No 3 (2022)


Breast milk oligosaccharides: what do we know today?

Zakharova I.N., Orobinskaia I.V., Sugian N.G., Kovtun T.A., Tabulovich E.V.


Breastfeeding remains the "gold standard" for feeding babies in the first year of life. Breast milk contains a mixture of nutrients; their amount varies throughout the lactation period and even throughout the day. The composition of breast milk (BM) is complex and dynamic. Currently, BM oligosaccharides (BMOs) are of most interest to researchers. Due to advances in science and biotechnology, more than 200 BMOs have been identified. Human BM is the richest source of oligosaccharides among all mammals (for instance, their content in cow's milk is almost 1,000 times lower). Numerous favorable effects of BMOs on child health are related to the immune response, gut barrier function, and protection against pathogens. BMOs as prebiotics contribute to the formation of the infant's intestinal microbiome. The BM contains a complex bacterial community whose composition depends on the maternal microbiome (skin, gut, genital, urethral tracts) that forms the infant gut microbial community. In the absence of breastfeeding, modern formulas can be used; BMOs in their composition make them more like BM.

Pediatrics. Consilium Medicum. 2022;(3):204-212
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Leading-edge non-specific prevention of a new coronavirus infection and acute respiratory infections of other etiology

Vavilova V.P., Vavilov A.M., Tsarkova S.A.


Background. Acute respiratory infections (ARI) in pediatric practice remain one of the most relevant problems, therefore, it is necessary to search for effective prevention schemes in terms of pandemic caused by the new SARS-CoV-2 coronavirus.

Aim. To evaluate preventive effect of one of the Polyoxidonium drug regimens in respect to SARS, influenza and COVID-19, compared with the absence of drug prophylaxis in children attending children's organized groups.

Materials and methods. A prospective open comparative cohort study of the effectiveness of Polyoxidonium used as a preventing treatment against acute respiratory viral infections (ARVI), influenza and coronavirus infection in children attending organized groups was carried out. In the 1st group children (n=300) received Polyoxidonium 1/2 tablet of 12 mg once a day for 7 days, then 21 days drug-free interval (3 courses over a period of 3 months), in the 2nd group children (n=300) received Polyoxidonium 1/2 tablet of 12 mg 1 time per day for 10 days, then 4 days drug-free interval (6 courses over a period of 3 months), group 3 (n=300) control – children did not receive prophylactic drugs. The effectiveness of prevention regimen was assessed using morbidity rate and changes in sIgA and lysozyme activity in the nasal secretion.

Results. In the active groups with Polyoxidonium treatment a significant decrease in the number of cases of ARI and COVID-19 was recorded compared with the control group. The beneficial effect of the preventive use of Polyoxidonium on the likelihood of developing ARVI, COVID-19 and their clinical course was more significant in group 2 (p=0.0001) than in group 1. A positive preventive effect of Polyoxidonium on the development of ARVI, COVID-19 and their clinical course in group 1 was noted when compared to the control group (p=0.0001). In group 2, none of the participants developed pneumonia, while in group 1 one case of pneumonia was registered, and in the control group pneumonia was noted in seven children (2.3%); p=0.0327, 0.0078. The use of Polyoxidonium led to a significant increase in local immunity of the mucous membranes of the upper respiratory tract lysozyme and sIgA in groups 1 and 2 [1 group sIgA 0.24±0.14 g/L (p=0.0085), lysozyme 60.9±18.53% (p=0.0084); 2 group sIgA 0.24±0.14 g/L (p=0.0024), lyzozyme 65.0±16.62% (p=0.0001)].

Conclusion. The use of Polyoxidonium drug as a preventing care for ARI and COVID-19 meets up to date requirements and can serve as an additional protection line against infection in children in organized groups.

Pediatrics. Consilium Medicum. 2022;(3):213-222
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Influenza: current topics of etiotropic drug selection

Savenkova M.S.


Influenza has almost always, except for the last two years, ranked first in importance, incidence, and morbidity. The article presents data on influenza, its features, and statistics in different countries and Russia in recent years. The features of the influenza course during the COVID-19 pandemic and avian influenza variants that began to circulate in the last two years are described. Etiotropic treatment regimens in children and adults are provided.

Pediatrics. Consilium Medicum. 2022;(3):223-228
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Study of the effect of using a foam form with ceramides and a cholesterol-phytosterol complex in patients with atopic dermatitis

Zaslavsky D.V., Barinova A.N., Plavinskij S.L., Zelianina M.I., Manylova E.S.


Background. In developed countries more than 20% of children have atopic dermatitis (AD). Clinical guidelines unite in the recommendation to use moisturizers/emollients as therapy mainstay. Deeper understanding of AD pathogenesis stimulates development of new, therapeutic moisturizers. To such moisturizers belong ceramide-containing moisturizers, in particular foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex.

Aim. To study effects of foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex on the course mild to moderate severity AD.

Materials and methods. In this prospective cohort study 30 children 3 to 17 years of age with mild to moderate severity AD were enrolled. They applied moisturizing foam skin lesion, surrounding skin and dry skin areas for 4 weeks. For all participants severity of AD was scored with SOCARD, EASI, IGA, skin pH, moisture and transepidermal water loss (TEWL) were measured and severity of itching and xerosis was elicited with visual analogue scale.

Results. Severity of AD in children who applied foam decreased on 22.8 score points with SCORAD, and on 3.1 points with EASI (for both indices p<0.001). Skin moisture during treatment period increased (23.5% to baseline; p<0.001), and TEWL decreased (for 5.45 g/h×m2; p<0.001); skin pH decreased 0.2 unit to normal values (р=0.002). It was found that skin moisture and TEWL correlate with AD severity so that less severe AD associated with moisture increase and TEWL decrease. As “good” and “excellent” rated foam smell 100% (95% CI 88.4–100%) respondents, consistence – 90% (95% CI 73.5–98.0%), and ease of use – 97% (95% CI 82.8–99.9%) respondents.

Conclusion. Moisturizing foam with ceramides and a cholesterol-phytosterol complex might be used in AD therapy.

Pediatrics. Consilium Medicum. 2022;(3):230-238
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Case report of pulmonary embolism in pediatric practice

Belousova T.V., Loskutova S.A., Zatolokina A.O., Plyushkin V.A.


An analysis of the clinical situation of a 14-year-old patient with pulmonary embolism (PE) and current information on the risk factors for the development of thrombotic events are presented. Due to the presence of gynecological pathology, the girl was prescribed hormonal drugs, in particular, dydrogesterone and estrogen + gestagen. Against the background of its use, complaints of shortness of breath appeared, which was regarded as a manifestation of bronchial obstruction and bronchodilator therapy was prescribed. Due to the lack of positive dynamics during treatment, she was hospitalized. MSCT of the chest organs was performed: signs of PE were revealed; A molecular genetic study of the DNA of buccal epithelial cells (PCR) was carried out: the carriage of prothrombogenic polymorphic variants of genes of the hemostasis system was revealed, the most significant of which is a heterozygous mutation of the prothrombin FII gene (G20210A); the study of the hemostasis system revealed thrombinemia. In therapy, thrombolysis was not performed, low molecular weight heparins were prescribed – the child's condition improved. The question of the need for a comprehensive examination, including research on the carriage of prothrombogenic polymorphic variants of the genes of the hemostasis system for pediatric patients in situations requiring the administration of hormonal drugs for a long course, to prevent the ocurrence of dangerous thrombotic complications, is discussed.

Pediatrics. Consilium Medicum. 2022;(3):239-243
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Carbohydrate and lipid metabolism in children after coronavirus disease: Observational study

Isaeva E.P., Zaytseva O.V., Lokshina E.Е., Zaytseva S.V., Murtazaeva O.A., Okorokov P.L., Zyabkin I.V.


Background. Six months after coronavirus disease (COVID-19), more than half of the children have various clinical manifestations of post-covid syndrome. In adult patients without a history of diabetes mellitus, cases of carbohydrate metabolism disorders against the background of COVID-19 and in the long term after the disease have been described. Coronavirus infection in adult patients with lipid disorders is associated with a high risk of severe COVID-19. A 12-year follow-up of patients with severe acute respiratory syndrome (SARS) caused by SARS-CoV showed that they were at an increased risk of developing dyslipidemia. For patients who have undergone SARS-CoV-2, there are no such data due to the short follow-up period. Studies in children evaluating the impact of coronavirus disease on the state of carbohydrate and lipid metabolism are isolated and contradictory.

Aim. To compare indicators of carbohydrate and lipid metabolism in children after a coronavirus disease with a control group of healthy peers without a history of COVID-19.

Materials and methods. The study included 108 children aged 3 to 17 years, divided into two groups. The study group included 50 children (mean age 12.0 [7.4; 14.5] years) after a coronavirus disease. The average follow-up period after the disease was 6 months (from 3 to 12 months). The control group consisted of 58 healthy peers (mean age 12.5 [7.5; 15.1] years) without a history of COVID-19. All children underwent an assessment of the level of glucose in the blood serum, lipid metabolism and the calculation of the triglyceride-glucose index (TyG index).

Results. The frequency of impaired fasting glycemia in children after a coronavirus disease was 2% and was comparable to the control group of healthy peers without a history of COVID-19. The TyG indices in the study groups did not differ significantly (4.46 [4.11; 4.65] vs 4.33 [4.0; 4.47]; p=0.37). None of the children included in the study showed an increase in the TyG index to values corresponding to the criterion of insulin resistance. An assessment of the state of lipid metabolism also did not reveal significant differences in the levels of total cholesterol, LDL, HDL and triglycerides, depending on the presence of a history of coronavirus disease.

Conclusion. In children six months (3–12 months) after coronavirus disease, there was no increase in the frequency of impaired fasting glycemia and insulin resistance compared to healthy peers without a history of COVID-19.

Pediatrics. Consilium Medicum. 2022;(3):244-248
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On the question of the characteristics of the menstrual cycle in adolescent girls with obesity

Liskina A.S., Zazerskaia I.E., Antoshina T.I., Safiullina S.R., Dzhamieva S.A., Nikitina I.L.


Background. Due to the increasing prevalence of abnormal uterine bleeding (AUB) among obese adolescent girls, a factorial analysis of the probable causes of this pathology is highly relevant.

Aim. To analyze and characterize clinical, hormonal, metabolic features and parameters relevant to the assessment of ovarian reserve in adolescent girls with obesity and AUB.

Materials and methods. The study included 2 groups of obese adolescent girls who have passed at least 12 months from the start of menarche, who do not have endocrine and severe somatic diseases; main group: adolescent girls with obesity (SDS BMI more than 2) and abnormal uterine bleeding of the type of opso-oligomenorrhea and secondary amenorrhea; comparison group: adolescent girls with obesity (SDS BMI more than 2) and absence of menstrual cycle disorders.

Results. Among adolescent girls without AUB, severe forms of obesity (3–4 art.) were more common than in the group with AUB. According to the metabolic status, plasma triglyceride and cholesterol levels were significantly higher in the AUB group compared with adolescent girls without menstrual disorders (p=0.035 and 0.043, respectively).When assessing carbohydrate metabolism, no significant differences between the groups were obtained (p=1.000). According to the results of the study of the hormonal status, no significant differences between the groups were obtained. The hirsute number had no significant differences in the groups. The correlation analysis revealed a positive correlation between the severity of obesity with the HOMA index (p=0.034), a positive correlation of the prolactin level with the hirsute number (p=0.021) and estradiol (p=0.04). The median level of anti-muller hormone in the group with AUB was significantly higher compared to the group without AUB (6.13 ng/ml vs 2.09 ng/ml, p<0.05). When analyzing the follicular apparatus of the ovaries, it was found that the median volume of both the right and left ovaries in girls of group 1 with obesity and the AUB was larger than in the comparison group. The median number of follicles in the section in group 1 also indicated a greater number of them compared to the comparison group.

Conclusion. In the studied groups, girls with a more severe degree of obesity were more often associated with the absence of AUB, but metabolic disorders were more common in the group of girls with AUB. When assessing the ovarian reserve, a direct correlation was obtained between the level of anti-muller hormone and the number of antral follicles in the ovary.

Pediatrics. Consilium Medicum. 2022;(3):249-254
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Constitutional delay of growth and puberty – features of the clinic and diagnosis: Prospective study

Filina N.Y., Cherednikova K.A., Bolotova N.V., Nikolaeva N.V., Novikova E.P., Petrova M.G., Nesterenko O.V.


Aim. To assess clinical, hormonal and metabolic characteristics of adolescent boys with constitutional delay of growth and puberty.

Materials and methods. One hundred teenage boys aged 15 were examined. The main group (n=70) – patients with constitutional delay of growth and puberty (inclusion criteria: height SDS -2.0 and below, Tanner 1); comparison group (n=30) – healthy adolescents of the same age. Objective examination: height SDS score, BMI SDS, puberty score. Laboratory diagnostics: IGF-1, testosterone, luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-Mullerian hormone; stimulating tests: clonidine test, triptorelin test. Instrumental methods: radiography of the bones of the wrist of the left hand with the wrist joint to assess bone age using the Greulich–Pyle method, ultrasound examination of the scrotum, assessment of the component composition of the body by bioimpedancemetry. Statistical data processing: XL Statistics version 7.0, Microsoft Excel, 2010. Nonparametric statistical methods were used. Data are presented as a median indicating the values of the 1st and 3rd quartiles ([Q1; Q3]), the Mann–Whitney test was used.

Results. Patients with constitutional delay of growth and puberty had significantly lower rates of physical development compared with healthy peers (p=0.003). Most patients of the main group were found to be underweight, accompanied by a persistent decrease in the proportion of active tissues and a significant, paradoxical increase in the proportion of fat mass according to bioimpedancemetry. The identified deviations indicated metabolic disorders and indicated the formation of sarcopenia syndrome in adolescents with CIGR. The level of sex hormones corresponded to the degree of biological immaturity of the patients, low values of inhibin B in combination with an increased level of AMH indicated Sertoli cell deficiency.

Conclusion. The pronounced deviations in the clinical, hormonal and metabolic status of patients with constitutional delay of growth and puberty obtained during the study were traced in the clinical picture of most adolescents, which is a significant deviation in the child's health and requires medical correction.

Pediatrics. Consilium Medicum. 2022;(3):255-259
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