No 4 (2021)


Results of a survey of mothers helped to clarify the reasons for the "failure" of breastfeeding in the Russian Federation

Kuchina A.E., Zakharova I.N.


Background. Breast milk is the most important food for the infant. A strong body of evidence now exists to show the health benefits of breastfeeding (BF) for infants. There is a growing conviction among some of today's young mothers to remain naturally breastfed and to fight for every drop of milk. However, despite UNICEF's investment in programmes to support the sustainability of breastfeeding, there is no consistent trend towards increased longevity.

Aim. We seek to understand in detail the reasons behind the obstacles to successful, long-term breastfeeding in every single region of Russia.

Materials and methods. We surveyed 801 women who had completed breastfeeding and selected the most comprehensive 459 questionnaires.

Results. Analysis of the obtained data allowed us to identify a number of predictors of premature lactation completion, to identify conditions under which women are able to breastfeed their infants for a long time, and to reveal a number of "pain points" of BF in our country.

Conclusion. We call upon paediatricians to improve their knowledge and to become specialists in the area of breastfeeding by focusing their preventive work on safeguarding and supporting breastfeeding.

Pediatrics. Consilium Medicum. 2021;(4):312-322
pages 312-322 views

Nutritional status analysis in preterm infants on different types of feeding

Ovchinnikova T.V., Taranushenko T.E., Salmina A.B., Karpova L.N., Antsiferova E.V.


Breathing newborns born prematurely is a challenging task of modern perinatology. One of the main factors determining the normal growth and development of newborns (especially premature babies) is adequate nutrition. Assessment of nutritional adequacy includes anthropometry data in the dynamics, analysis of nutritional tolerance and, when indicated, a set of laboratory tests, of which the most important are clinical laboratory results (hemoglobin and traditional parameters of erythrocyte evaluation) and biochemical parameters characterizing protein metabolism (including indirect method of assessment of visceral protein reserves by urea level), iron supply, vitamin status, etc. Data on the nutritional status of premature infants in the period of newborn feeding are very scarce and controversial in the modern scientific literature, which determines the need for further studies on this problem.

Aim. To study the parameters of nutritional status (hemoglobin, total protein, albumin, creatinine, urea, plasma glucose) at birth, in dynamics on 10, 20, 30 days of life in the preterm infants with very low (VLBW) and low body weight (LBW) at birth on different types of feeding (breast milk – GM, GM in combination with fortificator and artificial nutrition – AI) to assess measures of feeding success and quality of nursing.

Materials and methods. The study of 118 infants aged from birth to 1 month of life in the Department of Pathology of Newborn and Premature Babies, Krasnoyarsk Regional Perinatal Center of Maternal and Child Health Protection. Group 1 consisted of 50 infants with OMT at birth, of whom 3 subgroups were formed depending on the type of feeding: breastfed (HB) – 17 infants, "enriched" GM (HB + fortificator) – 17 children, IV feeding - 16 children; Group 2 consisted of 68 children with OMT at birth, of whom 36 were on HB, 12 were on HB + fortificator, 20 were on IV.

Results. Assessment of the nutritional status of neonates with NFMT during IM revealed specific features in the development of early anemia of prematurity (10% of cases), high values of total protein in children by the end of the observation period in combination with increasing urea at all stages of observation and a higher creatinine level on day 20 of life. The incidence of early anemia of prematurity was comparable between the subgroups on different types of feeding and lower levels of total protein, albumin, and urea in the subgroup of children receiving HF + fortificator were obtained in the group of neonates with NMT.

Pediatrics. Consilium Medicum. 2021;(4):323-329
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Gut microbiota and obesity. Can probiotics help?

Zakharova I.N., Berezhnaya I.V., Simakova M.A.


The high prevalence of obesity in children and adolescents, the complexity of therapy, a large number of comorbid conditions dictate the need for ongoing research into the causes of obesity and methods for its prevention. One of the newest and most promising aspects to study influencing the formation of obesity is the gut microbiota. The proposed mechanisms linking the gut microbiota to obesity are realized through strain-specific effects of bacteria on changes in the host's metabolism. Probiotics affect the microbiota directly by modulating its composition and indirectly through bacteriocins produced by probiotic bacteria. There is great scientific interest in the use of probiotics as part of therapy or for the prevention of obesity.

Pediatrics. Consilium Medicum. 2021;(4):330-334
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Polyunsaturated fatty acids: omega-3 and omega-6 and nonalcoholic fatty liver disease

Berezhnaya I.V., Zakharova I.N., Simakova M.A., Sgibneva A.I.


The history of the study of polyunsaturated fatty acids (PUFAs) began over 100 years ago. In 1909. P. Hartley isolated arachidonic acid. Later, 21 years later, Burr and Burr in 1930 showed its positive effect on the growth and development of rats. The important thing about this work was that after reintroduction of PUFAs into the diet of rodents, body functions began to recover. It took over 60 years from the time of the discovery of arachidonic acid to prove its effect on the cardiovascular system. Today, research into the effects of long-chain PUFAs on human health, intelligence, the immune system, neuronal connections, the course of pregnancy and infant health has led to recommendations for the widespread use of foods or supplements containing omega-3 PUFAs. Unbalanced diets in children and adolescents, selective appetite, and eating disorders lead to the development of deficit conditions, cognitive impairment, obesity, and metabolic syndrome with liver damage. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are asymptomatic in the early stages, but it is during this period that the prognosis in children can be changed. This article reviews international recommendations for the integrated use of long-chain PUFAs in the treatment of NAFLD and NASH in children. Supplementation of the diet with high-quality purified fish oil replenishes the requirement, improves disease prognosis, reduces insulin resistance and the level of liver fibrosis in patients with NAFLD and NASH.

Pediatrics. Consilium Medicum. 2021;(4):335-340
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Familial hypercholesterolemia: cascade screening along the “child–parent” pathway

Sadykova D.I., Galimova L.F., Slastnikova E.S., Kim Z.F., Khaliullina C.D., Salakhova K.R.


Familial hypercholesterolemia (FH) is the leading cause of premature cardiovascular disease and the most common disorder of lipid metabolism in childhood. Early diagnosis of FH and an effective patient monitoring strategy are extremely promising for reducing the risk of atherosclerosis in the future.

Aim. Conduct and analyze the results of cascade screening along the “child–parent” path for the diagnosis of FH.

Materials and methods. The study was carried out in the period from December 2018 to August 2021 on the basis of Children's Republican Clinical Hospital, City Clinical Hospital No.7 in Kazan, Kazan State Medical University. Inclusion criteria: age 0–17 years inclusive, diagnosed with “Heterozygous form of familial hypercholesterolemia” in accordance with clinical guidelines according to the criteria of the Simon Broome Registry, informed consent for participation in the study of children and/or their parents. Exclusion criteria: underlying diseases/conditions, as well as drugs that may cause a secondary increase in low-density lipoprotein cholesterol.

Results. During this period, 34 children were identified with a diagnosis of heterozygous FH (mean age 8.7±3.6 years). After further examination of relatives, FH was diagnosed in 33 parents, 15 siblings, 56 relatives of the 2nd line of relationship. The average age of the parents was 38±4.3 years. In 20 (60.6%) of them ischemic heart disease was diagnosed, in 18 (54.5%) atherosclerosis of the brachiocephalic arteries. In addition, 10 (30%) patients required coronary angiography, 3 (9%) – coronary artery bypass grafting, 2 (6%) – stenting of coronary vessels.

Conclusion. The diagnostic result of the cascade screening along the “child–parent” path was 3 new cases of FH per one child-proband.

Pediatrics. Consilium Medicum. 2021;(4):342-345
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Obesity is an important paediatric problem that paediatricians and endocrinologists should address together

Berezhnaya I.V., Simakova M.A., Zakharova I.N.


The increasing incidence of obesity in children and adolescents with its negative health consequences is one of the global problems of paediatrics and paediatric endocrinology. Approaches to the management of obese children are being developed and scientific and practical programmes for prevention and treatment are being established. Correctly assessing the risks of obesity in the long term and knowing how to influence them can help to reduce these risks. The primary care physician's priority is to make a diagnosis of overweight and obesity in children and to determine appropriate screening and treatment according to current clinical guidelines and known scientific evidence. The aim of this review is to briefly describe the risk factors, current epidemiological features of obesity and to provide a primary screening plan for children with exogenous obesity to assist the practicing paediatrician and paediatric endocrinologist.

Pediatrics. Consilium Medicum. 2021;(4):346-350
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New technologies in the control of the course of diabetes mellitus in children (continuous monitoring of glycemia): what a pediatrician should know

Taranushenko T.E.


The purpose of this publication is to provide pediatricians with modern methods of controlling the course of diabetes mellitus in children and adolescents. The paper discusses the modern possibilities of optimizing the observation of children with type 1 diabetes mellitus in a polyclinic. In accordance with the recommended standards of medical care, the method of continuous monitoring of glycemia at the stage of primary medical and primary specialized medical care of blood glucose control is discussed. Advantages (procedure, analysis of key indicators and their information content).

Pediatrics. Consilium Medicum. 2021;(4):351-356
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The most frequent ichthyosis in children's practice: how we can help the patient

Melnichenko O.O., Krasnikova V.N., Smolkina O.Y., Korsunskaya I.M.


The most common ichthyoses are vulgar and X-linked ichthyosis. Common in the pathogenesis of both types is a violation of the barrier function of the skin and increased transepidermal moisture loss. The clinical manifestations of these types of disease have some differences. As for the prevalence of ichthyosis, in recent years in Moscow there has been an increase in the incidence of both in the general population and in children. It is worth noting that ichthyosis has a very significant negative impact on the quality of life, especially in childhood. However, rational choice of therapy and means of care can improve the lives of our patients. The treatment regimen should include products with a long-lasting effect of increasing skin hydration. It is also necessary to pay attention to the choice of bathing products, avoid formulations containing potential allergens, which is especially important in cases where ichthyosis is combined with atopic dermatitis.

Pediatrics. Consilium Medicum. 2021;(4):357-360
pages 357-360 views

On the importance of implementing the vitamin D deficiency in children and adolescents of the Russian Federation program to improve anti-infectious immunity and long-term health prognosis in children

Malyavskaya S.I.


The article presents the literature data on the immunomodulatory properties of vitamin D and the results of studies in which the increased risk and frequency of various respiratory infections in children with its deficiency were noted. Vitamin D belongs to the class of secosteroids and, having a pleiotropic mechanism of action, plays an important role in maintaining basic regulatory functions in the body during all periods of ontogenesis. As numerous studies show, adequate provision of vitamin D helps to reduce morbidity, including infectious, and its low level is associated with many negative aspects in relation to a number of diseases (cancer, allergies, autoimmune, cardiac). The ability of vitamin D to act as a protective factor, providing an immunomodulatory response and, conversely, in the presence of deficiency to act as a risk factor for the development and course of respiratory viral infection makes it relevant to search for relationships and causal factors. Use of vitamin D preparations is necessary for prevention and treatment of children and adults at complex approach to therapy of infections, including SARS-CoV-2.

Pediatrics. Consilium Medicum. 2021;(4):362-368
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Difficulties of evaluation of pyeloectasia in children

Konoplev V.D., Zabotina E.K., Guseva N.B., Runkova M.V., Korsunskiy A.A., Bozhendaev T.L.


Pyelectasis is one of the most common pathologies on the part of the urinary system, which is detected by ultrasound examination carried out for medical reasons or during medical examination. When a pronounced pathology from the urinary system is detected, the question of management tactics does not arise. The child is sent for a consultation with a urologist (nephrologist) for an examination in order to clarify the diagnosis. But much more often pyelectasis is not large, and its assessment presents certain difficulties.

Aim. To study and analyze the protocols of ultrasound examination according to the data of outpatient records of patients observed by a nephrologist, urologist with a diagnosis of pyeloectasia.

Materials and methods. Outpatient records of 112 children aged from 1 month to 17 years old were analyzed; clinic with diagnoses: pyelectasis and pyelectasis in combination with urinary tract infection, cystitis, neurogenic bladder, enuresis.

Results. A comparative analysis of ultrasound studies performed at the place of residence and repeated in our center, subject to the water regime, with sufficient filling of the bladder and after emptying, was carried out. The dynamics of pyeloectasia at various intervals and the pathology revealed after additional examinations, which required surgical treatment, is shown. The article discusses the errors and difficulties in the diagnosis of pyeloectasia in children, the frequent combination of this pathology with an infection of the urinary system, neurogenic bladder, vesicoureteral reflux.

Conclusion. The preparation for ultrasound examination of the urinary system is substantiated. When evaluating the results of ultrasound, it is necessary to take into account the clinical and laboratory data to make a decision on the tactics of patient management.

Pediatrics. Consilium Medicum. 2021;(4):369-372
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Prevention of acute respiratory infections in children early age with chronic herpetic diseases infections

Pervishko O.V., Soboleva N.G., Baum T.G., Levchenko A.A.


Background. Primary viral infection most often results in acute disease, but prolonged persistence with emerging clinical manifestations may be considered a marker of immune malaise. Cytomegalovirus (CMV) and Epstein–Barr virus (EBV) directly suppress interferonogenesis and affect the ability to adequately respond to new viral agents.

Aim. To investigate the efficacy of prophylaxis of acute respiratory infections in infants with chronic herpes infections with interferon α-2b suppositories and aqueous vitamin D solution.

Materials and methods. The comparative study enrolled 214 infants with persistent herpes infections (CMV, EBV). Two observation groups were formed, the main group received interferon α-2b preparations in suppositories, 125,000 mg, 1 suppository 2 times a day, 3 times a week for 1 month, in combination with vitamin 25(OH)D in prophylactic doses depending on serum levels. The control group received no prophylactic treatment after herpetic infections. After completion of vitamin D therapy course quantitative content of CMV, EBV in blood, saliva, urine, concentration of serum level of vitamin 25(OH)D was determined by polymerase chain reaction method, and in case of deviation from normal values the treatment course was continued up to 6 months.

Results. The chosen scheme of prophylaxis significantly (p≤0.05) reduced the number of recurrent respiratory diseases and bacterial complications during a year in the study group. The average duration of acute respiratory infections in the control group was 12.9 days, which was 5 days longer than in the main group of patients. An exacerbation of CMV and EBV infection was more common in the control group, occurring in 31 (48.4%) children. These stabilizing clinical pictures were confirmed by laboratory indexes in the form of reduced viral activity of CMV, EBV, determined by polymerase chain reaction.

Conclusion. Administration of interferon α-2b in suppositories of 125,000 mg and an aqueous solution of vitamin D in infants decreases frequency, duration and severity of new-onset acute respiratory infections in children against the background of underlying pathology. Optimal level of vitamin D increases local reactivity of nasopharyngeal mucous membranes and normalizes immunoreactivity of the child's organism.

Pediatrics. Consilium Medicum. 2021;(4):374-377
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Clinical tasks

Holodova I.N.


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

Pediatrics. Consilium Medicum. 2021;(4):378-380
pages 378-380 views

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