Background. The high prevalence of asymptomatic sensitization complicates food allergy diagnosis, leading to unnecessary elimination diets and overuse of invasive oral food challen­ges. There is a critical need to develop objective predictive scoring models, particularly for common yet less studied allergens such as salmon (Sal s 1). The purpose was to identify the main clinical-anamnestic and immunological factors for building a logistic regression predictive model of the risk of developing clinical manifestations in sensitization to the β-parvalbumin allergen of salmon (Sal s 1). Materials and methods. We examined 239 children aged 1 to 18 years with confirmed sensitization to salmon β-parvalbumin (Sal s 1). The patients’ clinical-anamnestic data and immunological test results were analyzed; using a logistic regression model, the risk of developing clinical manifestations of food allergy was assessed. A preliminary diagnosis of food allergy was established based on the EAACI 2023 guidelines. Results. Among the 239 patients sensitized to Sal s 1, clinical manifestations of food allergy were detected in 144 cases (60.3 %). Binary logistic regression, which included 10 significant factors after refinement (AUC 0.83), determined that the strongest positive predictors of clinical manifestation risk were: the number of β-parvalbumin molecules to which the patient was sensitive in the sensitization profile (OR 1.99), the presence of respiratory allergy (OR 1.84), sensitization class 4 (OR 1.85), and atopic dermatitis (OR 1.59). The strongest protective effect was found for sensitization class 1 (OR 0.26). Conclusions. The developed logistic regression predictive model (AUC 0.83) allows for the assessment of individual risk for clinical manifestations of food allergy in children sensitized to salmon β-parvalbumin. Key prognostic factors include age, the degree of Sal s 1 sensitization, sensitivity to other β-parvalbumins, the pre­sence of atopic dermatitis, and respiratory allergy. This model can be used for non-invasive stratification of patients based on the risk level of developing clinical manifestations of food allergy, allowing for the implementation of elimination measures without risky provocative challenges in high-risk children.

Background. Hirschsprung’s disease is one of the most common neonatal obstruction diseases. The annual cases of Hirschsprung’s disease in Indonesia are approximately 1,400 live births. Its screening and diagnosis can be established using several methods, but they have various limitations; therefore, alternative methods are required. Patients with Hirschsprung’s disease tend to have higher acetylcholinesterase (AchE) levels, and it is potentially applied as an alternative diagnostic examination for this condition. The aim was to further determine AchE levels in patients with Hirschsprung’s disease. Materials and methods. This prospective cohort study was conducted in Dr. Soetomo Regional General Hospital, Surabaya, from November 2024 to January 2025. The demographic, surgery, and pre- and post-resection AchE levels data were collected. The Human AChE (Acetylcholinesterase) ELISA Kit (Elabscience E-EL-H6031) was used to assess the AchE levels. The collected data were analysed using the chi-Square test, the pre- and post-resection AchE levels were analysed using a paired t-test. A p-value < 0.05 was considered statistically significant. Results. The study included 6 participants. Most of them were male (83.3 %) with a mean age of 34.830 ± 34.143 months. The analysis revealed a significant difference in AchE levels pre- and post-resection (299.875 and 85.267 units/mL, p-value of 0.014) with a very strong relationship (Cohen’s d effect size 1.250). Conclusions. Acetylcholinesterase levels will decrease after surgery. Evaluation of AchE content may be potentially used as a diagnostic and prognostic examination for Hirschsprung’s disease.

Background. Undernutrition due to tuberculosis (TB) infection is high in children and is often accompanied by micronutrient deficiency resulting from insufficient nutritional intake such as iron deficiency anemia. Undernutrition also caused a decrease in IL-6, making children vulnerable to the infection. This study was aimed at analyzing the effect of oral nutritional supplements on hemoglobin, interleukin (IL)-6 levels, weight and length increment in stunted children with TB. Materials and methods. A pre-experimental study with one-group pre-test/post-test design was conducted from October 2022 to July 2023 in a private hospital, Surabaya, East Java, involving stunted children with TB infection aged 12 to 60 months. The statistical analysis included descriptive statistics (mean ± standard deviation or n (%)), independent sample T-test or Mann-Whitney U test, and paired sample T-test or Wilcoxon sign rank test, depending on the normality. Results. A total of 29 subjects were enrolled in this study, with a mean age of 25.40 ± 11.30 months. 58.62 % of subjects were aged below 24 months old, and 41.38 % were aged between 25 and 60 months. No significant differenсе was seen in IL-6 and hemoglobin before and after the intervention. The average hemoglobin level before the intervention was 12.07 ± 1.22 mg/dL, and after the intervention it was 12.00 ± 1.09 mg/dL, while for IL-6, these indicators were 125.76 ± 116.87 and 122.41 ± 104.43 µg/L, respectively (p = 0.441). Conclusions. Oral nutritional supplements intervention for 90 days did not affect IL-6 and hemoglobin levels of children with TB.

Background. Birth asphyxia remains the third leading cause of neonatal mortality (23 %) and is associated with a nearly equivalent incidence of severe neurological impairment. Therapeutic hypothermia (TH) is an effective and safe treatment strategy for term infants, reducing the combined risk of death or major disability at 18 months of age. However, more than 40 % of infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) still develop long-term adverse outcomes. Modern scientific publications are primarily focused on the issues of predicting brain damage in the context of therapeutic hypothermia. Predicting the outcomes of HIE at the present stage is based on combinations of clinical and laboratory parameters, such as the combined Multiorgan Dysfunction Evaluation (MODE) score. Nonetheless, individual indicators remain important, and their spectrum continues to expand. Thermoregulation assessment has emerged as a promising marker for outcome prediction, as it reflects the extent of brain injury. Higher body temperature in infants during TH has been associated with adverse neurodeve­lopmental outcomes at 18 months of age. Therefore, the purpose of our study was to test the hypothesis that infants with severe adverse outcomes of HIE exhibit impaired thermoregulation — manifested by fluctuations in axillary temperature after the completion of TH — within the first 10 days of life. Materials and methods. The study was conducted at the Neonatal Center and the Follow-up Observation Center of the Regional Medical Center for Family Health at the Dnipro Regional Council. The research design was defined as a retrospective, single-center clinical study. The study cohort included 19 children who had received device-controlled systemic TH as part of their neonatal management for post-asphyxial encephalopathy during 2023–2024 and had reached two years of age. Data concerning the neonatal period were obtained through the analysis of medical records. The degree of post-asphyxial multiorgan dysfunction was assessed using the MODE score, which encompassed evaluation of the neurological, cardiovascular, respiratory, gastrointestinal, and renal systems, as well as hematologic parameters, neuroimaging findings, and electroencephalographic characteristics. During TH, body temperature was monitored continuously via a rectal sensor; after hypothermia, axillary temperature was assessed up to the 10th day of life, with measurements performed every two hours. ­Results. Among the 19 infants examined (10 males and 9 females), 5 children (26.3 %) demonstrated severe adverse outcomes of HIE. They significantly differed (p < 0.05) from those without such outcomes in several key parameters. The frequency of advanced resuscitation measures, specifically the need for pharmacologic interventions during initial resuscitation, was markedly higher (80.0 vs. 21.4 %). These infants also exhibited more pronounced multiorgan dysfunction, as reflected by higher MODE scores: 8 (6–9) vs. 2 (1–3), and showed a greater incidence of temperature instability following TH, with episodes of axillary temperature elevation within the first 10 days of life observed in all affected infants (100.0 vs. 21.4 %). The occurrence of temperature elevation episodes during the first 10 days of life demonstrated significant correlations (p < 0.05) with several clinical parameters such as the need for advanced resuscitation (rs = 0.671), the degree of post-asphyxial multiorgan dysfunction according to the MODE score (rs = 0.673), presence of seizures (rs = 0.610), pathological muscle tone abnormalities (rs = 0.585) or absence of oral feeding at discharge (rs = 0.507), and destructive changes in brain tissue on neuroimaging (rs = 0.701). Signs of infection emerging within the first 10 days of life were identified in 1 infant (7.1 %) in the group without adverse outcomes and in 2 infants (40.0 %) in the group with adverse outcomes (p = 0.155). Thermoregulatory disorders predicted severe long-term outcomes with good diagnostic accuracy according to the ROC curve analysis (AUC = 0.893), whereas the MODE score demonstrated excellent diagnostic accuracy (AUC = 0.993). Both indicators achieved 100 % sensitivity at their optimal thresholds; however, specificity was higher for the MODE score (0.929 vs. 0.786). Conclusions. Our findings support the hypothesis that infants with severe adverse outcomes of HIE following TH exhibit impaired thermoregulation — manifested as elevated skin temperature during continued post-hypothermia temperature monitoring — within the first 10 days of life. Both evaluated parameters, the MODE score and manifestations of thermoregulatory disorders, demonstrated 100 % sensitivity for predicting severe adverse outcomes of HIE. However, the MODE score showed superior specificity for prognostic purposes. Further studies are needed to investigate whether episodes of temperature change after TH are associated with adverse outcomes of HIE.

Autonomy in medical decision-making involves an individual’s ability to decide which medical procedure is suitable for them or to refuse treatment. Parents are regarded as the primary decision-makers for their children’s health decisions. When parents do not act in the child’s best interest, disagreements between parents and healthcare providers over the child’s medical treatment typically require resolution by the court. In this process, the minor should be considered an active participant in their care. Therefore, the minor’s decision-making capacity becomes essential, and depending on their age, they can give or withhold consent to treatment, which may conflict with their parents’ decisions or what is deemed to be in their best interest. Medical consent ensures that the rights and the best interests of minors are always protected. The state must guarantee the best interest of the child even when the parents who are entitled to do so may jeopardize the welfare of the child. By reviewing some of the most important case laws of the ECtHR, the paper aims to examine the role of different actors in the medical decision-making of minors and the resolution of disputes that may arise from other considerations of parents and health providers.

Background. Acyanotic congenital heart defects (ACHD) often lead to right ventricular volume overload and elevated pulmonary pressures, contributing to pediatric heart failure. Tricuspid regurgitant pressure (TRP) estimated by echocardiography serves as a non-invasive marker of pulmonary hypertension and right-sided heart stress. Sildenafil, a phosphodiesterase-5 inhibitor, is commonly used to lower pulmonary vascular resistance in children with congenital heart disease. The purpose was to evaluate the correlation between echocardiographic TRP and the severity of pediatric heart failure, as measured by the Modified Ross Score, in children with ACHD receiving sildenafil therapy. Materials and methods. A cross-sectional observational study was conducted in 45 children with ACHD and clinical signs of heart failure at Dr. Soetomo General Hospital between January and May 2025. TRP was assessed via Doppler echocardiography, and heart failure severity was quantified using the Modified Ross Score. Data were analyzed using Pearson correlation and multiple linear regression. Results. TRP showed a moderate positive correlation with the Modified Ross Score (r = 0.401, p = 0.006). TRP > 38 mmHg was predictive of more severe heart failure and malnutrition. Sildenafil therapy was used for > 3 months in 66.7 % of patients. A regression model indicated TRP as an independent predictor of heart failure severity (β = 0.030, p = 0.007), while body weight had no significant effect. Conclusions. Elevated TRP correlates with increased heart failure severity in children with ACHD on sildenafil therapy. Echocardiographic TRP may serve as a useful non-invasive marker for monitoring disease progression and therapeutic response.

Background. Autism spectrum disorder (ASD) is a complex neurodevelopmental condition influenced by both genetic and environmental factors, with epigenetic mechanisms playing a central role in gene regulation. Early identification of risk factors is essential for timely intervention, particularly in children aged 1–3 years when diagnosis remains challenging. Materials and methods. This case-control study aimed to identify prenatal, perinatal, and postnatal factors associated with the incidence of ASD in young children. A total of 156 participants (79 with ASD and 77 controls) aged 1–3 years were enrolled from Dr. Soetomo General Hospital. Data were collected from medical records and structured parental interviews, covering variables such as maternal health, birth history, family background, socioeconomic status, and environmental exposures. Results. Statistical analysis using bivariate and multivariate logistic regression identified several significant risk factors. These included male gender (odds ratio (OR): 5.634, p = 0.011), being the youngest child (OR: 4.022, p = 0.023), lack of maternal folic acid supplementation during pregnancy (OR: 15.265, p = 0.032), history of premature rupture of membranes (OR: 28.401, p = 0.006), and screen time exceeding one hour per day (OR: 47.356, p < 0.001). Additionally, lower maternal education level and residence near industrial areas were associated with increased ASD risk. Conclusions. These findings highlight the multifactorial etiology of ASD and the importance of modifiable prenatal and postnatal factors. Promoting maternal education, prenatal care, folic acid supplementation, and reducing early screen exposure could help in ASD prevention strategies. Further research is needed to explore underlying mechanisms and validate these associations in larger populations.

Background. The purpose was to study the relationship between intestinal fatty acid-binding protein (IFABP) levels and markers of inflammation and severity to the children with COVID-19. Materials and methods. We conducted a cohort, observational, retrospective study involving 88 patients aged 1 month to 18 years with laboratory-confirmed COVID-19. The children were hospitalized in Kyiv City Children’s Clinical Infectious Disease Hospital (Kyiv, Ukraine). They were divided into the study and control groups according to the course of the disease: the study group included 42 patients with complicated COVID-19, and the control group consisted of 46 participants with uncomplicated disease. During a comprehensive examination on the first day of hospitalization, we collected blood serum for further study of IFABP by enzyme-linked immunosorbent assay using the Human IFABP/FABP2 (Intestinal Fatty Acid Binding Protein) ELISA Kit (FineTest, China) with a working measurement range of 0.156–10 ng/ml and a sensitivity of 0.094 ng/ml. The study was performed according to the principles of the Declaration of Helsinki and in compliance with modern principles of evidence-based medicine and bioethics in accordance with the principles of good clinical practice. The study was approved by the Local Ethics Committee of the hospital. Informed consent of parents and children was obtained. Diagnostic measures carried out during this study were not accompanied by risks. We used statistical, analytical methods and the method of empirical research. To calculate the results obtained, we used the statistical software EZR v. 1.54. Results. According to the calculations, IFABP in the control group was 15.1 ± 3.1 ng/ml, while in the study group it was higher, amounting to 21.7 ± 5.5 ng/ml (p = 0.01). The results of the study demonstrated a correlation between IFABP level and an increased level of leukocytes (r = 0.284, p < 0.001), erythrocyte sedimentation rate (r = 0.56, p < 0.001), D-dimer (r = 0.259, p < 0.001), C-reactive protein (ρ = 0.225, p = 0.03) and radiological changes in the lungs (ρ = 0.355, p < 0.001). Conclusions. We have found a correlation between IFABP level and the COVID-19 inflammation and severity markers in children.

Background. Armed conflicts in many regions of the world have a profoundly destructive impact on all aspects of life, including the health of children. One of the least studied yet critically important consequences is the deterioration of children’s oral health, driven by a complex interplay of physiological, social, and psychological factors. The purpose was to conduct a systematic analysis of the impact of armed conflicts on the prevalence of dental caries in children and adolescents, to identify key risk factors and to propose effective strategies for the prevention and maintenance of oral health in wartime conditions. Materials and methods. A literature search was conducted in March 2025 using the PubMed, Scopus, Web of Science, and Google Scholar databases, following the PRISMA 2020 guidelines. Only publications written in English and issued prior to March 2025 were included. A total of 20 relevant studies were selected, encompassing data on more than 125,000 children. Results. The analysis revealed that the primary determinants of deteriorating dental health in war conditions include psycho-emotional stress, post-traumatic stress disorder, malnutrition, socioeconomic hardship, poor oral hygiene, and limited access to dental care. Children exposed to traumatic experiences demonstrated significantly higher rates of dental caries, periodontal disease, and poorer hygiene practices. A direct association has been identified between caries prevalence and factors, such as poverty, parental education level, and type of residence. While some evidence suggests that reduced sugar access during wartime may lower caries incidence in isolated cases, the overall impact of armed conflict on children’s oral health is strongly negative. Conclusions. There is a pressing need for the implementation of targeted preventive strategies, including the deployment of mobile dental clinics, the use of telemedicine, oral hygiene education programs, psychosocial support, and volunteer-based initiatives, to ensure the delivery of essential dental care to children living in crisis settings.

Tuberculosis, caused by Mycobacterium tuberculosis, is transmitted through the release of bacteria into the air via respiratory activities, such as breathing and coughing. Untreated latent tuberculosis can act as a reservoir for future infections. Remote regions like Masalembu encounter additional challenges, including shortages of healthcare professionals, inadequate infrastructure, and restricted access to healthcare services. An 8-year-old boy, identified during active case finding conducted by the Ksatria Airlangga Hospital Ship, had been in contact with his father, who had bacteriologically confirmed tuberculosis and was undergoing five months of therapy. The child presented with prolonged cough and malnutrition. Notably, no Bacillus Calmette-Guérin vaccination scar was observed, the tuberculin skin test was positive, and rapid molecular testing yielded negative results. Diagnosis was established using the Indonesian tuberculosis scoring system, and the patient commenced a six-month treatment. Several factors contribute to diagnostic delays, including nonspecific symptoms, inadequate infrastructure, and limited capacity to perform diagnostic procedures, such as gastric aspiration and sputum induction, suboptimal contact tracing, incomplete immunization, and geographic isolation. The involvement of government entities, healthcare professionals, and the community is crucial in addressing pediatric tuberculosis. Emphasizing strategies like enhancing contact tracing could significantly improve tuberculosis management in isolated island communities.