No 1 (2024)

Cesarean section is one of the most common operations in obstetrics and gynecology. However, despite the widespread use of this procedure, it is associated with certain risks for the mother and the child. As a result of cesarean section (CS), newborns do not acquire some important microorganisms during the passage of the maternal birth canal, which can impact the development and alter the functioning of the microbial ecosystem of the child. The gut microbiota plays an essential role in maintaining human health. It promotes digestion, strengthens the immune system, and produces some vitamins. Recent studies show that the intestinal microbiota of children born with CS differs from that of children born naturally. This article addresses the consequences of this difference on children's health and available ways of correcting the intestinal microbiota composition in children born via CS. Understanding the mechanisms of gut microbiota formation and function in these children can help develop effective strategies to prevent and treat various diseases associated with gut microbiota imbalance.

Background. Atopic dermatitis (AD) is one of the most common skin disorders in pediatric practice. In AD, the barrier function of the skin and moisturizing factors are impaired, which requires using specialized care products. Therefore, healthcare professionals should be aware of effective and safe products that can be used in children.

Aim. To evaluate the clinical efficacy of LA-KRY cosmetics.

Materials and methods. The study included 39 patients with AD and 26 patients with allergic/contact dermatitis aged 0-7 years. In some children, skin corneometric indices (SCI) (humidity and oiliness) were measured before using care products and 14 and 30 days after the start of their use to assess their effectiveness. In the remaining patients, the clinical manifestations of skin disorders were assessed visually without instrumental methods.

Results. SCI improvement was observed after 14 days of using LA-KRY products and significantly improved by the end of month 1. Minimization of dryness and itching of the skin occurred by days 3-5, and clinical manifestations resolved by days 14-30 (depending on the nosology).

Conclusion. LA-KRY have shown their effectiveness in children with several dermatoses associated with skin barrier disruption, dryness, and itching; in particular, they help reduce inflammation and discomfort and normalize SCI.

Background. One of the critical and urgent problems of pediatric otorhinolaryngology is impaired hearing, which is considered both medical and social. In the absence of auditory feedback, children with hearing impairment suffer from voice and speech disorders due to their inability to control their voice.

Aim. To determine the nature of vocal apparatus (VA) disorders in children with bilateral chronic sensorineural hearing loss.

Materials and methods. A subjective and objective voice assessment was conducted in 100 children aged 4-12 years with varying severity of bilateral chronic sensorineural hearing loss.

Results. The study found that hearing impairment is associated with VA disorders in children with severe hearing loss (HL), reflected in their voice's acoustic characteristics. The medical care for children with grade 3-4 HL should not be limited to hearing aids; measures to identify and treat HA abnormalities are also necessary. Phonopedic classes are indicated for children with any HL since most of them (72.9%) have a change in the timbre and modulation of the voice, which can aggravate inevitable communication problems.

The emergence of bacterial resistance to antibacterial drugs is one of the most urgent issues of world health. The emergence of new strains of antibiotic-resistant microorganisms associated with more severe diseases is a serious clinical problem. Exacerbation of chronic tonsillitis (CT) and sore throat remain a common cause of unreasonable administration of systemic antibacterial therapy. In most cases, except for streptococcal tonsillitis, antibiotics can be considered an overtreatment, as they are totally inappropriate in treating viral infections. An important point is the negative changes in the microbiome of the patient's body, which have a negative impact on health, and abnormal changes can last longer and be more severe than the disease itself. Given the higher activity of the tonsils in childhood and their effect on the normal development of the immune system, approaches to surgical treatment should be very thoughtful and balanced. One of the urgent problems of otorhinolaryngology remains the search for pathogenetically based, effective, and safe methods of treating CT. In non-surgical therapy, drugs that can both restrain the inflammatory response and modulate the immune response are of great interest. The article highlights the possibilities of modern herbal medicine in the non-surgical treatment of CT. The presented herbal medicinal products are included in the clinical guidelines, and their use is pathogenetically justified.

Background. Currently, there are no multicenter studies to determine the prevalence and incidence of symptoms of post-COVID syndrome (PCS) in children in different age groups, to develop consistent observation algorithms, and to identify therapy options.

Aim. To establish the risk factors for PCS in children and its CSs in the Russian Federation.

Materials and methods. A retrospective multicenter cross-sectional study was conducted. The initial stage of the study included 565 children at 7.6±0.17 months after the new coronavirus infection (NCVI) who were on outpatient or inpatient observation in different regions of Russia from November 2022 to May 2023. Patients were selected from 9 regions of the Russian Federation, such as Izhevsk, Kemerovo, Moscow, Omsk and Omsk region, Yekaterinburg and Sverdlovsk region, Ufa, Tyumen, Samara, Naberezhnye Chelny. All patients were offered a questionnaire. The questionnaire was developed and adapted based on the British and American consensus on the PCS, which included an assessment of the history, severity of the disease, clinical form of acute NCVI, therapy in the acute period of NCVI, and the presence of comorbidities. In addition, the course of acute NCVI and symptoms 3 months after the disease were evaluated by the following groups of CS: asthenia, respiratory disorders (RD), gastrointestinal disorders (GI), neurocognitive disorders (NCD), skin/adnexal lesions, olfactory/taste disorders, autonomic dysfunction (AD), anxiety. Of the 565 questionnaires received, 435 (76.9%) met the inclusion criteria and were available for subsequent analysis. The mean age was 9.0±0.25 years.

Results. During the acute period of the NCVI, asthenic syndrome (AS), RD and NCD, anxiety symptoms, olfactory/taste disorders, manifestations of AD, GI and skin/adnexal lesions were most often detected. Our study showed that after 3 months or more after NKVI, AS, NCD, and RD recurred in almost half of the observed children (53.1, 49.0 and 47.8%, respectively), anxiety was detected in 42,5% of cases, in more than 1/5 of children, AD, olfactory/taste and gastrointestinal disorders, in 14.3% skin/appendage lesions. Even 90 days after recovery from NCVI, more than half of patients reported impaired functionality, and most children had multiple complaints, which significantly impaired their quality of life. The risk of developing certain manifestations of PCS was increased in patients with comorbidities.

Conclusion. The study found that PCS developed in patients with severe, moderate, and mild acute COVID-19. The presence of comorbidities (allergic, neurological diseases, ENT disorders) statistically significantly increased the risk of PCS. The study's results further confirm the importance of continuous monitoring of NKVI sequelae in children and adolescents and the need for follow-up in children recovered from NKVI for 3-12 months.

Aim. To determine the level of correspondence between endoscopic and histological data when performing esophagogastroduodenoscopie (EGD) in children. A secondary aim was to identify predictors that affect the correspondence between endoscopy and histology.

Materials and methods. A retrospective analysis of the EGD (patients aged 2–18 years) was carried out. Descriptive statistics and binary logistic regression were used to determine the level of agreement and potential predictors of agreement between endoscopy and histology.

Results. 135 EGDS were analyzed. The overall level of disagreement between endoscopy and histology was 39.3% (53 patients). Taken into account histology as the gold standard, the specificity of white light EGD was 45.3%, sensitivity, accuracy, positive and its negative predictive value was 80, 60,7, 53,9, 73,9% respectively. A comparison of endoscopic and histological conclusions for each upper GI organ showed that the collection of biopsies for histological examination in all children improves the diagnostic value of white light EGD by 33.3% in the esophagus, 41.5% in the stomach and 14% in the duodenum. Logistic regression analysis showed that only heartburn and belching turned out to be a statistically significant (p=0.018) predictor of a low degree of correspondence between endoscopic and histological results (OR 0.302, 95% CI 0.112–0.814). Abdominal pain, nausea and vomiting, diarrhea, an established diagnosis of IBD, the presence of a diagnosis of JRA, age, gender, experience of an endoscopist and endoscope model did not have a statistically significant effect on the agreement level between endoscopy and histology (p>0.05).

Conclusion. EGD as an instrumental intervention is by definition an invasive procedure, and its diagnostic potential should be used to the maximum through the performance of routine biopsies in all children. This is especially important for pediatric gastroenterology because it allows not only to improve the effectiveness of intraluminal diagnostic method by almost 40%, but also to reduce the number of repeated unproductive white light EGD’s without taking tissue for confirming or refuting the presence of the disease in the child.

Background. Polyps of the small intestine in Peutz–Jeghers syndrome and juvenile polyposis can cause obstruction of the gastrointestinal tract, and with age they can cause the development of cancer. Currently, there is no consensus on diagnostic methods and treatment tactics for polyps in the deep parts of the small intestine in children, since both diseases are rare and there are not many works devoted to this problem in the literature.

Aim. To analyze 13 years of experience in treating patients and formulate treatment tactics for children with hamartomatous polyps of the small intestine with Peutz–Jeghers syndrome and juvenile polyposis.

Materials and methods. In the period from 2012 to 2024, on the basis of the department of general and planned surgery of the National Medical Research Center for Children's Health, 44 children were treated – 35 (80.4%) patients diagnosed with Peutz–Jeghers syndrome and 9 (19.6%) diagnosed with juvenile polyposis, – who were hospitalized 81 times. All patients underwent abdominal ultrasound upon admission. Sixteen patients underwent video capsule enteroscopy (VCE), and 82 diagnostic and therapeutic balloon enteroscopy (BE) were performed – 74 (90.2%) antegrade BE and 8 (9.75%) retrograde.

Results. According to ultrasound of the abdominal organs, only 25 (30.8%) cases revealed pathological changes in the abdominal cavity. Ultrasound testing showed a specificity of 78% and sensitivity of 36%. However, ultrasound allows one to assess intramural blood flow and determine further treatment tactics. VBE demonstrates a sensitivity of 97.4% and a specificity of 85.5%, which makes it possible to reliably assess the prevalence and localization of the process. BE also showed high sensitivity of 92.1% and specificity of 82% as a diagnostic method, and also showed high efficiency and safety as a method of minimally invasive intraluminal treatment.

Conclusion. Diagnosis of small intestinal polyps requires a consistent and multidisciplinary approach. Evaluation of ultrasound and VCE data allows one to determine indications for intraluminal (antegrade/retrograde) or surgical treatment.