Vol 10, No 6 (2019)

Editorial
The feature of brain oxygenation in the sleep cycle of healthy newborn babies
Evsyukova I.I., Zvereva N.A., Gurieva N.G., Velichko T.A.
Abstract

Noninvasive monitoring brain oxygenation with near-infrared spectroscopy (NIRS) is becoming a widely used in neonatology for determine the optimal target oxygen saturation during resuscitation of newborns, but it’s use in clinical practice for diagnostics and prognosis perinatal pathology is limited because intra and especially interpatient variability are too large for this aim. This study aimed to determine cerebral oximetry values during the sleep cycle and wakefulness in healthy full term newborns. 38 newborns (gestational age 38 weeks were included in this study (22 after normal birth – I group and 16 after cesarean section). Near-infrared spectroscopy (CrSO2) from left fronto-parietal region was recorded in synchrony with polysomnography. Continuous cerebral CrSO2 were measured using near-infrared spectroscopy (Somanetic INVOS 5100C, USA). Fraction tissue oxygen extraction (FTOE) was calculated using SaO2 (pulse oximeter Radical “Masimo”) and CrSO2 (FTOE = (SаO2 – CrSO2)/SаO2). CrSO2 and SаO2 were analyzed during 15 minutes polysomnography-defined quiet, active sleep and wakefulness (defined according to standard guidelines). The results: cerebral oxygen saturation varies with sleep-wake states: during active sleep (74,18 ± 0,75%) was similar to the value in wakefulness (75,6 ± 1,0%) and smaller than in quiet sleep (81,93 ± 1,74%, р < 0,001), but FTOE during active sleep was significantly higher (0,221 ± 0,008% and 0,129 ± 0,005%, p < 0,001). There were no differences of rates between groups. The high oxygen consumption during REM sleep supports its role during postnatal brain functional development. The use of NIRS taking into account sleep structure will be new method for diagnostic and prognosis perinatal pathology CNS.

Pediatrician (St. Petersburg). 2019;10(6):5-11
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Original studies
Assessment of body length in infants born with different types of mild prenatal development delay
Ivanov D.O., Derevtsov V.V.
Abstract

Objective. To assess the length of the body in infants from mothers with a burdened somatic and obstetric-gynecological history, including with a delay in the growth of the fetus of various types of mild severity, in comparison with each other, with healthy children from practically healthy mothers and with children from mothers with an aggravated somatic and obstetric-gynecological history, but without delayed fetal growth.

Material and methods. 166 new-borns were monitored since birth, including 72 infants born after abnormal pregnancies with mild foetus growth and development retardation (gr. 1), and 69 infants born after abnormal pregnancies, but without any retardation (gr. 2), born by mothers with previous somatic and gynaecological disorders. The symmetrical intrauterine growth and development retardation was diagnosed in 15 infants (20.83%) (subgr. 1b), whereas the dissymmetric retardation was diagnosed in 57 children (79.17%) (subgr. 1a) from gr. 1. Practically healthy infants born by practically healthy mothers after normal pregnancies made up gr. 3 (25 subjects). Children are full-term, looked round in 1 (154), 3 (138), 6 (131), 12 (119 children) months. Comprehensive analysis of history, inspection, body height. Distribution-free statistical analysis methods.

Results. The differences (p < 0.01) in body length (Me, cm) in children at birth between the subgr. 1b (48) and gr. 2 (52); in 1 month between subgr. 1a (53) and 1b (52.5); in 3 months between subgr. 1a (60) and gr. 2 (62); in 6 months between subgr. 1a (66.5) and 1b (65.5); in 12 months between subgr. 1a (74.25) and 1b (73), subgr. 1a and gr. 2 (76), subgr. 1b and gr. 2. Increase of body length to 1 month in children subgr. 1a (4) and 1b (4.5) in comparison with children gr. 2 and 3 by 1 and 1.5 cm respectively more; to 3 months in children subgr. 1a (7) and gr. 2 (7) are comparable and more than children subgr. 1b. by 0.5 cm, gr. 3 by 1 and 0.5 cm respectively; to 6 months in children subgr. 1a (6.5) and 1b (6.5) more than the gr. 2 by 0.5 cm, less than the children gr. 3 by 0.5 cm; to 12 months in children subgr. 1a and 1b; gr. 1, 2 and 3 are comparable. To 12 months in children subgr. 1b in relation to children gr. 2 and 3 less by 0.5 cm.

Conclusion. The established difference in body-length should be taken into account during the dispensary observation in order to decide whether to carry out corrective measures.

Pediatrician (St. Petersburg). 2019;10(6):13-18
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Renal function in premature infants in the neonatal period
Obukhova A.N., Khaletskaya O.V., Tush E.V.
Abstract

The aim of the investigation was to assess the functional state of the kidneys of preterm infants of various gestational ages with signs of acute kidney injury.

Materials and Methods. The study included 30 preterm infants born at 29 to 36 weeks gestation with signs of acute kidney injury. Patients were divided into two groups: group I included children with low body weight, born at 32–36 weeks of gestation; group II – with very low birth weight, born at 29–31 weeks of gestation. In the study of kidney function, the main markers were analyzed – serum creatinine, urea, diuresis level, glomerular filtration rate (GFR) at the third week of life, as well as at discharge from the hospital when reaching the postconceptual gestational age of 36.0 [35.0; 39.0] weeks. Severity was assessed in both groups of patients.

Results. In both groups of children, a slight degree of severity was recorded, the risk stage (“Risk”) according to the pRIFLE classification criteria (2007). The evaluation of the biochemical blood test did not show a statistically significant difference in creatinine, urea, GFR, and the rate of diuresis between groups of children with low body weight and very low birth weight. In both groups of patients, creatinine and urea levels in the third week of life exceeded the age standards. By the time the postconceptual gestational age was reached at 36.0 [35.0; 39.0] weeks, there was a statistically significant decrease in the level of these indicators in patients of both groups. In addition, it was found that premature children are at risk for the formation of hyperoxaluria (53% in the structure of crystalluria).

Conclusion. Timely diagnosis of acute kidney injury in premature newborns will allow adequate therapy to prevent the progression and further formation of terminal renal failure. It is important to determine the level of excretion of oxalates in the urine to prevent the development of urolithiasis.

Pediatrician (St. Petersburg). 2019;10(6):19-25
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Pathogenetic features of formation of experimental preeclampsia-like condition
Reznik V.A., Ivanov D.O., Bagrov A.Y., Ruhlyada N.N., Tapilskaya N.I.
Abstract

Objective. To study the pathogenesis of clinical and laboratory syndromes of preeclampsia-like condition and the possibility of influencing them through the introduction of specific antibodies to marinobufagenin.

Materials and methods. 36 pregnant rats were used in the experiment. 24 rats from 12 to 19 days of pregnancy were prescribed a 1,8% NaCl solution to simulate a preeclampsia-like condition. Subsequently, this sample was divided into 2 groups. In one group (12 animals, the second group), preimmune rabbit serum was administered intraperitoneally as an immune agent. In another group (12 animals, the third group), a single intraperitoneal administration of polyclonal anti-marinobufagenin antibodies was performed. After the antibody injection, a comprehensive clinical and laboratory evaluation was performed.

Results. Against the background of a hypersol diet, an increase in systolic blood pressure was found, as well as the concentration of marinobufagenin in blood plasma. The introduction of antibodies to marinobufagenin caused a decrease in blood pressure. In addition, the formation of a preeclampsia-like condition showed an increase in endoglin and sFlt1 in the placenta, as well as an increase in sFlt1, collagen-1 and a decrease in Fli-1 in the thoracic aorta. The appointment of antibodies to marinobufagenin led to an increase in the content of Fli-1 to the level in the control group.

Summary. In the formation of a preeclampsia-like condition, an increase in the level of marinobufagenin in blood plasma leads to an increase in the content of antiangiogenic factors in the placenta and in the thoracic aorta. Intraperitoneal administration of antibodies to marinobufagenin contributes to a significant increase in the content of Fli-1.

Pediatrician (St. Petersburg). 2019;10(6):27-33
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Peculiarities of cellular and humoral immunity in 3–12 months old infants with atopic dermatitis
Dementieva E.A., Gurina O.P., Blinov A.E., Varlamova O.N., Blinov G.A., Stepanova A.A.
Abstract

The increasing frequency and severity of allergopathology in childhood dictate the need to deepen theoretical knowledge about the pathogenesis of immune reactions in allergies.

The aim of the work is to analyze the indicators of cellular and humoral immunity in children of the first year of life suffering from atopic dermatitis.

Materials and methods. 61 children were examined. Three groups were formed: group 1 – children aged 3–5 months (30 children), group 2 – 6–9 months (19 children), group 3 – 10–12 months (22 children). The study of the immune status was carried out by immunological tests of the first level. Immunophenotyping of lymphocytes-by flow cytometry.

Results. The subpopulation composition of lymphocytes revealed some age-related features: children of group 1 are characterized by the development of T-lymphocytopenia, group 2 – B- and T-cell lymphocytopenia, group 3 – B-lymphocytopenia. In all age groups, there is a decrease in the content of activated NK-lymphocytes, HLA-DR+ T-lymphocytes, and an increase in γδ-T-lymphocytes. Decrease in the immunoregulatory index in group 1 – 23.3% of cases, in group 2 – 26.3%, in group 3 – 45.5%. Violation of the process of phagocytosis is noted in 22.4% of children. All examined children have hyperimmunoglobulinemia E, which is ten times higher than the age norm. In group 3, a strong negative correlation was found between the value of the immunoregulatory index and the concentration of total IgE (r = –0.6). The content of immunoglobulins A, M, G in the blood serum tends to develop of hyperimmunoglobulinemia. However, more than 40% of children older than 6 months have a deficiency in the synthesis of one or two classes of immunoglobulins.

Conclusion. The detected changes in the immune status are predisposing for the development of a secondary immunodeficiency state in the future. The study of the immune status in children with atopic dermatitis is necessary for individual immunocorrection in order to increase the effectiveness of basic therapy, reduce the severity of the disease, the frequency of exacerbations.

Pediatrician (St. Petersburg). 2019;10(6):35-44
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Use of the method for the formation of the concepts of size and shape in preschool children for clinical research
Tikhonravov D.L., Voitenkov V.B., Golubeva I.U., Gerasimov A.P., Pashkov A.Y.
Abstract

The goal of the present study was to test the method of forming or actualizing preverbal concepts in the conditions of an independent search for a task solution in order to use the method in clinical practice. The conditions of the absence of researcher’s instructions allow: 1) to compare in ontogenetic and clinical aspects; 2) to develop the skills of an independent search for solutions in problem situations; 3) to improve the creative potential of a child; 4) to develop the ability to achieve a goal. The advantage of using the preverbal concepts of size and shape is that this method can be applied to children of primary preschool age and children with a delay in speech development. To test the method, 7 healthy children of the middle preschool age (4-5-year-old children) were selected. The first task was to form or actualize the concept of a bigger or smaller size in children during the simultaneous presentation of 4 flat or volume geometrical figures. The second task was to form or actualize the concept of a flat or volumetric object among simultaneously presented 4 figures of the same size (small, medium or big). To get reward children should have chosen the figure, which was different from the other 3 ones in a trial during the formation of both the concepts. In the both tasks, we calculated the quantity of trials, which were needed for the single attainment or excess of the 70% level of the correct task performance per each type of learning. The behavioral results showed that the learning speeds during the formation of the concepts of the bigger/smaller size and flat/volumetric shape did not significantly differ from each other. It could be suggested that those concepts were equally important for the 4-5-year-old children. The study showed that the concept formation model is a convenient psychological method for testing the level of the development of the higher cognitive functions in participants and its use is possible in clinical practice with the parallel recording of the brain activity (EEG, evoked potentials etc.) in children in the process of their performing cognitive tasks. The described model is promising for identifying intellectual developmental delays in preschool children and can be used to test children with various cognitive abnormalities.

Pediatrician (St. Petersburg). 2019;10(6):45-52
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Therapeutic tactics in cholelithiasis in children
Svarich V.G., Kagantsov I.M., Svarich V.A.
Abstract

There are still many questions concerning the choice of tactics for the treatment of cholelithiasis in childhood. For a long time, cholelithiasis traditionally considered a pathology of adults. Accordingly, virtually all research was devoted to the diagnosis and treatment of this pathology in the above group of patients.

Purpose of research. Justification of tactics in surgical treatment of cholelithiasis in children.

Patients and research methods. The work formed observations on 135 children aged from 2 to 17 years with cholelithiasis. In 70.4% of cases the disease is observed in girls and boys, respectively at 29.6%. 7.8% of patients have children disease arose against the backdrop of hemolytic anemia. One patient, who received urgent indications, had manifestations of mechanical jaundice: an increase in the level of common bilirubin and its direct fraction, pronounced jaundice of the skin. In the second group, 140 children with chronic stoneless cholecystitis were compared.

Research result. All patients with cholelithiasis identified different ways deformation in the area of gallbladder duct. One of the major causes of cholelithiasis in children are changes in the gallbladder duct. No patient has ever been found in concretions extrahepatic biliary passages. In patients with chronic stone-free cholecystitis pathology in the area of bladder flow was not found.

Conclusion. One of the major causes of gallstone disease in children are changes in the gallbladder duct, that most likely leads to obstruction of outflow of bile from the gall bladder, with the subsequent formation of concrements. Therefore, the conduct of conservative treatment of cholelithiasis in children appear to be ineffective and the method of choice in the treatment of this pathology can be a cholecystectomy.

Pediatrician (St. Petersburg). 2019;10(6):53-57
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The functional state of the heart in women prior to extracorporeal fertilization and its dynamics after stimulation of superovulation
Vakareva V.V., Avdeeva M.V., Scheglova L.V., Popova V.V., Voronkov P.B.
Abstract

The purpose of the work – to study echocardiographic parameters before and after the induction of superovulation to determine the nature of the effect of extracorporeal fertilization on the functional state of the cardiovascular system in healthy women of reproductive age.

Materials and methods. The article presents the results of clinical and instrumental examination of 80 practically healthy women (mean age 32.3 ± 3.5 years). All women were examined twice – before and after induction of superovulation during extracorporeal fertilization.

Results. It was established that a decrease in the stroke volume of blood (p < 0.001) was accompanied by a compensatory increase in heart rate (p < 0.001). These changes ensured the stability of the minute blood volume after induction of superovulation (before – 51.1 ± 1.1 ml; after – 52.1 ± 1.2 ml; p > 0.05). After induction of superovulation in women, an increase in the integral systolic index of cardiac remodeling was noted (before – 108.7 ± 2.5 units; after – 118.5 ± 4.7 units; p < 0.001), an indicator of myocardial stress in systole (before – 111.5 ± 6.7 dyne/cm2; after – 127.3 ± 7.4 dyne/cm2; p < 0.001) and the indicator of myocardial stress in diastole (before — 139.4 ± 6.8 dyne/cm2; after — 165.7 ± 7.9 dyne/cm2; p < 0.001). In practically healthy women, after induction of superovulation, the left ventricular ejection fraction increased (before – 71.3 ± 4.2%; after – 74.8 ± 4.1%; p < 0.001). The revealed dynamics is regarded as a response of the myocardium to a change in the hormonal background during superovulation induction. This is evidenced by the correlation between the estradiol level and the left ventricular ejection fraction (r = 0.36; p < 0.05).

Conclusion. Induction of superovulation does not adversely affect systolic and diastolic function of the left ventricle. However, after these manipulations there is an increase in systolic and diastolic myocardial stress, which reflects myocardial stress in response to hemodynamic changes. Remodeling indices are more informative for evaluating maladaptive and adaptive variants of myocardial changes in healthy women than traditional echocardiographic indicators. In this regard, remodeling indices should be used as additional indicators of the functional state of the heart in women before and after the induction of superovulation in vitro fertilization.

Pediatrician (St. Petersburg). 2019;10(6):59-65
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Reviews
On the effectiveness of mechanisms of psychophysiological adaptation in the dynamics of the educational process
Lezareva T.A., Lytaev S.A.
Abstract

The article presents a review of the literature on contemporary studies of adaptation to educational activity in elementary, middle and high school. Shows the importance of psychophysiological “cost” of adaptation in the process of achievement of result of learning activities. The possible content of the main psychophysiological complexes for assessing adaptation parameters is considered, including methods for determining the typological properties of the nervous system, heart rate variability indicators, constitutional features that make up the concept of the psycho-physiological status of students, which is not only genetically determined, but can also change under the influence of external influences. Attention is paid to gender heterochronism of development. Special attention is paid to the problem of adaptation of students to specialized education. The necessity of psychophysiological monitoring taking into account the “cost” of adaptation is shown that there are three main periods of tension of adaptation systems in the learning process – primary school, puberty and the first courses of study at the university, but the mechanisms of stress in these three groups differ significantly. So, among first graders, the failure to adapt is facilitated by the mismatch of the rates of morphofunctional development, and there is also a significant effect of gender heterochronism of development on adaptation processes. In adolescents, at the beginning of puberty, there is an increase in the “price” of adaptation to educational activities, and the tension of regulatory mechanisms increases during the transition to specialized education, however, the conformity of individual typological characteristics to the chosen educational direction is of great importance in further adaptation. First-year students, unlike five-year students, have a decrease in the reserve capacity of the cardiovascular and central nervous systems, especially in conditions of exam stress.

Pediatrician (St. Petersburg). 2019;10(6):67-77
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Clinical psychology
Defensive-coping behaviour of patients with atopic dermatitis
Biletskaya M.P., Golikova M.A.
Abstract

Atopic dermatitis – the multifactorial disease of skin which is characterized by an itch, the recurrent course, age features of localization and morphology of the centers of defeat. Today, a significant increase in the incidence of atopic dermatitis and, at the same time, its course is worsening. Exacerbation of the disease is a stressful situation, in order to cope with which it is necessary to form protective-coping behavior. Results of a research of features protective coping behavior of patients with the diagnosis “Atopic dermatitis” taking into account the sex are given in article of authors. All examinees have the lichenoid form of atopic dermatitis, the beginning of a disease was at early children’s age; the symptomatology of a disease is shown seasonally, or at influence of stressful factors. Frequency of exacerbation of a disease 3–4 times a year, hospitalization in connection with a disease 1–2 times a year. All examinees are registered in Dermatovenerologic clinics; on a question whether stirs this diagnosis in everyday life, answer in the affirmative. On the basis of the analysis of the received results authors allocated targets of psychological correction: non-adaptive coping behavior, low level of adaptation opportunities (personal adaptation potential, behavioral regulation, communicative potential). The authors developed a program of psychological correction of patients with atopic dermatitis, which can later be included in the system of integrated approach to prevention, treatment and rehabilitation of this of patients.

Pediatrician (St. Petersburg). 2019;10(6):79-84
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Clinical observation
A case of Nijmegen syndrome in a child with frequent relapses of a respiratory infection
Besedina E.A., Prometnoy D.V., Piskunova S.G., Selezneva O.S., Kharakhashyan L.E., Anchutin P.E.
Abstract

The article provides clinical dynamic observation of a child with a primary immunodeficiency state, presents the stages of the differential diagnostic search for congenital genetic pathology. Nijmegen syndrome is an autosomal recessive disease caused by a mutation of the NBN gene, characterized by microcephaly, “Bird” facial features, delayed physical development, immunodeficiency, congenital malformations, increased sensitivity to x-ray radiation and a high susceptibility to cancer. This syndrome is relevant for Russian pediatricians due to the high frequency of carriage of the “Slavic” NBN gene mutation among the population of the Russian Federation. The presented clinical observation describes a patient with characteristic phenotypic features, frequent episodes of acute respiratory viral infections (up to 8 times a year) with the addition of a bacterial infection, fever up to febrile numbers. The duration of verification of the immunodeficiency state was 5 years. Despite the complicated course of infectious diseases, the general well-being of the child did not suffer significantly, the level of neuropsychic development corresponded to age. The diagnosis of Nijmegen’s syndrome was made on the basis of characteristic phenotypic features, anamnesis, and laboratory data, instrumental studies and confirmed by the results of molecular genetic analysis.

Pediatrician (St. Petersburg). 2019;10(6):85-92
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Subdural hematomas in young children: clinical and electrophysiological features
Melashenko T.V., Fomina M.Y., Usenko I.N., Rodionov Y.V.
Abstract

Subdural hematoma is a sufficiently rare, but serious pathology of the brain in infants, which can lead to severe neurological deficit or result in death. Subdural hematomas are detected in 20–25 per 100,000 children under 1 year. A retrospective analysis of autopsy material revealed that subdural hematomas were diagnosed in 72% of children who died before the age of 5 months from intracranial hemorrhage. According to localization, subdural hematomas are divided into supra- and subtentorial, mainly associated localization, which are located along the tent of cerebellum and sickle of the brain, mainly. The main mechanism of development of subdural hematomas is associated with the rupture of the bridge veins of the subdural space as a result of their tension, both traumatic etiology and nontraumatic brain damage, accompanied by progressive cerebral atrophy. It is believed that perinatal hypoxic-ischemic brain damage is one of the leading etiological factors of developed subdural hematomas in young children. In addition, the formation of subdural hematomas in young children can be observed with intraamniotic infections, congenital fermentopathies, and above all, in children with aciduria. In some infants, subdural hematomas occur without clinical manifestation, but in most cases are accompanied by the development of neurological disorders, both in acute and in distant periods. In the main, subdural hematomas in the acute period manifest with focal convulsions with secondary generalization of seizures, behavioral disturbances, respiration, and symptoms of intracranial hypertension. During the formation of chronic subdural hematoma, development of structural epilepsy (up to 20%), microcephaly, impaired psychomotor development is observed. In 55% of young children with acute subdural hematomas, the formation of chronic subdural hematomas is observed.

Pediatrician (St. Petersburg). 2019;10(6):93-99
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