Pediatrician (St. Petersburg)

Scientific and practical peer-reviewed medical journal.

Published since 2010, 6 issues per year.

The Chief-editor: professor Dmitriy Olegovitch Ivanov.

Founders:

  • Saint Petersburg state pediatric medical university of the Ministry of Healthcare of the Russian Federation,
  • Eco-Vector, LLC

The audience of the journal: the Journal focuses on researchers, doctors: pediatricians, pediatric surgeons, anesthesiologists and all specialists in related areas of medicine, psychologists and researchers in the field of the fundamental medicine.

The Journal’s subject area:

The journal publishes the original articles about conducted clinical, clinical-experimental and fundamental scientific works, reviews, lectures, descriptions of cases from practice, as well as auxiliary materials on all actual issues of Pediatrics, child psychology, medical and biological research in medicine and related fields of knowledge.

The main journal’s scope is focused on key issues of the studying of the child's body: the etiology and pathogenesis, epidemiology, clinical features, latest diagnostic techniques and treatment of diseases in children, as well as studying of childhood diseases in adults. The main goal is to provide new knowledge on improving the prevention, diagnosis and treatment of children’s various diseases to improve the education and skills of medical and scientific health-care professionals.

Indexation

RSCI, Cyberleninka, Indexcopernicus, Google Scholar, Ulrich's Periodicals directory.

The project has been implemented with the financial support of the Committee on Science and Higher School of the Government of Saint Petersburg.

Distribution: by subscription in print and online

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Current Issue

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Vol 15, No 2 (2024)

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Editorial

Newborns’ routing organization in subjects of the Russian Federation
Ivanov D.O., Yakovlev A.V.
Abstract

Reduction of infant mortality is a priority task for achieving the national development goals of the Russian Federation. The paper analyzes the influence of regional routing of newborns on the infant mortality rate in the subjects of the Russian Federation. The infant mortality rate for the period January–November 2023 in the Russian Federation is below the target value and amounts to 4.1‰, which is lower than the rate for the same period of 2022 (4.3‰). At the same time, subjects implementing insufficiently effective intraregional routing of newborns have a high rate of neonatal deaths in the early and late neonatal period concerning medical organizations of the I and II level of medical care. In order to improve the availability and quality of medical care for newborns, as well as to reduce the number of re-hospitalizations of newborns between medical organizations of the same level, including those requiring emergency surgical correction, it is necessary to update regional and interregional routing schemes in the provision of care to newborns, taking into account the orders of medical care, principles of territorial planning (with a detailed description of the areas of responsibility of each medical organization located on the territory of the subject).

Pediatrician (St. Petersburg). 2024;15(2):5-11
pages 5-11 views
Etiological structure of acute respiratory viral infections in children hospitalized in infectious diseases hospitals in Saint Petersburg in 2017–2022
Sukhovetskaya V.F., Timchenko V.N., Kaplina T.A., Pavlova E.B., Chernova T.M., Bannova S.L., Subbotina M.D., Bulina O.V., Afanasieva O.I., Leonicheva O.A.
Abstract

BACKGROUND: The etiological structure of acute respiratory viral infections in children is diverse. During the COVID-19 pandemic, the problem of diagnosing infectious diseases of the respiratory tract in children has become particularly relevant.

AIM: The aim is to analyze the etiological structure of acute respiratory viral infections in children hospitalized in infectious hospitals in Saint Petersburg in 2017–2022.

MATERIALS AND METHODS: The analysis of data on the etiology of acute respiratory viral infections obtained from 1,561 patients aged 1 month to 17 years hospitalized in children’s infectious diseases hospitals in St. Petersburg in the period 2017–2022 is presented. The children were divided into three age groups: group I — 1 month to 3 years (n = 600), group II — 3–6 years (n = 534), group III — older than 6 years (n = 427). The etiological interpretation was carried out by the PCR method. The observation period was divided into epidemic seasons: 2017/2018, 2018/2019, 2019/2020, 2020/2021 and 2021/2022.

RESULTS: The viral etiology of the disease in children was diagnosed in 88.6% of cases. The predominance of influenza viruses was observed in 2017/2018 (22.6%) and 2018/2019 (23.8%), and 2019/2020, 2020/2021 and 2021/2022 — the dominance of new (SARS-CoV-2) and seasonal coronaviruses (CoV-OC43 and CoV-229E). Acute rhinopharyngitis was recorded in 33.5% of cases and acute bronchitis/bronchial obstruction syndrome in 25.2% of cases. Stenosing laryngotracheitis was more often observed in young children (5.6%), pneumonia — in all age groups (3.3–4.2%). Acute respiratory viral infections caused by coronaviruses was characterized by the involvement of both the upper (48.2%) and lower (51.8%) parts of the respiratory tract in the infectious process.

CONCLUSIONS: The study of the viral landscape in hospitalized children with respiratory infection during 2017–2022 revealed a change in the etiological structure of acute respiratory viral infections associated with the appearance of a new coronavirus in 2019 and the gradual displacement of other respiratory viruses from circulation.

Pediatrician (St. Petersburg). 2024;15(2):13-22
pages 13-22 views

Original studies

Clinical relevance of plasma cystatin C in the diagnosis of acute kidney injury in preterm infants
Volkova A.A., Kozlova E.M., Novopoltseva E.G., Shunkina G.L., Kolchina A.N., Rakhmanova N.A., Shmeleva A.O.
Abstract

BACKGROUND: Acute kidney injury is one of the most common syndromes in premature neonates requiring treatment in intensive care units. Early diagnosis of acute kidney injury in these patients is extremely difficult due to lack of specific signs, morphofunctional immaturity, low sensitivity and specificity of renal dysfunction markers.

AIM: The aim of the study is to assess the clinical significance of plasma cystatin C concentration in the diagnosis of acute kidney injury in premature newborns in the early neonatal period.

MATERIALS AND METHODS: The design was a primary, prospective, non-randomised study including 100 preterm neonates with gestational age less than 37 weeks and birth weight up to 1500 g. Indicators of renal functional status (creatinine, diuresis rate, cystatin C) were assessed on the first, third and seventh days of life.

RESULTS: Low birth weight (p = 0.001; OR = 0.226), the need for invasive control mechanical ventilation (p = 0.012; OR = 6.32) and inotropic therapy (p = 0.025; OR = 4.99) are associated with a high risk of acute kidney injury development. A direct correlation was found between the presence of acute kidney injury, plasma creatinine (p = 0.001, r = 0.688) and cystatin C (p = 0.001, r = 0.689) levels. The first increase in plasma creatinine levels relative to basal levels in preterm neonates with acute kidney injury was noted from the third day of life, which was statistically significant compared to those of children without acute kidney injury (91.0 vs 57.0 mmol/l; p < 0.001). The concentration of cystatin C in patients with acute kidney injury is increased from the first day of life (1.85 vs 1.57 ng/ml) and continues to steadily increase by the seventh day of life (2.27 vs 1.84 ng/ml; p < 0.001).

CONCLUSIONS: Increased concentration of cystatin C in preterm neonates with acute kidney injury is observed from the first day of life and increases in dynamics, which allows us to consider it a highly sensitive and significant marker of renal dysfunction in the early neonatal period.

Pediatrician (St. Petersburg). 2024;15(2):23-30
pages 23-30 views
Influence of transforming growth factor-β on endothelial dysfunction in children with arterial hypertension
Revenko N.A., Kaladze N.N., Aleshina O.K., Revenko O.A., Polonevich T.V.
Abstract

BACKGROUND: Chronic non-communicable cardiovascular diseases, including hypertension, started in childhood and adolescence. The presence and severity of early arterial changes is associated with the presence and severity of standard risk factors. Structural and functional disorders of the vascular bed in hypertension are represented by dysfunction of the compensatory dilating ability of the endothelium, a violation of the thickness of the intima-media complex of the common carotid arteries and a violation of the humoral, metabolic and myogenic regulation of vascular tone.

AIM: To assess the severity of endothelial dysfunction and determine the significance of transforming growth factor-β (TGF-β) and endothelin-1 (ET-1) in its development in children with hypertension and metabolic syndrome.

Materials and methods: 122 children with hypertension were examined. Along with a complete clinical, laboratory and instrumental examination, the concentration of TGF-β and ET-1 in the blood serum was determined.

RESULTS: It was found that endothelial dysfunction was detected in children with hypertension, most pronounced in children with hypertension and metabolic disorders, the level of which increases with stabilization of the disease. Assessment is given as to possible development and progression of the disease and its favorable course depending on the dynamics of TGF-β profiles. Positive statistically significant correlations were obtained between the level of ET-1 and body mass index, waist circumference, blood pressure, and disease duration.

CONCLUSIONS: The revealed results suggest that endothelial dysfunction in children with hypertension is involved in the formation and progression of hypertension and metabolic syndrome against the background of chronic inflammation processes.

Pediatrician (St. Petersburg). 2024;15(2):31-42
pages 31-42 views
Health state at the age of 12 months in preterm children who have suffered intraventricular hemorrhages I and II degree during early neonatal period. Risk factors for the formation of cerebral palsy
Kharlamova N.V., Shilova N.A., Ananyeva M.A., Matveevа E.A.
Abstract

BACKGROUND: The most significant pathology in very preterm newborns with very low body weight and extremely low body weight is intraventricular hemorrhage, which can subsequently lead to disability. It is necessary to identify risk factors for the formation of disabling pathology in very premature newborns for a personalized approach to their management.

AIM: The goal is to assess the health status of very premature children who have suffered intraventricular hemorrhage in the early neonatal period by the age of 1 year of life, to identify risk factors for the formation of disabling pathology.

MATERIALS AND METHODS: We examined 580 very premature infants with very low body weight and extremely low body weight who suffered intraventricular hemorrhage of grades I and II in the early neonatal period.

RESULTS: Risk factors for stage II intraventricular hemorrhage in very premature infants with very low body weight and extremely low body weight have been established: fetoplacental insufficiency, threat of miscarriage, pregnancy parity of 3 or more, premature abruption of a normally located placenta, severe asphyxia at birth. By the age of 1 year of life, only 10.2% of the examined children were neurologically healthy. Disability by the age of 1 year of life occurred in 19 children, and in first place among the causes of disability is cerebral palsy — 68.4%, in second place — bronchopulmonary dysplasia (15.8%), in third place — retinopathy of prematurity (10.5%). Risk factors for the formation of cerebral palsy by the year of life in very premature infants with very low body weight and extremely low body weight who have undergone intraventricular hemorrhage in the early neonatal period are: gestation period less than 28 weeks, birth weight less than 500 g, low Apgar score at 5 minutes of life, the need for artificial pulmonary ventilation lasting more than 4 days, the presence of stage 2 intraventricular hemorrhage in the early neonatal period.

CONCLUSIONS: Taking into account risk factors for the development of disabling pathology in very preterm newborns with very low body weight and extremely low body weight is necessary for a personalized approach to the management of such children to improve outcomes.

Pediatrician (St. Petersburg). 2024;15(2):43-52
pages 43-52 views

Reviews

Current knowledge of bronchial asthma with low T2-inflammation in school-aged children (review)
Furman E.G., Alieva Y.S., Khuzina E.A.
Abstract

Bronchial asthma in children is a heterogeneous disease; therefore, determination of the disease endotype is important for personalized therapy, overcoming refractoriness to bronchial asthma treatment, and selecting a targeted biologic drug. The endotype of the disease, which is not associated with eosinophilia and, therefore, characterized by an insufficient response to inhaled corticosteroids, may begin at school age. The prevalence of low T2-inflammatory bronchial asthma in school-aged children is poorly understood, but the evidence presented in this article supports the presence of this endotype. This endotype of bronchial asthma in children is characterized by clinical and pathogenetic features, including low degree of allergic sensitization, reduced level of total IgE, limited number of positive allergy tests, decreased concentration of nitric oxide in exhaled air and eosinophil content in blood. The role of neutrophils in the development and prognosis of bronchial asthma in children is currently insufficiently studied and defined, nevertheless, it is known that the neutrophilic type of inflammation is associated with a more severe course of the disease and inadequate control. It is important to emphasize the need for further research into the endotypes of bronchial asthma in children with the identification of novel biomarkers and molecular mechanisms underlying asthma with low T2-inflammation. This may further enable the achievement of control of bronchial asthma with different inflammatory endotypes.

Pediatrician (St. Petersburg). 2024;15(2):53-62
pages 53-62 views
Modern concepts about lysosomal acid lipase deficiency (review)
Kotova N.N., Shcherbak V.A., Shcherbak N.M.
Abstract

Lysosomal acid lipase deficiency is a rare heterogeneous autosomal recessive heterogeneous genetic disorder whose manifestations often result in severe morbidity and mortality. The development of the disease is associated with the accumulation of cholesterol esters and triglycerides in organs and tissues, which in turn leads to the development of atherosclerosis, hepatosplenomegaly, liver cirrhosis, malabsorption syndrome and other symptoms. The true prevalence of the disease is unknown, the estimated incidence in Russia is 1 : 100,000–150,000 of the child population. Depending on the residual activity of the enzyme, 2 variants of the clinical course of the disease are distinguished. The most severe and also rare variant is Wolman’s disease, identified and described in 1961 by Israeli neurologist Moshe Wolman. This disease progresses during the first year of a child’s life and in most cases, due to the difficulties of diagnosis, leads to the death of patients. A milder but more common variant of LAL-D, occurring in children over one year of age and adults, is cholesteryl ester storage disease, described in 1968. The nonspecificity of symptoms of LAL-D at an early stage leads to the fact that the diagnosis of this condition is prolonged or missed by clinicians. An increase in liver enzymes in combination with hepato- and splenomegaly, dyslipidemia should alert the doctor and lead to early diagnosis of LAL-D even at the outpatient stage of examination, thereby increasing the duration and quality of life of patients. Differential diagnosis is carried out with Gaucher disease, Niemann–Pick disease, familial hypercholesterolemia, non-alcoholic steatohepatitis and other storage diseases. The main method of treatment is enzyme replacement therapy with sebelipase-alpha. Studies have shown its effectiveness in increasing the life expectancy of patients. It is recommended to use a multidisciplinary approach in the management of patients with LAL-D at all stages, since the disease is characterized by damage to many organs and systems and requires complex therapy. The biochemical and pathophysiological processes occurring in the body with deficiency of lysosomal acid lipase are considered.

Pediatrician (St. Petersburg). 2024;15(2):63-70
pages 63-70 views
Intensive care corticosteroids for critical neonatal conditions (review)
Aleksandrovich Y.S., Ivanov D.O., Pshenisnov K.V., Sterlyagova E.V., Fomin S.A.
Abstract

Corticosteroids are widely used in clinical practice in the care of children in critical condition, but data on their efficacy in neonatal practice are very limited. This publication attempts to summarize and systematize the literature data on the use of exogenous corticosteroids in various diseases of the neonatal period. Special attention is paid to the pathophysiology of acute adrenal dysfunction in the structure of critical conditions, its diagnosis and treatment. The results of a number of studies confirming the effectiveness of various corticosteroids in neonatal cardiac surgery, arterial hypotension, neonatal sepsis, refractory septic shock, meconium aspiration syndrome and bronchopulmonary dysplasia are presented. It has been demonstrated that hydrocortisone is the drug of choice in critical situations due to its minimal half-life and low probability of side effects. It has been established that current data on the feasibility, efficacy and safety of corticosteroid use in critical conditions of the neonatal period are very controversial and require further experimental and clinical studies. The question of the necessity of corticosteroids use in neonatal cardiac surgery and in various lung diseases (meconium aspiration syndrome, bronchopulmonary dysplasia) remains open, although there is enough evidence of their positive therapeutic effect, but there are no randomized multicenter studies, which limits the use of corticosteroids in clinical practice. An absolute indication for the administration of corticosteroids in neonates is the presence of acute adrenal insufficiency, congenital adrenal cortical hyperplasia and catecholamine-resistant septic shock.

Pediatrician (St. Petersburg). 2024;15(2):71-83
pages 71-83 views

Clinical observation

A clinical case of liver iron overload in a child with liver cavernoma and extrahepatic portal hypertension
Belykh N.A., Kotova P.O., Piznyur I.V., Gavrilova V.V.
Abstract

Iron overload syndrome is a pathological condition that occurs as a result of congenital disorders of its regulation, as well as due to repeated hemotransfusions, hemolytic anemia or excessive intake of iron preparations. Accurate data on the prevalence of secondary liver iron overload are not available in the literature. Liver biopsy remains the gold standard for assessing iron overload, however, non-invasive methods, in particular magnetic resonance relaxometry, also allow for an accurate quantitative assessment of the body’s iron overload. In secondary iron overload, chelation therapy is the only therapeutic option to prevent excessive accumulation of iron in tissues, which reduces complications and improves patient survival. The presented clinical case in a 5-year-old child is interesting for a combination of factors contributing to the formation of liver iron overload, as well as the rapid development of hyperferritinemia. The boy has a history of prolonged neonatal jaundice. At 6 months old, the child was first diagnosed with grade 2 iron deficiency anemia, splenomegaly and liver cavernoma were detected during abdominal ultrasound, and therefore the child was referred for consultation to a surgeon. At the age of 1.5 years old, the boy underwent surgical treatment — the formation of splenic-renal anastomosis due to the danger of bleeding from dilated veins of the esophagus. However, in the postoperative period, the failure of the anastomosis was noted, and therefore an H-shaped mesenteric-caval anastomosis was performed. At 2 years old of age, a planned examination revealed an increase in ferritin to 1149.2 ng/ml. During the molecular genetic study, hereditary hemochromatosis was excluded. After the start of chelation therapy, there was a decrease in ferritin levels in dynamics and with its normalization in October 2023, therapy was canceled. The boy is currently under the supervision of a hematologist, a pediatric surgeon and a pediatrician. The clinical case demonstrates the peculiarities of the course of liver iron overload in a child with liver cavernoma and extrahepatic portal hypertension, which required a personalized approach to diagnosis and treatment.

Pediatrician (St. Petersburg). 2024;15(2):85-91
pages 85-91 views
Erythema nodosum in Gianotti–Crosti syndrome associated with cytomegalovirus infection: a case report
Pronskaya O.A., Bogomazov A.D., Bets O.G., Tynnikova V.V.
Abstract

Gianotti–Crosti syndrome and erythema nodosum can be triggered by many different infections. These conditions are rare, especially in combination with each other, and therefore require a competent approach to differential diagnosis and identification of the cause. This article describes a case of a rare combination of atypical nodular erythema and Gianotti–Crosti syndrome with cytomegalovirus infection. A 6-year-old patient was under outpatient treatment for acute respiratory viral infections and exanthema. The child had an aggravated family history of atopy. Acute cytomegalovirus infection was laboratory confirmed. The diagnosis was made: “Cytomegalovirus disease. Infantile papular acrodermatitis (Gianotti–Crosti syndrome)”. After 7 days, the symptoms of acrodermatitis resolved, but papular elements persisted and new hyperemic papular-vesicular rashes appeared. After 3 weeks, nodular erythema developed against the background of the existing elements. The clinical diagnosis was: “Erythema nodosum. Cytomegalovirus infection. Infantile papular acrodermatitis”. The diagnosis was confirmed after consultation with a rheumatologist. The prescribed treatment had no effect on the duration of the disease. Unusuality of erythema nodosum was manifested as absence of symptoms of acute respiratory viral infection, joint and muscle pain the day before. The patient was under paediatric care for 3.5 months, by the end of which the papular acrodermatitis and erythema nodosum resolved almost simultaneously. Paediatricians should consider the possibility of combining Gianotti–Crosti syndrome and erythema nodosum for timely diagnosis.

Pediatrician (St. Petersburg). 2024;15(2):93-100
pages 93-100 views


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