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Aim. To determine the frequency and factors contributing to the formation of c-ma "hyperechoic pyramids" in children born with very low and extremely low body weight, as well as to assess kidney function in this contingent of children in a three-year catamnesis. Materials and methods. A comparative analysis of the ultrasound pattern of the urinary system was carried out in 756 premature babies, from birth to 3 years of age, two groups were identified: group I – 133 children who had hyperechoic pyramids in the neonatal period; group II – 643 children without hyperechoic pyramids in the neonatal period; group III – the comparison group – 3000 full-term neonates. Results. The symptom of "hyperechoic pyramids" was detected in 15% of premature babies (group I) by the end of 1 month of life (25±6 days), in full-term babies (group III) – in 23 at the age of the first 3–10 days of life. In 2% of premature infants up to 2 months of age, hyperechoic inclusions were diagnosed, giving an acoustic shadow, which were interpreted as kidney concretions. It was revealed that the need (100% vs 71%) and duration (9.7 days vs 2.8 days) for mechanical ventilation, drug load and frequency of artificial feeding (92% vs 19%) in the I group were higher than in the II group. By 12 months of age, signs of nephrocalcinosis with hypercalciuria in group I were detected in 74% of patients and by 36 months were preserved in 23%. In 2% children with renal nodules detected in the first months of life, these changes up to 36 months of life and by 3 years of age, the frequency in group I was 6.6%. Conclusion. In children born with very low and extremely low body weight, there is a high frequency of detection of "hyperechoic pyramids," which tends to decrease with the growth of the child. In some children, the changes are persistent with a risk of progression in the absence of proper observation and treatment. Among the aggravating external influences, a significant role belongs to long-term mechanical ventilation and oxygen dependence, high drug load by various groups of drugs, as well as artificial feeding in neonatal and infancy.

Nowadays, when the number of couples affected by infertility increases significantly, the issue of the use of assisted reproductive technologies (ART) is particularly important. In vitro fertilization (IVF) is the ART that is used most frequently due to its high positive results. Priority status initially was accorded by the researchers to quantitative indicators, and the health of children born as a result of ART was analysed extremely rarely. At the present time, all the risks of using ART are being assessed. Despite the success of the procedure, there are times when children are born prematurely. In Russia, starting from 2012 all children born after 24 weeks of gestation and weighing more than 500 grams are legally regarded as human beings and must be provided with life-saving medical care. Observations show that such children have significant health problems: the most serious damage is caused to the nervous system, respiratory organs, and visual system. The article describes cases of premature IVF babies with critically low birth weight and reviews their further development. Approaches to the management of premature IVF babies should be based on the awareness of the problems of extreme morphofunctional immaturity, individual selection of habilitation programs. Observations should be comprehensive (involving narrow specialists according to indications), which plays an important role in the subsequent development of children. If the management of such babies is arranged properly, their health status improves significantly, and physiological parameters achieve close to “normal” standards.

Значимость особенностей генотипа в исходах тяжелой дыхательной недостаточности у новорожденных с экстремально низкой массой тела пока не ясна. Целью исследования являлась оценка взаимосвязи выживаемости с носительством некоторых генов предрасположенности к адверсивному течению респираторного дистресс - синдрома у новорожденных с экстремально низкой массой тела (ЭНМТ). Методы. Дизайн - контролируемое, проспективное, нерандомизированное, одноцентровое исследование. Критерии включения: новорожденные с ЭНМТ менее 1000 г и гестационным возрастом 28 недель и менее, ИВЛ более 3 суток. Критерии исключения: множественные пороки развития, гестационный возраст менее 26 недель, гибель в первые 48 часов жизни. В разработку включено 88 пациентов. Исследовался полиморфизм генов белка сурфактанта В (SFTPB 1580 C>T), интерлейкина-1β (IL1B 3953 C>T), рецепторного антагониста ИЛ-1 (VNTR полиморфизм интрона 2 IL-1RN), интерлейкина-10 (IL10 627 С>A), фактора некроза опухоли (TNF-α 308 G>A), гена протромбина (F2-20210 G>A), гена 5-го фактора свертывания (Лейдена) (F5-1691 G>A), гена проконвертина (F7-10976 G>A), гена фактора Хагемана (F13), гена фибриногена В (FGB 455), гена интегрина - альфа тромбоцитов (ITGA2 807 C>T), гена бета - субъединицы фибриногена тромбоцитов (ITGB3-1565 T>C), гена ингибитора активации плазминогена 1-го типа (PAI-1 675). Результаты. Полученные данные указывают на отсутствие взаимосвязи между распределением аллелей и генотипов исследуемых генов и выживаемостью пациентов. Заключение. Носительство изученных генов предрасположенности к развитию респираторного дистресс - синдрома новорожденных, инфекционных осложнений и тромбофилии у новорожденных с ЭНМТ не ассоциировано с их выживаемостью в неонатальном периоде.