Vol 10, No 4 (2019)


Cardiopulmonary resuscitation of neonate at delivery room

Aleksandrovich Y.S., Ivanov D.O., Pshenisnov K.V.


Improving the cardiopulmonary resuscitation quality in the delivery room is one of the most pressing issues in modern neonatology. Despite the fact that in recent years the number of surviving infants with low and extremely low birth weight has been steadily increasing, the nursing outcome is not enough favourable with unsatisfying quality of life. The cardiopulmonary resuscitation protocols have been regularly updated and upgraded (every five years in the last twenty years). This helps to improve resuscitation outcome. In 2015 the American Heart Association and the European Resuscitation Council issued the new edition of the guidelines on basic and advanced cardiopulmonary resuscitation in children, including infants. The guidelines are believed to improve the quality of resuscitation care in the delivery room and to contribute to a better neurological outcome.

Pediatrician (St. Petersburg). 2019;10(4):5-16
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Original studies

Current trends in the physical development of infants living in the northwest region

Sahno L.V., Bairova S.V., Koltunceva I.V., Gaiduk I.M., Revnova M.O., Mishkina T.V., Karelina N.R., Komissarova E.N.


Assessment of the physical development of children, which is an objective reflection of their state of health, is carried out regularly by pediatricians at preventive examinations, the frequency of which decreases with increasing age of the child. To date, the subject of discussion remains the question of which particular standards of physical development are preferable, drawn up taking into account the characteristics of a particular region or unified, developed by experts of the World Health Organization. The article presents the results of a study of the physical development of children of St. Petersburg aged 0 to 12 months. For the period 2016–2017 years. 2419 children were examined. Average values were calculated with standard deviations, centile indicators of length and body weight, all indicators are correlated with gender and age. The data obtained are compared with the standards of the World Health Organization. Higher rates of physical development of babies in St. Petersburg compared with the standard of the World Health Organization may be due to regional characteristics, as well as the transverse method of our study. Given that the World Health Organization’s indicators are “reference”, it is necessary to use them in assessing the physical development of children, regardless of region of residence, which will make the results comparable.

Pediatrician (St. Petersburg). 2019;10(4):17-24
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The efficiency of vitamin D using in the formation of food tolerance to cow’s milk protein in children with food allergy

Nalyotov A.V., Shapchenko T.I., Masjuta D.I.


The problem of vitamin D deficiency is one of the most actual today, because, according to the results of numerous studies, its deficiency is registered in half the world’s population. The article presents the results of a study on the level of vitamin D in children of first year of life, suffering from cow’s milk proteins allergy, as well as in children who have formed a secondary food tolerance to this allergen. In the article was evaluated the effectiveness of the additional use of vitamin D against the background of the therapeutic dairy-free diet use. It was found that the 57.1 ± 4.8% children of first year of life with cow’s milk proteins allergy have vitamin D insufficiency. Normal vitamin D level was found in only 36.2 ± 4.7% of patients. In turn, vitamin D deficiency was found in 6.7 ± 2.4% children, suffering from cow’s milk proteins allergy. It was found that the additional daily intake of vitamin D on the background of the use of therapeutic dairy-free diet may reduce the time of development of food tolerance to cow’s milk proteins and achieve the formation of secondary food tolerance for the three years in 92.0 ± 3.8% of children with cow’s milk proteins allergy. It was found, that the use of only therapeutic dairy-free diet allows to achieve the formation of secondary food tolerance only in 76.0 ± 6.0% children (p < 0.05). The normal level of vitamin D were established in 97.6 ± 1.7 % children, formed a secondary food tolerance to cow’s milk proteins.

Pediatrician (St. Petersburg). 2019;10(4):25-29
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Quantitative MRI as marker of the effectiveness of steroid treatment in patients with Duchenne muscular dystrophy

Suslov V.M., Pozdnyakov A.V., Ivanov D.O., Rudenko D.I., Suslova G.A., Suslova A.D.


Due to development of new methods for the treatment of Duchenne muscular dystrophy (DMD), aimed at suppressing inflammatory activity in skeletal muscles, there is a necessity for objective instrumental methods for assessing the effectiveness of the therapy. This method could be selective excitation of the water T2 signal.

Aim of the study: to determine the possibility of applying the method of selective excitation of water T2 signal as a quantitative biomarker of the effectiveness of steroid treatment in patients with DMD at different stages of the disease. The study involved 34 DMD boys, who were divided into three groups: ambulant patients taking steroid treatment (n = 14), steroid-naive ambulant patients (n = 10), steroid-naive non-ambulant patients (n = 10) and a control group (n = 10). MRI of the pelvic girdle, thighs and lower legs with multi-slice-multi-echo (MSME) sequences has been done for all subjects. Calculation of the water T2 values has been done by the three-exponential method.

Results: There was a significant difference (p < 0.01) between the three study groups, the highest inflammatory activity was determined in the steroid-naive patients and signal intensity was 39.4 ± 1.0 ms for the pelvic girdle muscles, 37.3 ± 1.1 ms for the thighs muscles and 38.1 ± 1.8 ms for the legs muscles. Thus, using of the technique of selectively determination of the signal from water on T2 weighted images can be quantitative biomarker of inflammatory activity and the effectiveness of steroid treatment in patients with Duchenne muscular dystrophy in different stages

Pediatrician (St. Petersburg). 2019;10(4):31-37
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Differential diagnosis of pathological and physiological types of overlay

Puzdyreva M.N., Fomin I.V., Subbotin R.S., Fishchev S.B., Kondratyuk A.A., Orlova I.V.


Relevance. To diagnose pathological teeth location suggested many methods of research. However, the available literature we have not met the information relating to the characteristics of the abnormal protrusion or retrusioni, not showing the diagnostic criteria determine the position of the cutters for their planned in a constructive position is incorrect.

Aim. To diagnose pathological teeth location suggested many methods of research. However, the available literature there is no information concerning the characteristics of the abnormal protrusion or retrusion, not showing the diagnostic criteria determine the position of the cutters for their planned positions in constructive is incorrect.

Materials and methods. Survey of 62 people coming of age in the first period, two clinical groups. In 1st group included 24 patients with physiological occlusion, and the 2nd (38 persons) with abnormal occlusion. In each group were identified in patients with protrusion or retrusion incisors. Evaluation of vertical overlap conducted on MRI and plaster models of the jaws between horizontal lines passing through the cutting edge of the incisors of the upper and lower jaws parallel to the occlusal plane.

Results. People with Group 1 protrusion incisors angle was 149.55 ± 3.92°. Tork upper incisors were 24.36 ± 2.39° degrees. When retrusion incisors angle was 151.47 ± 2.94°, tork upper incisors was 5.85 ± 1.42°. In this case, the vertical overlap is in the sagittal and 2-3 mm is not exceeded. Group 2 patients, as a rule, noted the violation of form dental arches in the anterior segment.

Conclusion. To diagnose physiological protrusion or retrusion incisors used values overlap in the sagittal and vertical direction, consistent with each other and do not exceed 3 mm.

Pediatrician (St. Petersburg). 2019;10(4):39-44
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Experience of treatment precocious puberty by gonadotropin-releasing hormone agonists of prolonged action

Lagno O.V., Turkunova M.E., Bashnina E.B.


Central precocious puberty (CPP) occupies an important place in the practice of pediatric endocrinologist. In the treatment of all forms of CPP, there are used drugs of GnRH (gonadotropin-releasing hormone) agonists group, whose pharmacological effect of is based on desensitization of the pituitary gland to the stimulating effect of GnRH. Therapy with agonist of gonadotropin-releasing hormone allows to stop the progression of sexual development, reduce the rate of bone maturation and, thereby, increase the final growth of the child. The article demonstrates the structure of the dispensary group of patients with CPP who were treated with the agonists GnRH of prolonged action. There has been conducted the analysis of the observation results of patients with idiopathic CPP who received 3.75 mg Triptorelin therapy in the standard regimen once every 28 days and transferred to Tryptorelin 11.25 mg once every 3 months, as well as patients with different forms of CPP with a newly established diagnosis. The presented results of treatment with 11.25 mg Triptorelin drugs by intramuscular injection in a regimen of 1 time in 3 months in comparison with the results of treatment with 3.75 mg of Triptorelin patients in the regimen of intramuscular injections once every 28 days in patients with CPP showed their effectiveness. Preparations of the agonists GnRH group of prolonged action inhibit the development of secondary sexual characteristics, lead to a decrease in the size of the internal genitalia in female and external genitalia in male and reduce the progression of bone age. It was also noted that reducing the frequency of injections of drugs of this group from 1 time in 28 days to 1 time in 3 months positively affects the emotional state of children receiving this treatment for a long period (3-6 years).

Pediatrician (St. Petersburg). 2019;10(4):45-50
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Target announcer voice detection by shcoolchildren of different psychophysiological status in case of vocal competition

Erkudov V.O., Ogorodnikova E.A., Pugovkin A.P., Sergeev I.V., Slyaptsova T.N., Kundrat E.O., Lupanova P.A., Pakhomova M.A., Denisenko M.D., Balashov A.L.


Management of variability of the cardiac rhythm (VCR) is widely applied as a marker of psycho emotional state in educational institutions. This approach is suitable for testing properties of the pupils for the detection of vocal signals.

The aim of the study was a comparative analysis of VCR as an objective parameter corresponded with psycho-emotional tension and acoustic perception of the speech in youngsters under sophisticated condition of the competition between vocal signals pronounced by different individuals.

Methods. VCR was measured in 44 male and female youngsters 13–16 years old with the comparison of identification of competing acoustic signals – random sequences of words simultaneously pronounced by male or female voice. VCR analysis provided distinction the prevalence of sympathetic versus parasympathetic tone reflecting high or moderate level of psycho-emotional tension.

Results. Identification of target words pronounced by female voice in subjects with prevalence of sympathetic or parasympathetic tone was correct in 96% and 87% respectively. Target words pronounced by the male voice were correctly identified in 88% cases in both groups. It is suggested that in primary schools where women compose majority of teachers, the developing juvenile brain imprints the corresponding acoustic wave band. Under the conditions of psycho-emotional tension these links are realized with maximal effectiveness.

Pediatrician (St. Petersburg). 2019;10(4):51-59
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Area of the territory and features of the health care system in the arctic zone of the republic of Sakha (Yakutia)

Gogolev N.M., Burtseva T.E., Avrusin S.L., Melnikova L.N., Batilova T.V., Chasnyk V.G.


Implementing major projects for development of the Arctic regions of the Russian Federation and ensuring sustainable economic growth of these regions, the government pays a special attention to the social development and improvement of medical care in remote and hard-to-reach areas of the Russian Arctic. In recent years, research of the people’s health and influencing factors have intensified. The Ministry of Health of the Republic of Sakha (Yakutia) carried out large federal and republican programs to develop the material and technical equipment and ensure appropriate staffing of medical institutions in the Arctic and northern regions. The Republic of Sakha (Yakutia) is one of the most isolated and hard-to-reach regions of Russia, therefore, development of medical care in the Arctic zone is particularly important. The article presents the characteristics of the Arctic zone of the Republic of Sakha (Yakutia), population density 1 km2, distance of settlements from the center. The percent of remote and hard-to-reach settlements in the arctic regions ranges from 38 to 80%. The network of medical institutions with analysis of equipment and staffing is presented in detail. The article reflects the specifics of medical care in the Arctic zone in the context of the territory scale. The identified peculiarities make it necessary to develop differentiated regional mechanisms of implementing the state policy of healthcare development in the regions of the Far North of the Russian Federation. It would be reasonable to consider the possibility of developing a medical care sub-program taking into account the Arctic specifics.

Pediatrician (St. Petersburg). 2019;10(4):61-66
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Formation of metabolic syndrome in childhood: theoretical and clinical aspects

Bulavko I.E., Uspenskiy Y.P., Aleksandrovich Y.S., Reznik V.A., Filimonov A.E.


According to statistical data the number of the children with obesity steady grows every year. In this regard the attention to a problem of metabolic syndrome (MS) has to be paid at the first stages of its formation, since early childrenʼs age, for the further preventive measures of development of cardiovascular diseases. The special contribution to the development of MS on geniture is made by fetal programming. Metabolic changes in mother are associated with the development of gestosis which makes a negative impact on the “mother–feto–placentary complex–fetus” system, and with increase of frequency and severity of perinatal pathology which demand urgent resuscitation actions. In childhood, syndromes that are part of the MS are gradually and often asymptomatic. One of the first components of MS developing is obesity, at the age of 10 hypertension joins, in the pubertal period — impaired glucose tolerance. Dyslipidemia can occur at any age, including debuting only in adulthood. In addition, the components of the syndrome significantly limit the vital activity and reduce the social activity of children, thus worsening the general and mental state, reducing the quality of life. In children with MS anesthetic management has a set of features, both in organizational aspects and in the management of patients in conditions of increased risk of complications. Thus, early detection of children suffering from MS, primary and secondary preventive measures will allow to prevent or delay the manifestation of cardiovascular diseases, their transformation into chronic nosological forms, as well as improve the course and prognosis of cardiovascular disease in adulthood.

Pediatrician (St. Petersburg). 2019;10(4):67-78
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Current international guidelines for the diagnosis and treatment of acute pancreatitis in children

Kamalova A.A., Urazmanova I.M., Khayretdinova R.F., Badretdinova A.N.


The article presents current data on the etiology, diagnosis and treatment of acute pancreatitis in children. Over the past 10-15 years, the incidence of pancreatitis has increased and is 3.6-13.3 cases per 100,000 children. According to the results of an international study INSPPIRE a group of researchers involving in to the study of pediatric pancreatitis gave a definition of acute, acute recurrent and chronic pancreatitis and developed clinical guidelines for the management of this pathology in children. Acute pancreatitis is a polyetiological disease, the causes of which may be abnormalities in the development of the pancreatobiliary system, drugs, injuries, infections, systemic diseases. Diagnosis is based on clinical manifestations and laboratory and instrumental data. Clinically acute pancreatitis is manifested by abdominal, dyspeptic and asthenic syndromes. Particular attention is paid to the timely diagnosis of pancreatitis in children with unexplained abdominal pain syndrome. In such cases, it is mandatory to determine the level of amylase and lipase. Transabdominal ultrasound is the screening method among instrumental methods. Computed tomography and magnetic resonance imaging are necessary imaging techniques for suspected pancreatic necrosis. Magnetic resonance cholangiopancreatography, in turn, plays an important role in the diagnosis of anomalies and lesions of the biliary and pancreatic ducts. There are modern classification, diagnostic criteria of acute pancreatitis, laboratory and instrumental methods of the diagnosis and approaches to the treatment in children in the article.

Pediatrician (St. Petersburg). 2019;10(4):79-87
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Autoimmune and lymphoproliferative malignant diseases associated with Epstein-Barr viral infection

Fedorova A.V., Timchenko V.N., Bannova S.L., Kaplina T.A., Balashov A.L., Gasanova S.K., Vasilenova Y.S., Yarmolitskaya E.A., Sokolova K.V.


Currently, in medical practice, there is a high interest in diseases caused by herpes viruses, among them the Epstein-Barr virus (EBV) occupies the leading place. Almost 90% of the world’s population over the age of 40 are infected with VEB. In patients of the first two years, the proportion of asymptomatic carriage reaches 90%, and at the age of 2-10 – 30-50%. The article considers current data on the impact of EBV on cellular and humoral immunity, its connection with autoimmune and lymphoproliferative diseases. EBV has been shown to play a significant role in the onset of oncological diseases such as Hodgkin’s lymphoma, Burkitt’s lymphoma, nasopharyngeal carcinomas, as well as autoimmune diseases – systemic lupus erythematosus, rheumatoid arthritis, Sjogrenʼs syndrome, autoimmune hepatitis, lymphoid interstitial hepatitis, lymphoid interstitial syndrome. The results of studies over the past 5 years of cases of activation of autoimmune processes associated with EBV infection, as well as predisposing factors underlying these manifestations, are presented. Due to the fact that the autoimmune effect of EBV infection is manifested in various organs and tissues, this problem is multidisciplinary, affecting such fields of medicine as pediatrics, infectious diseases, endocrinology, oncology, gynecology, ophthalmology, gastroenterology, etc.

Pediatrician (St. Petersburg). 2019;10(4):89-96
pages 89-96 views

Bacterial vaginosis as a risk factor for preterm birth

Ruhljada N.N., Taits A.N., Romanova L.A., Matukhin V.I., Logunova M.A., Sabyrzhanova K.A.


At the moment, the problem of preterm birth is one of the most urgent in the modern world. Preterm birth is of the greatest interest in obstetrics, as they can lead to various conditions that interfere with the further development and vital activity of the baby, which can lead to various disorders in the baby’s body systems, and in the worst case, can also lead to its death. Nowadays, there is no complete understanding of the mechanisms of development of preterm labor. The pathogenesis and pathophysiology of preterm birth are extremely complex, however, of course, many factors affect the development of this process, including the state of the microflora of the female genital tract. This article provides a review of current literature on the effects of bacterial vaginosis and significant infectious microorganisms (Prevotella sp., Mobiluncus sp., Gardnerella vaginalis, Mycoplasma hominis, etc.) on the development of preterm labor. This work presents a review of the current literature on the available data on the effect of various microorganisms of the female genital tract, as well as the significant cytokines, defensins, prostaglandins, and other biologically active substances secreted by them that are most likely involved in the process of preterm delivery. A probable mechanism for the development of preterm labor is presented under the influence of changes in the vaginal microflora and the predominance of pathogenic and conditionally pathogenic flora with the participation of matrix metalloproteinases, phospholipases and ligands of Toll-like receptors.

Pediatrician (St. Petersburg). 2019;10(4):97-101
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Congresses’ and conferences’ reports

Development of a new conceptual platform in asthmology. EAACI 2018

Nesterenko Z.V., Bulatova E.M., Lagno O.V.


Asthma remains one of the most important medical and social problems of current medicine. Despite significant approaches the increase in its incidence continues. 334 million people worldwide are affected by this chronic disease and more than 250 thousand die every year. Current asthma treatment methods aren’t useful to achieve asthma control in half of patients that associates with high risk of exacerbation of the disease. Modern asthma management requires a deep analysis of the factors responsible for the asthma progression and the development of exacerbations. The European Academy of Allergology and Clinical Immunology was held May 26-30, 2018 in Munich. The present publication sums up speeches of leading experts in the field of allergology and clinical immunology. Well-known experts in the field of diagnostics, treatment, prevention of bronchial asthma, modern views on the problem, a common pathology, which, despite considerable efforts, continues to grow, especially in the children’s population. The use of recent advances in molecular allergology, clinical immunology makes it possible to convincingly prove the heterogeneity of bronchial asthma, the need to use new diagnostic and therapeutic methods: biomarkers to detect pheno-endotypic diseases with the appointment of strictly targeted individualized treatment of patients with the results of new biologics. All attention was paid to the study of emerging and clinical trends of uncontrolled bronchial asthma, proposals for the use of new classification structures with indication of biological markers of each pheno-endotype of uncontrolled bronchial asthma were considered. A revised version of the GINA with the revision of therapeutic tactics, including in children, is presented. The latest EAACI Congress made a significant contribution to improving the diagnosis and effective treatment of bronchial asthma, which will allow treating patients with different clinical manifestations of this disease.

Pediatrician (St. Petersburg). 2019;10(4):103-110
pages 103-110 views

Clinical observation

Case of methemoglobinemia in an infant with cyanosis

Biktimirova A.A., Kamalova A.A., Sabirova D.R., Shakirova A.R., Gayanova C.I., Saifullina R.M., Cheminava L.D., Fattakhova I.I.


Methemoglobinemia refers to a group of hemoglobinopathies which characterized by an increase of the hemoglobin (Hb) amount, in which oxidation of ferrous iron to ferric iron is observed with the loss of the ability to reversibly bond with oxygen and the development of hemic hypoxia. Cyanosis is the most common symptom of methemoglobinemia and is the reason for the differential diagnosis of cardiovascular and respiratory diseases. Timely determination of the cause of cyanosis in a newborn can be a difficult task. By origin, cyanosis in children at birth and in the first weeks of life is cardiac, respiratory, cerebral, metabolic, and hematological. The prognostic value of cyanosis is different for different diseases. Pronounced and persistent cyanosis in diseases of the lungs and heart indicates a high degree of respiratory or heart failure and prognostic unfavorable. Most of the causes of acute cyanosis is an immediate threat to the life of the patient. Prolonged tissue hypoxia in patients with persistent cyanosis leads to the development of secondary erythrocytosis, an hematocrit increase, blood viscosity, which worsens the microcirculation in tissues, aggravating the deficit of tissue respiration. If cyanosis is detected in infants, differential diagnosis should include hemoglobinopathies, in particular, methemoglobinemia. A carefully collected medical history, the exclusion of all possible causes of cyanosis and hypoxemia, and the assessment of methemoglobin in the blood allow a timely diagnosis. The purpose of the article is to describe the clinical observation of methemoglobinemia in an infant with a detailed discussion of the characteristics of the case.

Pediatrician (St. Petersburg). 2019;10(4):111-116
pages 111-116 views

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