No 1 (2022)


Post-covid syndrome in children in rare cases of COVID-19

Zakharova I.N., Osmanov I.M., Tvorogova T.M., Berezhnaya I.V., Makhaeva A.V.


Post-covid syndrome (PCS) is a symptom complex that occurs during and after COVID-19 lasting more than 12 weeks, which is not a possible disease. The clinical manifestations of PCS are many-sided, under their mask or manifestations or exacerbations of chronic organic activity, the trigger of which was the virus, are hidden. PCS is a diagnosis of exclusion. The main manifestations of PCS: autonomic dysregulation, cognitive and psycho-emotional disorders, disorders of the respiratory system, cardiovascular, digestive systems. Direct pathogenic factors, the main neurological manifestations are PCS of preservation of brain hypoperfusion, hypoxia and hypoxemia, resulting in energy deficiency of neuronal structures, violation of the probable, as well as virus-induced structural detection of neurons in the cortex and subcortical structures of the brain. The severity and duration of exposure appear to be increasingly dependent on the body's response to SARS-CoV-2. PCS has a different severity of severity in recovered patients and does not always depend on the severity of the acute period. Timely examination with differential diagnosis allows not only to make a diagnosis, but also to recommend therapy with a personalized approach to the correction of PCS.

Pediatrics. Consilium Medicum. 2022;(1):8-14
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Features of the cardiovascular system in newborns, carrying out the cerebral ischemia

Uzunova A.N., Nazarova M.V.


Aim. To identify the features of the function of the cardiovascular system in newborns with cerebral ischemia (CI) of hypoxic origin.

Materials and methods. In the neurological department of the children's hospital in 64 newborns coming from maternity hospitals with CI, a clinical and instrumental examination confirmed the diagnosis of CI of hypoxic origin after excluding structural damage to cardiomyocytes, infectious, traumatic and dysmetabolic causes of its occurrence; 12.2% of children were diagnosed with CI of easy degree, 81.2% – CI of moderate severity; the control group consisted of 24 healthy full-term children, comparable in age. All patients were examined by a pediatric cardiologist with an electrocardiogram (ECG), echocardiographic ultrasound screening assessment of the heart (ECHO-CG), Holter electrocardiogram monitoring, cardiointervalography.

Results. In newborns, who underwent CI, there is a higher heart rate, more often there is a single supraventricular extrasystole. Bradycardia with heart rate less than 100 beats/min, sino-atrial block II degree, atrioventricular block II degree were recorded only in newborns after CI. According to ECHO-CG data, a hypokinetic type of hemodynamics takes place in newborns with CI. A decrease in cardiac output reflects a narrowing of the adaptive range of its regulation. In every second child with CI, homeostasis is achieved by a sharp overstrain of the autonomic nervous system regulatory systems, which is most likely based on a shift in regulation from the reflex vegetative to the humoral-metabolic type. As the severity of CI progresses, depletion of reserves to support reflex and humoral homeostasis has been established.

Conclusion. In connection with the revealed clinical and instrumental features of the cardiovascular system, newborns with CI who came under the supervision of pediatricians at children's clinics, at the age of one month, in addition to a neurological examination, an examination of a pediatric cardiologist with an ECG is shown. If, according to ECG data, heart rhythm and conduction abnormalities, fluctuations in the duration of the QT interval are detected, CI and/or HM-ECG are indicated to determine further observation tactics.

Pediatrics. Consilium Medicum. 2022;(1):15-19
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Assessment of the state of compensatory resources and the degree of adaptation of the body to environmental conditions in full-term infants: cross-sectional study

Derevtsov V.V., Neudakhin E.V., Antonova L.K., Romanyuk F.P., Ivanov D.O., Kozlova L.V., Bekezin V.V., Chumakova G.N., Chistyakova G.N., Shcherbakova M.Y., Derevtsova A.V.


Aim. Assessment of the state of compensatory resources and the degree of adaptation of the body to environmental conditions in early and full-term infants in comparison with each other and with practically healthy children.

Materials and methods. Under the supervision of 135 infants. 110 were born from mothers with a burdened somatic and obstetric-gynecological history, 41 of them were born at 37–38 weeks (Group 1), 69 at 39–42 weeks (Group 2). The control group (Group 3) consisted of 25 practically healthy children born to practically healthy mothers as a result of physiological pregnancies and childbirth at 38–40 weeks. The children were examined in dynamics at the age of 1 (n=126), 3 (n=116), 6 (n=110), 12 (n=111) months. A comprehensive analysis of the data of anamnesis, physical examination, cardiointervalography was carried out. The following parameters were evaluated initially and in response to the tilt test: mode (М0), mode amplitude (AM0), delta x (∆Х), voltage index (IN). Nonparametric methods of statistical analysis were used.

Results. At the age of 2 to 3 days infants born to women with a history of poor health recorded a significant decrease in the median IN1 value, respectively, in Groups 1, 2, and 3, which indicates a decrease in compensatory reserves, particularly in neonates born at 38–40 weeks. At 1 month of age, Group 1 and 2 had higher median IN1 values of 804 and 746 versus 550 in Group 3, indicating the development of compensatory resource tension, particularly in children born at 37–38 weeks. At 3 months of age, children in group 1 retained a compensatory tension of IN1 resources – 521 versus 468 and 460 in groups 2 and 3. At 6 months of age, there is a slight decrease in compensatory IN1 reservers at 6 months of age in children from women with a history of a history of a history of a history of a disease – 376 and 357 versus 400 in Group 3. At 12 months of age, children in the main groups have even more decreased compensatory resources, especially in group 1 IN1 – 206, 284 and 380 respectively in groups 1, 2 and 3.

Conclusion. The decrease of functional reserve of adaptation in children of groups 1st and 2nd was facilitated by the influence burdened with somatic and obstetric-gynecological history of mothers, regardless of gestational age and subsequently the health characteristics of children themselves. The statistically significant differences found in the state of compensatory resources and the degree of adaptation of the organism to environmental conditions justify the personalized approach, which justifies a personalized approach when choosing rehabilitation measures.

Pediatrics. Consilium Medicum. 2022;(1):20-27
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Features of hereditary thrombosis (analysis of clinical cases in newborns)

Vaganov A.A., Taranushenko T.E., Parshin N.A.


Background. Dysfunctions of hemostasis include conditions occurring both with hemorrhagic syndrome and in the form of thrombosis, the number of which is growing due to the intensification of the therapy. The relevance of the topic is determined by the prevalence of these pathological conditions in newborns, the peculiarities of the hemostasis system in the neonatal period, as well as the difficulties of diagnosis and interpretation of laboratory parameters.

Aim. Studying the features of clinical manifestations and genetic markers in newborns with clinical thrombosis on the background of primary thrombophilia.

Materials and methods. A retrospective continuous analysis of the case histories of newborn children with thrombophilia who were hospitalized at the Krasnoyarsk Regional Clinical Center for Maternity and Childhood Protection in the period from January 2014 to January 2020 was carried out.

Results. The debut of thrombosis in newborns is represented mainly by venous thrombosis of various localizations. Genetic mutations were identified in these patients, which are mainly associated with the work of the folate and methionine cycles (MTHFR: g.677C>T, MTHFR: g.1298A>C, MTRR: g.66A>G and MTR: g.2756A>G). A complicated course was noted in the presence in the genome of the combinations MTHFR: g.677C>T, MTR: g.2756A>G and MTRR: g.66A>G and/or homozygous carriage of MTHFR: g.677C>T, MTHFR: g.1298A>C. The main trigger was peripheral vascular catheterization.

Conclusion. A decrease in the levels of natural anticoagulants in newborns with some physiological features of hemostasis deserves close attention of neonatologists and clinicians, requires an integral assessment of the hemostasis system and additional examinations, including the analysis of genetic changes not only in the hemostasis system, but also in folate and methionine cycles.

Pediatrics. Consilium Medicum. 2022;(1):28-32
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The role of ω3-polyunsaturated fatty acids in the prevention of atherogenic cardiovascular diseases starting in childhood

Zakharova I.N., Osmanov I.M., Pshenichnikova I.I., Skorobogatova E.V., Koba Y.V., Kuznetsova I.S.


Diseases of the cardiovascular system are one of the main causes of morbidity, disability and mortality. One of the most significant risk factors for their development is atherogenic dyslipidemia. Atherosclerotic vascular damage occurs long before clinical manifestation and often begins to progress as early as childhood. This is why children represent the most important cohort for the prevention of cardiovascular diseases of atherosclerotic genesis. Studies show that taking ω₃-polyunsaturated fatty acids reduces the risk of atherosclerotic vascular disease in adults and children. The effect is achieved by multidirectional effects on risk factors such as insulin resistance, obesity, diabetes mellitus, dyslipidaemia, arterial hypertension, inflammation and endothelial dysfunction. In children with primary dyslipidemia (heterozygous familial hypercholesterolemia) taking ω₃-polyunsaturated fatty acids leads to normalization of serum triglycerides and a moderate decrease in total cholesterol and low-density lipoprotein cholesterol. The most significant therapeutic and prophylactic effects are observed in patients with secondary dyslipidemias caused by obesity and diabetes mellitus, when, besides the decrease in triglycerides and the increase in HDL cholesterol, ω₃-polyunsaturated fatty acids increase the insulin sensitivity of cells and tissue, body weight reduction, increase in muscle mass, stabilization of blood pressure and improvement of liver function are observed. Considering pleiotropic protective effect and good tolerability, ω₃-polyunsaturated fatty acids can be widely used for primary and secondary prevention of atherosclerotic cardiovascular diseases in children and adolescents.

Pediatrics. Consilium Medicum. 2022;(1):33-38
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The choice of antihypertensive drugs in the treatment of arterial hypertension in children and adolescents: retrospective study

Kozlova L.V., Krikova A.V., Mikhailova O.S.


Aim. To conduct a study of prescribed antihypertensive therapy in order to determine the criteria for choosing antihypertensive drugs and assess their effectiveness in children with arterial hypertension (AH).

Materials and methods. A retrospective study was carried out. We have analyzed medical records of 102 children with AH aged 6 to 17 years, who were examined and treated at the Smolensk Regional Children's Clinical Hospital in the period from 01.01.2019 to 31.12.2019.

Results. Based on the inclusion criteria, 102 children were selected for the retrospective study, of which 74 (72.6%) were boys and 28 (27.4%) – girls. In 56 (54.9%) patients heredity was burdened by cardiovascular diseases in the line of parents and grandparents, in 46 (45.1%) patients heredity was not burdened. The most frequent complaints registered in the case histories of patients were: 89 (87.3%) – headache, mainly in the occipital region; 18 (17.7%) – dizziness; 16 (15.7%) – stabbing pain in heart; 10 (9.8%) – increased heart rate. In 31 (28.4%) of the examined children, grade I AH was detected; in 56 (54.9%) – grade II AH; 6 (5.9%) – autonomic dysfunction syndrome; 9 (8.8%) had labile AH. As a drug antihypertensive monotherapy for the treatment of hypertension in children and adolescents in the Russian Federation, five main pharmacological groups are recommended: angiotensin-converting enzyme inhibitors (ACE inhibitors); angiotensin receptor blockers; β-blockers; calcium channel blockers (dihydropyridine); thiazide diuretics, which was confirmed by a retrospective analysis. Drug therapy for AH was prescribed to children after 6–12 months of ineffectiveness of non-drug therapy. Of the ACE inhibitors group, 46 (45.1%) patients were prescribed a drug enalapril, 5 (4.9%) – fosinopril, 2 (2%) – captopril. β-blockers 11 (10.7%) patients were prescribed bisoprolol, 1 (1%) patient – atenolol. From the group of angiotensin receptor blockers, 1 (1%) child was prescribed losartan, 1 (1%) – irbesartan. Calcium channel blockers were recommended for 1 (1%) patient as amlodipine. Diuretics were prescribed to 1 (1%) child with the drug indapamide.

Conclusion. Based on our study, it was found that angiotensin-converting enzyme inhibitors are the priority pharmacological group in the treatment of hypertension in children and adolescents.

Pediatrics. Consilium Medicum. 2022;(1):40-45
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Characterization and assessment of endothelial dysfunction in adolescents with obesity and vitamin D deficiency

Todieva A.M., Zvartau N.E., Nikitina I.L.


Background. Obesity and vitamin D deficiency in children are widespread in economically developed countries. Among children with obesity and components of the metabolic syndrome, vitamin D deficiency is more common than in children with a normal body mass index (BMI). The growth of metabolic disorders, atherosclerosis, early onset of type 2 diabetes mellitus lead to fatal vascular accidents in young people, and therefore the search for new ways of early diagnosis of these processes is relevant.

Aim. To study of the relationship of endothelial dysfunction with vitamin D deficiency, obesity and associated metabolic disorders among adolescents in Saint Petersburg.

Materials and methods. 5 adolescents aged 14–16 years (15±0.76 years) with primary obesity were examined. Anthropometric parameters were studied: waist circumference, weight, height, calculation of BMI, stage of puberty according to Tanner. Laboratory examination included the following parameters: serum glucose, cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, insulin, 25(OH)D. Atherogenicity index (AI), insulin resistance index (HOMA-IR), vitamin D sufficiency were calculated. Endothelial function was assessed by the value of the reactive hyperemia index (RHI), automatically calculated by the EndoPAT 2000 device (Itamar Medical, Israel).

Results. All examined patients had abdominal obesity (median BMI 33.5 kg/m2 [30.9; 34.2]) and reduced vitamin D supply (median 25(OH)D 17.2 ng/ml). Hypercholesterolemia and dyslipidemia due to an increase in low density lipoproteins were diagnosed in 1 (20%) case. Dyslipidemia due to a decrease in high density lipoproteins was detected in 3 (60%) patients. An increase in IA was found in 4 (80%) people. Insulin resistance was present in 60% of the examined, the median value of HOMA-IR was 5.6. The median RHI was 1.74 [1.72; 2.13]. Optimum RHI values were observed in 2 (40%) patients; in most (60%) adolescents, the RHI values corresponded to subnormal values and were close to the lower limit of this zone. A significant inverse correlation of RHI with AI was obtained (R=-0.63, p<0.05).

Conclusion. Taking into account the risk factors previously identified in the examined patients (dyslipidemia, insulin resistance, reduced vitamin D supply), endothelial dysfunction in these patients was regarded as a cardiovascular risk factor. A manageable risk factor is a reduced supply of vitamin D, which can be corrected by an additional donation of cholecalciferol.

Pediatrics. Consilium Medicum. 2022;(1):46-52
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Features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks

Pankratova E.S., Chernenkov Y.V., Panina O.S., Kurmacheva N.A., Kuznetsova N.A., Pylaev T.E.


Background. Preterm infants are at high risk for respiratory distress and vitamin D deficiency, which may be associated with a need for intensive care and long-term respiratory support.

Aim. To study the features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks.

Materials and methods. The object of the study were 64 moderate and late preterm infants with respiratory disorders and their mothers. The level of 25(OH)D in cord blood serum was determined by enzyme immunoassay.

Results. 60.9% of children were diagnosed with respiratory distress syndrome (Group 1), 39.1% had congenital pneumonia (Group 2). Mothers of all children had a high incidence of chronic diseases and pregnancy complications. Hypovitaminosis D was detected in 71.8–88% of newborns of both groups, mainly at the stage of deficiency. The median concentrations of 25(OH)D in cord blood serum were 15.41 [12.49–34.25] ng/ml in the 1st group of newborns, and 18.42 [14.01–23.44] ng/mL in the 2nd group. The need for exogenous surfactant administration and CPAP respiratory therapy is significantly higher in neonates with respiratory distress syndrome. Children with congenital pneumonia significantly more often required mechanical ventilation, and they also had a longer total duration of respiratory support in the form of humidified oxygen supplementation. The duration of inpatient treatment in children of both groups with hypovitaminosis D was significantly higher compared to newborns with adequate levels of vitamin D.

Conclusion. Moderate and late preterm infants with respiratory problems should be identified at high risk for hypovitaminosis D, screened for blood levels of 25(OH)D, and developed optimal vitamin D supplementation regimens a promising direction to reduce the risk of preterm birth, neonatal morbidity and reduce the time of inpatient treatment of respiratory disorders.

Pediatrics. Consilium Medicum. 2022;(1):53-58
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Pediatric basics about tumors of hematopoietic and lymphoid tissues in children

Susuleva N.A.


Inspite of hemoblastoses rare incidence in common structure of pediatric morbidity, pediatrician of every specialty face with hemoblastoses in his practice. Nowadays it is possible to cure these fatal in the beginning of 1970s diseases. But it could be realized only in team work of pediatric oncologists, hematologists with primary care pediatrics of hole pediatric medical service. Early diagnosis of hemoblastoses different forms, relapse diagnosis timely, early and delayed treatment complications, realization of rehabilitation action, treatment of comorbid diseases, case follow up – sphere of duties, which could be resolved by doctors team.

Pediatrics. Consilium Medicum. 2022;(1):59-65
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Choline deficiency in the body, clinical manifestations and long-term consequences

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


Choline, a substance essential for the existence of any organism, is the basis for the synthesis of phosphatidylcholine and sphingomyelin, the two main phospholipids of cell membranes. Acetylcholine is the main neurotransmitter of the parasympathetic nervous system, i.e. part of the autonomic nervous system. It affects smooth muscles, vascular wall tone, heart rate and regulates metabolism as a source of methyl groups. Choline enters the body through food and is partially synthesized endogenously. Choline plays an important role in gene expression, cell membrane signalling, lipid transport and metabolism, and early infant brain development. Choline deficiency increases the risk of cardiovascular and metabolic disorders. Current scientific evidence suggests a negative effect of choline deficiency on the development of non-alcoholic fatty liver disease. Choline deficiency is associated with impaired memory, concentration, and cognitive functions. This article deals with the mechanisms of choline influence on the organism and possibility of choline deficiency correction in the organism.

Pediatrics. Consilium Medicum. 2022;(1):66-71
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Assessment of changes in urinalysis from the position of general pediatrician

Chugunova O.L., Yaroshevskaya O.I.


Abnormal findings in urinalysis are one of the most common symptoms kidneys and urinary tract diseases. Authors discuss assessment of changes in urinalysis from the position of general pediatrician. The normal values of protein, erythrocytes, leukocytes, cylinders, crystals, glucose in urine are considered, as evidenced by changes in these parameters, as well as changes of urinary color and specific gravity. The algorithm of the pediatrician's tactics after detection of different degrees of proteinuria, erythrocyturia and leukocyturia is presented. It is shown that with a high degree of severity of changes in urine, especially in combination with arterial hypertension, edema, fever, and other clinical symptoms, needs in emergent specialized impatient medical aid. In other cases, outpatient examination and treatment are recommended. The issues of urinary tract infection (UTI), diagnosed by the presence of piuria and bacteriuria, are discussed. Routine method of UTIs treatment is antibiotic therapy, but the existence of uropathogens in the form of biofilms contributes to their drug resistance, which dictates actuality of alternative therapeutic methods search. In cases without anatomical obstacles to urinary flow, including patients with functional disorders of urination, the application of the phytodrug Canephron® N, which contains three medicinal plants (centaury herb, lovage root and rosemary leaves), can be effective. The drug is prescribed after antibacterial therapy or simultaneously with it, is effective as an anti-relapse therapy, helps to reduce crystalluria and normalize the passage of urine. In vitro experiments show its ability to inhibit the formation of microbial biofilms. The drug in the form of a solution can be prescribed to children aged 1 year and older.

Pediatrics. Consilium Medicum. 2022;(1):72-82
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Functional constipation in children: pediatrician's checklist


Interview with Professor Irina N. Zakharova.

Pediatrics. Consilium Medicum. 2022;(1):84-89
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Resolution of the Council of Experts “Dysbiosis. Immediate and long-term consequences of microbiome disorders and options for their correction with probiotics”

Gorelov A.V., Zakharova I.N., Khavkin A.I., Kafarskaya L.I., Usenko D.V., Belmer S.V., Kornienko E.A., Privorotsky V.F., Krasnov V.V., Kondyurina E.G., Panfilova V.N., Tkhakushinova N.K., Plaksina A.N., Rychkova O.A., Pechkurov D.V., Nizhevich A.A., Fayzullina R.A., Yablokova E.A.


The appearance of new high-tech microbiological research methods has significantly changed the understanding of the human microbiome. The purpose of the meeting of the Council of Experts “Dysbiosis. The immediate and long-term consequences of microbiome disorders and options for their correction with probiotics” was the definition of modern positions about possible methods of studying the intestinal microbiome, the possibilities of correcting dysbiosis, the use of Saccharomyces boulardii CNCM I-745 to correct microbiome disorders in various clinical situations. The criteria of the microbiological “norm” for the intestinal microbiome have not been definitively established. To study the microbiome, a set of methods is used that combine cultural and molecular genetic methods that complement each other. Currently, there are no clinical markers of dysbiosis, and laboratory markers of dysbiosis require modification.

Probiotics can provide restoration of the intestinal microbiota. The effectiveness and safety of the use of Saccharomyces boulardii CNCM I-745 for this purpose has been proven. In the case of acute intestinal infection, antibiotic-associated diarrhea, and the consequences of HP infection eradication, studies have a high level of evidence.

This article is a reprint. Primary Publication: Gorelov AV, Zakharova IN, Khavkin AI, Kafarskaya LI, Usenko DV, Belmer SV, Kornienko EA, Privorotsky VF, Krasnov VV, Kondyurina EG, Panfilova VN, Tkhakushinova NKh, Plaksina AN, Rychkova OA, Pechkurov DV, Nizhevich AA, Fayzullina RA, Yablokova EA. Resolution of the Council of Experts “Dysbiosis. Immediate and long-term consequences of microbiome disorders and options for their correction with probiotics”. Vopr. prakt. pediatr. (Clinical Practice in Pediatrics). 2022;17(1):213–221 (in Russian). DOI: 10.20953/1817-7646-2022-1-213-221. With the permission of the copyright holder. Published with reductions.

Pediatrics. Consilium Medicum. 2022;(1):90-96
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Are clinical guidelines important in pediatric practice?

Bekhtereva M.K., Komarova A.M.


Due to measures to optimize the healthcare system, the role of the primary care specialist is constantly increasing. The professional standard of a primary care pediatrician clearly defines his/her job functions, but a significant number of pediatricians do not always follow the regulatory documents on the provision of medical care to patients. Nevertheless, in case of any conflicts and in case of assessing the quality of medical care within the framework of various types of examinations, first of all, the compliance of the provided medical care with the current regulatory documents is assessed. The standard of medical care is not intended to make any decisions on the treatment of a particular patient, it is an economic tool. Amendments to the law №323-FZ "On the Fundamentals of Healthcare in the Russian Federation", adopted in 2018, gave clinical guidelines the status of mandatory for implementation along with standards, regulations, and procedures for providing medical care. Thus, clinical guidelines in our country are the basis for medical care, prepared by professional medical communities taking into account domestic and foreign meta-analyses and randomized clinical trials, and are aimed at protecting the rights of patients and medical workers. In the article on the example of clinical guidelines for salmonellosis in children the therapy option in the form of probiotics, the validity of their use in various clinical situations is analyzed.

Pediatrics. Consilium Medicum. 2022;(1):98-104
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Laryngoplasty with T-tube stenting in the treatment of subglottic stenosis in children

Komina E.I., Alkhasov A.B., Rusetski Y.Y., Yatsyk S.P., Lokhmatov M.M., Ratnikov S.A.


Introduction. Laryngeal stenosis is a congenital or acquired narrowing of the larynx that causes airway obstruction. Approximately 90% of cases of acquired subglottic stenosis in infants and children are due to endotracheal intubation. Laryngotracheoplasty with T-tube placement is a method for treating laryngotracheal stenosis.

Aim. To demonstrate our experience of treating children with stenosis of the subglottic space using laryngoplasty with T-tube placement.

Materials and methods. 53 patients with postintubation laryngeal stenosis are treating in the surgical thoracic department of the National Medical Research Center for Children's Health for the period from 2019 until now. All children were examined. 33 patients underwent laryngoplasty with T-tube stenting.

Results. Nowadays, 18 children have been decannulated after laryngoplasty with T-tube stenting, the rest of the patients continue their treatment.

Conclusion. According to our materials, T-tube stenting is safe and can be an alternative method for treating children with severe acquired laryngeal stenosis.

Pediatrics. Consilium Medicum. 2022;(1):105-109
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Clinical tasks

Kholodova I.N.


The column is written by Doctor of Medical Sciences, Professor I.N. Kholodova, Department of Pediatrics named after G.N. Speransky,  Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia

Pediatrics. Consilium Medicum. 2022;(1):110-112
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