No 4 (2023)

Articles

Mechanisms of formation of cow's milk protein allergy: a clinical case in a breastfed infant

Zakharova I.N., Dmitrieva D.K., Osmanov I.M., Skorobogatova E.V., Berezhnaya I.V.

Abstract

Cow's milk protein allergy (CMPA) is one of the urgent problems of modern health care, which pediatricians often encounter in their practice. CMPA imposes a burden on babies and their mothers, forcing them to limit their diet and plan the family budget, taking into account the cost of therapeutic infant formulas. Also, CMPA is still a challenging diagnosis since it can present in three variants and has various developing mechanisms. The elimination diet is the most reliable test in an infant with suspected CMPA. All dietary restrictions are imposed on the mother if the baby receives breast milk. The article presents a clinical case of CMPA in a breastfed infant, which occurred when a formula was included in the diet and presented with rashes, mucus diarrhea, constipation, and projectile vomiting.

Pediatrics. Consilium Medicum. 2023;(4):226-230
pages 226-230 views

Fermented milk products and functional nutrition in children

Belmer S.V., Kovtun T.A.

Abstract

Even in ancient times, people noticed that sour milk could be not just a food or a way of storing it for a certain period; in some cases, it is a healing drink. Currently, many microorganisms, mainly lactobacilli and bifidobacteria, are used to produce fermented milk products (FMP). Most of the microorganisms have probiotic properties. Also, additional probiotic strains are often introduced into these products, significantly increasing their nutritional, prophylactic and therapeutic value. In addition, prebiotics, most often oligofructose and inulin, can be included in the FMP. Yogurts are widely consumed throughout the world. They are prepared by fermenting milk using Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus. Their properties have been well-studied for more than 100 years. The fermentation results in a thick product with an extended shelf life.

Yogurt is a rich source of calcium in bioavailable form and a good source of phosphorus, potassium, vitamins A, B2 and B12. It contains proteins of high biological value and essential fatty acids. FMPs improve lactose cleavage, have an anti-atherogenic effect, reduce blood cholesterol, increase bone density, and have many other favourable properties for the human body. FMPs, particularly yogurts, can be entirely attributed to functional foods and are good for children and adults.

Products intended for children must meet special requirements considering the age-related features of metabolic processes. Thus, probiotic FMPs, including yogurts, positively affect the health of a child and an adult, both healthy and in many diseases. Their regular consumption is advisable throughout a person's life.

Pediatrics. Consilium Medicum. 2023;(4):231-237
pages 231-237 views

Nutrition of preschoolers and junior schoolchildren: trends, problems and search for ways of optimization

Samorodnova E.A.

Abstract

Nutrition is one of the key factors shaping and determining the health of children in all periods of childhood. Rational nutrition provides adequate development of children’s organism, contributes to the prevention of a wide range of diseases, while nutritional imbalance affects not only physical health, but also all spheres of life activity. The article presents generalized data on the factors that ensure the formation of nutritional behavior of the child, discusses the issues of age physiology of preschool and school age, the peculiarities of the organization of nutrition, taking into account the attendance of educational institutions. The main trends and problems in the nutrition of children 3–10 years old are presented, as well as possible ways to solve them. The article discusses the possibilities of preventive interventions in case of unbalanced diet and/or increased nutrient requirements of the organism through the correction of diet, lifestyle and the use of combined vitamin and mineral complexes and biologically active additives both to ensure the physiological needs of the child’s organism and in the situation of deficiency.

Pediatrics. Consilium Medicum. 2023;(4):238-245
pages 238-245 views

Gluten-related disorders: wheat allergy and non-celiac gluten sensitivity

Kamilova A.T., Azimova N.D., Zakharova I.N.

Abstract

Gluten-related disorders have gradually turned into an epidemiologically significant phenomenon, attracting the attention of the scientific community. Although they have specific pathogenetic pathways, they present with similar clinical manifestations, which makes their differential diagnosis challenging. The review presents current data on wheat allergy and non-celiac gluten sensitivity. Although wheat allergy is clearly defined by clinical forms and the diagnosis is based on specific diagnostic criteria, the diagnosis of non-celiac gluten sensitivity, on the contrary, can be considered only after excluding celiac disease and wheat allergy. This article describes a practical methodological approach to studying differences in the clinical presentation and diagnosis of gluten-dependent diseases.

Pediatrics. Consilium Medicum. 2023;(4):246-251
pages 246-251 views

The role of endoscopic ultrasonography for assessing the activity of ulcerative colitis in children

Vinokurova A.V., Lokhmatov M.M., Potapov A.S., Budkina T.N., Prokhorenkova M.O., Fisenko A.P.

Abstract

Background. Endoscopic diagnostic methods, namely ileocolonoscopy with biopsy, are the „gold standard“ in the diagnosis of ulcerative colitis. Due to the improvement of methods for the diagnosis of ulcerative colitis, the use of endoscopic ultrasonography, that combines endoscopic and ultrasound diagnostic methods, has attracted widespread attention. Endoscopic ultrasonography allows examination of the mucous membrane and the underlying layers of the intestinal wall, which makes it possible to measure the thickness of the intestinal wall. Both in Russia and abroad, there are no publications on the use of endoscopic ultrasonography for ulcerative colitis in children, and that requires further research in this area.

Aim. To evaluate the possibilities of endoscopic ultrasonography in order to determine the activity of ulcerative colitis in children.

Materials and methods. The study includes 97 children with an established diagnosis of ulcerative colitis. All children underwent ileocolonoscopy and endoscopic ultrasonography. The UCEIS scale (Ulcerative Colitis Endoscopic Index of Severity) was used to assess endoscopic activity. During endoscopic ultrasonography, the thickness of the intestinal wall and blood flow were evaluated using the color Doppler mapping mode.

Results. According to the study, there was a statistically significant increase in the thickness of the intestinal wall amid the development of endoscopic activity. The statistically significant increase in the activity of blood flow in the intestinal wall was found.

Conclusion. Endoscopic ultrasonography is a relatively new research method with a number of functions that can be used to solve complex diagnostic problems in children with ulcerative colitis. The ability to measure the thickness of the intestinal wall and assess the severity of blood flow allows endoscopic ultrasonography to assess patients with ulcerative colitis dynamically, which makes it a promising method in primary diagnosis.

Pediatrics. Consilium Medicum. 2023;(4):252-257
pages 252-257 views

Intraluminal removal of hamartoma polyps of the gastrointestinal tract in children

Korolev G.A., Lokhmatov M.M., Dyakonova E.Y., Tupylenko A.V., Oldakovsky V.I., Budkina T.N., Bekin A.S., Yatsyk S.P.

Abstract

Background. Peutz-Jeghers syndrome and juvenile polyposis lead to the formation of hamartoma polyps in the small intestine, which are the cause of anvagination of the small intestine, gastrointestinal bleeding and obstruction of the gastrointestinal tract. Polyps form throughout life and most patients undergo multiple surgeries.

Aim. To determine the effectiveness and safety of balloon enteroscopy (BE) as a method of intraluminal minimally invasive method for removing hamartoma polyps of the deep sections of the small intestine in children with Peutz-Jeghers syndrome and juvenile polyposis.

Materials and methods. The study was performed on the basis of the Endoscopic Research Department of the National Medical Research Center for Children’s Health. In the period from 2013 to 2022, 40 patients were hospitalized: 32 (80%) with Peutz-Jeghers syndrome and 8 (20%) with juvenile polyposis. During the observation period, 78 diagnostic and therapeutic balloon enteroscopies were performed: 70 (89%) antegrade, 8 (11%) retrograde.

Results. A total of 309 polyps of the small intestine were detected during BE: with antegrade BE – 283 (91.5%, mean – 4.1±2.59), with retrograde BE – 27 (8.5%, mean – 3, 48±3.39). A total of 129 polyps of the small intestine were removed: 119 (92.2%) during antegrade BE and 10 (7.8%) during retrograde BE. For BE, detection of clinically significant polyps is predicted with a sensitivity of 90.1% and a specificity of 81.7%. In the postoperative period, 6 complications (7.89%) were revealed. In three cases, a control ultrasound of the abdominal organs revealed small intestinal intussusceptum, so the clinical effect was not achieved: retrograde BE – n=2 (2.62%), antegrade BE – n=1 (1.31%), in two of patients, perforation of the small intestine was detected – retrograde BE – n=1 (1.31%); antegrade BE – n=1 (1.31%) and one patient had bleeding during BE – antegrade BE – n=1 (1.31%).

Conclusion. BE is an effective and safe method of intraluminal minimally invasive removal of small intestinal polyps.

Pediatrics. Consilium Medicum. 2023;(4):258-261
pages 258-261 views

Effectiveness of osteosynthesis with flexible titanium rods in the long-term treatment of femoral fractures in children aged 0 to 7 years

Sidorov S.V., Сhelpachenko O.B., Yatsyk S.P., Serova N.Y., Nikishov S.O.

Abstract

Background. In recent years, in the treatment of hip fractures in pediatric practice, there has been a tendency to move from conservative methods using a plaster cast and traction to surgical stabilization.

Aim. To evaluate the results of treatment of femoral fractures by osteosynthesis with flexible titanium rods in children aged 0 to 7 years in the long-term period.

Materials and methods. The study included 118 children aged 0–7 years with femoral fractures. Average age – 3.3±1.8 years, 74 (62.7%) boys, 44 (37.3%) girls. In the main group (n=62), surgical treatment was performed, mainly with the help of osteosynthesis with flexible titanium rods – ESIN (n=56; 90.3%). The reference group (n=56) underwent conservative treatment of fractures.

Results. In the main group, accelerated fracture consolidation was noted in 74.2%, in the reference group – 32.1% of cases (p=0.032). With the use of conservative treatment, half of the patients had delayed consolidation of fractures, after surgical treatment there were only 5 such cases (8.1%, p=0.005). The overall frequency of long-term complications after fracture treatment (contracture and deformity of adjacent joints) in the main group was 8.1%, in the reference group it was 23.2% (p<0.05). In the main group, 51.6% of patients had no movement restrictions in adjacent joints (in the reference group – 19.6%, p=0.012) and 64.5% had no change in limb length (in the reference group – 17.9%, p=0.025). In the main group, 88.7% of the children's relatives rated the result of treatment as “excellent” and “good”, in the reference group 83.9% of the ratings were satisfactory and unsatisfactory.

Conclusion. Long-term results of treatment of femoral fractures in children aged 0–7 years using ESIN are better, and satisfaction with treatment of relatives of children is higher than with conservative methods.

Pediatrics. Consilium Medicum. 2023;(4):262-268
pages 262-268 views

Ensuring the safety of surgical correction of scoliosis in children using neuromonitoring and O-arm navigation

Pimburskiy I.P., Butenko A.S., Samokhin K.A., Сhelpachenko O.B., Zherdev K.V., Yatsyk S.P., Zubkov P.A., Petelguzov A.A.

Abstract

Severe multiplanar spinal deformities of various etiologies are accompanied by disorders of the organ systems, causing early disability and reduced life expectancy of patients, which, in turn, dictates the need for surgical correction. The method of choice for the surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Despite the advantages of this spinal stabilization technology, it has its own specific difficulties and risks of various complications, most often associated with malposition of the supporting elements. To reduce the number of complications associated with the surgical correction of scoliosis, methods have been developed, including intraoperative neuromonitoring and O-arm navigation, the effectiveness of which will be discussed in this article.

Pediatrics. Consilium Medicum. 2023;(4):269-274
pages 269-274 views


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