No 3 (2021)


Pneumonia in newborns

Ovsyannikov D.Y., Boitsova E.V.


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.

Pediatrics. Consilium Medicum. 2021;(3):214-223
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Rhinitis in children of the first years of life

Karpischenko S.A., Tikhomirova E.K.


Nasal breathing disturbance in young children is a serious problem, since the anatomical features of the structure of the nasal cavity and nasopharynx in young children can become a background for the development of complications. Regardless of the form of rhinitis, the leading symptoms are nasal congestion and rhinorrhea. Many over-the-counter drugs are used to relieve rhinitis symptoms, but the vast majority of these drugs are contraindicated for babies. Among the safe and effective drugs that eliminate the main symptoms of rhinitis, the topical decongestant spray Otrivin “For children” and the nasal aspirator Otrivin Baby with drops for irrigation of the nasal cavity are used. These products are specially designed for children in the first years of life, have a high safety profile and effectively eliminate nasal congestion and discharge, quickly restoring the well-being of the youngest patients.

Pediatrics. Consilium Medicum. 2021;(3):224-230
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Specific features of electrocardiograms in infants with intrauterine growth restriction and developmental delays

Derevtsov V.V., Ivanov D.O., Shcherbakova M.Y., Romanyuk F.P., Chumakova G.N., Chistyakova G.N.


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.

Pediatrics. Consilium Medicum. 2021;(3):231-238
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The results of monitoring children with a new coronavirus infection, hospitalized in the infectious diseases department

Samigullina N.V., Faizullina R.M., Viktorov V.V.


Aim. The analysis the clinical, laboratory and instrumental data and the results of therapy of children hospitalized with the new coronavirus infection in the infectious clinic hospital.

Materials and methods. The analysis of the clinical course of the disease was carried out in 105 children aged 1 month to 17 years with confirmed COVID-19 infection, hospitalized in the infectious diseases hospital of the clinic. The examination included physical examination, determination of ferritin, coagulogram, IL-6, markers of bacterial infection – procalcitonin and C-reactive protein, PCR diagnostics for detecting SARS-CoV-2 RNA in swabs from the nasopharynx and oropharynx, microbiological examination of nasal swabs and pharynx, pulse oximetry, computed tomography of the chest organs, specialist consultations according to indications.

Results and discussion. A large proportion of the patients were school-age boys. The etiology of the disease caused by the SARS-CoV-2 virus was confirmed by PCR. It was found that more often the disease was accompanied by complaints characteristic of asthenic syndrome, fever and cough. The main clinical forms of the disease were acute viral infection and pneumonia without respiratory failure of moderate severity. In most children, the infection proceeded without damage to the lung tissue or with minimal damage to the lung parenchyma. A more severe course of infection with the development of respiratory failure was noted in schoolchildren and adolescents. In 42.9% of children were revealed multimorbid conditions. The most common conditions were iron deficiency anemia and autonomic dysfunction. The most severe course of infection was noted in children with hematological malignancies. In laboratory tests, children showed leukopenia, an increase of ferritin and activation of thrombus formation. 51.4% children were discharged in 11–14 days of the disease. Deaths were in 1.9% of patients with leukemia.

Pediatrics. Consilium Medicum. 2021;(3):239-243
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Nasal pathology as a cause of lacrimation in children

Karpishchenko S.A., Rodneva Y.A., Karpov A.A.


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.

Pediatrics. Consilium Medicum. 2021;(3):244-248
pages 244-248 views

The human microbiome, respiratory viral infections and probiotics: practical benefits

Kapelovich M.B.


Interview with Professor Irina N. Zakharova.

Pediatrics. Consilium Medicum. 2021;(3):249-254
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Diagnosis of immunodeficiency conditions. Overview of the training event. Speakers I.N. Zakharova, I.A. Korsunsky


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.

Pediatrics. Consilium Medicum. 2021;(3):255-260
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Violation of the neuro-humoral regulation of the act of urination

Bozhendaev T.L., Guseva N.B., Goncharov N.P.


The pathology of urination in childhood is now a frequent problem with which they turn to a pediatric urologist. Taking into account children's morphofunctional immaturity, the formation of a mature type of urination is associated with the maturation of nerve structures and the formation of hormonal levels. The detrimental effect of the “benefits” of civilization on the formation and maturation of a child entails functional disorders both in the formation of the nervous system and in hormonal maturation. The body's regulation is based on neuro-humoral control. Impaired coordination and harmonious interaction of this control is carried out in the hypothalamic region, the dysfunction of which determines functional disorders in children.

Pediatrics. Consilium Medicum. 2021;(3):262-264
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Modern approaches to surgical treatment of children with osteogenesis imperfecta

Solodovnikova E.N., Zherdev K.V., Chelpachenko O.B., Ovechkina A.A., Yatsyk S.P., Timofeev I.V.


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.

Pediatrics. Consilium Medicum. 2021;(3):265-270
pages 265-270 views

Vitamin D suppiciency and cardiovascular risk factors in adolescence and young adulthood

Malyavskaya S.I., Kostrova G.N., Lebedev A.V.


Background. Vitamin D deficiency is common worldwide in all age groups, including children and adolescents, and is associated with adverse health outcomes. Evidence from observational studies indicates that vitamin D deficiency is associated with pathogenetic mechanisms of cardiovascular disease.

Aim. To assess vitamin D availability and prevalence of cardiovascular disease risk factors in adolescents and young adults.

Materials and methods. The cross-sectional clinical and laboratory study was carried out including schoolchildren aged 10–15 years (319 subjects), of whom 49.2% were girls, mean age 13.3±1.6 years; young adults aged 18–24 years (278 subjects), of whom 77% were girls, mean age 19.9±1.5 years, living in Arkhangelsk, Russia.

Results. The median level of 25-hydroxyvitamin D – 25(OH)D in schoolchildren was 15.7 (12.2–19.2) ng/ml, in young adults – 20.5 (14.9–26.9) ng/ml. The proportion of study participants with normal 25(OH)D levels (30 ng/ml or more) among schoolchildren was 1.6% and 19.0% among young adults. Both schoolchildren and young adults were found to have a high prevalence of cardiovascular risk factors. Proatherogenic metabolic abnormalities were found to be associated with low 25(OH)D levels.

Conclusion. The results obtained point to the necessity of implementing measures to prevent vitamin D deficiency in the groups indicated in the national program "Vitamin D Deficiency in Children and Adolescents in the Russian Federation: Modern Approaches to Correction".

Pediatrics. Consilium Medicum. 2021;(3):271-276
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Heart failure in children and adolescents (high yield topics for primary care pediatrician)

Delyagin W.M., Lukjanova I.V.


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.

Pediatrics. Consilium Medicum. 2021;(3):277-284
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Sleep disorders in children with rheumatic diseases

Kelmanson I.A.


Rheumatic diseases (RD) are often diagnosed in childhood. Sleep disorders are commonly associated with RD in children. It is stressed that sleep disorders found in this type of clinical pathology cannot be exceptionally considered as an epiphenomenon typical to any form of chronic disease; rather, sleep disorders should be regarded as a part of the clinical manifestations of RD. An important role in the origins of this association is played by specific inflammatory mediators involved in the pathogenesis of various RD, which simultaneously affect the structure of sleep and contribute to sleep disorders. There are both nonspecific and characteristic variants of sleep disorders detected in some leading clinical forms of RD in children, in particular in juvenile rheumatoid (idiopathic) arthritis, systemic lupus erythematosus, systemic scleroderma, seronegative spondyloarthropathies, fibromyalgia. There is a relationship between the severity of sleep disorders, the activity of RD, the degree of emotional disorders and pain symptoms in children. Approaches to the correction of sleep disorders in children in the context of the treatment of RD are substantiated.

Pediatrics. Consilium Medicum. 2021;(3):285-291
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Obesity and oxidative stress in children and adolescents

Peresetskaia O.V., Kozlova L.V., Bekezin V.V.


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.

Pediatrics. Consilium Medicum. 2021;(3):292-297
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Clinical tasks

Kholodova I.N.


The heading is headed by Doctor of Medical Sciences, Professor I.N. Kholodov, Department of Pediatrics. G.N. Speransky.

Pediatrics. Consilium Medicum. 2021;(3):298-300
pages 298-300 views

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