No 1 (2020)

Articles

TO THE BIRTHDAY OF NIKOLAI PAVLOVICH SHABALOV

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Pediatrics. Consilium Medicum. 2020;(1):12-15
pages 12-15 views

PEDIATRIC QUESTIONS ABOUT A NEW CORONAVIRUS INFECTION -ARE THERE ANY ANSWERS TODAY?

Zaplatnikov A.L., Gorev V.V., Dmitriev A.V., Dement'ev A.A., Chabaidze Z.L., Svintsitskaia V.I.

Abstract

A review of the literature on the main features of the new coronavirus infection in children is presented. It is noted that to date there is no convincing evidence in favor of vertical infection, while the possibility of horizontal transmission of the infection from mother to her newborn child has been shown. The main provisions of the agreed recommendations of international and national professional medical communities on tactics of managing newborn babies from mothers with COVID-19 (Coronavirus disease 2019) are presented. It was shown that in the structure of patients with severe COVID-19, the share of children is no more than 5%. It has been established that in children the new coronavirus infection in the vast majority of cases is asymptomatic or mild. The main hypotheses of a milder course of COVID-19 in pediatric patients are presented. Moreover, it is emphasized that children with asymptomatic and mild disease constitute the main vector-borne potential for the continuation of the pandemic.
Pediatrics. Consilium Medicum. 2020;(1):16-19
pages 16-19 views

THE VALUE OF INSTRUMENTAL METHODS IN THE DIAGNOSTICS OF PNEUMONIA IN CORONAVIRUS INFECTION

Voitenkov V.B., Marchenko N.V., Skripchenko N.V., Kapiton M.G., Bedova M.A.

Abstract

Main goal in the managing of the coronavirus infections is the timely diagnosis of the viral pneumonia. Along with the key clinical signs main instrumental methods are computed tomography (CT) and lungs X-ray. However, in the lungs tissues evaluation in viral pneumonias, including ones associated with a COVID-19, X-ray are not very informative. We propose the tactic of the early instrumental diagnostic of lung's degree of lesion and functional state in coronavirus infection. As the lung CT is more informative in the evaluation of the state of the lungs, it has to be done in the first place. In case of general lack of resources and high demand for CT, lung ultrasound may be performed as a secondary measure. Limitations and low specificity of lung ultrasound should be considered in evaluation of its results. If some need arise to evaluate the functional state of the lungs, we propose the spirometry. Bilateral interstitial pneumonia would be suspected if restrictive pattern is registered. In that case diffusion capacity and total lung capacity are evaluated as well.
Pediatrics. Consilium Medicum. 2020;(1):20-25
pages 20-25 views

THE ROLE OF FOOD ALLERGY IN THE DEVELOPMENT OF ATOPIC DERMATITIS. POSITION PAPER OF THE ASSOCIATION OF CHILDREN'S ALLERGISTS AND IMMUNOLOGISTS OF RUSSIA

Smolkin Y.S., Masalskiy S.S., Cheburkin A.A., Gorlanov I.A.

Abstract

For opinion, experts Association Pediatric Allergist and Immunologist of Russia a new definition of atopic eczema: chronic recurrent inflammation of the skin, arising as a result of a violation of the epidermal barrier and entailing its further dysfunction. Maximum development atopic dermatitis reaches on the background of predisposition to IgE-mediated hypersensitivity, implemented in sensitization to surrounding allergens. Key points: 1. Allergic sensitization is not the only and main cause of atopic dermatitis. 2. Allergy special examination should be carried out to prove atopic dermatitis with food allergy. 3. Conducting eliminationprovocation tests with food allergens is necessary in case of doubt about the of allergy food reactions. 4. We recommend using skin prick test and specific IgE (solid-phase ELISA) providing a high sensitivity of 0.1-100 mgA/L. 5. A proven allergic reaction to food requires the exclusion of all foods that contain this protein for a time enough for the development of tolerance. 6. The expectation of cross-reactions should not be the reason for the exclusion of food. Only an elimination and provocation diet (test) is able to prove food intolerances. 7. Elimination diet-a temporary action, because after a few months of complete exclusion of the allergenic product from the diet, most children will be able to eat previously intolerant food. 8. In infants, the best nutrition option is breastfeeding for duration of 6 months. It is not advisable to delay the introduction of complementary foods and restriction of highly allergenic products if they are not proven hypersensitivity to it.
Pediatrics. Consilium Medicum. 2020;(1):26-35
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FUNCTIONAL GASTROINTESTINAL DISORDERS IN INFANCY: IMPACT ON INFANTS AND FAMILY HEALTH

Vandenplas Y., Hauser B., Salvatore S.

Abstract

Aim. Functional gastrointestinal disorders (FGIDs) such as infantile colic, constipation and colic occur in almost half of the infants. The aim of this paper is to provide health care physicians a critical and update review on the management of FGIDs and their impact on infant’s and family health. Materials and methods. Guidelines and expert recommendations were reviewed. Results. FGIDs are a frequent cause of parental concern and consequent impaired infants and relatives’ quality of life, and impose a financial burden to health care, insurance and families. Therefore, the first management of these FGIDs should focus on improving both infants symptoms and family quality of life. If more than parental reassurance is needed, available evidence suggests that nutritional advice is recommended as it is effective and most of the time devoid of adverse effects. Conclusion. The role of healthcare providers in reassuring parents and proposing the correct behavior and nutritional intervention, avoiding inappropriate use of medication, is essential in the management of FGIDs.
Pediatrics. Consilium Medicum. 2020;(1):36-41
pages 36-41 views

ASSESSMENT OF PROSPECTS OF REHABILITATION ACTIONS AT THE BABIES BORN WITH HYPOTROPHIC TYPE OF DELAY OF PRENATAL GROWTH

Ivanov D.O., Derevtsov V.V.

Abstract

Aim. To estimate prospects of rehabilitation actions at the babies born with hypotrophic type of light severity of delay of pre-natal growth. Materials and methods. Since the birth under observation 151 children, from them also development of a fruit of hypotrophic type of light severity - 57 (group 1) and without that - 69 (group 2) from mothers with the burdened somatic and obstetric and gynecologic anamnesis are given rise in the result of the complicated pregnancy and childbirth, including with a growth inhibition. Almost healthy children born by almost healthy mothers made the 3rd group - 25 children. Children are full-term, mature, looked round in 1 (n=142), 3 (n=132), 6 (n=122), 12 (n=124) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of electrocardiography and cardiointervalography. Distribution-free statistical analysis methods. Results. Correlation connections on the 2-3 day between body weight and length r=0.57, body weight and tooth width P r=0.33, body length and tooth width P r=0.37, mode amplitude and voltage index r=0.87, mode amplitude and interval width PQ r=-0.28, voltage index and interval width QT r=-0.31, tooth width Q and interval P=0.4; 1 month between body weight and length r=0.6, mode amplitude and voltage index r=0.71, voltage index and interval width QT r=-0.32, tooth width P and interval PQ r=0.4, complex width QRS and interval QTr=0.33; 3 the month between body weight and length r=0.66, body length and complex width QRS r=0.37, mode amplitude and voltage index r=0.8, tooth width P and interval PQ r=0.46, tooth width P and complex QRS r=0.48, complex width QRS and interval QT r=0.31; In the 6 months between body weight and body length r=0.63, body length and mode amplitude r=-0.32, body length and pressure index r=-0.34, body length and interval width QT r=0.36, mode amplitude and voltage index r=0.87, sympathetic activity and interval width QT r=-0.36, voltage index and interval width QT r=0.41, interval width QT=12 months between body weight and length r=0.6, body weight and mode amplitude r=-0.44, body weight and voltage index r=-0.4, mode amplitude and voltage index r=0.89, shary tooth P and interval PQ r=0.34, tooth width P and complex QRS r=0.47. Conclusion. The revealed correlation communications of some studied parameters of health allow doctors to allocate groups of dispensary observation, to diagnose changes at early stages, to carry out differential diagnostics between the beginning of diseases, correctional actions with assessment of their efficiency.
Pediatrics. Consilium Medicum. 2020;(1):42-47
pages 42-47 views

THE HEALTH STATUS OF CHILDREN WHO HAD CARDIAC SURGERY IN THE FIRST 3 MONTHS OF LIFE DUE TO COARCTATION OF THE AORTA

Delyagin V.M.

Abstract

Relevance. Congenital heart defects (CHD) as a cause of disability are in second place after central nervous system damage. The possibilities of modern medicine have significantly increased the survival rate of such children. A significant part of newborns with CHD survives to adulthood. The task is to provide such people with the highest possible quality of life, which is impossible without integral studies of the state of health in the remote postoperative period. Materials and methods. 12 children (6 girls and 6 boys) were operated on for aortic coarctation. Duration of observation 1-9 years (Me - 5.5). Results. Coarctation of the aorta was combined with other malformations (11/12): abnormalities of the aortic valve with moderate hemodynamic impairment (4/12), defects of the heart walls (5/12), open ductus arteriosus (4/12). A combination of vices has been reported. In the distant period, restlessness, difficulties in mastering the school curriculum, sleep disturbances, neurotic reactions, pituitary microadenoma, iron deficiency anemia, infantile anorexia were revealed. Often there were allergic reactions, abdominal pain, constipation, gastroesophageal reflux, impaired posture, malocclusion and tooth growth, hernia, and deformation of the feet. Conclusion. CHD is not an isolated defect in the structure of the heart, but the suffering of all tissues and structures of the heart (therefore, the term "chronic heart disease" is eligible). But at the same time, other body systems also suffer as a result of circulatory disorders and related conditions. Recommendations are given on improving care for children with CHD.
Pediatrics. Consilium Medicum. 2020;(1):48-51
pages 48-51 views

A RATIONAL APPROACH TO THE CHOICE OF ANTIVIRAL THERAPY FOR ACUTE RESPIRATORY INFECTIONS IN CHILDREN

Chugunova O.L., Melekhina E.V., Muzyka A.D.

Abstract

The article discusses the treatment of acute respiratory infections in children based on a discussion of contemporary features of etiology, pathogenesis, clinical manifestations. A change in the classical clinical picture of the course of acute respiratory infections depending on the etiology of the pathogen, as well as the increasing share of combined infections every year, necessitates the etiological interpretation of cases of acute respiratory infections in children. The fastest test (obtaining the result within a few hours), with high sensitivity and specificity, is the detection of nucleic acids of respiratory viruses in the material of swabs from the oropharynx. The peculiarities of the interaction of herpes viruses with host cells, the long course of the infectious process, and the change in immunological reactivity as a result of this determine the advisability of administering antiviral therapy to patients with clinical manifestations of acute respiratory viral infections (ARVI) and active forms of herpes virus infections. Based on a survey of more than 1,500 children aged 1 year to 17 years, we have shown that up to 90% are infected with at least one herpes virus, the most common human herpes virus is 6A / B. The problematic issues of ARVI therapy are indicated, including the prevalence of mixed viral infections, the development of secondary immunological deficiency and post-viral asthenia syndrome. The results of a metaanalysis published in 2017, based on 531 clinical studies, demonstrated that the use of meglumine acridone acetate as a prophylactic and therapeutic agent for acute respiratory diseases, acute respiratory viral infections and influenza in children and adults more than 5 times increases the chances of preventing the development of the disease or transferring it its in a lighter form.
Pediatrics. Consilium Medicum. 2020;(1):52-57
pages 52-57 views

CLINICAL AND IMMUNOLOGICAL FEATURES IN ACUTE RESPIRATORY-VIRAL INFECTIONS IN CHILDREN WITH BRONCHIAL ASTHMA

Melnikova I.Y., Buryak V.N., Dudko M.V., Melnik S.I., Batrachenko N.V.

Abstract

Aim. To study the immune status during acute respiratory viral infections (ARVI) in children with bronchial asthma (AD). Materials and methods. We examined 96 children aged 3 to 7 years during the development of ARVI. At the same time, 62 children (the main group) suffered from AD, 34 - did not have a history of allergy and constituted a comparison group. The control group included 20 healthy children of a similar age. The levels of interferons a and g, interleukins (IL)-4, IL-5, IL-13, CD3+, CD4+, CD8+, CD22+, immunoglobulins (Ig) A, M, G, E were determined in all patients. Results. It was found that acute respiratory viral infections in children with AD are characterized by a complicated and torpid course, an increase in the duration of the main syndromes and the overall duration of the disease (in the main group 15.47±0.56 days, in the comparison group - 9.35±0.74 days; p<0.001). The immune status of children with AD during ARVI is characterized by a significant (p<0.05) lower relative content of T lymphocytes (CD3+) in the blood, an increase in the level of total IgE and a decrease in the concentration of serum IgA in all periods of ARVI. Conclusion. The immune status of children with AD during the period of acute respiratory viral infections is characterized by inhibition of both cellular and humoral immunity, which persists at the time of clinical recovery.
Pediatrics. Consilium Medicum. 2020;(1):58-61
pages 58-61 views

SYMPOSIUM "MODERN APPROACHES TO THE MANAGEMENT OF PATIENTS WITH ACUTE RESPIRATORY INFECTIONS IN THE OUTPATIENT PRACTICE OF A PEDIATRICIAN" (REVIEW)

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Abstract

The issues of prevention and treatment of acute infectious diseases of the upper respiratory tract remain one of the most pressing problems of modern medicine. Measures for the prevention and treatment of acute respiratory infections (ARIs) in the daily practice of a pediatrician were discussed during the satellite symposium “Modern approaches to the management of patients with ARI in the outpatient practice of a pediatrician”, held as part of the XXII Congress of Pediatricians of Russia with the international participation “Actual problems of pediatrics”.
Pediatrics. Consilium Medicum. 2020;(1):62-71
pages 62-71 views

VIOLATIONS OF THE VENTILATION FUNCTION OF THE LUNGS IN CHILDREN WITH SEVERE NEUROGENIC AND DYSPLASTIC DEFORMITIES OF THE SPINE

Chelpachenko O.B., Fisenko A.P., Zherdev K.V., Yatsyk S.P., Simonova O.I.

Abstract

Aim. Comparative evaluation of ERF in children with dysplastic and neurogenic spinal deformities and the determination of their correlation with the radiological parameters of the severity and mobility of the deformation. Materials and methods. A comparative clinical and radiological study was carried out to determine the parameters of the external respiration function (ERF) in children with severe dysplastic (61 patients), neurogenic spinal deformities (30 patients) and conditionally healthy children without spinal deformities (reference group - 30 children) over the age of 6 under 17 years old. Patients were hospitalized in the neuro-orthopedic department of the Research Institute of Pediatric Surgery FSAI "Scientific Research Center for Children's Health" from 2010 to 2020 to further examine and perform surgical correction of spinal deformity. Results. Significantly more severe disturbances of the ERF were revealed in children with neurogenic spinal deformities, which were accompanied by a decrease in conductivity along the bronchi of all calibers: large, medium and small, as evidenced by the indicators MOS25(%D), MOS50(%D) and MOS75(%D), while dysplastic deformities of the spine were characterized mainly by impaired conduction in the small bronchi - MOS75(%D). Conclusions. A high correlation was established between the radiological indicators of the severity and mobility of spinal deformity with revealed impairments of the ERF, to a greater extent in patients with neurogenic scoliosis, which allows us to judge the severity of the course of scoliotic disease and make a timely decision on the need for surgical correction.
Pediatrics. Consilium Medicum. 2020;(1):72-76
pages 72-76 views

EFFICACY AND SAFETY OF ENDOSURGICAL BIOPSY IN CHILDREN WITH CHRONIC LIVER DISEASE

Khrolenko P.V., Yatsyk S.P., D'yakonova E.Y., Surkov A.N., Tumanova E.L., Gusev A.A., Kulikov K.A.

Abstract

Background. A variety of pathomorphological manifestations of chronic liver diseases (CLD) in children necessitates a sufficient size for a reliable morphological assessment of the size of the hepatobioptate. Marked fibrotic changes in liver tissue and the presence of a high incidence of hemostatic disorders increase the risk of complications during a biopsy. In view of this, the liver biopsy method should be selected in accordance with the amount of biopsy material necessary for an accurate verification of the diagnosis, being the most effective and at the same time the safest with respect to the risks of complications both during the biopsy and in the postoperative period. Materials and methods. The one-center bi-directional (retro- and prospective) study included 175 patients with CLD: 75 children who made up the main group had a liver biopsy by edge resection, and 100 patients with CLD included in the comparison group had previously undergone a biopsy. A comparative analysis of the duration of the biopsy, the presence and nature of the complications, the number of portal tracts contained in the obtained samples, the number of fragmented and uninformative biopsy samples during the behavior of the puncture biopsy and marginal resection of the liver tissue under laparoscopic control was performed. Results. Hepatobioptate marginal resection took an average time of 21.7 minutes. No complications were noted. A puncture biopsy took an average of 19.4 minutes. In four cases, the development of complications was noted (two cases being the bleeding from the puncture site, one case being a violation of the integrity of the gallbladder wall with the development of local biliary peritonitis, the development of pneumothorax due to lung damage). According to the Mann - Whitney criterion, statistically significant differences in the number of portal tracts in the main and comparison groups were revealed (p=0.000). The number of portal tracts during the regional resection of the hepatobioptate averaged 93, while those happened during the puncture averaged 5. The information content of the biopsy samples in the main group was 100%. Fragmentation of biopsy material was not noted. In the comparison group, the informative value of biopsy samples was 86%, 20% of biopsy samples were fragmented.
Pediatrics. Consilium Medicum. 2020;(1):77-81
pages 77-81 views

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