No 2 (2022)


Innovations in the dietary therapy of cow's milk protein allergy: enrichment of highly hydrolyzed infant formulas with human milk oligosaccharides: A review

Zakharova I.N., Osmanov I.M., Berezhnaya I.V., Dmitrieva D.K., Skorobogatova E.V., Gostiukhina A.D.


The prevalence of food allergies has been increasing over the past 30 years. One of the most common causes of food allergies in children today is an allergy to cow's milk proteins (ACMP). Diagnosis of the ACMP can often be difficult, given the pathomorphism of the manifestations. Both in the diagnosis and in the treatment of children with manifestations of ACMP, a rejection of any dairy products and, consequently, the selection of a complete substitute to maintain a diet adequate in composition, action and caloric content is required. The use of highly hydrolyzed and amino acid formulas in the nutrition of children with ACMP is preferable, given the current opportunities that bring adapted formulas closer to the composition of breast milk, using breast milk oligosaccharides to support the development of early oral tolerance.

Pediatrics. Consilium Medicum. 2022;(2):122-127
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Nutritional support for preterm infants at the outpatient stage: how to maintain continuity? A review

Pershina E.S., Korotaeva N.V., Ippolitova L.I.


Globally, 15 million babies are born prematurely each year. Improvements in intensive care methods and treatment approaches have significantly improved the survival rate of this vulnerable group of patients. Suctioning of these babies does not end when they are discharged from hospital, but continues on an outpatient basis. In modern practice, the term "catch-up growth" is used to mean compensatory acceleration of growth of the organism after a period of stunted growth, particularly as a result of a lack of nutrients. To assess catch-up growth in the outpatient phase, body weight, height and head circumference should be assessed weekly or every 2 weeks during the first 4–6 weeks after discharge and then according to an individual plan until the child reaches the parameters of full-term peers, making adjustments for postconceptual or adjusted age. Different scales can be used to assess the physical development of preterm infants, such as the Fenton scale or the Intergrowth 21st, each of which has advantages and disadvantages. Maintaining breastfeeding of premature babies after discharge from hospital should remain our goal because of the many advantages, but at the same time on purely breastfeeding a premature baby will not receive sufficient protein, energy and fatty acids. This is where the neonatologist and paediatrician alike come in handy with breast milk fortifiers, whose application in practice is much easier than it seems. According to the "Programme for the Optimisation of Infant Feeding in the First Year of Life in the Russian Federation", breast-milk fortification should be carried out tentatively until 40–52 weeks of post-conceptional age (provided the catch-up parameters of 10–25th centile have been reached). If the child is artificially fed, adapted prematurity formula (with a protein content of 2.0 to 2.2 mg/100ml) should be continued until reaching the 10–25th centile, with caloric intake calculated on the basis of 130 kcal/kg with a subsequent reduction. Although premature infants are a very vulnerable group of patients and require a special approach from paediatricians, the seeming difficulties of enteral feeding are quickly resolved if simple algorithms and proven approaches are followed.

Pediatrics. Consilium Medicum. 2022;(2):128-132
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Vitamin D as the essential immunonutrient – the evidence base update: A review

Makarova S.G., Emelyashenkov E.E., Yasakov D.S., Pronina I.Y., Ereshko O.A., Gordeeva I.G., Galimova A.A., Chumbadze T.R., Lebedeva A.M.


The micronutrient status plays a key role for adequate immune response, including in diseases caused by respiratory viruses. Numerous studies conducted since the beginning of the COVID-19 pandemic, examining the impact of micronutrient availability, have shown their importance in the prevention of this disease. The largest number of publications is devoted to vitamin D. As a result, in less than two years, 17 meta-analyses and analytical reviews were published on the role of vitamin D and the availability of this micronutrient in various population groups in reducing the incidence, incidence of severe forms of COVID-19 and mortality. This review summarizes the results of published meta-analyses and systematic reviews. The analysis of literature data confirms that vitamin D has the highest evidence base as a micronutrient that reduces the risk of disease and the occurrence of severe forms of COVID-19. It also provides up-to-date recommendations on vitamin D supplementation for adult and pediatric patients.

Pediatrics. Consilium Medicum. 2022;(2):133-138
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The history of the creation of special temperature measurement devices in humans

Zakharova I.N., Osmanov I.M., Berezhnaya I.V., Sugian N.G., Maykova I.D., Samitova E.R., Tvorogova T.M., Kolushkin D.S., Pupykina V.V., Rodionov I.А.


Thermometry has firmly entered our lives. Today, we habitually put the thermometer in the armpit and evaluate the result after 10 min. At the same time, doubts often arise concerning the interpretation of the measurement results, especially in case of severe infections, impaired general well-being, feeling feverish or hot and headache. This article deals with thermometry in light of history of the development of medical thermometers and the assessment of the different types of fever before the development of new technical possibilities for assessing body temperature. In children – especially young children, high fever is not only a symptom of the disease, but also a dangerous factor for the development of complications. The control of body temperature, the detection of the periods of hyperthermia, the efficacy of antipyretic drugs can alleviate the course of the disease and prevent the development of terrible complications (dehydration, cerebral edema, convulsions, etc.). Today, in the period of rapid development of computer technologies, the possibilities of thermometry are also changing. The application of small and lightweight smart devices allows to control the change in child's body temperature, especially during the illness, and to respond in a timely manner to changes.

Pediatrics. Consilium Medicum. 2022;(2):140-146
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Possibilities of effective topical therapy in treatment of acute otitis media in children: A review

Garashchenko T.I., Ilenko L.I., Payganova N.E.


Acute otitis media (AOM) is a common infection of the middle ear in children with predominant symptoms of pain and hearing impairment. If antibiotics are prescribed, they take time to act on the inflammatory process, so the main focus is on relieving pain. Topical anesthetics have the advantage of having fewer systemic side effects when analgesic is used. The review covers a systematic analysis of the literature on the problem of AOM in children for the period from 1990 to 2021. Analgesic ear drops with lidocaine and phenazone can provide first-line pain relief for otitis media without systemic side effects such as gastrointestinal disorders and nausea and can maintain a wait-and-see attitude towards saving antibiotics. A combined drug containing a combination of the anesthetic lidocaine and the anti-inflammatory drug phenazone shows optimal action to eliminate pain and inflammation in children with AOM. The drug, which is recommended from the birth of a child and included in the National clinical guidelines for the treatment of AOM (2021), can be prescribed by a pediatrician and a general and family practitioner.

Pediatrics. Consilium Medicum. 2022;(2):147-152
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Nasopharyngeal cysts in children

Kotova E.N., Vyazmenov E.O., Baranov K.K.


Background. Nasopharyngeal cysts are mostly congenital malformations. However, their clinical manifestation can also occur in adolescence, depending on their severity, size and location. Nasopharyngeal cysts are rare in the practice of an otolaryngologist, but can be found in nasal obstruction. The article presents the literature data on the theories of the origin, clinical manifestations, peculiarities of the diagnostics and surgical treatment of the nasopharyngeal cysts.

Aim. To increase the efficiency of diagnostics and treatment of nasopharyngeal cysts in children on the basis of a differentiated approach to the manifestation of the disease symptoms.

Materials and methods. 29 patients aged from 1 to 8 years (mean age – 4.21±0.39 years) with nasopharyngeal cysts and cyst-like neoplasms were treated at the clinical sites of the Department of Otorhinolaryngology and Pediatric Department of Pirogov Russian National Research Medical University (Moscow) from 2009 to 2022.

Results. On admission all 29 (100%) children complained of an increasing nasal obstruction, anterior and posterior purulent rhinorrhea, snoring, decreased hearing, and epiphora. 18 patients (62.1%) had a history of recurrent otitis media and were diagnosed with bilateral exudative otitis media on examination. Transnasal or transoroepipharyngeal endoscopic marsupialization and cyst coagulation with an electrosurgical complex were performed in 28 (96.5%) children. In 19 (65.5%) cases the operation was performed with a single-stage adenotomy and in 8 (27.6%) cases – with tubal valvular plasty, partial destruction of the tubal tonsils.

Conclusion. Improvement of diagnostics quality due to modern imaging technologies leads to detection of a greater number of «accidental» findings of nasopharyngeal cysts and requires systematization and detailed elaboration of the accumulated knowledge in the work of the pediatric otorhinolaryngologist.

Pediatrics. Consilium Medicum. 2022;(2):154-159
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Efficacy of the extract of marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark, and dandelion herb in preschool children with pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections

Vavilova V.P., Vavilov A.M., Cherkaeva A.K., Nechaeva I.A.


Background. Acute upper respiratory tract infections (AURTIs) are common in children and can become recurrent, especially in patients with pharyngeal and/or palatine tonsil disorders.

Aim. To evaluate the efficacy and safety of the herbal medicine of marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark and dandelion herb (Tonsilgon® N) in preschool children with adenotonsillar disorders.

Materials and methods. The study included 1876 children aged 2 to 5 years with a history of pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections. The subjects were randomized into two groups: Group 1 (n=940) received herbal medicine (10 drops 5–6 times daily) for 30 days, and Group 2 (n=936) received no additional medication. Efficacy and safety were evaluated after the therapy course and during the follow-up (3, 6, and 12 months after the treatment started). The assessment included nasopharyngeal endoscopy, cytological examination of nasal mucosa smears, measurement of soluble immunoglobulin A (sIgA) levels and lysozyme activity in nasal secretion.

Results. After a course of therapy, a significant decrease in the incidence of AURTIs (p<0.05), associated with a local immunity improvement, estimated by sIgA levels and lysozyme activity (p<0.001 for both values versus the control group), was noted. By the end of the study, in 86.5% of patients of Group 1, the pharyngeal tonsil volume decreased from grade 2 to grade 1 of hypertrophy (p=0.000). The pharyngeal and palatine tonsil hypertrophy worsened in 83.6% of Group 2 patients.

Conclusion. The study results showed that Tonsilgon® N significantly reduced the incidence of AURTIs in children with pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections. This effect was associated with an increase in sIgA and lysozyme levels in the nasal secretion and a decrease in neutrophil counts, indicating an improvement in local immunity.

Pediatrics. Consilium Medicum. 2022;(2):160-165
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Non cystic fibrosis-related bronchiectasis in children: etiological structure, clinical and laboratory and computed tomographic characteristics

Frolov P.A., Zhestkova M.A., Ovsyannikov D.Y., Ayrapetyan M.I., Topilin O.G., Korsunskiy A.A., Bojcova E.V., Zapevalova E.Y., Orlov A.V., Makarenko H.V., Marchenkov Y.V., Berezhanskiy P.V., Gorev V.V.


Aim. To establish the etiological structure and to present clinical and laboratory and instrumental characteristics of bronchiectasis (BE) not associated with cystic fibrosis (CF) in children.

Materials and methods. Sixty-seven hospitalised patients with BЕ not related to CF were followed up between 2017 and 2022. Examination methods: clinical-anamnestic method, general clinical laboratory investigations, investigation of allergological and immune status, phagocytosis system, determination of concentration of specific IgE and IgG to fungi of genus Aspergillus, sweat test, radiological examination and computed tomography (CT) of chest organs, bronchoscopy, Bacteriological examination of sputum and/or tracheobronchial aspirates, nasal and/or bronchial ciliary motility, esophagogastroduodenoscopy, 24-hour pH-metry, intra-esophageal combined impedance-pH-metry, genetic study, lung biopsy.

Results. Etiologic factors of BЕ not associated with CF in children were severe pneumonia (22%), primary ciliary dyskinesia (22%), bronchial asthma (13%), Williams-Campbell syndrome (7%), bronchial foreign bodies (7%), gastroesophageal reflux disease (6%), Bronchopulmonary dysplasia (6%), postinfectious bronchiolitis obliterans (5%), allergic bronchopulmonary aspergillosis (3%), chronic granulomatous disease (3%), AIDS (1%), prolonged bacterial bronchitis (1%), brain-lung-thyroid syndrome (1%). The clinical picture is characterized by cough (91%), shortness of breath (67%), fever during exacerbation (48%), chest pain (24%), exercise intolerance (55%), drumstick symptom (9%), moist (76%) and dry wheezing (37%). CT-semiotics of BЕ not associated with CF is characterized by localization in one (58%) or several (42%) lobes; traction (42%), non-traction (49%) B and their combination (9%); increased broncho-arterial ratio >0.9; thickening of bronchial wall; "mosaic perfusion"/"air-trap" symptom (9%); more frequent involvement of lower lungs (64%). The main infectious agents in BЕ not associated with CF were Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus.

Conclusion. On the basis of a multicentre study, the etiological structure, clinical and laboratory and CT-characteristics of non-CF ВE in children were established.

Pediatrics. Consilium Medicum. 2022;(2):166-173
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Problems of gut microbiota formation as a risk factor for the development of immunopathological diseases and opportunities for their prevention: A review

Kornienko E.A.


The formation of infant intestinal microbiota begins in the womb when there is a selective transport of certain bacteria from the intestine through the placenta and amniotic fluid which has been proved in experiments. The mode of delivery has a significant impact on the establishment of the intestinal biocenosis: babies born by caesarean section show a slower colonisation rate and a higher risk of developing food allergies later in life. Antibiotic therapy at an early age can permanently alter the composition of the intestinal microbiota and has a proven risk of developing a range of diseases, both immunopathological and metabolic. The type of feeding also has a significant impact. Exclusive breastfeeding from birth promotes the establishment of a bifidobacterial and bacteroide-dominated infant microbiota. Supplementation at birth and early transfer to complementary feeding contribute to microbiocenosis alteration and sensitisation to cow's milk protein. Probiotics due to their protective and immunomodulatory effects can improve the composition of the microbiota of breast milk and the baby's gut and their perinatal administration reduces the risk of food allergies and other diseases.

Pediatrics. Consilium Medicum. 2022;(2):174-179
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Approach to the choice of methods for correction of neurogenic bladder dysfunction in children

Bozhendaev T.L., Guseva N.B., Krapivkin A.I., Gatkin E.I.


Currently, parents of various specialties are turning to doctors with complaints of urination disorders in children, which is manifested by urinary incontinence during the daytime, imperative urges and enuresis. These disorders are associated with functional disorders, if there are no malformations of the spinal cord resulting from the immaturity of the growing organism or may be the cause of the detrimental effect of the “benefits” of civilization on the emerging organism. The function of the lower urinary tract consists of the friendly but opposite activity of the detrusor and sphincter. We have a wide range of medicines, treatment methods, biofeedback and physiotherapy, but the so-called “golden standard” of treatment does not yet exist. Each of these methods should be prescribed according to clearly identified diagnostic criteria.

Pediatrics. Consilium Medicum. 2022;(2):180-184
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A familial case of Duncan's dirty dermatosis. Case report

Ufimceva M.A., Bochkarev J.M., Efimova M.S., Nikolaeva K.I., Galiullina D.F., Ivanova A.A.


Terra firma-forme dermatosis (TFFD) belongs to the group of dirty-like dermatoses. The disease was described in 1987, but the etiology and pathogenesis are still insufficiently understood. The true incidence and prevalence of TFFD isn`t clear, there are few publications devoted to this disease. TFFD is clinically manifested by rashes that visually resemble dirt, which can persist for a long time despite the patient's compliance with hygiene standards. There are separate reports on the connection of TFFD with other skin diseases, as well as somatic pathology and malignant neoplasms. The article provides a review of the literature demonstrate two clinical cases of TFFD in children from the same family, draws attention to the development of TFFD after suffering a new coronavirus infection. The article is of interest to dermatovenerologists, family doctors and pediatricians.

Pediatrics. Consilium Medicum. 2022;(2):185-187
pages 185-187 views

Clinical features of the course of Graves' disease in children

Bolotova N.V., Filina N.I., Polyakov V.K., Aldashkin S.I., Fedotova A.O.


Aim. To evaluate the features of the course and treatment of Graves' disease in children at the present stage.

Materials and methods. Thirty two children diagnosed with Graves' disease aged 5.5 to 16.5 years were examined; 19 girls and 5 boys were admitted to the department for the first time, 6 girls and 2 boys with relapses of the disease. The duration of the disease in these children ranged from 2 to 8 years, the number of relapses was from 2 to 4, the intervals for the onset of relapse of the disease ranged from 6 months to 2 years. The examination algorithm included the study of the anamnesis of life and disease, the assessment of objective data. Thyroid ultrasound was performed on a GE Healthcare Medical Systems Vivid machine. The level of thyroid hormones was determined: triiodothyronine, thyroxine, thyroid-stimulating hormone (TSH), the level of antibodies to the microsomal fraction with the IMMULITE 2000 XPi and ARCHTESTo2000SR kits (Siemens, Abbott, Germany) and antibodies to the TSH receptor with the ARCHTESTo2000SR kits (Abbott, USA).

Results. During an objective examination, tachycardia was determined in all children, an increase in the thyroid gland was noted. Almost all children had eye symptoms. The level of thyroid hormones was elevated in all children, both newly diagnosed and those admitted with a relapse of the disease. The level of TSH in all patients was reduced. The antibody titer was high for both the microsomal fraction and the TSH receptor. All patients admitted for the first time were prescribed drug therapy with thyreostatics. Three out of eight children with a recurrence of the disease were referred for radioactive iodine treatment and 1 for surgical treatment. The remaining four children continued drug treatment with thyreostatics, due to the parents' disagreement with other methods of treatment.

Conclusion. Thus, despite the pronounced manifestations of Graves' disease, almost all children had a late diagnosis of the disease: from the moment the complaints appeared to the diagnosis and start of treatment, it took from 4 months to 1 year. Initially, the children were treated and treated by specialists in various fields. Relapses of the disease, as a rule, developed after discontinuation of therapy, either after the end of the recommended treatment period (2 years), or at different times, due to self-cessation of treatment. In some patients, unreasonably long treatment with thyreostatics was noted, despite the development of: 3–4 relapses of the disease and the ineffectiveness of conservative therapy.

Pediatrics. Consilium Medicum. 2022;(2):188-191
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Experience of switching biological therapy in a patient with juvenile idiopathic arthritis and uveitis. Case report

Galstian L.A., Verbitsky M.V., Polyanskaya A.V., Chebysheva S.N., Kudryashova M.A., Batyreva O.V., Tikhaya M.I., Zholobova E.S.


Uveitis associated with juvenile arthritis can be complicated by cataracts, retinal edema, and glaucoma, which carries a potential risk of disability in the child's organ of vision. Approximately 25–40% of patients demonstrate insufficient effectiveness of the ongoing standard antirheumatic therapy, which requires the inclusion of genetically engineered biological therapy. According to the protocols, the drug of choice for juvenile arthritis associated with uveitis is adalimumab, which has shown high efficacy in many studies. However, some patients stop “responding” to therapy over time, which raises the question of “switching” to another genetically engineered biological drug (GЕBD). Our article presents a case of severe course with an early onset of juvenile idiopathic arthritis associated with uveitis. Due to the insufficient effectiveness of basic monotherapy with methorexate, as well as topical glucocorticoids, adilimumab was added to therapy a year after the onset of the disease. Over the next 5 years, the child was on this therapy with exacerbations of uveitis about 1–2 episodes per year. Subsequently, uveitis began to continuously recur, which raised the question of the development of probable resistance to adalimumab and the change of GEBD. The girl was switched to golimumab, which is a human monoclonal antibody that can bind to tumor necrosis factor-α. This drug has been used for the treatment of juvenile idiopathic arthritis since 2017 for children weighing 40 kg and above, and after the completion of the multicenter GO-KIDS study, it is registered for children from 2 years of age. According to a number of studies, golimumab has shown its effectiveness in relation to the activity of uveitis in patients with arthritis, including those in childhood. In general, the issues of switching GEBD in cases of ineffective therapy with first-line drugs are a very urgent problem in pediatric rheumatology. In our case, switching to the GIBP golimumab resulted in a positive effect on the activity of rheumatoid uveitis and induction of remission of the articular syndrome.

Pediatrics. Consilium Medicum. 2022;(2):192-196
pages 192-196 views

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