Issue 9/2025
Vasilev, T.
Children’s Hospital “Ivan Mitev” – Sofia;
Department of Pediatrics; Medical University – Sofia
Cardiovascular autonomic neuropathy (CAN) is a frequent and often underestimated complication of type 1 diabetes in childhood, associated with increased cardiovascular risk and mortality. The five-test battery proposed by Ewing and Clarke remains the gold standard for non-invasive assessment of sympatho-vagal balance and early detection of autonomic dysfunction. This article reviews the clinical applicability of the Ewing battery in pediatric diabetic patients, emphasizing its diagnostic utility, sensitivity, and risk stratification capacity. Core physiological mechanisms, age-specific considerations, and complementary methods such as heart rate variability spectral analysis are presented. The importance of glycemic control in the prevention of CAN is underscored, and an integrated approach for early diagnosis and follow-up in pediatric practice is proposed.
Key words: cardiovascular autonomic function; diabetic autonomic neuropathy; Ewing tests; children; spectral analysis
Address for correspondence:
Dr. Teodor Vasilev
Clinic of Rheumatology,
Children’s Hospital “Ivan Mitev” – Sofia
11, Аcad. Ivan Geshov, Blvd.
1612, Sofia
e-mail: tvasilev@medfac.mu-sofia.bg