Vol 9, No 2 (2018)

Articles
Analysis of selected statistical indicators of the North-Western Federal district in aspect of infant mortality and stillbirths
Ivanov D.O., Shevtsova K.G.
Abstract

The paper presents results of some analyzed statistical indicators of infant mortality and stillbirth in the North-Western Federal District of Russia. The following indicators are considered: availability of medical personnel and inpatient beds, morbidity of pregnant women, the number of abortions, as well as some socio-economic indicators. The negative correlation between infant mortality rate in the region and availability of obstetricians-gynecologists, pediatricians, neonatologists was revealed. Stillbirth rates in the region were found to be related to the provision of pregnant pathology beds, to the proportion of these beds in the total number of obstetric beds, to provision of the population with obstetricians and gynecologists. In addition, both factors are equally dependent on such index of work of women's family planning counseling services as the number of abortions per 100 live and stillbirths. A comparative analysis of the pregnant women morbidity, together with the investigated medical care provision in the region, emphasized the effective organization of the child protection and child delivery service activity in the North-Western Federal District, on the one hand. On the other hand, it determined that, in the search for a reserve of reducing fetal and infantile losses in North-Western Federal District, the priority area is a differentiated study of the pregnant women morbidity aimed at developing an appropriate comprehensive prevention program to reduce of the pregnant women morbidity.

Pediatrician (St. Petersburg). 2018;9(2):5-15
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Сlinical features of newborn children in patients with perinatal losses
Ivanova L.A., Titkova E.V.
Abstract

The article presents the data of a complex analysis of the course of the early period of the newborn in children born to 456 women who were delivered in the maternity hospitals of St. Petersburg and the Leningrad Region in 2009-2016. These patients were divided into the main group (99 women who gave birth to live children who died in the first 7 days of life) and a comparison group (357 women who gave birth to live children who survived the first 7 days). Estimated the duration of pregnancy at the time of delivery, clinical features of newborn children in the group of patients with perinatal losses, in comparison with the control group, were analyzed. The article compares the anthropometric data of newborns (weight and height at birth), Apgar scores, and the frequency of fetal hypotrophy. The results of the clinical analysis of the blood of newborn children of the patients of the main and control groups (hemoglobin, erythrocytes, leukocytes, platelets and venous blood glucose) were also evaluated. A number of significant differences in the main group and comparison group that can be regarded as predictors of perinatal fetal death have been identified. Thus, the risk group for perinatal fetal death includes preterm newborns with hypotrophy, low body weight, smaller body length, a low Apgar score, changes in the clinical analysis of blood (lowering of hemoglobin, erythrocytes and platelets, and an increase in the level of venous blood glucose). The level of leukocytes in peripheral blood in newborns in both groups is not significantly different.

Pediatrician (St. Petersburg). 2018;9(2):16-21
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Complementary food - important components of the child’s ration: effects on health and ways of optimization
Bulatova E.M., Bogdanova N.M., Shabalov A.M., Razheva V.A., Gavrina I.A.
Abstract

Relevance of the research. Timing, order and sequence of complementary feeding remain the subject of discussion until now. The aim of the study. Estimate influence of different outlines of introduction of complementary foods on nutritional status and food behavior in children of first year of life.

Materials and methods. Examined 96 children in age of 4-6 months during introduction of complementary foods. Main group – 50 children (27 breast-feed (BF) children and 23 on milk formulas (MF)), in whose diet were introduced only complementary foods, which were made in special factories. Comparison group – 46 children (33 – BF and 13 – MF) received complementary foods made at home and in special factories. Duration of follow-up was 3 months. Physical examination, mother’s diary analysis, evaluation of tolerance of complementary foods, bacteriological examination of feces.

Results. On the background of introduction of complementary foods in the main group, increased the number of children with normal fatness (BF from 66.8% to 74.2%, MF from 82.7 to 88.4%), in comparison group, their number decreased (BF from 84.8% to 78.8%, MF from 69.3 to 62.3%). In the main group when a child refuses a product, mother continues offer it insistently. 61.5% of children began to eat unloved product at the end of first year of life. In comparison group, where mother changed unloved product at once, only 25% of children began to relate to it positively. In the main group dyspeptic disorders were mild in 4% of children. In in comparison group prevailed diarrheal syndrome, related to contamination with pathogenic strains of E. coli in 13% of children.

Conclusions. Using of industrial made complimentary foods according to the optimal order, with determined mothers perseverance provides equalization of fatness, allows to form a correct food behavior and decreases risk of intestinal colonization by pathogenic microorganisms.

Pediatrician (St. Petersburg). 2018;9(2):22-29
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The effectiveness of applying medical rehabilitation methods during pregnancy in order to relieve back pain caused by dorsopathy
Vaganova Y.A., Suslova G.A., Gaiducov S.N., Bobko A.Y.
Abstract

The study is held in order to estimate the efficiency of applying the methods of manual therapy on pregnant women during the second and third trimesters of their pregnancy to relieve pain caused by dorsopathy. During the period from October 2015 until March 2017 was defined a “study” group (n = 25) and the “control” group (n = 25) of pregnant women with the diagnosis of “dorsopathy” (mostly osteochondrosis 66%, scoliosis 18%, intervertebral hernia 16%). The age of pregnant women is ranged from 22 up to 39 years with the gestational term from 18 to 38 weeks. During the study the following methods are used: cranio-sacral technique, traction technique, myofascial release, post-isometric relaxation, and soft tissue techniques. The number of therapy sessions for pregnant women with dorsopathy is ranged from 1 to 4. To assess the quality of life and, separately, of the pain syndrome was used McGill questionnaire, visual analogue scale (VAS), verbal rating scale, questionnaire EuroQol-5D, Oswestry questionnaire, as well as medical and social characteristics of pregnant women with this pathology. Decrease of pain syndrome was noted in patients already after the first session. Preliminary results were already evaluated and allow us to speak about the effectiveness of applying manual therapy for pregnant women at their II and III trimesters of pregnancy. The data obtained not only prove the reduction but also the complete elimination of the back pain syndrome caused by dorsopathy.

Pediatrician (St. Petersburg). 2018;9(2):30-35
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A meta-analysis of prenatal diagnosis of congenital malformations of the airways
Kuranova L.B., Breusenko D.V., Zakharova M.L.
Abstract

Congenital malformations of the respiratory tract is an important issue. They cause more than 100 deaths annually in the Russian Federation. The definition and classification of congenital malformations of the respiratory tract are described and developed by Je. A. Cvetkov. The ultrasound is the primal method used in prenatal diagnosis of congenital malformations of the upper respiratory tract. Starting from the age of 17-23 weeks old, the ultrasound shows the following signs: hyperechoic lungs, dilatation of the lower respiratory tract, flattening of the diaphragm. This ultrasound pattern is typical for Congenital High Airway Obstruction Syndrome (CHAOS). If the doctor suspects an identifying of these signs, a follow-up examination is recommended. If the congenital obstruction of the upper respiratory tract is diagnosed during the pregnancy, the childbirth for patients must be performed in the hospital, where it is possible to perform tracheotomy and artificial ventilation of the lungs to the newborn, to operate him with placental support. This type of surgical treatment by the EXIT method (The ex utero intrapartum treatment procedure) is a new stage in neonatal surgery. A meta-analysis of 15 articles in the foreign literature about the detection of CHAOS from 1993 to 2014 was conducted. The analysis includes studies with more than 5 described cases. The statistics of diagnosis and treatment of congenital malformations of the larynx of patients of the ENT clinic of SPbSPMU for the period from 2003 to 2016 with the diagnosis of congenital malformation of the larynx is presented.

Pediatrician (St. Petersburg). 2018;9(2):36-40
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Features of the initial vegetative tone and vegetative reactivity in vegetative-vascular dysfunction of the hypotensive type in childhood
Buryak V.N., Zhuravleva N.S., Pokusaeva O.S.
Abstract

VVD hypotensive type significantly reduces the quality of life, prevents normal growth and differentiation of organs and tissues of the child’s body, promotes the formation of a number of life-threatening pathological processes in adulthood. In order to determine the initial vegetative tonus in 63 children aged 11-14 years suffering from hypotensive type VVD, the averaged values of cardiointervalograms consisting of 100 consecutive cardiocycles were determined. Vegetative reactivity has been studied through the conduct and evaluation of a clinoortostatic test, consisting in the sequential recording of blood pressure and cardiograms first in a horizontal and then in an upright position. As a control group, 27 practically healthy peers were examined, who underwent a similar complex of clinical, laboratory and instrumental studies. Statistical processing of the obtained results was carried out by parametric and nonparametric methods with the help of STATISTICA and Microsoft Excel for Windows packages on the IBM “Pentium 166” computer. As a result of the study, a significant difference in vegetative tone was found in children with hypotensive VVD from normal. In this case, vegetative status is characterized either by the initial high level of functioning of sympathoadrenal regulatory mechanisms with insufficient increase in their adaptive activity or by the predominance of the initial cholinergic vegetative tension and the corresponding hypersympathicotonic reactivity, which is the marker of the greatest threat of transformation in this group of children of the hypersensitive type to the hypertensive and then into hypertensive disease.

Pediatrician (St. Petersburg). 2018;9(2):41-48
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The Prevalence of Some Lifestyle Risk Factors, Negatively Affecting the Health of High School Students
Iurev V.K., Zhirkov P.G.
Abstract

Important role in shaping the health of adolescents is played by the environmental factors and lifestyle, the influence of which they are exposed to a greater degree than adults. At the same time, adolescents have not yet formed attitudes to conscious attitude to their health, extremely low medical activity, which exacerbates the impact of risk factors on their health. The aim of the study was to assess the awareness of high school students about the risk factors of lifestyle that adversely affect health, and their prevalence among adolescents. To achieve this goal on a specially designed statistical forms conducted an anonymous survey of 325 boys enrolled in high school four secondary schools in the city of Yakutsk. It was found that high school students are quite well informed about most lifestyle risk factors that have an impact on health. At the same time, in the way of life of many young men (73,9 ± 2,4 of 100) there is at least one risk factor that adversely affects health. Among the risk factors for health in high school students of Yakutsk are more common: prolonged stay at the computer, sleep, excessive consumption of food with high carbohydrate content, small stay in the fresh air, long additional classes, low physical activity. In this regard, it is now a very important task of school, family, health workers is to create in adolescents’ belief in the need to maintain a healthy lifestyle, the formation of a cult of health.

Pediatrician (St. Petersburg). 2018;9(2):49-54
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Assessment of adaptation of children of younger school age with cerebral palsy to occupations at correctional school
Ponomareva O.P., Suslova G.A.
Abstract

Formation of a school maturity at children of younger school age is the main objective of modern education. Special attention in the last decades is paid to children with disturbances of a musculoskeletal system, in particular, to children with the cerebral palsy (CP). Such children study at special correctional schools which prepare the pupils for independent life and work in society.

Research objective: to estimate adaptation of children of younger school age with cerebral palsy to occupations at correctional school.

Materials and methods. 75 children with the diagnosis are examined: Cerebral palsy, spastic diplegia mild or moderate severity, delay of psychomotor development, pseudobulbar dysarthtia. All children studied in state-funded educational institution for children with limited opportunities of health special (correctional) comprehensive school (the IV look) No. 584 "Ozerki" of Vyborgsky district of St. Petersburg (school No. 584 "Ozerki"). The age of children was from 7 to 11 years. The following indicators were estimated: quality of life of children by means of the questionnaire of PedsQL for category of children of 8-12 years, electroencephalogram indicators, the neurologic status, extent of disturbance of the speech. Children were examined by the neurologist, the psychologist and the logopedist.

Results. 72% of children had the average and low level of adaptation. According to classification by L.A. Wagner (1989), “the low level” of adaptation prevailed at boys (42.2%) (the negative relation to school, suppressed mood, frequent complaints to an illness). “High level” also dominated at boys (33.4%) while at girls “the high level” of adaptation was observed only at 6 people (20%). Clinical inspection taped that at children the hyper excitability syndrome prevailed (at boys – 51.2%, girls – 63.3%). Also it was noticed that extent of disturbance of the speech depends on degree of a lesion of the central nervous system and also on age and sex features. The quality of life of children of elementary school is reduced. In scales of the questionnaire of PedsQL “physical functioning”, “emotional functioning”, “life at school” points don’t exceed 50. Only in a scale “social functioning” an indicator more than 70 points.

Conclusions. The complex rehabilitation including the medical, psychology and pedagogical and logopedic care is necessary for children of elementary school of school No. 584 “Ozerki”.

Pediatrician (St. Petersburg). 2018;9(2):55-66
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Parental compliance and influences factors in treatment of children with irritable bowel syndrome
Nalyotov A.V., Vunichenko Y.S., Masyuta D.I.
Abstract

Summary. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. At the present time, the therapy of most diseases requires special attention not only from the treating physician, but also from the patient. In turn, in the treatment of children, the monitoring of compliance with the treatment is carried out not by the patient, but by his parents who control the regimen of taking medications.

The aim of the study was to determine the level of parental compliance and factors affecting it in the treatment of children with irritable bowel syndrome. It was established that the level of parental compliance to the treatment of irritable bowel syndrome for their children is low, which may lead to a decrease in the effectiveness of the treatment. It was found that only in less than 1/3 of the patients the parents are fully compliant with respect to the therapy received by their child. The main causes that influence the adherence of parents to the treatment of their child with irritable bowel syndrome are revealed. Establishment of interpersonal relationships in the “doctor-patient-parent” system, working with parents, aimed at explaining the essence of the disease (in some cases, the mechanisms of its formation), the consequences of the disease, treatment tactics are an important stage in the therapy of a sick child.

Pediatrician (St. Petersburg). 2018;9(2):67-70
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Irritable bowel syndrome and food allergy in children
Novikova V.P., Revnova M.O., Listopadova A.P.
Abstract

Dysplasia of the main veins (DMV) is known by the names of authors had described this pathology as the Klippel-Trenone syndrome (KTS). Many authors consider the cause of the syndrome to be the impact of various teratogenic factors. These include drugs, infectious agents, radiation exposure, domestic and occupational hazards. Teratogenic factors can damage embryo vessels, causing local stasis and hemorrhages, which can be cause for the perverse formation of veins and surrounding tissues. The clinical picture of severe and extremely severe degrees embryonic type DMV is quite simple. It include asymmetric hypertrophy of the extremities, “disfiguring” in patients with extremely severe degree, extensive cyanotic vascular spots, often accompanied by papillomatous nevus of the skin. The spots are located on the anterolateral surface of the thigh and lower leg. Embryonic veins, which can be found under the spots – a characteristic pathognomonic sign of the KTS. Disturbances in the shape of the limb and external signs of angiodysplasia (vascular spots, atypical veins) in children with mild to moderate severity degree are less pronounced and can be inconstant. Examination and treatment of children with DMV, depending on the severity of the lesion, it is rational to start from the time of detection to 6 years. Phlebography reveal various variants of violation of the surgical anatomy of the veins of the affected limbs. Medium and light forms of dysplasia of the main veins should be differentiated with similar forms of fetal type, congenital Parkes Weber syndrome and acquired iliofemoral thrombosis (atypical veins above the bosom). Sometimes there are combinations of dysplasia of the main, deep, intermuscular and superficial veins. The following operations, according to the indications, are performed: phlebectomy and perforant veins ligation; embryonic veins removal and main outflow correction; musculoskeletal system surgery, abdominal and retroperitoneal surgery, as well as amputation of affected limb. Treatment including surgical and non-surgical methods should be comprehensive and should be performed in highly specialized, multidisciplinary hospitals.

Pediatrician (St. Petersburg). 2018;9(2):71-77
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Klippel-Trenone syndrome. Etiology, pathogenesis, diagnosis and treatment
Azarov M.V., Kupatadze D.D., Nabokov V.V.
Abstract
Dysplasia of the main veins (DMV) is known by the names of authors had described this pathology as the Klippel-Trenone syndrome (KTS). Many authors consider the cause of the syndrome to be the impact of various teratogenic factors. These include drugs, infectious agents, radiation exposure, domestic and occupational hazards. Teratogenic factors can damage embryo vessels, causing local stasis and hemorrhages, which can be cause for the perverse formation of veins and surrounding tissues. The clinical picture of severe and extremely severe degrees embryonic type DMV is quite simple. It include asymmetric hypertrophy of the extremities, “disfiguring” in patients with extremely severe degree, extensive cyanotic vascular spots, often accompanied by papillomatous nevus of the skin. The spots are located on the anterolateral surface of the thigh and lower leg. Embryonic veins, which can be found under the spots - a characteristic pathognomonic sign of the KTS. Disturbances in the shape of the limb and external signs of angiodysplasia (vascular spots, atypical veins) in children with mild to moderate severity degree are less pronounced and can be inconstant. Examination and treatment of children with DMV, depending on the severity of the lesion, it is rational to start from the time of detection to 6 years. Phlebography reveal various variants of violation of the surgical anatomy of the veins of the affected limbs. Medium and light forms of dysplasia of the main veins should be differentiated with similar forms of fetal type, congenital Parkes Weber syndrome and acquired iliofemoral thrombosis (atypical veins above the bosom). Sometimes there are combinations of dysplasia of the main, deep, intermuscular and superficial veins. The following operations, according to the indications, are performed: phlebectomy and perforant veins ligation; embryonic veins removal and main outflow correction; musculoskeletal system surgery, abdominal and retroperitoneal surgery, as well as amputation of affected limb. Treatment including surgical and non-surgical methods should be comprehensive and should be performed in highly specialized, multidisciplinary hospitals. (For citation: Azarov MV, Kupatadze DD, Nabokov VV. Klippel-Trenone syndrome. Etiology, pathogenesis, diagnosis and treatment. Pediatrician (St. Petersburg). 2018;9(2):78-86. doi: 10.17816/PED9278-86).
Pediatrician (St. Petersburg). 2018;9(2):78-86
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Histological examination as one of the main methods that allow to substantiate conclusions of forensic medical examination
Davydova Z.V., Sokolova O.V., Nasyrov R.A.
Abstract

We present the case of postmortem diagnosis of rare in forensic medical practice disease — of arrhythmogenic dysplasia and the analysis of morphological and microscopi manifestations of the disease. Arrhythmogenic right ventricular dysplasia (ARVD) belongs to primary cardiomyopathy. This pathology of unclear etiology is usually an isolated impairment of the right ventricle (RV), often running in the family, characterized by fatty or fibrofatty infiltration of ventricular myocardium accompanied by heart rhythm disorders (HRD) of the ventricles of various severity, including ventricular fibrillation. Prevalence of ARVD has been studied not enough due to the fact that the onset of the disease is often asymptomatic. In 80% of cases it is revealed under the age of 40, more frequently in males. Some authors consider ARVD to be the cause of sudden cardiac death (SCD) in 26% of children and adolescents. SCD may be the first and the only manifestation of ARVD, particularly in young people and sportsmen. According to the data by the American authors, ARVD is diagnosed posthumously approximately in 5% of SCD cases in people younger than 65 years of age and in 3-4% cases of death in young sportsmen during competitions. Opinions as to pathogenesis of the disease come to two theories: ARVD is a congenital anomaly of development of RV myocardium called dysplasia. The onset of tachycardia may be postponed for many years until RV is considerably enlarged and the size of arrhythmogenic substrate is big enough to cause persistent ventricular tachyarrhythmia (VT). The second theory connects the onset of RV dysplasia with metabolic disturbances involving RV and causing progressing myocyte replacement (apoptosis). Islets of fibrofatty tissue revealed in ARVD form arrhythmogenic substrate carrying conditions for development of reentry underlying malignant VT.

Pediatrician (St. Petersburg). 2018;9(2):87-90
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Clinical observation of severe laryngomalacia an infant
Zakharova M.L., Pavlov P.V., Kuznecova A.A., Rachkova K.K.
Abstract

Relevance. Disorders of the larynx are a poorly studied section of pediatric otorhinolaryngology. In recent years, the incidence of congenital malformations of the larynx increases, and laryngomalacia is the most common. Diagnosis of this disease is difficult in the conditions of outpatient department without necessary equipment. However, each doctor should understand the importance of diagnosis of laryngomalacia, because this disease can get a severe form with a potential injury to the life and health of the child, especially during the catarrhal disease.

Objectives: development of diagnostic algorithm and the choice of optimal treatment strategy, intended to restoring of laryngeal functions.

Materials and methods. Your attention is the case of severe clinical course laringomalacia an infant and its surgical correction in the clinic of Otorhinolaryngology, St. Petersburg State Pediatric Medical University. The child was observed by the standard method: flexible laryngoscopy, x-ray examination of the neck in the lateral view, x-ray examination of the chest, laboratory blood tests.

Results. This article demonstrates the diagnostic algorithm and the choice of optimal treatment strategy, which avoids the imposition of tracheostomy and rehabilitation the child in infancy. A multidisciplinary approach to the treatment of children with laringomalacia is validated.

Conclusions. This clinical case is a striking example of the need for early diagnosis of the type of congenital malformation of the larynx in newborns with congenital stridor and other signs of dysfunction of the larynx.

Pediatrician (St. Petersburg). 2018;9(2):91-95
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