 54 hand preparations using macromicroscopic dissection and morphometry of human fetuses aged 4-10 months without external signs of anatomical abnormalities or congenital malformations of the upper extremities. The author used his own method of sequential anatomical dissection of the vessels and nerves of the human hand.

Results. At the site of the distal edge of the transverse carpal ligament, the median nerve trunk divides into the first, second, and third common palmar digital nerves. In 5 cases, the first common palmar digital nerve was absent and replaced by branches directly originating from the median nerve. The fourth common palmar digital nerve and the proper palmar digital nerve of the fifth finger arise from the superficial palmar branch of ulnar nerve. The primary source of blood supply to the common palmar digital arteries is the superficial branch of ulnar artery and the superficial palmar arterial arch it forms. Compared to the corresponding nerves, the common palmar digital arteries demonstrate greater variability in their structure, number, topography, and origin. The branching sites of the common palmar digital arteries are located distal to the division sites of the corresponding nerves.

Conclusions. In human fetuses, the branching sites of each common palmar digital nerve into proper palmar digital nerves are variable and individualized for each hand. The second and third common palmar digital nerves are the most topographically constant among the palmar nerves. The sites of branching of the common palmar nerves are evenly shifted in the proximal direction with increasing fetal age. There are communicating branches between the common and proper palmar digital nerves, which cause the formation of anastomotic networks with different loop shapes.

The study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper.

The authors declare no conflict of interest.

Cholangitis as a factor affecting the effectiveness of treatment of biliary atresia in children

H.V. Kurylo — Sun, 28 Dec 2025 00:00:00 +0200

Biliary atresia (BA) is a severe progressive liver disease in neonates, characterized by obliteration of bile ducts, cholestasis, fibrosis, and cirrhosis. Acute cholangitis (AC) after Kasai hepatoportoenterostomy (KPE) is a key factor influencing treatment efficacy and liver function prognosis.

Aim - to determine diagnostic criteria, assess the effectiveness of treatment, and evaluate the role of interventional procedures in children with BA after KPE.

Materials and methods. Sixty-four children with BA who underwent KPE at 1,5-4,5 months of age were included. AC subtypes were classified by episode frequency: isolated (IAC), early (EAC), recurrent (RAC), and non-resolving (NAC). Treatment included third-generation cephalosporins, combinations with meropenem, co-trimoxazole, and intravenous immunoglobulins. Effectiveness was evaluated by clinical symptoms, laboratory parameters (direct bilirubin, ALT, AST, GGT, CRP, PCT), and instrumental methods. Statistical analysis was performed using the t-test and ANOVA.

Results. AC occurred in 100% of children after KPE. IAC and EAC were characterized by moderate

increases in liver enzymes and inflammatory markers and achieved full normalization after third-generation cephalosporin therapy. In RAC patients, combination therapy with meropenem provided rapid normalization of laboratory parameters: direct bilirubin decreased from 78.5±5.3 to 3.1±0.3 µmol/L, CRP from 42,1±1,1 mg/L to 1,1±0.3 mg/L, PCT from 49,7±1,6 ng/mL to 0,9±0,1 ng/mL. In NAC patients, persistent clinical symptoms and elevated inflammatory markers were observed: direct bilirubin 35,9±0,8 µmol/L, CRP 20,6±0.6 mg/L, PCT 12,8±0,5 ng/mL, indicating a severe course and the need for additional interventional and surgical procedures.

Conclusions. AC subtype after KPE determines the severity of clinical and laboratory disturbances and prognosis in children with BA. Differentiated conservative therapy according to AC subtype allows normalization of clinical and laboratory parameters in mild and recurrent forms, whereas severe cases (NAC) require additional interventional procedures. High levels of CRP and PCT are prognostically unfavorable markers of AC severity.

The author declares no conflict of interest.

Efficacy of multimodal psychotherapy in the management of pediatric patients with irritable bowel syndrome

M.O. Semen, O.L. Lychkovska, V.D. Semen — Sun, 28 Dec 2025 00:00:00 +0200

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by abdominal pain, changed bowel habits, and often accompanied by psycho-emotional distress. In pediatric practice, according to the limited efficacy of pharmacological treatment, non-pharmacological approaches, particularly psychotherapeutic and psychosocial interventions, are gaining increasing importance in the management of the disorder.

Аim - to evaluate the efficacy of integrating multimodal psychotherapy into the treatment of IBS in children based on clinical changes at the somatic, psycho-emotional, and psychosocial levels.

Materials and methods. The study involved 54 patients aged 6-12 diagnosed with IBS: 24 patients received multimodal psychotherapy in combination with pharmacological treatment (main group), while 30 patients received pharmacotherapy only (control group). The multimodal psychotherapy included family counseling, elements of cognitive-behavioral therapy, relaxation techniques, and group art therapy in a hybrid format. Treatment efficacy was assessed based on the dynamics of clinical symptoms using a 4-point Likert scale.

Results. Children with IBS who received psychotherapy showed a statistically significant reduction in the intensity of pain and asthenic syndrome symptoms, as well as lower levels of trait anxiety, compared to those who received symptomatic pharmacotherapy only. Other indicators of psychotherapy efficacy included decreased frequency of clinical symptoms, increased awareness of the role of psycho-emotional factors in IBS development, improved family relationships, and positive changes in the child's social interactions. Overall treatment efficacy, assessed by parents, was significantly higher in the main group.

Conclusions. Multimodal psychotherapy enhances the efficacy of IBS treatment in children by reducing symptoms and improving emotional well-being and social functioning.

The authors declare no conflict of interest.

Implementing a new model of counselling to prevent fetal alcohol syndrome in Ukraine: pre-implementation stage

Sun, 28 Dec 2025 00:00:00 +0200

Alcohol consumption during pregnancy is a serious threat to maternal and fetal health, leading to fetal alcohol syndrome (FAS) and other disorders. Despite the existence of international recommendations for prevention, there is no standardized model of counselling pregnant women on alcohol consumption in Ukraine.

Aim - to study alcohol use behavior among women of reproductive age, including pregnant women, and assessed barriers, facilitators, and the feasibility of implementing an Alcohol Use Disorders Identification Test (AUDIT-C)-based counselling model for preventing fetal alcohol syndrome (FAS), as part of the The Joint Action Prevent Non-Communicable Diseases project.

Materials and methods. Focus group discussions were conducted with healthcare professionals and women of reproductive age. The data were analyzed by content analysis using MaxQDA and Excel software.

Results. After evaluation of the AUDIT-C-based counselling model healthcare providers indicated the following barriers: limited appointment time, insufficient preparation for motivational interviewing, and stigmatization of the topic. Women of reproductive age noted a low level of awareness of FAS and insufficient availability of information.

Conclusions. The study revealed that doctor overload, stigma, and low awareness of alcohol-related risks among women are major barriers to implementation. Optimizing the model requires training of healthcare professionals and better access to reliable information. Proposed AUDIT-C-based counselling model is feasible and has potential to strengthen alcohol prevention efforts within routine antenatal care in Ukraine. Our data serves as a basis for making new counselling model more efficient and targeted.

The authors declare that there is no conflict of interest.

Acute rheumatic fever or post-streptococcal reactive arthritis? Diagnostic challenges illustrated by a clinical case

O.R. Boyarchuk, I.E. Yuryk — Sun, 28 Dec 2025 00:00:00 +0200

Acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA) are complications of infection caused by group A β-hemolytic streptococcus. These conditions share similar clinical manifestations but differ substantially in prognosis and treatment strategies. In clinical practice, differential diagnosis remains challenging, particularly in the absence of cardiac involvement or other major Jones criteria for ARF.

Aim - to demonstrate the diagnostic difficulties in distinguishing ARF from PSRA using a clinical case of an adolescent with acute polyarthritis and a pronounced inflammatory response following streptococcal infection.

Clinical case. We analyzed clinical data from a 14-year-old patient, including medical history, physical examination, laboratory parameters, instrumental investigations (еlectrocardiogram, echocardiography, and ultrasound evaluation of joints), and treatment strategy. The patient presented with fever, polyarthritis, a pronounced systemic inflammatory response (high C-reactive protein, elevated erythrocyte sedimentation rate, leukocytosis), and a markedly elevated antistreptolysin-O titer (3200 IU/mL), findings compatible with the Jones criteria for ARF. However, the characteristics of arthritis - non-migratory and prolonged, with a poor response to non-steroidal anti-inflammatory drugs (NSAIDs) and absence of carditis - favored the diagnosis of PSRA. Glucocorticoid therapy was required due to insufficient response to NSAIDs.

Conclusions. This case illustrates the complexity of differentiating PSRA from ARF in the presence of overlapping clinical features and a pronounced inflammatory response. In such situations, dynamic clinical monitoring, assessment of treatment response, and surveillance for potential development of carditis over the following months are essential. Timely diagnosis and appropriate management of streptococcal infections remain the cornerstone of preventing post-streptococcal complications.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the patient and his parents prior to study participation.

The authors declare no conflict of interest.

A clinical case of recurrent cold acral foot lesions in a child: diagnostic challenges

L.A. Volianska, O.R. Boyarchuk, E.I. Burbela, O.B. Chubata, U.M. Mudryk — Sun, 28 Dec 2025 00:00:00 +0200

Manifestations of transient vasospasm of peripheral arteries and arterioles are an infrequent phenomenon in pediatric age, which always prompts an in-depth examination of the patient due to the need to differentiate the causes of its origin and differentiate its nature:primary or secondary. A clinical case of longitudinal observation of a patient for 4 years with Raynaud's syndrome is described.

Aim - to increase the awareness of doctors about Raynaud's phenomenon, clinical features of its course in childhood, differentiation of the nature of occurrence, treatment and prevention options based on the analysis of the observation of a clinical case.

The presented clinical case demonstrates the course of episodic-recurrent acropathia (three episodes during 4 years of observation) with damage to the skin and small vessels of the lower extremities in a child of primary school age, associated with the winter season, with a predominant lesion of the toes in the form of whitening, soreness, the appearance of papules, hemorrhagic elements and epidermolysis. The absence of systemic disorders and minimal changes in laboratory parameters justify the importance of dynamic clinical monitoring of children with recurrent acroischemic manifestations and illustrate the need for an interdisciplinary approach (rheumatologist, dermatologist, immunologist, vascular surgeon), especially with the progression of symptoms, the appearance of painful elements, necrosis or hemorrhagic changes. Verification of the clinical diagnosis remains a prospect subject to monitoring of autoantibodies, capillaroscopy evaluation, examination for genetic autoinflammatory syndromes, and the effectiveness of empirical treatment.

This clinical case demonstrates the need to raise awareness of systemic autoimmune diseases in primary care pediatricians and family medicine physicians, especially in cases of recurrent and seasonally associated skin and vascular lesions. The observation was performed in accordance with the principles of the Declaration of Helsinki. Written consent was obtained from the patient's mother for the publication of its results.

The authors declare that there is no conflict of interest.