Vol 10, No 1 (2019)

Articles
Contemporary placentography: harm or benefit?
Bezhenar V.F., Ivanova L.A., Grigoriev S.G., Titkova E.V.
Abstract

Currently, pediatricians, neonatologists of maternity hospitals often take part in perinatal consultations. One of the indications for early delivery may be chronic placental insufficiency diagnosed during an ultrasound examination.

Objective: to evaluate the effectiveness of the main method of diagnosis of placental insufficiency at the present time – ultrasound evaluation of the placenta.

Materials and methods. An analysis was made of 357 birth histories, exchange cards, protocols for screening ultrasound in the third trimester of pregnancy and conclusions of pathoanatomical investigation.

Results. To substantiate the need for prenatal diagnosis of chronic kidney disease, a comparison was made of the evaluation of newborn babies on the Apgar scale and the state of the placenta according to histological data. With compensated chronic placental insufficiency, there was no difference in Apgar scores at the first and fifth minutes, whereas in the subcompensated stage, Apgar score on the Apgar scale was significantly lower in the first and fifth minutes than in the control group. To identify possible in practical use of the objective parameters of diagnosis of chronic kidney disease, the thickness of the placenta was measured during the screening ultrasound in the third trimester of pregnancy, as well as the thickness of the placenta after its separation. Significant differences in the thickness of the placenta or in the screening ultrasound, or when measuring the placenta after separation in patients with and without chronic placental insufficiency was not detected. When assessing a violation of the rate of maturation of the placenta in the third trimester of pregnancy, no significant differences were found in the presence and absence of placental insufficiency. An analysis of the amniotic index was carried out to determine the amount of amniotic fluid in patients of the main and control groups, which revealed no significant differences between the groups.

Conclusions. The authors believe that the main indicators currently used for diagnosis of chronic placental insufficiency (thickness of the placenta, degree of maturity of the placenta, appearance of structural changes in the placenta, change in the amount of amniotic fluid) are uninformative and modern placenography does more harm than benefit. The only parameter determined during the screening study in the third trimester of pregnancy and having significant differences in the main and control groups is fetal hypotrophy.

Pediatrician (St. Petersburg). 2019;10(1):5-12
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Insulin-like growth factor and its dynamics in babies born from mothers with obesity
Petrenko Y.V., Ivanov D.O., Marthiagina M.A., Novikova V.P., Gurina O.P., Yakovlev A.V., Islamova K.F.
Abstract

Insulin-like growth factor is one of the regulators of fetal growth in the intrauterine period, and is responsible for its further development.

Purpose. To study postnatal growth in relation to insulin-like growth factor-1 and somatotropic hormonelevels in infants born to obese mothers.

Materials and methods. The prospective study included 18 children (16 full-term and 2 premature infants of gestational age 31-35 weeks) born to mothers who were obese before pregnancy (group 1) and 18 children (17 full-term and 1 premature baby of gestational age 34 weeks) from mothers with normal body mass index before pregnancy. Weight and height were estimated at birth, at 3 and 6 months. Serum levels of insulin-like growth factor-1 and somatotropic hormonewere determined by ELISA at birth in umbilical cord blood at 3, 6 and 12 months.

Results. During the neonatal period, at 3 and 6 months, height and weight did not have significant differences in both groups. At the age of 1 year in group 1 weight and height were higher than in group 2 (p < 0.05). Indicators of insulin-like growth factor-1 (128.71 ± 74.29 and 21.33 ± 15.21 ) and somatotropic hormone (4.3 ± 1.5 and 1.84 ± 0.36) was also higher in children of group 1 aged 1 year.

Conclusion. Changes in the somatotropic hormone – insulin-like growth factor-1 axis in children born to obese mothers may form the basis of metabolic syndrome in the future.

Pediatrician (St. Petersburg). 2019;10(1):13-20
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Early detection of insulin resistance in children with different types of intrauterine growth restriction
Islamova K.F., Kaplina A.V., Shabalova N.N., Plotnikova E.V., Medinskaya K.A.
Abstract

Relevance of the research. Intrauterine growth restriction in children is associated with an increased risk of insulin resistance and non-insulin-dependent diabetes mellitus later in life. The influence of type of intrauterine growth restriction and the mechanisms of insulin resistance are still unknown; the role of catch-up growth in this process is controversial.

The aim of the study was to identify insulin resistance in children with different types of intrauterine growth restriction and to analyze the role of catch-up growth in this process.

Materials and methods. The research involved 95 newborns, which were divided into groups based on birth weight and length: 60 newborns with intrauterine growth restriction (group I – 31 with asymmetrical intrauterine growth restriction; group II – 29 with symmetrical intrauterine growth restriction) and control group (group III) – 35 newborns without intrauterine growth restriction. Children also were divided into groups according to the presence of catch-up growth to 3 months old. The levels of insulin, insulin-like growth factor-1, growth hormone were measured in cord blood at birth and in blood serum at 3 months old. Glucose levels were measured in serum and insulin resistance index “the homeostasis model assessment of insulin resistance” (HOMA-IR) was calculated in children at 3 months.

Results. The children with intrauterine growth restrictioncompared to control group had significantly lower levels of insulin-like growth factor-1 in cord blood. The differences between types of intrauterine growth restrictionhave been observed: children with symmetrical intrauterine growth restriction had higher levels of growth hormone, insulin and HOMA-IR then in asymmetrical one. Correlations between insulin and glucose in children with symmetrical intrauterine growth restriction were absent unlike to asymmetrical intrauterine growth restriction (+0.61). The negative role of catch-up growth in insulin resistance development has been defined: it was related to hyperinsulinemia and increased the frequency of insulin resistance in children either in asymmetrical or in symmetrical intrauterine growth restriction, but more in symmetrical one.

Conclusion. Children with symmetrical intrauterine growth restriction especially with catch-up growth are at the highest risk of metabolic syndrome development in later life and require increased monitoring by pediatricians and endocrinologists.

Pediatrician (St. Petersburg). 2019;10(1):21-28
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Capabilities of voxel based morphometry and diffusion tensor imaging in diagnostics of bilateral spastic forms of cerebral palsy
Lvov V.S., Pozdnyakov A.V., Ivanov D.O., Tashilkin A.I., Makarov L.M., Pozdnyakova O.F., Melashenko T.V., Bessonova L.B., Popov P.A., Aleksandrovich V.Y.
Abstract

The aim of the study was to determine the capabilities of magnetic resonance morphometry and diffusion tensor imaging in the diagnosis of bilateral spastic forms of cerebral palsy in children. The main groups were 33 children aged from 1 year to 4 years 5 months. with bilateral spastic forms of cerebral palsy, the comparison group – 11 children who did not have movement disorders. The patients underwent magnetic resonance morphometry, diffusion tensor imaging. A comparison was made between the volumes of brain structures and diffusion values between groups. Significant differences (p < 0,05) were found in the volumes of the right lateral, 3rd ventricles, white matter, thalamuses, globus pallidus, putamen, hippocampus. Significant differences (p < 0,05) in diffusion values in the thalamuses and in the posterior limb of internal capsules were also identified. The correlation of the identified changes with the clinic of the disease was demonstrated. The obtained data demonstrate wide possibilities and high diagnostic value in the detection of bilateral spastic forms of cerebral palsy in children.

Pediatrician (St. Petersburg). 2019;10(1):29-36
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The frequency of postpartum hemorrhage in women with different somatotypes
Gaidukov S.N., Tomaeva K.G., Komissarova E.N.
Abstract

The aim of the study was to study the frequency of postpartum hemorrhage in women with different somatotypes and to develop a method for predicting the risk of this pathology.

Materials and methods. 390 women were examined, 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).

Results. It was found that postpartum hemorrhage was significantly more prevalent among the women of macro-and microsomatic body type compared with women with mesosomatotypes (p < 0.05). In the course of multiple regression analysis, we obtained a regression equation (formula) for predictive models, which predicts the development of postpartum hemorrhage in women of different somatotypes. The calculations according to the presented formula, allows to predict with high accuracy the prognosis of postpartum bleeding, 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, long before delivery, which will contribute to more effective implementation of therapeutic and preventive measures to prevent the development of postpartum bleeding.

Pediatrician (St. Petersburg). 2019;10(1):37-41
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Morbidence of pregnant anemia and its impact on infant mortality
Ivanov D.O., Iurev V.K., Shevtsova K.G., Moiseeva K.E., Kharbedia S.D., Berezkina E.N.
Abstract

An important role in the normal development of the fetus and the successful outcome of pregnancy is played by the state of health of pregnant women. One of the significant factors of perinatal risk is anemia of pregnant women. In order to assess the level and dynamics of the incidence of anemia in pregnant women, official statistical reports and publications of the Federal State Statistics Service for 2005-2017 and Central Research Institute for Organization and Informatization of Health of the Ministry of Health of the Russian Federation for 2012-2018 were analyzed. Using a trend analysis using a trend method, a prognosis was made for the incidence of anemia in pregnant women up to 2021 in the Russian Federation as a whole and separately in the North-West Federal District. In order to assess the impact of the predictor “anemia of pregnant women” on the infant mortality rate, data from primary medical documentation was copied to 250 children who died before the age of 1 year in the North-West Federal District. It has been established that the incidence of anemia in pregnant women in the North-West Federal District significantly exceeds the average level in the Russian Federation. Provided that factors affecting the course of pregnancy remain unchanged, the incidence of anemia in pregnant women by 2021 on average in the Russian Federation will decrease to 32.2% of the number of women who have completed pregnancy, and in the North-West Federal District will increase to 37.5%. During pregnancy, the incidence of anemia in women whose child died before the age of 1 year in the North-West Federal District amounted to 44.16 ± 0.39% of the number of women who completed the pregnancy, which significantly exceeded the average figure in the district, which in 2017 was equal to 35.90 ± 0.35% (p < 0.05). A direct correlation has been established between the predictor “anemia in pregnant women” and the infant mortality rate.

Pediatrician (St. Petersburg). 2019;10(1):43-48
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The activity of transforming growth factor-β in young age with marfanoid habitus
Timofeev E.V., Malev E.G., Luneva E.B., Zemtsovsky E.V.
Abstract

According to contemporary views, hereditary connective tissue disorders divided classified Marfan syndrome, Loeys-Dietz’s, Ehlers-Danlos syndrome, the primary mitral valve prolapse. It is known that the fibrillinopaty, which include the Marfan syndrome and Loeys-Dietz’s is characterized by activation of TGF-β signaling pathway. With high le vels of TGF-β attributed most of these clinical manifestations these diseases – aneurysm of the aorta, arahnodaktylya, duralectasy. Assessment of the activity of TGF-β in persons with marfanoid habitus has not previously been studied.

Materials and methods. As part of this work, surveyed 70 people: 61 patients young age (median age of 20.1 ± 2.1 years), among which 36 boys and 25 girls and 9 men with verified diagnosis Marfan syndrome (median age 27.9 ± 9.3 years). All survey performed Echocardiography with a targeted search of small anomalies of heart.

Results. Correlation analysis showed a direct and reliable connection between arahnodaktylya and concentration of TGF-β1 in serum (r = 0.4, p = 0.05). For young people with signs of marfanoid habitus are characterized by reliably a higher concentration in the serum of both isoforms of TGF-β. Excess of threshold levels of TGF-β1 revealed at 20% of the core group and not found at all in the control (p < 0.05). Among persons with exceedances of threshold values for at least one faction of the TGF-β patients with signs of marfanoid habitus met almost three times more often than in the group with normal values of TGF-β (p = 0.01, χ2 = 5.58). In the group of persons with marfanoid habitus and increases TGF-β are detected more frequently such as atrial septal aneurysm, false chord left ventricle papillary muscles, incremental, deflection of shutters of the mitral valve in 1-2 mm, asymmetry tricuspid aortic valve.

Pediatrician (St. Petersburg). 2019;10(1):49-56
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Some results of the organization assessment of outpatient aid to children’s population in a municipal area
Sobolev I.B., Moiseeva K.E., Kharbedia S.D., Glushchenko V.A., Alekseeva A.V.
Abstract

Primary health care for children is the mainstay of the system of medical care for children and includes measures for the prevention, diagnosis, treatment of diseases, medical rehabilitation, the development of healthy lifestyles and sanitary and hygienic education for the children. Medical organizations located in rural areas have particularities in the system of providing medical care to the population. This concerns the type, capacity, disposition of medical organizations, their provision with qualified medical personnel, and the possibility of obtaining qualified medical care. In order to assess the state of outpatient care for children under the conditions of municipal health care, data was taken out of the federal statistical reporting “Information on medical organization” form 30 “Information about the number of diseases registered in patients living in the area of service of the medical organization” form 12 for 2015-2017. The research was based on the Toksovo District Hospital, a state budgetary health care institution in the Leningrad Region. In the course of the study, pediatric staff were evaluated for pediatric staff, indicators of outpatient care for the children, indicators of the burden of pediatricians and morbidity rates for the treatment of children. It was found that in the years under study there was a high level of provision of pediatricians with an attached pediatric population, an increase in the number of district pediatricians and a decrease in the part-time ratio. The increase in the workload of pediatricians conducting outpatient admissions, including district pediatricians, associated with an increase in visits for diseases in 2015-2017, indicates a deterioration in the health of the children’s population, as evidenced by an increase in the overall morbidity rate for outpatient using the child population.

Pediatrician (St. Petersburg). 2019;10(1):57-63
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State of health of St. Petersburg’s children which are engaged in sports schools
Zemlyanoy D.A., Antonov A.A., Alexandrovich I.V., Krutova E.S.
Abstract

Pupils have a high level of chronic disease, the indicators of their physical development are reduced with increasing educational load. In this regard, of particular interest is the state of health of schoolchildren, additionally engaged in active sports in special clubs.

Purpose of research. To study the state of health of schoolchildren of St. Petersburg attending the clubs of active sport, depending on age. Materials and methods. Data of medical examinations of 1122 schoolchildren 8-16 years old, engaged in sports schools in St. Petersburg. The Mann-Whitney U-test and the comparison of relative frequencies in two populations were used. Results of the research and discussion. Among children, the most popular sports are football (36.7%) and athletics (29.4%), the prevailing majority of children attend clubs from 1 year to 6.5 years. The proportion of pupils from the second health group was 84.9%, healthy children from the first health group – 13.1%, respectively. The most frequent deviations of musculoskeletal system were posture disorders (69.7% of children) and scoliosis (10.0%), at the same time, by the age of 16, the incidence of posture disorders significantly decreased (p < 0.05), and the proportion of scoliosis increased (p < 0.01). Myopia of weak and moderate degree was revealed in 13.3% of surveyed schoolchildren, the proportion of children with myopia by the age of 16 increased significantly (to 20.7%, p < 0.05). Among children attending sports clubs, fewer have myopia than among pupils enrolled in regular schools. The revealed dynamics of morbidity of the musculoskeletal system among children engaged in sports sections, indicates the need for continuous medical monitoring of the level of physical activity and the need to correct the training regimen in identifying children’s health abnormalities.

Pediatrician (St. Petersburg). 2019;10(1):65-70
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Medical staff’ practical skills enhancement in urgent hospital aid to children
Piskunova S.G., Prometnoy D.V., Besedina E.A., Prikhodko N.N.
Abstract

Strategic task of healthcare system is decreasing of lethality among children. High level of skills of emergency care to children is improve of treatment outcomes. Supporting of high level of skills is actually. The skills can high level support by regular simulation education of pediatricians in condition of low quantity of patients in low level hospitals. System of control of the skills’ level is imperfect and requires of optimizing.

Purpose. To estimate of the skills’ level of emergency care to children among in-hospital pediatricians by anonym questioning.

Methods. It was prepared anonym questioning on in-hospital emergency care to children of 103 in-hospital pediatricians from 10 Rostov-on-Don and Rostov region hospitals. It was suggested to answer on 1 of 3 variants of tests, which consists of 50 questions: 30 of them (60%) – were the first level questions (one correct answer), 12 (24%) – the second level (some correct answers), 8 (16%) – the third level (need formulating of correct answer). One of 15 situation tasks was included in test-sheet. The solution of the problem involves to make a diagnose, to plan of paraclinic diagnostics and to formulate of results, to provide emergency care, to make a plan of patient’s treatment. Testing was prepared after 6 months from finishing of training.

Results. More of incorrect answer had questions dedicated to issues of infusion 40% (150 of 375 asked questions), acute respiratory insufficiency – 39.7% (282 of 711), cardio-pulmonary resuscitation – 38.1% (121 of 318). More incorrect answers had tasks dedicated to emergency care – 17.2% (from 103 tasks), diagnostics – 14.6%, objective examination – 10.3% and treatment – 7.7%.

Conclusion. Low level of skills on separate directions of emergency care require additional monothematical trainings. Exam on practical skills in attestation of pediatricians is need.

Pediatrician (St. Petersburg). 2019;10(1):71-78
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Testosterone replacement therapy in male urolithiasis patients with metabolic syndrome
Tagirov N.S.
Abstract

Urolithiasis is one of the most wide-spread kidney lesions in males and females all over the world. It is particularly important for males with hypogonadism and metabolic syndrome.

The goal of the study is to assess the effectiveness and safety of Testosterone replacement therapy in males with hypogonadism and metabolic syndrome. Patients and methods. 465 male urolithiasis patients were studied. Mean age was 46 (38-54 years). All patients involved in the study had excessive body mass and obesity of various extent. Mean body mass was 92 (85-97 kg) and body mass index 40.5. More than 50% of the patients had Ischaemic Heart Disease, Cholelithiasis and Goiter. Essential Hypertension was present in 76.3% of cases. In more than 50% of the cases there was a combination of two or three nosological forms present. Depending on the replacement therapy used all patients were distributed into two groups: the main (300 patients) and the control one (165 patients).

Results of the study. Testosterone replacement therapy proved to contribute to normalization of mineral and lipid metabolism as well as improvement of kidney function and restoration of normal bone tissue density. Analysis of 5-year relapse frequency demonstrated it to be considerably lower in the main group (10%) than in the control one (30%) which is astatistically valid difference (p < 0.05).

Conclusion. Testosterone replacement therapy is a highly effective and safe method for urolithiasis therapy in males with hypogonadism.

Pediatrician (St. Petersburg). 2019;10(1):79-90
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Contemporary concepts of uterine fibroids’ pathogenesis
Taits A.N., Ruhljada N.N., Matukhin V.I., Somova A.D., Dudova K.A.
Abstract

Uterine myoma is the most common benign tumor among women which affects mainly those of reproductive age. Moreover, the frequency of emergence of this pathology in population is growing while the age of patients is steadily decreasing. Despite the enormous prevalence of this disease, its pathogenesis has not been studied properly. This article is concerned with an analysis of publications devoted to the study of the mechanisms of growth and development of uterine fibroids, it provides some data on the role of various factors in its extension. The article concerns the most popular concepts of the pathogenesis of this disease according to which the illness may be caused by increased levels of sex hormones (estrogens and progestins), enhanced expression of their receptors, impaired apoptosis, the effect of growth factors (e. g. epidermal growth factor, heparin-binding epidermal growth factor, acid and basic fibroblast growth factors, vascular endothelial growth factor, insulin-like growth factor, platelet-derived growth factor, transforming growth factor-β, activin, myostatin), abnormal deposition extracellular matrix, genetic (chromosomal aberration and various MED12 gene defect) and epigenetic mechanisms (such as action microRNA), circulatory disorders and impairment of cell differentiation from a population of accessory stem cells. However, it is noted that the pathogenesis of this pathology requires further detailed study, as the understanding of the processes leading to its development could greatly contribute to the improvement of the tactics of treatment and possibly allow to elaborate some preventive measures to avert the development of fibroids.

Pediatrician (St. Petersburg). 2019;10(1):91-99
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Methods of efferent therapy in prolongation of pregnancy in the isthmic-cervical insufficiency (two clinical observations)
Vetrov V.V., Ivanov D.O., Reznik V.A., Romanova L.A., Ryazanov V.V., Nikolaev A.V., Sadykova G.K.
Abstract

The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.

Pediatrician (St. Petersburg). 2019;10(1):101-106
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About preparing clinical psychologists in medical higher education institutions
Orel V.I., Averin V.A.
Abstract

On the background of the current difficult medical and social situation associated with an increase in the overall morbidity of the population, including socially significant pathology, the need for highly qualified psychological assistance is growing. The article presents an analysis of the problems associated with the training of clinical psychologists at the present stage. The article consists of two parts. The first part presents data on the dynamics of the number of non-medical and medical universities for the period from 2011 to 2017, as well as the number of budget places allocated to these universities for the same period. The main problems of training clinical psychologists in medical and non - medical universities: 1) the problem of shortage of highly qualified psychological personnel, especially in the specialty 19.00.04 – medical psychology, as well as the problem of the use of teachers of biomedical and medical departments in the preparation of clinical psychologists; 2) the problem of the qualitative composition of applicants and freshmen. The role of professional motivation of future clinical psychologists is emphasized: 3) the problem of quality of educational process in medical University. The second part of the article is devoted to the peculiarities of training clinical psychologists who will provide medical and psychological assistance to pregnant women, their families and children, starting with the perinatal period, and in institutions of maternal and child health,as well as how to solve the above problems at the faculty of clinical psychology of Saint Petersburg State Pediatric Medical University.

Pediatrician (St. Petersburg). 2019;10(1):107-115
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The problem of determining the criteria for speech disorders in modern preschoolers in the aspect of interdisciplinary interaction of specialists
Malkova E.E., Mashnina E.M.
Abstract

Based on Russian and foreign sources in the field of medicine, psychology and speech therapy, an overview of the main approaches to the systematization of speech disorders in childhood is conducted. It is shown that despite the long and winding path of research, there are numerous descriptions of phenomenology, but there is no consensus about the nature and mechanisms of speech disorders in children. Currently, there are two main directions in the study of speech pathology in children: clinical and psycholinguistic. In a clinical approach, impaired speech is considered as a pathological condition with certain symptoms, etiology and pathogenesis. Psycholinguistic approach to speech pathology involves the correlation of the observed violation with the normal functioning of the processes of generation and perception of speech, as well as an assessment of the degree of formation of language ability. As a result, the analysis of clinical, psychological and psycholinguistic studies shows a lot of contradictions, pushing for an active search for more accurate nominations and differential diagnostic criteria for distinguishing between different states of a child’s speech deficiency. Thus, a tendency is shown to move to a new level of professional reflection from a narrowly focused (clinical, speech therapy, psychological) to a systemic one, in which the focus of scientists will be not only the problem of determining the disadaptive development, but also the prospects for the mental and speech development of the child.

Pediatrician (St. Petersburg). 2019;10(1):117-126
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