Vol 26, No 10 (2019)

In the structure of malignant neoplasms in the Russian Federation, CNS tumors take the second place in detection rate. Despite the continuous improvement of their treatment protocols, therapy is associated with a high risk of developing various complications, a high level of disability and a decrease in the quality of life in those children whose antitumor treatment has been completed successfully. In the structure of these complications, nutritional insufficiency (NI) has a significant role, which increases after the end of the main treatment, since non-timely corrected NI itself is a factor that aggravates any complication and can increase disability. In children with CNS tumors, NI has a significant prevalence: both due to the underlying disease, and the treatment effect. In this regard, it is important to understand the essence and causes of NI in pediatric oncology, the need for its timely detection and adequate correction using various methods and ways of nutritional support. In this cohort of children, preventive nutritional support is effective, and the use of a nasogastric tube and gastrostomy for long-term enteral nutrition is quite reasonable. This article provides a mini-review of world literature regarding these issues.

The article discusses the issues of diagnosis and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP). The emphasis is placed on the clinical and electromyographic criteria for the diagnosis, and the features of the CIDP manifestations in childhood. Pathogenetic methods of treatment - intravenous immunotherapy with standard human immunoglobulin (IVIG), glucocorticosteroid therapy and plasmapheresis - are discussed from the standpoint of evidence-based medicine. The advantages of IVIG (high clinical efficacy, rapid onset of effect, good tolerability, multi-component mechanism of action with multiple points of application, the possibility of carrying out at any age) are emphasized when initiating therapy in children. The use of IVIG with a high 10% concentration of IgG is considered a priority, since it allows to reduce the volume load and provides a significant reduction in the duration of infusion.

The article presents modern algorithms for differential diagnosis and treatment of the central form of diabetes insipidus (CDI) in the framework of intensive care of infectious diseases of the central nervous system. A clinical case of treatment of CDI with severe polyuria in a patient with meningoencephalitis is described. The authors emphasize the key role of infusion therapy under the control of the blood electrolyte levels and the administration of desmopressin as factors that ensure a favorable outcome of neuroinfections complicated by intracranial hypertension syndrome and CDI.

Background. Pertussis again became a serious problem in the 21st century. The decrease in vaccination coverage, the use of acellular vaccines that create a shorter immunity, and most importantly, a change in the epidemiology of the infection as a result of half a century of mass vaccination, has led to an increase in the incidence of disease in adolescents with waning immunity who infect infants. Until now, there are no reliable drugs for the pertussis treatment; antibiotics have an intermittent effect, and only with very early prescription, symptomatic agents are ineffective, and the infants are especially affected, until deaths. In the literature, there are indications of the effectiveness of systemic glucocorticosteroids in severe pertussis, only a few works concern the use of inhaled glucocorticosteroids (IGCS). Objective: currently, when pertussis infection again becomes relevant, we want to share the experience of using IGCS in pertussis and draw the attention of pediatricians to this safe opportunity to alleviate the manifestations of this infection. Methods. An observational study on the use of IGCS included 16 children of different ages hospitalized with frequent severe spasmodic attacks in a pediatric boxed department, including 3 children of the first months of life with complicated pertussis hospitalized in ICU. Budesonide was used together with the antitussive drug butamirate; macrolides were prescribed to reduce the excretion of the pathogen. Results. In all cases, the use of budesonide with butamirate in children in the boxed department led to the decrease in the frequency of cough and reduction of the severity of coughing attacks from the 2nd day, especially at night, with rapid improvement of the condition of patients, that led to the reduced the length of hospitalization to 2-3 days for senior children and to 3-6 days for younger children. In children of the first months of life with complicated forms of pertussis, the administration of IGCS with butamirate led to rapid relief of spasmodic cough and apnea, and allowed to focus on the treatment of pneumonia. Conclusion. According to the authors, IGCS therapy with butamirate should be carried out from the first days of a paroxysmal cough, which helps to alleviate the course of the spasmodic period of pertussis and reduce its duration.

Background. The atonic-astatic form of infantile cerebral palsy (ICP) is quite rare, but represents a serious problem in modern pediatrics due to the difficulty of curability. Objective. The evaluation and comparison of the effectiveness of the combined use of kinesio taping (KT) with robot-assisted training sessions and the standard neurorehabilitation scheme with robot-assisted mechanotherapy against the background of pharmacotherapy in children with atonic-astatic form of ICP. Methods. An open, prospective, nonrandomized comparative study included children with the atonic-astatic form of ICP. Patients were consistently included in the main or control group with the appointment of neurometabolic and non-drug therapy (massage, exercise therapy, physiotherapy, robot-assisted training on the «MOTOmedgracile12» apparatus). In patients of the main group, KT of the muscles of the lower limbs was additionally used. The duration of treatment was 10 days. The effectiveness of the therapeutic measures was evaluated using MRC Muscle Strength Scale, visual and palpatory determination of muscle tone, and parents’ questionnaire for registration of improved and/or new motor skills. A p value of <0.05 was considered statistically significant. Results. The study included 30 patients (main group, n=15; control group, n=15), mean age - 6.75±3.34 years, 73.3% boys. The groups were matched by gender, age and degree of motor impairment (according to the GMFCS and MRS classifications). After completion of the course of neurorehabilitation, an increase in muscle strength and tone was observed in 12 patients of the main group and 5 patients of control group (p=0.031); improvement of support function - in 14 (appearance - in 1) and 5 (p=0.023), and improvement of the walking pattern - in 10 (appearance - in 1) and 3 patients (p=0.036), respectively. Conclusion. The use of KT significantly increases the success of robot-assisted training sessions, exercise therapy and massage therapy against the pharmacotherapy, improves the self-maintenance and socialization of a disabled child, which in turn increases the medical and economic effectiveness of neurorehabilitation measures and improves the quality of life of patients with atonic-astatic form of ICP.

Background. Currently, a number of laboratory methods are used to confirm the presence of allergies, however, confirming the diagnosis of allergic bronchial asthma (ABA) remains a challenge. Objective. Determination of the immunological criteria for ABA. Methods. 160 children aged 6 to 18 years were examined, including 130 patients with ABA and 30 children in the control group. The relative and absolute CD19+, CD19+CD23++ B-lymphocyte, CD23+IgE+-eosinophil levels were determined. Results. The level of B-lymphocytes carrying the CD19+CD23++ receptor serves as a highly informative diagnostic criterion for patients with ABA. With absolute values of the CD19+CD23++ B-lymphocyte level 23.23 cells^l, and a relative level of >5.40%, it is possible to say with a high degree of confidence that the patient has ABA. To confirm the diagnosis of ABA, the CD23+IgE+-eosinophil level should be determined. With an absolute value of the level of these cells of >73.01 cells/iJl and a relative level of >35.10%, it is possible to say with a high degree of confidence about the presence of ABA in the patient. Conclusion. To confirm the diagnosis of ABA, the CD19+CD23++ B-lymphocyte and CD23+IgE+-eosinophil levels should be determined.

Eating disorders in children of early and preschool age remain an urgent problem of pediatrics. Malnutrition in many children leads to an increase in the prevalence of nutritional disorders and health problems, including in adults. Long-term difficulties in feeding are observed in 20-30% of children under the age of 7 years. Loss of appetite in the absence of timely detection and adequate correction leads to negative consequences for the health and development of children due to chronic deficiency of nutrients. Treatment should be comprehensive and aimed primarily at the psychological side of the problem with simultaneous correction of nutrition, if necessary. The article presents a modern approach to the diagnosis and correction of feeding difficulties, which are most common in children of early and preschool age.

Cough is one of the most frequent manifestations of respiratory diseases, especially in children, and it is often caused by inflammation of the tracheobronchial tree; the mucociliary transport system plays the main role in the protection of tracheobronchial tree and maintains airway patency. Disorders of the production and rheological properties of airway secretion contribute to cough, causing mucociliary transport (mucociliary clearance - MCC) disorders. In slowing the MCC, an important role is played by hyperplasia of the bronchial mucosa under the influence of infectious, allergic or other inflammation, edema of the mucous membrane of the tracheobronchial tree, increased secretion of mucus, increased viscosity of bronchial secretion, etc. Among mucolytic drugs used to treat bronchopulmonary diseases in children accompanied by cough, Ambroxol deserves attention. The mechanism of its action is determined by a pronounced expectorant, secretolytic and secretomotor action on the bronchopulmonary system, anti-inflammatory and slight antioxidant effects, as well as stimulation of production and blocking the destruction of surfactant.