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Vol 13, No 5 (2022)

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Newborns death risk factors after surgical interventions in the early neonatal period

Bezhenar V.F., Ivanova L.A., Ivanov D.O., Krasnogorskaya O.L.


BACKGROUND: The mortality rate of children operated on in the early neonatal period remains high, despite the combined efforts of surgeons, anesthesiologists, clinical pharmacologists, and many other specialists.

AIM: to determine the risk of death of children in the period of birth, after surgical interventions carried out in the period of the neonatal period.

MATERIALS AND METHODS: A retrospective study was conducted between two groups of children treated at the Perinatal Center of the Pediatric University. The main group included 77 newborns operated on in the early neonatal period and died in the first 28 days of life. The control group included 287 children operated on in the perinatal period and survived 28 days.

RESULTS: In the main group, the percentage of defects detected prenatally was statistically significantly lower; statistically significantly more often multiple congenital malformations and congenital malformations of the cardiovascular system were diagnosed. Risk factors for the death of newborns after surgery performed in the perinatal period have been established: features of the somatic status of mothers (chronic nicotine intoxication, hypertension and arterial hypertension, chronic serum hepatitis B and C, pathology of the urinary system and thyroid gland, cervical ectopia), obstetric gynecological history (chronic inflammation of the organs of the lower floor of the genital tract, two or more abortions in multiparous women, placental insufficiency in history during a previous pregnancy, previous delivery by caesarean section), course of pregnancy (threatening abortion, acute respiratory viral infections, exacerbations of chronic infectious diseases, early toxicosis, carriage of Cytomegalovirus and Herpes simplex types 1 and 2, asymptomatic bacteriuria, gestational anemia, circulatory failure, fetal malnutrition, abnormalities in the amount of amniotic fluid diagnosed by ultrasound study in the 3rd trimester of pregnancy), childbirth (breech presentation of the fetus and meconium staining of amniotic fluid), afterbirth conditions (chlamydial and ascending infection).

CONCLUSIONS: In pregnant women with prenatally diagnosed congenital malformations of the fetus, it is necessary to conduct bacteriological studies, emergency histological examination of the placenta to identify possible microbial damage, as well as timely examination and treatment of newborns and upcoming / undergone surgery.

Pediatrician (St. Petersburg). 2022;13(5):5-21
pages 5-21 views

Original studies

Connective tissue dysplasia in children with broncho-obstructive syndrome

Tsymbal A.A., Arsentev V.G., Shabalov N.P., Pahomova M.A.


BACKGROUND: Changes in the respiratory system in children with connective tissue dysplasia (CTD) have not been studied enough.

AIM: To study the features of CTD in patients of the pediatric pulmonology department with broncho-obstructive syndrome and chronic inflammation of the bronchi, to assess complaints and the nature of the disease.

MATERIALS AND METHODS: Patients admitted to the department were evaluated according to the table of diagnostic signs of CTD. 380 children were examined, aged 2 to 17 years 11 months.

RESULTS: Out of 380 children, the following were identified: with bronchial asthma — 309, with obliterating bronchiolitis — 18, with bronchiectasis — 11, with recurrent bronchitis — 42. Three groups were distinguished: 1st — patients with CTD (172; 45%), 2nd — with increased dysplastic stigmatization (111; 29%), 3rd — children without signs of CTD (97; 26%). Most patients admitted to the pulmonology department have signs of CTD or dysplastic stigmatization (74%). Children with CTD often complain of feeling unwell, asthenia, joint pain, they are more likely to have orthopedic pathology. Patients of the 1st group often complain of articular syndrome — 19.2%, group 2 — 13.5%, children without CTD — 4.1 % (p < 0.001). Complaints about feeling short of breath were presented by 32.6% of patients with CTD, 21.6% with dysplastic stigmatization, and 7.2% in the comparison group (p < 0.001). Children with CTD and dysplastic stigmatization more often had chest deformities.

CONCLUSIONS: Patients with CTD are characterized by asthenic physique, changes in the axial skeleton — chest deformities of II and III degrees, scoliotic deformity of the spine of II and III degrees, which may contribute to the development of the pathology of the respiratory system. CTD is a comorbid condition that significantly affects all organs and systems. Timely diagnosis and an integrated approach to these patients are required. Diseases proceed with severe clinical symptoms, require more active examination and aggressive treatment.

Pediatrician (St. Petersburg). 2022;13(5):23-32
pages 23-32 views

Original experimental model of tuberculosis and lung cancer

Kudriashov G.G., Nefedov A.O., Tochilnikov G.V., Zmitrichenko Y.G., Krylova Y.S., Dogonadze M.Z., Zabolotnyh N.V., Dyakova M.E., Esmerdyaeva D.S., Vitovskaya M.L., Gavrilov P.V., Azarov A.A., Zhuravlev V.Y., Vinogradova T.I., Yablonskii P.K.


BACKGROUND: The potential relationship between pulmonary tuberculosis and lung cancer has been the subject of intense interest over the past few decades. Nevertheless, the features of the pathogenesis of concomitant pathology remain poorly studied.

AIM: The ain of the study to develop an experimental model of the concomitant pathology of tuberculosis and lung cancer.

MATERIALS AND METHODS: The study was performed on mice of the C57BL/6 line at the age of two months in four groups: 1st — intact mice (n = 12), 2nd — mice without a tumor infected with tuberculosis (n = 24), 3rd — tumor-bearing mice not infected with tuberculosis (n = 23), 4th — tumor-bearing mice infected with tuberculosis (n = 24). Individual and group parameters were evaluated using the SPSS Statistica v23 software package.

RESULTS: Tumor was developed at the site of primary transplantation in all mice from groups 3 and 4, which was confirmed by visual assessment and the results of histological examination. Tumor growth in the main group was significantly less than in the control group of the tumor, which may be due to intoxication against the background of tuberculosis infection. All infected mice from groups 2 and 4 developed pulmonary tuberculosis, confirmed by computed tomography of the lungs, bacteriological and histological examination of lung samples. Mycobacterial load in the lungs was the highest in animals with concomitant pathology of tuberculosis and tumor. The survival rate of mice was determined to a large extent by tumor growth rather than by the progression of tuberculosis infection.

CONCLUSIONS: The results of the study indicate the possibility of creating an experimental biological model of the concomitant pathology of tuberculosis and lung cancer in mice. The features of the course of the concomitant pathology were revealed: Lewis lung epidermoid carcinoma develops more slowly in tuberculosis infected animals than in the tumor control group; the development of the tuberculosis process in mice with a tumor occurs more intensively than in the tuberculosis infection control group. The survival rate of mice with concomitant pathology is determined more by the intensity of tumor growth than by the progression of tuberculosis.

Pediatrician (St. Petersburg). 2022;13(5):33-42
pages 33-42 views

Using cardiovascular parameters for determination of person’s gender identity

Gorziy T.S., Belogurova E.A., Denisenko N.P., Denisenko M.D., Nikolaev V.I.


BACKGROUND: Emotional stress is a significant risk factor for the development of cardiovascular diseases. Prenosological diagnostics of these conditions becomes important. The peculiarities of adaptive reactions are largely determined by individual psychological characteristics of an individual, including gender identity.

AIM: Determination of correlation of functional parameters of the cardiovascular system for objectification of psychological criteria for classification of gender identity.

MATERIALS AND METHODS: Hemodynamics and heart rate variability were studied in people with different gender identities. A total of 200 volunteers of both sexes were examined in a state of mental and physical rest. 14 parameters of cardiovascular activity were selected to construct discriminant functions: stroke volume of blood flow, cardiac output, cardiac index, stroke index, heart rate, standard deviation of RR intervals, square root of the mean squared difference of successive RR, percentage of RR intervals with a sinus rhythm of the heart, which differ by more than 50 ms, index of vegetative equilibrium, vegetative rhythm index, indicator of the adequacy of regulatory processes, stress index of regulatory systems, indicator of the activity of regulatory systems. The obtained indicators and initial coefficients reflecting the contribution of each parameter to the discrimination of groups were used to calculate discriminant functions.

RESULTS: It was found that the graphs reflecting the results of discriminant analysis showed a high degree of accuracy in classifying men (97.6%) and women (96.5%) by gender identity based on objective characteristics of cardiovascular activity. The objectivity of psychological testing with a high probability of predicting the type of gender identity based on the analysis of rheography and rhythmocardiography data is shown.

CONCLUSIONS: The use of objective characteristics of cardiovascular activity obtained during rheography and rhythmocardiography made it possible to predict the type of a person’s gender identity with high probability.

Pediatrician (St. Petersburg). 2022;13(5):43-50
pages 43-50 views

Biodistribution and kinetic characters of radiopharmaceutical medication based on biospecific antibodies to tumor-associated stroma elements and 177lutcium

Trashkov A.P., Gagloeva T.D., Budko A.I., Timaeva O.I., Kopaeva M.Y., Cherepov A.B., Tsygan N.V., Stanzhevsky A.A., Vasiliev A.G., Pahomova M.A., Maistrenko D.N., Sergunova C.A., Sysoev D.S., Shatic S.V., Antuganov D.O., Konevega A.L.


Biodistribution and kinetics were studied of potentially target biospecific radiopharmaceutical medication for the treatment of malignant tumors of various histologic type and location with expression of cytotoxic T-lymphocyte membrane associated glycoprotein 4 and glucocorticoid Induced Tumor Necrosis Factor Receptor) — 177Lu-DOTA-anti-CTLA4-GITR. Colorectal cancer experimental model has been successfully reproduced by means of murine large intestine experimental adenocarcinoma cells (AKATOL) СТ26 EGFR) direct transplantation. The model was characteristic of moderate growth rate and practically complete absence of metastatic spread. Immunohistochemical assay of tumor tissue has revealed satisfactory expression level of target antigens for the medication under study, i.e. cytotoxic T-lymphocyte associated protein 4 (CTLA4) as well as membrane receptor of tumor necrosis factor group (GITR). This medication 177Lu-DOTA-anti-CTLA4-GITR has been shown to store in the tumor tissue. Its major pathways out of the organism were through urinary system. On the other hand, the medication has also been demonstrated to store in non-target tissues, namely: kidneys, liver, large intestine. The results of this study may be used in preclinical studies of medications and serve as a basis for broader studies of 177Lu-DOTA-anti-CTLA4-GITR and its safety.

Pediatrician (St. Petersburg). 2022;13(5):51-60
pages 51-60 views

Transient hyperammonemia in newborns: clinical and laboratory parameters and neurological outcomes in patients in the first year of life

Kolchina A.N., Haletskaya O.V., Borisova V.N.


BACKGROUND: Transient hyperammonemia in newborns (THAN) is a dangerous condition of the neonatal period that does not have a specific clinical picture, which often makes timely diagnosis difficult. Insufficient coverage of the problem of THAN in the literature, as well as the need to assess the neuropsychiatric development (NPD) of patients in the follow-up, served as the basis for this study.

AIM: To evaluate clinical and laboratory manifestations of THAN and its influence on the neuropsychological development during the first year of life.

MATERIALS AND METHODS: During the study, 22 preterm newborn patients were divided into 2 groups depending on the presence or absence of THAN: study group (n = 11) and comparison group (n = 11). All patients were assessed for risk factors, features of clinical manifestation of THAN, and neurological outcomes using the CAT/CLAMS scale at 3, 6, 9, and 12 months of age.

RESULTS: Analysis of the obtained data showed that the depression syndrome was the leading one in the clinical picture of THAN (81.8%). Laboratory changes are characterized by the respiratory failure (p = 0.039), anemia (p = 0.023), hypoproteinemia (p = 0.049), hypoalbuminemia (p = 0.048), lower blood sodium levels (p = 0.019). In the constructed prognostic model for determining the probability of having THAN, the critical cutoff p level was 20% (p = 0.012). Assessment of the neuropsychiatric development showed that 41.6% of children who had THAN maintained a moderate neuropsychiatric development delay in the first year of life with predominant impairment of motor skill formation.

CONCLUSIONS: Allocation of a risk group for THAN formation, timely prescription of a low-protein diet, correction of syndromic therapy, and monitoring of patients in the first year of life will help to avoid severe neurological disorders and reduce the need for rehabilitative measures.

Pediatrician (St. Petersburg). 2022;13(5):61-70
pages 61-70 views


Search for new therapeutic targets in asthma. Review.

Nesterenko Z.V., Lagno O.V., Pankov E.A.


A review of recent publications devoted to the study of risk factors for the onset of the disease, mechanisms, diagnosis and treatment of asthma from the point of view of molecular allergology is presented. New concepts and problems in the implementation of the exposome paradigm and its practical application are considered, including genetic and epigenetic factors, environmental impact. The most relevant experimental studies are noted that contribute to further understanding of molecular and immune mechanisms with potential new targets for the development of therapeutic agents. Reliable diagnosis of asthma, endotyping of the disease and monitoring of its severity are of great importance in the treatment of asthma. The heterogeneity of asthma is due to individual genetic and epigenetic variability, exposure to individual environmental factors (depending on regional characteristics, changing climatic conditions and population distribution), which explains the occurrence of asthma is not associated only with allergies. The modern assessment and treatment of comorbid/multimorbid asthma is described, including interaction with asthma phenotypes, which is important for the formation of a new therapeutic personalized approach to precision medicine and testing of prognostic biomarkers. The results of clinical trials, multicenter international studies on the use of new approaches in the diagnosis of asthma (candidate biomarkers) based on molecular allergology and treatment in adults and children using biological preparations are given.

Pediatrician (St. Petersburg). 2022;13(5):71-80
pages 71-80 views

Endometriosis and adenomyosis: common and disparate features

Deryabina V.A., Brus T.V., Pyurveev S.S.


Endometriosis and adenomyosis are diseases of the gynecological profile, which are ectopic endometrioid tissue and have long been considered tangible manifestations of the process. Only recently have scientists begun to put forward a theory about the unequal origin of these pathologies. In endometriosis, the lining of the uterus extends beyond it, mainly to the ovaries, fallopian tubes, and bladder. With adenomyosis, the nodes grow into the muscular wall of her uterus and thicken. They do not go outside the uterus. Both conditions cause severe pain due to local inflammation, swelling and adhesions in the abdominal cavity. The only reliable way to identify the diagnosis of endometriosis is invasive exploratory laparoscopy with biopsy of tissue samples. In contrast, an enlarged uterus with adenomyotic nodules can be assessed even on routine examination, and on ultrasound or MRI they are visualized in the report. Obviously, despite the high frequency of pathophysiological and molecular mechanisms, endometriosis and adenomyosis has rare causes, clinics and effects on the reproductive system of the female body, which significantly reduces the risk and treatment of diseases.

The review provides a comparative characteristic of endometriosis and adenomyosis in terms of prevalence, etiology, pathogenesis, clinical manifestations, effects on fertility and experimental modeling, obtained from domestic and foreign sources.

Understanding the pathophysiology of adenomyosis and endometriosis opens up additional possibilities for diagnosis, prevention, and treatment. The development of new diagnostic methods based on modern high-tech methods allows us to assume a preclinical stage and identify the diagnosis, predict and carry out adequate treatment depending on the histological picture.

Pediatrician (St. Petersburg). 2022;13(5):81-97
pages 81-97 views

Blood-brain barrier: peculiarities of structural and functional organization in patients with glioblastoma

Sklyar S.S., Trashkov A.P., Matsko M.V., Konevega A.L., Kopaeva M.Y., Cherepov A.B., Tsygan N.V., Safarov B.I., Voinov N.E., Vasiliev A.G.


The research of the blood-brain barrier began at the turn of the 18th–19th centuries. To date due to the large number of studies conducted, it is obvious that this system has an impossibly complex structure at the organ, tissue and molecular genetic levels. Scientific interest in the changes in the blood-brain barrier that occur during pathological neoplastic processes is increasing. As it turned out, the restructuring of this system is an important and integral stage in the pathogenesis of glioblastoma, a tumor of the central nervous system with the most unfavorable prognosis. Heterogeneous structure with the formation of areas of altered cellular composition, uneven and uncontrolled permeability, provided by a large number of transport vesicles and the destruction of tight contacts between endotheliocytes, active outflow of molecules from the parenchyma due to the continuous synthesis of new portions of ABC-carrier proteins, the creation of an immature vascular network under the influence of high expression of VEGF by tumor cells — the main characteristics of the hematopoietic barrier, formed in glioblastoma and supporting its survival. The further research of the features of the structure and mechanisms of functioning of the blood-brain barrier in glioblastoma is a new and promising task in modern neuro–oncology, the solution of which will not only expand the understanding of the biology of the most common and malignant brain tumor but will also improve the effectiveness of treatment of patients and improve the prognosis.

Pediatrician (St. Petersburg). 2022;13(5):99-108
pages 99-108 views

Clinical observation

Neonatal diabetes mellitus and polycystic ovaries in a child with severe insulin resistance caused by a variant in the INSR gene. Description of the clinical case

Ivanov D.O., Taits A.N., Ditkovskaya L.V., Matveeva N.N., Krasnogorskaya O.L., Pozdnyakov A.V., Myznikova I.V., Malysheva A.A., Kuzminykh S.V., Orlova A.D., Veretennikova A.A.


Rare severe insulin resistance syndromes such as Donohue syndrome, Rabson–Mendenhall syndrome, and type A insulin resistance are caused by mutations in the insulin receptor (INSR) gene. Donohue and Rabson–Mendenhall syndromes are caused by biallelic mutations in the α- and / or β-subunits of INSR, are characterized by a severe course with severe clinical symptoms and an unfavorable prognosis. The difficulty of managing and treating these patients is associated with a low incidence, lack of practice in managing such patients, as well as a lack of experience in surgical interventions in these patients.

All insulin resistance syndromes are characterized by a significant increase in the level of insulin in the blood plasma in the absence of obesity, progressive diabetes mellitus and an excess of androgens. Polycystic ovary syndrome or stromal hyperthecosis develops in adult patients with syndromic forms of insulin resistance.

We present a rare clinical case of a complicated course of Donohue syndrome, diagnosed in a 2-month-old patient. A feature of this clinical case was the giant growing multifollicular ovaries, which became an absolute indication for organ resection surgery.

The experience of treatment and observation of this patient reflects the importance of early verification of the diagnosis, timely appointment of adequate therapy, allows you to objectively assess the effectiveness of the treatment, helps in choosing medical tactics and predicting the course and outcome of the disease.

Pediatrician (St. Petersburg). 2022;13(5):109-119
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A clinical case of induced lactation in a biological mother in perimenopause in a surrogacy program of art

Barinova V.V., Bushtyreva I.O., Abovyan A.A., Kuznetsova N.B., Shatalov A.E., Botasheva T.L.


According to Rosstat, the number of breastfed children is rapidly decreasing year by year. The reserve for increasing the percentage of women practicing breastfeeding lies, first of all, in broadly informing patients about the simplicity and benefits of lactation, as well as in support from medical staff and family. The procedure of surrogate motherhood is becoming more and more widespread in our country. Induction of lactation, that is, the establishment of lactation in a woman who did not bear or give birth to a child, can not only serve as a reserve for the spread of breastfeeding culture, but also significantly contribute to the psychological rapprochement of a biological mother with her child. In this article, we present a clinical case of successful lactation induction in a perimenopausal biological mother. A 52-year-old patient who entered the surrogacy program as a biological mother showed clinical and laboratory signs of perimenopause. Despite the coronavirus infection with significant lung damage, the patient showed a high motivation to induce breastfeeding and was disciplined in pumping. Medical intervention (metoclopramide) and mechanical pumping of breast milk led to established lactation by the time the child was born by a surrogate mother, which made it possible to attach the newborn to the breast in the obstetric ward and begin successful breastfeeding with good weight gain in the first months of life.

To date, unfortunately, there is no information on the conduct of studies of induced lactation in a significant sample of patients, in addition, there are no clearly regulated guidelines for medical induction of lactation. The presented clinical case can stimulate the interest of the scientific community to this problem. Induction of lactation should be offered to every biological mother in the absence of contraindications for breastfeeding, which will allow establishing a close psychological connection between the newborn and the biological mother and increasing the percentage of children breastfed in our country.

Pediatrician (St. Petersburg). 2022;13(5):121-127
pages 121-127 views

Pigmented xeroderma: literature review and clinical case

Gorlanov I.A., Mineeva O.K., Laptiev S.A., Leina L.M., Milyavskaya I.R., Fedotova E.P., Bolshakova E.S.


Xeroderma pigmentosum (XP) is heterogeneous group of diseases associated with defects in DNA repair, inherited in an autosomal recessive manner. Exposure of DNA to UV radiation produces photoproducts based on multiple nucleic acids, which serve as a substrate for DNA excision repair (NER). Mutations in the NER pathway genes result in impaired DNA repair and it associated with variety of clinical syndromes, which include xeroderma pigmentosa, Cockayne’s syndrome, and trichothiodystrophy. Some forms of the disease are accompanied by damage to the central nervous system. In recent years, precise molecular anomalies responsible for complementation patterns have been identified. All the patients with this disease have photosensitivity, an increased risk of skin cancer and melanoma, but there are number of differences between them. Considering the rare frequency of occurring this disease throughout the world, this article presents our own clinical observation of an 8-year-old patient with xeroderma pigmentosa. The first change on the girl’s skin appeared at the age of 2 months after insolation, in the form of hyperemia of the skin and blisters, later on multiple pigmented rashes of varying intensity appeared. Upon admission to the clinic, the girl had small dark brown spots and depigmented scars on her face and open areas of the body. Sequencing revealed the NGS variant in the hemizygous state in the XPA gene. Early diagnosis and preventive measures can dramatically improve and prolong the lives of patients. Considering the genetic heterogeneity, molecular diagnosis is an important step in the diagnosis and prognosis of the disease.

Pediatrician (St. Petersburg). 2022;13(5):129-139
pages 129-139 views

Clinical psychology

Dynamics of parental attitudes of women before and after the birth of the first child

Malenova A.Y.


The demographic situation against the background of the reproductive attitudes of young people urgently requires research into the dynamics of parental attitudes, especially among women. Identification of potential resource areas and risk zones will make it possible to determine the main directions of psychological work with young people at the pre-parental and parental stages, strengthening the value of families and children among young people. The purpose of the study is to study the dynamics of parental attitudes before and after the birth of the first child. Sample: stage 1 (n = 50) — married pregnant young women (first pregnancy in the third trimester, no history of complications); Stage 2 (n = 39): young mothers with a baby from 3 to 5 months. Data collection was carried out in the course of a longitudinal study using psychological testing — methods: PARI E.S. Schaefer and R.K. Bella (adapted by T.V. Neshcheret); “Ideas about the ideal parent” R.G. Ovcharova; “Relationship Color Test” by A. Etkind. The results showed that women at the stage of early motherhood showed changes in all components of parental attitudes — cognitive, emotional, behavioral. The greatest dynamics occur in the emotional sphere, which is characterized by ambivalence of experiences, and in the mother’s self-awareness. The systems of attitudes towards the child and the maternal role (attitude towards oneself as mother and motherhood) are gradually differentiated. There is a restructuring of marital interaction and relations with the parental family: rapprochement with one’s own mother while distancing from a marriage partner. Thus, at the stage of early parenthood, a woman needs to form the skills of emotional and volitional self-regulation and increase the level of communicative competence, which are of central importance for high-quality relationships with a child and a spouse.

Pediatrician (St. Petersburg). 2022;13(5):141-150
pages 141-150 views

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