No 3 (2021)

Depending on the time and conditions of infection, neonatal pneumonia is divided into intrauterine and postnatal, which can be community-acquired, nosocomial, ventilator-associated, aspiration. Congenital pneumonia, which is difficult to distinguish from the respiratory distress syndrome of newborns – is a component of generalized infection of the fetus and newborn. According to the time of clinical manifestations, neonatal pneumonia is divided into early (the first week of life) and late (8–28 days of life). The etiology of pneumonia in newborns depends on the time, path and conditions of infection. The diagnosis of pneumonia in newborns is determined by the level and equipment of the clinic and is based on the determination of antenatal and postnatal risk factors, respiratory and general symptoms, radiological signs, markers of the systemic inflammatory reaction/bacterial infection syndrome and the results of etiological diagnosis. The deterioration of the newborn's condition on a ventilator can be associated not only with ventilator-associated, but also with other fan-associated events (fan-associated condition; ventilator is an associated event in children receiving antimicrobials), the causes of which may be pulmonary edema, atelectasis, acute respiratory distress syndrome, recent surgical procedures, sepsis, the formation of bronchopulmonary dysplasia. For the initial therapy of early neonatal pneumonia, a combination of ampicillin with gentamicin is used. In case of late neonatal pneumonia that occurred in a hospital, primary therapy should necessarily include anti-pseudomonas and anti-staphylococcal antibiotics. For community-acquired pneumonia in newborns, antibiotics acting on gram-negative bacteria (inhibitor-protected beta-lactams, cephalosporins of the third generation, aminoglycosides) are prescribed.

Aim. Assessment of electrocardiographic indicators in infants born on time with delayed intrauterine growth and mild development.

Materials and methods. Under the supervision of 164 infants. From mothers with an aggravated somatic and obstetric-gynecological history, 139 children were born: 71 (gr. 1) – with delayed intrauterine growth and development of mild severity, 68 (gr. 2) – without delayed intrauterine growth and development. The control group (gr. 3) consisted of 25 practically healthy children born to practically healthy mothers. All children were born full-time. They were examined in dynamics at the age of 1 (n=154), 3 (n=142), 6 (n=133), 12 (n=130) months. A comprehensive analysis of the data of history, physical examination, electrocardiography was carried out. There was no medical intervention. The duration of the study is 3 years. Heart rate, incidence of early ventricular repolarization syndrome and nonspecific disorders of the repolarization process were evaluated; in the II standard retraction, morphology, amplitude in millimeters and width in seconds of the tooth P; duration in seconds of PQ interval (PR), QRS complex and QT interval; morphology, amplitude in millimeters of tooth T. Non-parametric methods of statistical analysis were used.

Results. The median amplitude of the tooth P on day 2–3 in children of subgr. 1b, compared with children of gr. 3, is 0.2 mm less; 1 month in children of gp. 1 (1b), compared with children of gp. 3, less by 0.1 mm; at 3 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.35 mm, in children of subgp. 1b, compared with children of gp. 3, more by 0.2 mm; at 6 months in children of gp. 1 (1a and 1b), compared with children of gr. 3, more by 0.2 mm; at 12 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.2 mm, in children of subgp. 1b, compared with children of gr. 2, more by 0.2 mm, in children of gp. 1 (1a), compared with children of gr. 3, less by 0.2 (0.5) mm, and, compared with children of gr. 3, less by 0.2 mm. From 3 to 6 months increased in children of subgp. 1a by 0.35 mm. In children of gp. 1st (1a), a slowdown from 2–3 days to 1 month of intradermal conduction by 0.01 s, from 1 to 3 months of intraventricular conduction by 0.01 s, from 3 to 6 months of intradermal conduction by 0.01 s. Electrical systole in children of gr. 1 slowed from 1 to 3 and from 3 to 6 months by 0.01 s; in children of subgp. 1a from 1 to 3 months increased by 0.01 s, from 3 to 6 months decreased by 0.01 s, from 6 to 12 months increased by 0.01 s. Median tooth amplitude T on 2–3 days, 1 month in children of gp. 1 (1a and 1b), compared to children of gr. 3, more by 0.4 mm and 0.3 mm, respectively; at 3 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.35 mm, and, compared with children of gr. 2, less by 0.2 mm, in children of subgp. 1b, compared with children of gr. 2 more by 0.15 mm, in children of gp. 1 (1b), compared with children of gr. 3, more by 0.3 (0.45) mm; at 12 months in children of subgp. 1b, compared with children of gr. 2, more by 0.4 mm, in children of gp. 1 (1a), compared with children of gp. 3, less by 0.3 mm. From 2–3 days to 1 month in children of gp. 1 (1a) increased by 0.8 mm.

Conclusion. Certain peculiarities of electrocardiogram in dynamics of growth and development of the organism of infants born on time with delay of intrauterine growth and development of mild severity related to volume overload of atrium, enlargement of interventricular septum, hypoxia, sympathetic activity, requiring corrective events are revealed.

Lacrimation or epiphora is one of the most common complaints in pediatric ophthalmic practice, indicating the presence of lacrimal duct obstruction. It is customary to distinguish between congenital or primary obstruction of the nasolacrimal duct – the most common cause of lacrimation in newborns and children in the first year of life. Secondary or acquired dacryostenosis, characteristic of children from one year and older, most often has a rhinogenic origin, is more difficult to treat, and often leads to the development of complicated forms of the disease. Assessment of the cause of the epiphora is the key to making the correct diagnosis and choosing the optimal treatment tactics, conservative and/or surgical. A multidisciplinary approach, the interaction of an otorhinolaryngologist and an ophthalmologist is of great importance, which ensures the final successful result of lacrimation treatment in children.

Primary immunodeficiencies (PIDs) are a heterogeneous group of genetic diseases. When PID is suspected, first of all, it is necessary to carefully collect the anamnesis, identify the features of clinical symptoms and the course of diseases in the child. To confirm the diagnosis, laboratory and instrumental methods of examination, immunological examination, and molecular genetic analysis are evaluated. As part of the immunological examination, as a screening method for detecting abnormalities in the T and B-cell parts of the immune system, a technique can be used to measure TREC (T-cell Receptor Excision Circle) and KREC (Kappa-deleting Recombination Excision Circle) levels – by-products of T and B-cell receptor formation. A decrease in the amount of TREC and/or KREC in the blood indicates the presence of cellular PID. The assay can be performed using both whole blood and dried blood spots in children and adults.

Osteogenesis imperfecta (OI) is a heterogeneous group of diseases with different types of inheritance, characterized by frequent fractures and deformities of the bone skeleton. Conservative and surgical treatment of children with this pathology is an integral part of a multidisciplinary approach. In the surgical treatment of bone deformities in children with OI, the method of choice is corrective osteotomies, and an effective method of fixation is intramedullary osteosynthesis. Surgical treatment of children with OI is aimed at reducing the number of fractures, correcting deformities and increasing motor activity. Aim of the study to determine the indications for intramedullary osteosynthesis of long tubular bones in children with the disease. To review the studies concerning treatment of children with OI. Consider the different types of metal fixers, their advantages and disadvantages. Today the technique of intramedullary fixation is the "gold" standard in the surgical treatment of children with OI. There is a clear advantage of telescopic rods in terms of the frequency of reoperations, but their use does not exclude the presence of postoperative complications.

HF in children is a life-threatening polyethiological state with a tendency to progression. There are acute and chronic heart failure, the causes of which are largely determined by age. Depending on the causes and features of hemodynamics, HF can occur with a stored (and borderline) and with a reduced ejection fraction. In early and young childhood, HF is manifested primarily by a decrease in appetite, sweating, decreased physical activity and a slowdown in physical development. At an older age, shortness of breath, edema, and enlargement of the liver are highlighted. The determination of biochemical markers of myocardial insufficiency (natriuretic peptide, troponin) is important for assessing the degree of HF, although the standards for their concentration for different age groups require further refinement. An instrumental study noted a decrease in myocardial contractility. Initially, myocardial oxygen consumption is increasing, which indicates its irrational use and corresponds to increased peroxidation. Subsequently, myocardial oxygen consumption decreases even without signs of coronary pathology. Treatment should include mandatory sufficient calorie intake, sparing regimen, complex drug therapy.

The article presents a review of the literature on the role of oxidative stress in the development of metabolic and cardiovascular disorders in children and adolescents against the background of obesity. It has been shown that oxidative stress should be considered as an early marker of metabolic syndrome. Prescribing drugs with antioxidant activity in the complex treatment of obese children with confirmation of oxidative stress is effective. The article also presents the experience of the authors of the effective use of metabolic therapy in obese children.