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Children with spastic cerebral palsy (CP) are at risk of undernutrition, which increases with the severity of movement disorders. Objective of the study: to assess and compare anthropometric indicators and body composition in children with cerebral palsy, depending on the level of impairment of gross motor function classification system (GMFCS). Materials and methods of research: 102 children were included in a prospective open-label comparative single-center non-randomized study: 58 (56.8%) boys and 44 (43.1%) girls with cerebral palsy aged 2 years to 16 years and 9 months who were undergoing rehabilitation in the National Medical Research Center of Children's Health in the period from 2019 to 2021. Anthropometric measurements (body weight, length, knee height, triceps and subscapular skinfold thicknesses) were performed on admission. Body fat percentage (%FM) was calculated by CP-modified (Gurka) equations and compared with results obtained using bioelectrical impedance analysis. A survey on the EDACS scale was performed to determine the ability to eat and drink. Results: patients were divided into 2 groups: the main group – 53 children (52%) with GMFCS levels IV–V and a comparison group – 49 children (48%) with GMFCS levels I–III. The groups did not differ statistically significantly in terms of gender (p=0.956) and age (p=0.207). The median age in the main group was 7.1 years, in the comparison group – 5.3 years. Children of the main group had statistically significantly lower growth indicators (HAZ1 –1.5 [–2.6; –0.74] and HAZ2 –0.58 [–1.59; 0.44], p=0.003), BMI (BAZ1 –2.43 [–3.67; –0.93]; BAZ2 –0.91 [–1.942; 0.28], p

A complex case report of the diagnosis and surgical correction of ovaricovaricocele (OVC) in a girl with portal hypertension syndrome is presented. The disease manifested itself with symptoms atypical for portal hypertension – dysmenorrhagia and persistent recurrent pelvic pain. The cause of OVC was thrombosis of the left renal vein after splenorenal shunt. Venous hypertension of the left kidney persisted even after creating a mesenteric-caval anastomosis and improving portal hemodynamics. Left-sided ovarian-caval shunt was made with a good clinical effect, which was confirmed by angiography.

Despite the positive developments in the sphere of ensuring the special needs of disabled children, a comprehensive socio-hygienic assessment of the conditions and lifestyles, as well as of their families, has not been carried out in the recent years. The purpose of the study is to identify, through a sociological survey, the problems that a disabled child encounters in his life, in order to further improve the provision of medical and social assistance to him. Materials and methods of research: 506 legal representatives of minors (aged 0–17 years) with the status of a disabled child were interviewed. Study design: single-center, non-randomized, uncontrolled. Results: the study of the living conditions of a disabled child in the family, the assessment by the parents of the state of his health, the problems arising during the registration of disability, in the provision of medical and rehabilitation assistance, and issues of medical and social support, made it possible to determine the position of this part of the child population in modern legal and medical and social conditions. The main problems were the large number of documents required for the registration of a disability, the long wait for the day of the examination, the remoteness of the location of the medical and social examination bureau, the shortage of specialist doctors, the problem with subsidized drugs, the lack of taking into account the individual needs of the child when carrying out rehabilitation programs, the need to contact different organizations and departments, lack of medical and social assistance, violation of rights in the provision of medical services to a disabled child. Conclusion: The acquired information is important for the further improvement of the provision of medical and social assistance to handicapped children and children with disabilities. The main task today is to develop mechanisms for fulfilling the declared rights and freedoms of persons with disabilities and the obligations undertaken by the state in relation to them. The principle of individualization of the provision of various benefits, depending on the condition of a disabled child, his needs, material security, remains relevant.

Objective of the study: assessment of the nutritional status of infants with bronchopulmonary dysplasia. Materials and methods of research: a retrospective uncontrolled non-randomized cross-sectional comparative study was carried out. It involved 40 premature babies (boys – 19, girls – 21) at the corrected age of 3,3 [2,3–4,0] months and 16 age matched full-term babies (comparison group). Children born prematurely were divided into 2 groups depending on their body mass (BM) at birth: 1st – 25 children with BM less than 1500 g, 2nd – 15 children with BM from 1500 to 2500 g. The first group included subgroups 1A and 1B, depending on the presence or absence of bronchopulmonary dysplasia in children. Physical development was assessed using INTERGROWTH-21st and WHO Anthro, 2009 anthropometric calculators, body composition was determined by air plethysmography using a PEA POD apparatus. Results: the assessment of anthropometric indices (WAZ and HAZ) calculated for postnatal and corrected age revealed the most severe manifestations of nutritional deficiency in children with very low BM at birth who developed bronchopulmonary dysplasia. The percentage of fatty BM was statistically significantly lower in children of subgroups 1A and 1B compared to full-term infants (p

The prevalence of food allergy (FA) among children with atopic dermatitis (AD) ranges from 26 to 38%. The article presents an analysis of domestic and foreign publications devoted to the peculiarities of the AD flowing from the FA in children, in which the withdrawal diet plays a leading role in elimination diet. The complete or partial exclusion of one or several foods from the diet contributes to an insufficient intake of macro- and micronutrients, which can lead to a decrease not only in body weight, but also in a delay in the growth of children, as well as in decrease in parameters of bone mineral density. According to research results, the intake of calcium and vitamin D in children with AD and FA is below the recommended levels. The serum 25(OH)D level in these patients is lower than in the general population and is inversely proportional to the SCORAD index. Vitamin D supplementation improves the effectiveness of treatment, helps to reduce the clinical manifestations of AD, as evidenced by a decrease in indicators of both the SCORAD index and the EASI index. The timely and adequate correction of the diets of children with FA who follow strict elimination diets requires an interdisciplinary approach in close cooperation between the pediatrician, allergist and nutritionist.

Objective. To evaluate the significance of therapeutic drug monitoring of adalimumab (ADA) concentration levels and antibodies to it in inflammatory bowel disease (IBD) in children. Patients and methods. In this study, 103 children with IBD (24 patients with ulcerative colitis (UC) and 79 with Crohn’s disease (CD)) aged 3–18 years were examined during maintenance therapy with ADA (100 mg/mL in 0.4 mL). Body weight, duration of disease and therapy, use of azathioprine (AZA), achievement of clinical and endoscopic remission, albumin levels, residual levels of ADA and antibodies to the drug, circulating cytokine levels in serum were assessed. Results. A significant decrease in ADA levels in children in the absence of clinical remission in CD (5.21 [3.32; 7.43] μg/mL in remission) and in UC (2.42 [0.42; 4.51] μg/mL, p = 0.001) was shown. A high-quality separation model for residual ADA levels for exacerbation/remission conditions for clinical and endoscopic activity for children with CD and UC was obtained through ROC-analysis. The minimum residual ADA levels for maintaining clinical remission in children with CD were 8.1 μg/mL and 10.5 μg/mL for mucosal healing. In children with UC, as well as in children weighing

Objective. To evaluate the prognostic value of serum levels of infliximab (IFX) and anti-IFX antibodies for predicting treatment efficacy in children with inflammatory bowel disease (IBD). Patients and methods. This study included 123 children with IBD (65 patients with ulcerative colitis (UC) and 58 patients with Crohn's disease (CD)) aged between 3 and 18 years. Children were examined upon the completion of an induction course of therapy and then after 1 year of therapy and between 1 and 3 years of treatment. The induction course was administered according to the scheme of 0–2–6 weeks; maintenance therapy was administered with 6-week and 8-week intervals. The residual level of IFX and the level of anti-IFX antibodies in serum were measured using enzyme-linked immunosorbent assay. Results. We observed a significant increase in the IFX level during clinical remission of CD (remission – 5.21 [3.32; 7.43] μg/mL; exacerbation – 2.42 [0.42; 4.51] μg/mL, p = 0.001) and UC (remission – 4.57 [3.4; 6.74] μg/mL; exacerbation – 0.63 [0.4; 3.27] μg/mL, p = 0.000). ROC analysis demonstrated high accuracy of our model based on measuring residual IFX level for distinguishing between exacerbation and remission in both CD patients (AUC = 0.812) and UC patients (AUC = 0.851). The optimal minimum level of IFX for maintaining clinical remission was 3.7 μg/mL in children with CD and 3.4 μg/mL in children with UC. Anti-IFX antibodies were detected in 18% of patients; children with exacerbation were 4.7 times more likely to have detectable level of anti-IFX antibodies than those in clinical remission. Conclusion. Monitoring of serum levels of IFX and anti-IFX antibodies is a promising method for predicting treatment efficacy and its optimization in children with IBD. Key words: inflammatory bowel disease, tumor necrosis factor-α, infliximab, residual level of infliximab, anti-infliximab antibodies

Objective. To analyze the connection between the complex of platelet indices in complete blood count test with the clinical and endoscopic activity scores for Crohn's disease (CD) and ulcerative colitis (UC) in pediatric patients and to determine their most informative threshold values. Patients and methods. In this study, 370 children aged 5 to 18 years with diagnosed CD (n = 150) and UC (n = 220) were examined. The clinical activity of UC was assessed according to PUCAI, CD – according to PCDAI; the assessment of endoscopic activity in children with UC was carried out according to UCEIS and CD – according to SES-CD. The study included platelet indices of 630 complete blood count tests (270 in patients with CD and 360 in patients with UC): platelet count (PLT), mean platelet volume (MPV), platelet large cell ratio (P-LCR) and platelet distribution width (PDW). Results. Increased platelet count and decreased platelet indices were noted as the clinical and endoscopic activity of CD and UC in children increased. A positive correlation between the clinical and endoscopic activity indices in inflammatory bowel diseases and platelet count and negative correlations with platelet indices were revealed. ROC analysis showed that the informative value of platelet indices in assessing the endoscopic activity of CD and UC is higher than in assessing the clinical activity. The optimal threshold values for platelet count (cut-off) for determining the endoscopic activity of CD and UC were 340 × 109/L and 350 × 109/L (Se 77%, Sp 69% and Se 63%, Sp 67%, respectively). The specificity of determing the endoscopic activity of 99% was obtained for platelet count of 459 × 109/L and 390 × 109/L for CD and UC, respectively. In children with CD, the indicators MPV

A significant interest in the diagnosis and treatment of orphan diseases, among which inherited metabolic diseases (IMD) constitute a significant part, has been currently increased. For many of them, diet therapy with specialized food products remains the basis of pathogenetic therapy and complex treatment. The expansion of diagnostic capabilities of neonatal and selective screening requires timely guaranteed patients’ provision with specialized therapeutic food products. The article highlights the basic principles of diet therapy for the most common inherited metabolic diseases and the current rules for providing these products to disabled children and patients with IMD who do not have the status of “children with disabilities”. Key words: inherited metabolic disorders, diet therapy, specialized food products, phenylketonuria, galactosemia, cystic fibrosis, celiac disease

Objective. To assess antimicrobial susceptibility, presence of resistance genes and determine the phenotypic groups of K. pneumoniae, P. aeruginosa and A. baumannii isolated from blood and cerebrospinal fluid of children with nosocomial infections in intensive care units from 2014 to 2020. Materials and Methods. Minimum inhibitory concentrations of antibiotics were determined using the serial broth microdilution method. The identification of genes encoding the production of carbapenemases was carried out using hybridization fluorescence detection. Results. A total of 63 isolates of K. рneumoniae, 23 isolates of P. aeruginosa and 14 isolates of A. baumannii were tested in this study. K. pneumoniae was detected in 10.3%. P. aeruginosa was isolated at a frequency of 3.5%. A. baumannii accounted for 2.3%. The proportion of carbapenemresistant K. pneumoniae strains to meropenem and imipenem was 33% and 37%, respectively, of all isolates. Resistance to colistin and polymyxin in K. pneumoniae isolates was 33% and 24%, respectively. The production of carbapenemases OXA-48 was detected in 25 (89%) isolates. The presence of NDM, VIM, KPC carbapenemases was not detected. Among P. aeruginosa, 65% were resistant to meropenem, and 74% to imipenem. The highest activity against P. aeruginosa in vitro was exhibited by polymyxins. There were no strains that were insensitive to colistin. The detection rate of metallo-β-lactamases (MBL) in P. aeruginosa strains was 48%. Only VIM-type MBLs were identified. No other types of MBL have been found. A. baumannii was non-susceptible to meropenem in 64% and to imipenem in 71%. The highest in vitro activity against A. baumannii was shown by polymyxin. Rate of colistin resistance was 29%. The OXA-40 and OXA-23 genes were detected in 5 and 3 isolates, respectively. Conclusions. There were high resistance rates to most antimicrobials among K. pneumoniae, P. aeruginosa и A. baumannii isolated from blood and cerebrospinal fluid in children with nosocomial infections. The increase in carbapenem resistance rates was also observed. Carbapenem resistance was due to OXA48 carbapenemases in K. pneumoniae, VIM-type MBLs in P. aeruginosa, and OXA-40 and OXA-23 carbapenemases in A. baumannii.

The review analyses the available literature on the main principles of breastfeeding support in cases of confirmed/suspected novel coronavirus infection in breastfeeding mothers. Various approaches to management of mother and baby in the conditions of the COVID-19 pandemic have been studied that found reflection in the protocols of the World Health Organization, Chinese, American and European medical communities. The evolution of Russian recommendations is analysed. A rationale is offered for the current guidelines on temporary mother-child separation in the healthcare settings when maternal COVID-19 is suspected/confirmed and on the organization of infant feeding with expressed maternal milk. The literature on the nutritional and biological value and the safety of expressed breast milk stored in various conditions is reviewed. Practical advice is given on organization of an individual breast milk bank at home. Key words: breastfeeding, breast milk, individual milk bank, coronavirus infection, newborns, COVID-19 pandemic, breast milk expression

Objective. To analyze clinical and instrumental characteristics of sleep disorders in children with cardiomyopathies (CMPs). Patients and methods. We performed retrospective analysis of clinical, laboratory, and instrumental parameters in 107 children with CMPs aged 2 to 17 years treated in the National Medical Research Center of Children's Health in 2018–2019. The study sample was formed in accordance with inclusion criteria (confirmed diagnosis of CMP with functional class I or II, NYHA or Ross R.D.) and exclusion criteria (age

For the first time in pediatric practice, the psychological state of 100 children (7-17 years old) with COVID-19 in the state of hospitalization was studied on the basis of the Scientific Medical Research Center of Children's Health of the Russian Ministry of Health Care and the directions of psychological and pedagogical assistance were determined. Analysis of medical and psychological-pedagogical documentation, conversation, observation, screening diagnostics were conducted. It was established that according to the totality of physical and psychological factors (the main psychological difficulty) patients can be grouped into the following groups: children in a severe physical state, with unstable manifestations of mental activity (n = 4; 4%); children in a predominantly moderately severe state with significant distress related to the disease (n = 48; 48%); children in a satisfactory physical state, with mild and mostly situational difficulties in adapting to the situation of hospitalization (n = 46; 46%); children in a satisfactory physical state, in a relatively stable positive psychological state (n = 2; 2%). Consideration of the severity of their physical and psychological condition and their basic psychological difficulties allows differentiated psychological aid to be rendered to children and teenagers in special conditions of the «red zone».

The trends in economic situation requires periodic repetition of studies concerning qualitative evaluation of impact of medical, social and economic factors on population health at the regional level. The purpose of the study is to establish the relationship between the disability of children and the main medical, social and socioeconomic indices in the Russian Federation. The materials and methods. The official data on prevalence of disability in children of 0-17 years and the level of basic medical, social and socioeconomic indices were analyzed in the context of 83 subjects of the Russian Federation in 2017-2019. The demographic and epidemiological data and data on medical care support of children population were used as medical and social indices. The socioeconomic indices (unemployment rate, cash income, housing conditions and consumption of basic food products were used as the socioeconomic indices. The Spearman rank correlation method was used to determine the particular relationships. The results. It was established that the significant inter-regional variability of disability of children both in the Federal Okrugs and the subjects of The Russian Federation persists. The relationship of various degrees of intensity between the prevalence of disability of children in the subjects of the Russian Federation and many medical, social and socioeconomic factors such as demographic indices (fertility, mortality); level of primary and total morbidity of children of all age groups; medical care support (medical personnel, pediatric beds); unemployment level; average per capita cash income; percentage of population with cash incomes below cost of living; total area of residential premises that is on average per inhabitant; share of young families registered as needing housing from total number of families with children aged under 18 years; consumption of cheaper food. The conclusion. The obtained results are to be taken into account in the development of programs of preventing disability of children avoiding to place full responsibility on the health care system only.