Pediatrics. Consilium Medicum

Early diagnosis of malignant neoplasms in children is an important and relevant task. Despite the growth of “actively” diagnosed malignant neoplasms, the proportion of cases of the disease at stage III or IV remains high. In the structure of pediatric mortality, malignant neoplasms occupy a significant fraction, which marks the need for a thorough diagnostic search and, in turn, early detection of cancer. For patients who have completed treatment for a malignant neoplasm, active observation regarding the occurrence of a relapse or the appearance of second tumors remains relevant. Detection of malignant neoplasms in the early stages is possible with an appropriate level of cancer alertness, a multidisciplinary approach to the diagnosis and treatment of this rare group of diseases.

Aim. To study the nutritional characteristics of pregnant and lactating women in the context of the development of the pandemic of the new coronavirus infection COVID-19.

Materials and methods. The study has been conducted on 203 women. The first observation group included 100 women whose pregnancy and lactation took place before the development of the pandemic, the second group included 103 women whose pregnancy and lactation took place during the pandemic of a new coronavirus infection. The research of nutrition has been carried out using a comparative analysis based on a frequency questionnaire-survey method.

Results. Specific nutritional abnormalities of pregnant and lactating women in the conditions of the pandemic of the new coronavirus infection, different from the nutrition of this contingent before the pandemic, have been identified. This is reflected in the increased consumption of confectionery, low-alcohol beverages, poultry meat, eggs and reduced consumption of dairy products, “red meat” and seafood in combination with an increased level of anxiety, psycho-somatic abnormalities and a reduced level of physical activity. A nutrition optimization scheme for pregnant and breastfeeding women has been developed.

Сonclusion. The nutrition of a woman during pregnancy and period of lactation has a direct impact on the normal course of pregnancy, the formation of full lactation, the health of the mother and child. It is important to compose a balanced diet, review and correct it taking into account the individual needs of women, physiological characteristics, level of physical activity, pregnancy and lactation.

Meat is one of the main food products, as it is an valuable source of proteins containing all the essential amino acids, some mineral products, primarily iron and zinc. Meat products are an obligatory component of the diet throughout the entire childhood. The results of the assessment on the role of meat in ensuring the health of children, as well as the impact of inadequate intake on cognitive and motor functions, bone condition, etc. are presented. The article presents data on the evaluation of the role of meat in the concept of food programming. Specialized baby food products have undeniable advantages in the nutrition of young children. Standards are established for this category of products, which include regulated requirements for raw meat, ingredients, product quality, labeling, packaging, transportation and storage. These requirements guarantee high quality products with great nutritional and biological value.

Background. Palivizumab has been successfully used in many countries worldwide to prevent respiratory syncytial infection in children at risk of severe infection. Despite the drug use experience in some regions of the Russian Federation, evidence on the outcomes of specific immunoprophylaxis in children from risk groups is scarce.

Aim. To assess the results of the regional immunoprophylaxis program for children at high risk of severe respiratory syncytial virus infection (RSVI) with palivizumab in the Republic of Bashkortostan.

Materials and methods. A single-center retrospective cohort study was conducted at the Catamnesis Cabinet of the Republican Clinical Perinatal Center, Ufa. A total of 516 preterm infants born before the full 35 weeks of gestation and who reached the age of 1 year of life between April 2020 and April 2022 were included in the study. Group 1 (palivizumab+) included 250 infants who received at least one immunization against RSVI at a dose of 15 mg/kg; Group 2 (palivizumab-) included 266 infants without immunization. In both groups, the percentage of children admitted to the clinic for acute respiratory infections and hospitalized for lower respiratory infections was determined.

Results. It was found that children born at a gestational age of 32 weeks had immunoprophylaxis more often than children born at a gestational age of 32–35 weeks (58.1% vs 37.2%; p<0.001); also, they more often received 3–5 injections of palivizumab (32.9% vs 17.9%; p=0.018). The proportion of children who were admitted to the clinic for ARI was lower among those immunized than among those not immunized: 63.6% vs 82.0% (p<0.001; relative risk – RR 0.77, 95% confidence interval – CI 0.69–0.86). Of children who received 1–2 injections of palivizumab, 70.2% sought medical care for acute respiratory infections versus 53.3% of children who received 3–5 injections (p<0.001; RR 1.51, 95% CI 1.15–1.98). Among the immunized infants, the percentage of children admitted to the hospital for bronchitis was significantly lower: 24.0% vs 31.6% (p=0.045; RR 0.74, 95% CI 0.55–0.99). The most significant effect of palivizumab was demonstrated in children born at the gestational age of 32 weeks or less, who received 3–5 injections of the drug.

Conclusion. The study demonstrated the effectiveness of the regional RSVI immunoprophylaxis program with palivizumab in children in the first year of life at risk for severe infection in the Republic of Bashkortostan.

Aim. To detect known risk factors for allergic rhinitis and determine the associated risks in five regions of the Central Federal District of the Russian Federation for 2017–2021 in different age groups.

Materials and methods. The study was conducted at the Odintsovo Regional Hospital (Odintsovo), the Regional Children's Clinical Hospital (Yaroslavl), the City Children's Clinical Hospital (Tver), the Regional Children's Clinical Hospital (Vladimir), and the Vologda Children's City Polyclinic (Vologda). The homogeneity of the studied populations for the time criterion was assessed; the risk factors for allergic rhinitis (AR) recorded by the pediatrician in patients with an established diagnosis with ICD-10 codes J30.1, J30.2, J30.3, and J30.4 were analyzed. The total children population was 361,281 in the fourth quarter of 2021, and the number of children diagnosed with AR was 6,757. The study included children aged from 0 to 17 years. When assessing the evidence base, the data analysis and synthesis for each study site in each time range was performed in 100% of patients with AR.

Results. The analysis results showed that in 2017–2021, in all studied regions, there was a steady increase in the total children's population and an increase in AR patients from birth to 17 years, and in some regions, such as Odintsovo and Tver, the prevalence of AR is growing exponentially. All risk factors were divided into three groups according to the feasibility of controlling their effect: uncontrollable (6 factors), partially controlled (10 factors) and controlled (12 factors). Most controlled risk factors were socio-biological and medical, and partially controlled ones were medical and socio-economic.

Conclusion. The breakdown of risk factors into groups according to control feasibility will enable the reformatting of therapeutic and preventive measures aimed at reducing the prevalence of AR, which is a predictor of bronchial asthma occurrence.

Интервью с д-ром мед. наук, проф., гл. науч. сотр. отд. гастроэнтерологии Научно-исследовательского клинического института педиатрии им. акад. Ю.Е. Вельтищева ФГАОУ ВО «РНИМУ им. Н.И. Пирогова», рук. Московского областного центра детской гастроэнтерологии, гепатологии ГБУЗ МО «НИКИ детства», проф. каф. педиатрии с курсом детских хирургических болезней Медицинского института ФГАО ВО НИУ БелГУ Анатолием Ильичом Хавкиным.

The article presents the structure of diseases that led to the need for liver sector transplantation in children living in the Novosibirsk region. The paper provides a detailed description of progressive familial intrahepatic cholestasis, principles of modern diagnosis and treatment. A description of the medical history of family members and, in particular, a clinical case in a young child with type 2 PFIC (Byler's syndrome) is given.

Background. The main orthopedic manifestation of osteogenesis imperfecta is multiple fractures. In severe disease, frequent fractures lead to malunion and deformity, which increases the risk of refracture. Surgical treatment of children with osteogenesis imperfecta is aimed at reducing the risk of complications and improving the quality of life of the child. The Fassier-Duval telescopic intramedullary system has taken the leading place among the “growing” metal fixators. In this study, we conduct a comparative analysis of the results of a longitudinal study between patients with osteogenesis imperfecta types I and III, as well as an assessment of motor activity.

Aim. To evaluate the efficiency of using the telescopic intramedullary system depending on the type of osteogenesis imperfecta.

Materials and methods. A prospective analysis of surgical treatment of 20 children with types I and III was carried out. Group I included 8 patients with type I NO, group II included 12 with type III. The average age of patients was 8.2 years. Surgical treatment was carried out on the basis of the neuroorthopedic department with orthopedics of the National Medical Research Center for Children's Health. A total of 48 intramedullary telescopic pins were installed. The average period of postoperative dynamic follow-up was 42 months. The analysis of the results of surgical treatment was carried out according to the following criteria: the frequency of migrations of metal structures, the formation of bone deformities, the number of revisions, as well as the number of bone fractures with an installed metal fixator. Evaluation of the results of motor activity was carried out using two scales: Gillette Functional Assesment Questionnaire (Gillette FAQ) and Hoffer–Bullock.

Results. There were no statistical differences in the number of complications in the two groups. Fractures among patients with type I occurred more often than in patients with type III by 19.3%. The frequency of migrations in the I study group was 7.1% (1 segment), in the II group 35.3% (12 segments). The formation of deformation was the main factor in the revision intervention, which in our case amounted to 83.3%. In the group of patients with type I, the number of repeated operations was 7.1% (1 segment in 1 patient), in the group of patients with type III – 17.6% (6 segments in 4 patients). All patients in the postoperative period had II or I level of motor capabilities on the Hoffer–Bullock scale. According to the Gillette FAQ scale in the postoperative period, the subjects showed a result above 4 points.

Conclusion. The Fassier-Duval telescopic rod is a modern and reliable metal fixator. Despite the absence of statistical differences in the two study groups (p-value²<0.005), there was an increase in the tendency to complications in severe course with NO. Correction of varus deformation when restoring normal values of DN>125° and HEA within 25–38° is the prevention of the re-formation of the truth of Coxa Vara. The motor activity of children with severe course did not statistically differ from children with mild course (p-value²>0.005) in the postoperative period with an average follow-up period of 42 months, regardless of the initial low motor capabilities in children with type III.