ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v17i4.2167ppharm-1875Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCASE REPORTПоздний неонатальный сепсис с очагами острого гематогенного остеомиелита: клинический случайLate Neonatal Sepsis with Acute Haematogenous Osteomyelitis Foci: Clinical Casehttps://orcid.org/0000-0003-3926-0881МанучарянМ. В.ManucharyanMarietta V.https://orcid.org/0000-0002-4955-0121ТуртиТ. В.TurtiTatiana V.

Турти Татьяна Владимировна, врач-педиатр высшей квалификационной категории, д.м.н., профессор кафедры факультетской педиатрии педиатрического факультета ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России

117997, Москва, ул. Островитянова, д. 1

тел.: +7 (499) 259-01-08

turtit@mail.ruhttps://orcid.org/0000-0002-7981-6349БеляеваИ. А.BelyaevaIrina A.https://orcid.org/0000-0003-4680-2925ПриваловаТ. Е.PrivalovaTatiana E.МакароваЛ. М.MakarovaLudmila M.ОвсянниковаМ. А.OvsyannikovaMarina A.Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; НИИ педиатрии и охраны здоровья детей ФГБУЗ Центральная клиническая больница РАН Минобрнауки; НИИ организации здравоохранения и медицинского менеджмента ДЗ г. Москвы; Детская городская клиническая больница № 9 имени Г.Н. СперанскогоРоссияPirogov Russian National Research Medical University; Research Institute of Pediatrics and Children’s Health in «Central Clinical Hospital of the Russian Academy of Sciences»; Research Institute for Healthcare and Medical Management of Moscow Health Department; G.N. Speransky Children’s Municipal Clinical Hospital № 9Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; НИИ педиатрии и охраны здоровья детей ФГБУЗ Центральная клиническая больница РАН Минобрнауки; Морозовская детская городская клиническая больницаРоссияPirogov Russian National Research Medical University; Research Institute of Pediatrics and Children’s Health in «Central Clinical Hospital of the Russian Academy of Sciences»; Morozov Children’s City Clinical HospitalRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; НИИ педиатрии и охраны здоровья детей ФГБУЗ Центральная клиническая больница РАН МинобрнаукиРоссияPirogov Russian National Research Medical University; Research Institute of Pediatrics and Children’s Health in «Central Clinical Hospital of the Russian Academy of Sciences»Russian FederationДетская городская клиническая больница № 9 имени Г.Н. СперанскогоРоссияG.N. Speransky Children’s Municipal Clinical Hospital № 9Russian Federation202009092020174345351Copyright © Манучарян М.В., Турти Т.В., Беляева И.А., Привалова Т.Е., Макарова Л.М., Овсянникова М.А., 20202020Манучарян М.В., Турти Т.В., Беляева И.А., Привалова Т.Е., Макарова Л.М., Овсянникова М.А.Manucharyan M.V., Turti T.V., Belyaeva I.A., Privalova T.E., Makarova L.M., Ovsyannikova M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/1875Обоснование

Обоснование. По данным научной литературы, заболеваемость сепсисом среди новорожденных детей в мире колеблется от 1–12 до 38 на 1 000 живорожденных [1, 2]. Клинический случай демонстрирует особенности реактивности организма новорожденного ребенка, трудности лечебно-диагностического процесса.

Описание клинического случая. Мальчик родился на 37-й неделе гестации, 1-й из двойни, масса тела 3330 г, длина 51 см, оценка по шкале APGAR 8/9 баллов. Вскармливание грудное. Состояние резко ухудшилось на 9-е сут жизни. Состояние очень тяжелое за счет синдрома интоксикации, манифестации некротизирующего энтероколита (НЭК), последующего развития синдрома системного воспалительного ответа и синдрома полиорганной недостаточности. Выраженный болевой синдром и ограничение движений в конечностях появились на 20-е сут жизни. Рентгенография: выявлены признаки НЭК; картина множественных очагов остеомиелита конечностей.

Заключение

Заключение. Адекватная диагностика и обоснованная тактика лечения обусловили эффективность терапии: состояние ребенка нормализовалось, зарегистрирована положительная динамика массы тела, купирован болевой синдром, увеличился объем движений в конечностях; нормализовались маркеры воспаления. В возрасте 2 мес ребенок выписан домой в удовлетворительном состоянии.

Background

Background. The incidence of sepsis among newborns ranges from 1–12 to 38 per 1,000 live births in the world according to scientific literature [1, 2]. The clinical case demonstrates the features of the newborn organism sensitivity and the therapeutic and diagnostic process difficulties.

Clinical case description. The boy was born on the 37th week of gestation, 1st of twins, with body weight 3330 g, height 51 cm, APGAR score 8/9 points. He was on breastfeeding. His condition has deteriorated rapidly on the 9th day of life. The condition was severe due to intoxication syndrome, necrotising enterocolitis (NEC) manifestation, further development of systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Severe pain syndrome and movement restraint in limbs have appeared on the 20th day of life. X-ray imaging: NEC signs, multiple osteomyelitis foci in the limbs.

Conclusion

Conclusion. Modern adequate diagnosis and justified treatment tactics have led to positive outcome: child’s condition has improved, body weight has increased, pain syndrome has been managed, the volume of movements in the limbs has increased, inflammatory markers have stabilised. The child was discharged from hospital in satisfactory condition at the age of 2 months.

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The authors declare that there are no conflicts of interest present.