Vol 15, No 3 (2024)

Perinatal infections occupy a leading place among the causes of neonatal morbidity, maternal and perinatal mortality. Infections are among the main causes of termination of pregnancy and premature birth. The practical recommendations presented in the work are intended for doctors of obstetric institutions in order to make a clinical diagnosis of an infection specific to the perinatal period, the tactics of examination and treatment of newborn children. The clinical recommendations correspond to the latest scientific data on the topic, contain information that is applied to the practical activities of a neonatologist, intensive care specialist and pediatrician. These clinical recommendations contain information about infections specific to the perinatal period, including the definition, frequency of occurrence, etiology of infections, pathogenetic mechanisms of disease development Numerous high-risk factors for infection of the fetus and newborn are described in detail. The document discusses and proposes the classification of the disease, the criteria for the adoption of the diagnosis. The features of the clinical picture of the disease are described, it is noted that the inflammatory process in a newborn child can be localized in any organ or acquire a systemic (generalized) character, in some cases, the ingress of an infectious agent into a macroorganism is not necessarily accompanied by clinical manifestations, which indicates an asymptomatic or subclinical course of infection. The recommendations provide advanced laboratory and instrumental diagnostics. The stages of treatment are described, including the choice and correction of antibacterial therapy, taking into account the peculiarities of the mother’s anamnesis, the child’s gestation period and the etiology of the disease. These clinical recommendations have been prepared taking into account the level of credibility of the recommendations and the level of reliability of the evidence.These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation.

BACKGROUND: Diseases of the nervous system and mental disorders have a leading place in the structure of childhood disability. Perinatal factors are principal in the development of nervous system damage in children. Of particular importance in the formation of perinatal disorders of the nervous system are lesions of the brain of pre-term infants, which is due to the specific morphology, functional and neurochemical characteristics of the brain of a pre-term baby. The listed circumstances determine the need to create a diagnostic system that allows the earliest possible identification of deviant signs in the structure and function of the nervous system in pre-term infants of different gestational age. Previously, the low diagnostic and prognostic value of a routine neurological examination was shown. A scheme for assessing the neurological state of a pre-term baby depending on the gestational age is proposed. The scheme is based on the principles of developmental neurology: continuity of neurological functions in the embryo, fetus, newborn and infant; optimality; standardization; quantification; a system of “credits” for the quantitative assessment of neurological states.

AIM: The purpose of this study was clinical testing of the early developed scheme.

MATERIALS AND METHODS: Using a routine neurological examination, a proposed original scheme for quantitative and qualitative assessment of the neurological status of the pre-term infant, and cranial ultrasonography, 40 pre-term infants during the neonatal period were examined. A follow-up study was carried out at 18 corrected months through a routine neurological examination, cranial ultrasonography, and the Denver Screening Test using the Development Quotient calculation.

RESULTS: It has been shown that a routine neurological examination has low specificity (6.6%) and negative predictive value (14.3%), which indicates its low ability to identify normal conditions of the nervous system in the acute period and predict optimal development. Cranial ultrasonography has low sensitivity (33.3%). The tested scheme showed high sensitivity (100%), specificity (100%), positive (83.3%) and negative (100%) predictive values.

CONCLUSIONS: Clinical testing of the new scheme for assessing the neurological status of a pre-term baby showed its high diagnostic and prognostic value.

BACKGROUND: The state policy in the field of public health protection is aimed at increasing the birth rate, reducing mortality, and preventing diseases. The topic of the health of the indigenous peoples of the North (IPN) has been and remains relevant today for Russia.

AIM: To assess the physical development of children of indigenous small-numbered peoples of the North, depending on the mother’s comorbid pathology, complications of pregnancy and childbirth.

MATERIALS AND METHODS: The study examined the physical development of children of indigenous small-numbered peoples of the North, the comorbid pathology of their mothers, the course of their pregnancy and childbirth. Factorial and regression analysis methods were used to identify relationships and interdependencies.

RESULTS: In the studied group of children of the IPN, low physical development is observed in 4.49% of children, average in 49.43%, high in 48.31% of children. Girls have a significantly lower physical development (2.12%) compared to boys — 7.14%. In the studied group of children of the IPN, there is not a single case of sharply disharmonious physical development. In pregnant women, representatives of the IPN, anemia, chronic urogenital infections, liver and biliary tract diseases, obesity and diseases of the cardiovascular system are most often observed in the structure of comorbid pathology. Among the pregnancy complications of the mothers of the examined children, fetoplacental insufficiency, gestosis, high/low water intake, the threat of termination of pregnancy, threatening premature birth are observed. Among the complications of childbirth, there are umbilical cord entanglement, labor reinforcement, neonatal jaundice and perinatal lesions of the central nervous system. At the stage of regression analysis, predictors were identified that affect the physical development of the child — these are intrauterine growth retardation and fetal hypotrophy, threatening premature birth in a woman in labor, and the gestational age of the newborn.

CONCLUSIONS: A high level of physical development is determined in 48.31% of children of the IPN, average in 49.43%, low in only 2.26%, which indicates the adaptation of the indigenous population to the harsh conditions of the North. The structure of comorbid pathology in women living in the Khanty-Mansiysk Autonomous Okrug — Yugra mainly corresponds to the average indicators in the Russian Federation, both in qualitative and quantitative terms. The exception is a regional pathology with liver and biliary tract damage associated with the epidemiological situation in the opisthorchiasis district. Regression analysis revealed the interdependence of the child’s physical development from intrauterine growth retardation, threatening premature birth, intrauterine hypotrophy and gestational age.

The review is devoted to one of the pressing problems of modern obstetrics — the delivery of women with a uterine scar after cesarean section. A scar on the uterus can cause various complications during pregnancy and childbirth. One of the main problems is scar failure. Pregnant women with a uterine scar, even after one cesarean section, should be considered at high risk for the development of complications. Visual diagnostic methods, such as ultrasound, magnetic resonance imaging, can only detect anatomical defects. Predicting the viability of a uterine scar is based, first of all, on a thorough analysis of data on a previous cesarean section. The choice of delivery method for pregnant women with a uterine scar is determined by its viability. It is not just the anatomical consistency of the uterine scar that is important, but also the functional one. The review presents criteria for diagnosing failure of the uterine scar according to ultrasound examination, data on the relationship between the initial thickness of the residual myometrium in the first trimester of pregnancy and the outcomes of pregnancy and childbirth. Considering that the functional viability of the uterine scar in subsequent pregnancies is largely determined by the course of reparative processes in the myometrium, especially the nature of angiogenesis, original studies are aimed at searching for diagnostic markers of the intensity of reparative angiogenesis. Generalization of existing knowledge about the possibilities of preclinical diagnosis of the consistency of the uterine scar will increase the number of vaginal births after cesarean section, reducing the number of abdominal births.

Nevus comedonicus is a rare benign hamartoma of the sebaceous follicle which is more common on the face, neck, shoulders, chest or abdomen. Nevus is group of small or large open comedones. It is a type of organoid epidermal nevus and usually appears before the age of 10 years. The linear configuration of the lesion along Blaschko’s lines suggests that the nevus is a manifestation of mosaicism. A possible cause of nevus comedonicus is mosaic postzygotic mutation of the NEK9 gene. Nevus comedonicus syndrome is also associated with extracutaneous abnormalities. Extracutaneous manifestations most often include ocular abnormalities: ipsilateral cataracts and corneal changes. Associated skeletal abnormalities include abnormalities of the fingers/toes (polysyndactyly or clinodactyly, etc.), scoliosis and other spinal malformations. We present our patient with a large nevus comedonicus localized on the left half of the abdomen with transition to the thigh. The lesion consists of multiple densely located elements with a diameter up to 1–2 mm in the form of expanded orifices of hair follicles — open comedones and inflammatory nodes. Scars remain in place of resolved nodes. A feature of the nevus in our patient is the large size of the nevus and the presence of inflammatory nodes. Dermoscopy reveals numerous light and dark brown, round or barrel-shaped, homogeneous areas with protruding keratin plugs. The treatment was carried out at the clinic with minocycline and gel adapalene externally. Thus, comedo nevus is a rare skin pathology that usually appears at birth and can affect any area of the skin. It can be an isolated skin pathology or as a component of comedo nevus syndrome, which requires additional examination of patients.

BACKGROUND: At the moment, a large number of scientific studies are devoted to the topic of post-COVID cognitive disorders, as well as to the study of the neurological and psychiatric consequences of COVID-19. However, the issues of describing the cognitive profile that is pathognomonic for a post-COVID patient, as well as the treatment and neurocorrection of emerging disorders are considered extremely rarely.

AIM: The aim of this study is to compile a cognitive profile of a post-COVID patient and identify targets for neuropsychological rehabilitation.

MATERIALS AND METHODS: A complete neuropsychological examination was carried out on 50 patients who had suffered moderate or mild COVID-19 no more than six months ago from the time of research. Used: MoCA test, clock drawing test, verbal association technique, FAB, G. Head test, test for understanding comparative constructions, “barrel and box” test, symbol-numeric coding test, asthenia rating scale (MFI-20), Hospital scale anxiety and depression.

RESULTS: According to the results of screening scales, patients scored borderline between normal and mild (subjective) cognitive decline. No impairments in operational auditory-verbal and visual memory were detected. Low performance in the symbolic-numeric coding technique was revealed, combined with a deterioration in the understanding of logical-grammatical structures. These same scales have a direct correlation with the general level of cognitive integrity. High rates of anxiety and asthenia and low rates of depression were revealed.

CONCLUSIONS: This cohort of patients was found to have mild cognitive deficits. A decrease in neurodynamic parameters and a violation of quasi-spatial concepts come to the fore. There are high rates of anxiety and asthenia with the leading mental component of asthenia, against the background of preserved motivation and low rates of depression. The targets of neurocorrection for these patients are: stability of attention, fluency of speech, speed of thinking, quasi-spatial concepts.

Transient neonatal thrombocytopenia occurs with a frequency of 0.7–0.9% and is divided by etiological factor into primary (alloimmune and transimmune) and secondary (symptomatic) thrombocytopenia, according to the time of occurrence of thrombocytopenia is divided into early and late. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome of varying severity, which occurs in 20–30% of newborns with thrombocytopenia, in other newborns thrombocytopenia is asymptomatic. The most severe clinical symptom is intracranial hemorrhages, which occur in 10–30% of cases. The most common types of bleeding of the platelet-vascular type are petechiae, ecchymoses, nosebleeds, melena, hematuria, cephalohematoma and other types of bleeding. In dynamics, symptoms of posthemorrhagic anemia may appear with massive bleeding (pallor, tachycardia, tachypnea, decreased blood pressure). The main criterion for the diagnosis of transient neonatal thrombocytopenia is a decrease in the number of platelets below the reference values for a given gestational and chronological age of a newborn child. To diagnose the type of thrombocytopenia, a thorough collection of maternal anamnesis is necessary, examination of parents if they suspect the immune nature of the disease, diagnosis of the disease as a result of which thrombocytopenia has developed, if it is secondary. Correction of thrombocytopenia, if indicated, is carried out by intravenous administration of platelet concentrate. If the immune nature of thrombocytopenia with severe thrombocytopenia is suspected and/or the presence of moderate and higher hemorrhagic syndrome, the administration of normal human immunoglobulin is recommended. If immunoglobulin therapy for immune thrombocytopenia is ineffective, glucocorticoids are prescribed.

In 2024, the medical community will celebrate the 130^th anniversary of the birth of the outstanding pediatrician, scientist, creator of scientific and practical schools of pediatrics — Alexander F. Tur. Alexander F. Tur was born on September 3 (15), 1894. In 1911 he was enrolled in the Imperial Military Medical Academy. From April 1915 he worked as a doctor in the active army; in August of the same year, A.F. Tur was captured and worked as a doctor in the infirmary for 3 years. In 1918, A.F. Tur resumed his studies at the Academy. From 1921 to 1930 — he worked part-time in the clinic of childhood diseases of the Military Medical Academy, under the guidance of Professor M.S. Maslov, in 1925 he was enrolled in the staff of the Leningrad Scientific and Practical Institute of Maternity and Infancy Protection named after Clara Zetkin. In 1939, the Department of Hospital Pediatrics was organized at the institute, headed by Alexander F. Tur and worked there until the end of his life. During the war years, A.F. Tur supervised the organization of clinic bomb shelters, advised children, conducted rounds, lectured students, and gave lectures to residents of the besieged city. A.F. Tur worked on a wide range of scientific problems in pediatrics, devoting his work to the most pressing issues of medicine: physiological characteristics and education of healthy children, physiology and pathology of newborns and premature babies, hematology of a healthy and sick child, dietetics of a healthy and sick child, rickets in children and its prevention, organization of children’s healthcare. A.F. Tur laid the foundations of preventive medicine at the outpatient stage, which are still followed today. The legacy of scientist is a fundamental pediatric school, a large number of scientific discoveries and works, thousands of trained do.