Vol 11, No 2 (2020)


The treatment of children infected with COVID-19 in a non-core hospital

Ivanov D.O., Zabolotskii D.V., Koriachkin V.A., Alexandrovich Y.S., Kopylov V.V., Puzyrev V.G., Nabieva A.S., Bondarenko V.V., Bannova S.L., Ustinova A.S., Pogorelchuk V.V.


According to the World Health Organization (WHO), viral diseases form serious public health problem. WHO announced that the disease caused by the new virus named “coronavirus disease 2019” or “Coronavirus disease 2019” (COVID-19), and the virus causing the infection was named SARS-Cov-2 by the International Committee on Taxonomy of Viruses. Children usually have asymptomatic or mild forms. However, children with comorbidity are in risk of developing severe forms of COVID-19. The review presents modern ideas about the amount of laboratory tests in cases of suspected presence of the SARS-CoV-2 virus, methods of radio diagnostic (computer tomography, x-ray, thorax ultrasound), features of the clinical course of infection in children depending on the severity of the of infection and indicated detailed criteria for severe forms of coronavirus infection. Special attention is focused on the clinical monitoring of children in a non-core hospital: the detection of leukopenia and lymphopenia, CRP level control, monitoring of coagulation disorders, providing tests on other respiratory viruses. Specific recommendations, comprehensive to date, on the use of drugs for the treatment of children with COVID-19 upon admission to a non-core hospital are given. The organisational issues of treatment children infected with COVID-19 in a non-core hospital are described in details. Special attention is focused on the compliance of strict safety rules by staff working with infected patients entering and leaving the “Red” zone. Thus, the proper organisation of the units for the treatment of children infected with COVID-19 in a non-core hospital, taking into account the features of their disease, will make it possible to provide complete and high-quality treatment of infection during the pandemic.

Pediatrician (St. Petersburg). 2020;11(2):5-14
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Original studies

The nature of relationship between some health parameters in infants born with hypoplastic type mild intrauterine growth retardation

Ivanov D.O., Derevtsov V.V.


Objective. Assessing the relationship between health indicators in infants born with intrauterine growth retardation (JGR) of hypoplastic type of mild severity among themselves, compared with infants born without IGR, and with practically healthy infants from practically healthy mothers.

Materials and methods. Under the supervision were 109 infants. From mothers with a burdened somatic and obstetric-gynecological history, 84 children were born: 15 (gr. 1) – with mild of hypo-plastic type IGR, 69 (gr. 2) – without IGR. The control group (gr. 3) consisted of 25 healthy children born to healthy mothers. All observed babies were born full-term. They were examined in dynamics at the age of 1 (n = 104), 3 (n = 98), 6 (n = 92), 12 (n = 94) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of electrocar-diography and cardiointervalography. Distribution-free statistical analysis methods.

Results. A correlation was found at 2–3 days between weight and body length (r = 0.63), body weight and stress index (r = –0.56), sympathetic activity and stress index (r = 0.84), intraatrial and atrioventricular conductivity (r = 0.64); at 1 month between sympathetic activity and stress index (r = 0.62); at 3 months between weight and body length (r = 0.79), sympathetic activity and stress index (r = 0.87), sympathetic activity and intraventricular conduction (r = 0.67), intraatrial and atrioventricular conduction (r = 0.71); at 6 months between weight and body length (r = 0.81), body weight and intraatrial conduction (r = 0.65), body weight and electric systole (r = –0.58), sympathetic activity and stress index (r = 0.92); at 12 months between body length and intraatrial (r = 0.74), body length and atrioventricular conduction (r = 0.76), sympathetic activity and stress index (r = 0.94), sympathetic activity and electrical systole (r = –0.71), stress index and intraventricular conduction (r = 0.68), stress index and electric systole (r = –0.69), intraatrial and stress index (r = 0.9), atrioventricular conduction and electric systole (r = 0.63).

Conclusions. The revealed correlation communications between of some studied parameters allow doctors to allocate groups of dispensary observation, to diagnose changes at early stages of the pathological process, conduct correctional actions with assessment of their efficiency.

Pediatrician (St. Petersburg). 2020;11(2):15-24
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Anatomic and surgical features of lower extremities blood vessels in case of major veins dysplasia in children with various type and severity of the disease according to data of contrast flebography

Azarov M.V., Kupatadze D.D., Nabokov V.V., Kocharyan S.M.


Dysplasia of the main veins (DMV) is known by the names of the authors who described this pathology as Klippel – Trenone syndrome. The clinical picture of Klippel – Trenone syndrome (CTS) in the classical version is characterized by a triad of symptoms: vascular spots, varicose atypical veins, hypertrophy of soft tissues and bones with an increase in the volume and length of the affected limb. The incidence of this defect from all vascular malformations is 49.6%. To diagnose a malformation, ultrasound is used – Dopplerography, MRI and MSCT with contrast, ascending venography. Vasocontrast methods reveal various options for surgical anatomy of the veins of the affected limbs. To assess the anatomy of deep veins, we used upward contrasting, since we consider this species to be more accurate and low-cost. The study is based on the results of examination and treatment of 200 patients. Long-term results were analyzed in 108 patients with congenital malformations of the vessels of the lower extremities aged 1 year to 18 years, who were in the angiomicrosurgical department of the Pediatric Medical University from 2005 to 2015. Patients were divided into 2 groups: the embryonic type – 70 people (of which 42 boys and 28 girls), and the fetal type – 38 people (16 of them boys, 22 girls). In this paper, we analyze the results of ascending phlebography of the extremities, which is considered the gold standard for examining vein malformations. Contrast phlebography in 108 patients with dysplasia of the main veins, hypo- and dysplasia of segments of the deep and superficial veins were detected 63%; atypical location of superficial or deep veins with the presence of congenital pathways of the collateral outflow 30%, aplasia of the veins – 7%. Conclusions: phlebography data accurately determine the surgical anatomy of blood vessels in patients with dysplasia of the main veins. The data obtained during the ascending phlebography, in almost 100% of cases coincide with intraoperative data thus allowing the development of optimal tactics of operations in the veins, and also scrutinize the pathology of musculoskeletal system.

Pediatrician (St. Petersburg). 2020;11(2):25-32
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The role of human constitutional type in forming of bodymass excess and deficite in children of various ages

Erkudov V.O., Pugovkin A.P., Volkov A.J., Musaeva O.I., Slyaptsova T.N., Chistjakova M.V., Rogozin S.S., Pakhomova M.A., Kravtsova A.A.


Nowadays there are no decicive descriptions of constitutional features and body mass deviations in a narrow group taking into consideration their sex, age, habitation region, and a concrete type of body mass deficit or excess. The present study focuses at comparative assessment of number and frequency of pronounced deficit, deficit, nominally normal body mass, preobesity and obesity in junior schoolchildren and adolescents with lepto-, meso- and hypersomal somatotype. All in all 274 persons took part in the study, 130 of junior schoolchildren aged 7 to 9 years (64 boys and 66 girls) as well as 142 adolescents 14–17 years old (65 boys and 77 girls). Somatotype was determined in all children with the help of I.I. Salivon and V.A. Melnik’s method, as well as body mass index was calculated. Comparing the number of children with various deviations of body mass in case of lepto- meso- and hypersomal somatotype was accomplished with the help of precise Fisher’s criterion for conjugated features tables 3 × 5. In boys and girls of junior school age with leptosomal (boys – 62%, girls – 81%) somatotype body mass deficit was predominant, while in adolescents with leptosomal somatotype body mass deficit was found in 37% boys and 15% of girls. Hypersomal boys form obesity and excessive body mass when they enter adolescence. On the other hand 40% girls of junior school age with hypersomal somatotype are already obese and 100% of them preserve obesity till puberty. The results of the study may be useful for specifying individual recommendations for children with metabolic pathology at pre-hospital stage for correction of both excess and deficit of body mass should be made prior to entering puberty.

Pediatrician (St. Petersburg). 2020;11(2):33-42
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Predicting the risk of anemia in pregnant women with different somatotypes

Tsidaeva T.I., Tomaeva K.G., Gaidukov S.N., Rukhliada N.N., Cheldieva A.A., Plieva E.G., Salbieva N.G.


The aim of the study: to study the frequency of anemia in pregnant women with different somatotypes and to develop a model for predicting the risk of this pathology.

Materials and methods. 390 women were examined. Of the women studied 110 were mаcrosomatotype, 173 – mesosomatotype, and 107 – microsomatotype. Somatometry was performed according to R.N. Dorokhov for women in early pregnancy (before 9–10 weeks of gestation). In blood test the level of hemoglobin, red blood cells, and hematocrit is determined using the Medonic M-series hematological automatic analyzer. Serum iron levels were determined colorimetrically with ferrosine. Serum ferritin levels were determined spectrophotometrically using ELISA methods.

Results. It was found that iron deficiency anemia was significantly more common in pregnant women of macro-and microsomatic body type compared to women with mesosomatotypes (p < 0.05). Pregnant women with severe anemia were not found. There were iron deficiency anemia of mild and moderate severity, and latent iron deficiency. Hematological parameters (hematocrit, serum iron, serum ferritin) were significantly lower in pregnant women with latent iron deficiency compared to women without anemia (p < 0.05). Using multiple regression analysis, we obtained the regression equation (formula), which predicts the development of iron deficiency anemia in pregnant women of different somatotypes.

Conclusions. The calculations according to the presented formula, allows to predict with high accuracy the prognosis of iron deficiency anemia in pregnant women, and also allows to form among patients a high-risk group for the development of this disease in the first trimester of pregnancy when the pregnant woman is registered in the women’s consultation, which will contribute to more effective implementation of therapeutic and preventive measures to prevent the development of this pathology.

Pediatrician (St. Petersburg). 2020;11(2):43-50
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The availability of vitamin D in children of the first year of life with food allergies residing in conditions of military conflict in Donbass

Nalyotov A.V., Shapchenko T.I., Svistunova N.A., Vakulenko M.V.


The problem of vitamin D deficiency is one of the most actual today. According to numerous clinical studies, its insufficiency of this micronutrient is registered in half of the world’s population.

Aim of the study. To study the provision of vitamin D in infants, suffering from food allergy and living in the Donbass in a military conflict.

Materials and methods. 105 infants living in the Donetsk People’s Republic suffering from food allergy were examined. The level of vitamin D in serum in these patients was studied by determining serum levels of 25(OH)D.

Results and discussion. Insufficient vitamin D levels were found in 57.1 ± 4.8% infants with food allergy, which was significantly higher (р < 0.05) compared to healthy children (12.5 ± 5.2%). At the same time, children with food allergies, long-term living near the region of active hostilities, statistically significant (р < 0.001) often had a reduced level of vitamin D. It was found that in the group of patients with low level of vitamin D polyvalent food allergy was determined statistically significantly more common compared to the group of patients with normal level of vitamin D.

Conclusion. Infants, suffering from food allergy and living in the Donetsk People’s Republic in a long-term military conflict are characterized by a decrease in vitamin D level, which may play a role in the formation of the immune response, the development of clinical symptoms of pathology and disrupt the development of tolerance to the food allergens.

Pediatrician (St. Petersburg). 2020;11(2):51-56
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Anthropogenic environmental factors as triggers of type 1 diabetes mellitus in children

Soprun L.A., Utekhin V.J., Gvozdetskiy A.N., Akulin I.M., Churilov L.P.


In the 21st century, environmental factors of anthropogenic origin began to come under the close attention of scientists. There is an increase in the incidence of various nosological forms, with autoimmune pathogenesis. Among them, one of the most important endocrinopathies is type 1 diabetes mellitus (DM1), especially in children. In parallel, the urban population continues to grow. At the same time, up to 60% of the urban population of Russia (about 58.8 million people) lives in areas with high and very high levels of environmental pollution. Among the pollution factors, special attention is now drawn to the car and road complex, during the operation of which destruction aerosols are formed, forming a mixture of particles that includes a chemical composition of a mixture of silicon oxides, aluminum, iron, calcium, magnesium and organic substances, as well as compounds with heavy metals. The article analyzes the main sources of environmental pollution in Russian Federation, identifies the central/dominant model, and predicts significant and secondary models of possible regional correlation between the factors related to urbanization and spread of an autoimmune disease, which is DM1 among children of Russia.

Pediatrician (St. Petersburg). 2020;11(2):57-65
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Causes of unsuccessful surgical treatment of hiatal hernia

Bechvaya G.T., Ahmatov A.M., Vasilevsky D.I., Kovalik V.V.


Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years – in 60%. Four types of hiatal hernias (I–IV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 10–15 – 40–60%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

Pediatrician (St. Petersburg). 2020;11(2):67-72
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Changes in the electrobiological activity of the brain in full-term newborns with hypoxic-ischemic encephalopathy

Melashenko T.V., Fomina M.Y.


Early diagnosis of hypoxyc encephalopathy contributes to the timely correction of neurofunctional disorders, which reduces mortality and the severity of acute and distant neurological complications of cerebral injurie. The importance of early detection of cerebral disorders in newborns has become especially relevant with the introduction of therapeutic hypothermia in full-term infants with hypoxic encephalopathy. It has been established that with the early onset of therapeutic hypothermia, full-term neurological prognosis in the long-term period, including motor, is observed in full-term newborns. The correspondence between structural disorders and neurophysiological changes in the brain at different age periods is proved. Among the methods for the early diagnosis of cerebral injuries in newborns, the electroencephalogram is one of the leading places. The correspondence between structural disorders and neurophysiological changes in the brain at different age periods is proved. Such characteristics of the electroencephalography method as non-invasiveness, high sensitivity in assessing neurobiological activity, safety, delicacy in maintaining the stability of a critical patient, allows electroencephalography in newborns from the first hours of life. The relevance of the review is associated not only with the scattered information about changes in the electrical activity of the brain in children with hypoxic-ischemic encephalopathy in the neo. Describes the main poor prognostic EEG patterns in the form of a suppression rate (decrease in the amplitude with the maximum manifestation of the oppression of the electrobiological activity in the form of a pattern burst – suppression), slowing of the basic rhythm, rarely revealed epileptic, epileptiform activity, focal sharp activity. Such characteristics of the electroencephalography method as non-invasiveness, high sensitivity in assessing neurobiological activity, safety, delicacy in maintaining the stability of a critical patient, allows electroencephalography in newborns from the first hours of life. The relevance of the review is associated not only with the scattered information about changes in the electrical activity of the brain in children with hypoxic-ischemic natal period, but also with the peculiarity of brain electrogenesis during the neonatal period.

Pediatrician (St. Petersburg). 2020;11(2):73-84
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Aspiration lipoid pneumonia in a child 1.5 years

Budarova K.V., Shmakov A.N., Bokut V.A., Makarova D.Y., Polonskaya M.A., Uspenskaya S.V.


Aspirated lipoid pneumonia is a rare lung disease, in which interstitial lesion with chronic respiratory failure is predominantly expressed. In the available literature, this pathology is described in the form of separate observations with an empirical selection of therapeutic measures. The appearance of lipophages in a bronchial aspirate is recognized as a pathognomonic sign of lipoid pneumonia. There is no etiological treatment of the disease. The effectiveness of intensive therapy, according to available sources, depends on the severity of respiratory failure and on the timing of the start of complex bronchodrainage therapy, and theoretically the most attractive is kinesitherapy. Only one observation describes the use of bronchial lavage with sequential separate intubation of the main bronchi. Hormone therapy is considered effective, but the physiological basis for its use is not presented. The published observation is characterized by a late start of treatment due to a long diagnostic search. The applied therapeutic measures are given and described in detail with an assessment of the expected and achieved practical benefits. It was shown that beneficial effects were due to the use of bronchodrainage therapy techniques, including the jet high-frequency artificial ventilation of the lungs. There are doubts about the appropriateness of the use of corticosteroids in this pathology.

Pediatrician (St. Petersburg). 2020;11(2):85-92
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Clinical observation

Acute methadone poisoning in infants

Udaltcov M.A., Pshenisnov K.V., Aleksandrovich Y.S., Kaziakhmedov V.A., Pochinyaeva L.M., Storozhuk O.D.


Acute poisoning in children is one of the most frequent reasons for seeking medical care and hospitalization in intensive care units, but it is extremely rare in children of the first year of life. On the example of the clinical case, the peculiarities of the course of acute severe methadone poisoning in a two-month-old child against the background of natural feeding are considered. The main data of history and clinical-laboratory examination are reflected, which allowed to suspect acute poisoning in a timely manner and to carry out reasonable intensive therapy, against the background of which the maximum rapid improvement of the child ‘s condition is achieved. The algorithm of differential diagnosis of comatose state in children is presented, which can be used in all cases of sudden suppression of consciousness of unclear genesis. Special attention is paid to the need for maximum early recognition of exogenous poisoning and targeted pathogenetic treatment aimed at elimination of toxicant metabolites. A distinctive feature of this case was the severe course of acute methadone poisoning in the infant with the development of coma and respiratory distress, which regressed against the background of the treatment carried out with the full recovery of the patient.

Pediatrician (St. Petersburg). 2020;11(2):93-99
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Clinical psychology

Characteristics of professional adaptation of correctional school teachers

Kosina N.V., Radkevich A.V.


Training and education of children with physical and mental health problems makes a number of requirements for teachers working in various correctional medical institutions. These specialists must have a high level of adaptive characteristics allowing combining up-to-date pedagogical methodology with individual approach, taking into account the current state of the child. As a result of applying complex experimental psychological techniques we managed to identify specific features of correctional teachers’ adaptive characteristics (when comparing with public school teachers), namely: low level of activity and optimism, insufficient adaptive strategy to cope with stress characterizing maladaptive personality types. There were also a lot of negative organizational factors affecting the process and result of professional activity: a lot of work, unauthorized persons at the lessons, interaction problems with parents, insufficiency of pupils’ independent work, need for individual explanation, lack of real results in teacher’s activity. Teachers working in correctional schools and having an average level of social and psychological adaptation give a lower evaluation of various aspects in professional activity. They have a pronounced value of psychological and physiological professional maladjustment shown in somatic, emotional and social spheres as well as motivation decrease in their professional activity. Correctional school teachers have a high degree of professional burnout and their emotional exhaustion and depersonalization are more pronounced.

Pediatrician (St. Petersburg). 2020;11(2):101-108
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Hospital clownery – entertainment or treatment? History of development and experience

Uvarov N.A., Uvarova D.B., Sakhno L.V., Zemlianykh M.V.


The article discusses one of the areas of psychological rehabilitation of children in a hospital – hospital clowns. The theoretical and practical prerequisites of the history of the development of hospital clownery both abroad and in the Russian Federation are shown. The results of studies of the effectiveness of the impact of hospital clownery and laughter therapy on the emotional state of children and their parents, in particular on the experience of anxiety and fears in the postoperative period, as well as on the severity of pain during medical manipulations such as venipuncture, allergy tests and radionuclide scanning are presented. The results of a qualitative analysis of the author’s empirical research of 133 children and 65 parents are presented. The aim of the research was to study the effect of hospital clownery on the emotional state of children resulting from hospitalization and treatment received (painful manipulations, surgical intervention). Subjective assessments by children and parents of their psycho-emotional state were recorded using questionnaires. The projective method was also used – the Luscher Test. The results of a qualitative analysis demonstrated a subjective sensation of an improvement in the psychoemotional state in 97% of children and in 92% of parents (improving mood, decreasing of anxiety and fears). 67% of children noted a weakening of the pain syndrome. Thus, the authors have confirmed by their own research the positive effect of hospital clownery on children’s health. The presented review clearly demonstrates the feasibility of expanding the use of this method in children’s hospitals of various profiles.

Pediatrician (St. Petersburg). 2020;11(2):109-116
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