MEDICAL NEWS

Given very high prevalence of urinary tract infection (UTI) in the setting of renal pathology in children, timely disease identification, adequate antibacterial treatment and, if necessary, anti relapse therapy are of extreme importance. It is known that recurrent UTI is a risk factor of renal damage progression and development of renal failure. The given clinical recommendations on UTI diagnosis and management are based on the evidence-based approach. This helps to optimize work of pediatricians and pediatric nephrologists.

Background: Adverse course of HIV infection, rapid development of immunosuppression, severe opportunistic infections and malignant tumors and high mortality substantiate the importance of timely prescription of highly active antiretroviral therapy (HAART). The initial therapy pattern must remain efficient and safe in the long term.

Objective: Our aim was to study effectiveness and safety of different patterns of initial HAART in HIV-infected children.

Methods: The randomized controlled trial involved HIV-infected children aged 1–3 years. Clinical, immunological and virological examinations were conducted before and 12 months after HAART. The initial therapy pattern included 2 nucleoside HIV reverse transcriptase inhibitors — zidovudine and lamivudine. Children were randomized to the groups differing in the third therapy component: lopinavir/ritonavir or nevirapine.

Results: 25 patients were randomized to the lopinavir/ritonavir group, 23 children — to the nevirapine group. After 12 months of treatment, HIV replication suppression (blood viral load < 50 copies/ml) was achieved in 25 (100%) lopinavir/ritonavir group patients and in 16 (70%) nevirapine group patients (p = 0.003). HIV infection did not progress clinically regardless of the pattern. The median number of CD4+CD3+ lymphocytes in the lopinavir/ritonavir group increased from 20.5% (12; 23) to 30% (27; 34) (p < 0,001), in the nevirapine group — from 21.5% (17; 23) to 29% (27; 38) (p < 0.001). Adverse events developed in 13 (27%) children. 3 and 2 children in the lopinavir/ritonavir group suffered from nausea and emesis, respectively. 1 and 1 patient in the nevirapine group suffered from allergic rash and drug-induced hepatitis, respectively.

Conclusion: High effectiveness and safety of lopinavir/ritonavir allow recommending this drug as the third component of the initial HAART pattern for HIV-infected children.

Background: Premature infants with extremely low and very low birth weight with a severe overlapping perinatal pathology often feature slower growth rate within the first year of life and require special nutritional support.

Objective: Our aim was to study physical development of infants with protein-calorie deficiency in the setting of using a specialized protein- and calorie-rich pediatric milk product for enteral feeding.

Methods: We analyzed tolerability and efficacy of clinical nutrition within the framework of a prospective two-month-long case series. We assessed actual children’s diets and the chemical composition thereof. We determined body weight and length, body mass index (BMI), adipodermal flap thickness over the triceps. Anabolic effect of clinical nutrition was assessed on the basis of transthyretin concentration dynamics.

Results: The study involved 30 infants with protein-calorie deficiency (7 term infants and 23 premature infants) with a severe perinatal pathology. High tolerability of the formula under analysis was registered in most patients. Termination of functional gastrointestinal tract disorders (posseting, colics, flatulence, constipations) was observed in 23 (87%) patients. In most cases, the use of a protein- and calorie-rich formula as a part of a therapeutic diet helped to satisfy children’s protein demand and improve their weight/length parameters: BMI increased in 19 (72%) children, body weight — in 16 (63%), body length — in 24 (92%), adipodermal flap thickness over the triceps — in all the children (100%). We observed transthyretin concentration increase from 162 (157; 171) in the beginning of the study to 187 (170; 208) mg/l in the end thereof (p = 0.028).

Conclusion: A specialized protein- and calorie-rich product for enteral feeding may be used for feeding infants with protein-calorie deficiency born with a severe a perinatal pathology, including premature infants.

Background: Early anemia of prematurity (EAP) is a serious issue of contemporary neonatology due to increasing survivability of premature infants. One of the most efficient preventive methods is extreme prematurity prevention. At the same time, efficacy of different methods of EAP therapy remains undetermined.

Objective: Our aim was to compare efficacy of erythrocyte-containing donor blood components (packed red cells, erythrocytic suspension) and recombinant epoetin beta for treating premature infants with EAP.

Methods: The retrospective cohort study provided analysis of data of premature infants (gestation age — 27–32 weeks) born with very low (VLBW) and extremely low birth weight (ELBW) and EAP (hemoglobin < 110 g/l, hematocrit < 27%, reticulocyte share < 20‰, normochromia, normocytosis; all criteria must have been met). We determined primary hematological morphological parameters and population structure of umbilical (at birth) and peripheral blood (after 30 days of treatment) leukocytes.

Results: 32 premature infants with EAP underwent donor blood component transfusions, 26 — recombinant epoetin beta injections. The groups were comparable in terms of the primary clinical laboratory parameters. In the donor blood component group, we observed lower hemoglobin concentration (108 ± 17 vs. 119 ± 16 g/l in the epoetin beta group; p = 0.07) and reticulocyte share (3.7 ± 1.5 vs. 8.7 ± 1.7‰, respectively; p = 0,053) at the age of 1 month. We revealed a drop in cell immunity parameters in the setting of donor blood component transfusions: CD4+ lymphocyte share — down to 32,2 ± 14,0% (in the epoetin beta group; p = 0.055); CD8+ lymphocyte share — down to 21,2 ± 7,1% (in the epoetin beta group; p = 0.050).

Conclusion: Epoetin beta is more efficient in terms of EAP correction in premature infants with VLBW and ELBW that erythrocyte-containing donor blood component transfusions. The latter are characterized by adverse effect on cell immunity parameters.

Convulsions, especially prolonged convulsion, are an urgent state associated with high risk of development of life-threatening complications and frequent development of metabolic disorders, multiple organ deficiency and acute brain damage. Paroxysmal states of both epileptic and non -epileptic nature and similar clinical presentation complicating diagnosis and selection of ethiopathogenetic therapy are among the most prevalent conditions in children. The article presents the issues of etiology, clinical presentation and differential diagnosis of convulsions in children. We formulated recommendations on care rendering in the event of development of epileptic and non-epileptic convulsions. The article also describes contemporary views on epileptic status as a life-threatening condition and principles of stepped therapy based on the duration of paroxysmal epileptic status.

The article presents contemporary data on the peculiarities of etiology and pathogenesis of chronic itching dermatosis in children. We provide classification of various itching forms and pathophysiological mechanism of the development thereof underlying chronic skin disorders. We describe results of clinical studies of effectiveness and safety of methylprednisolone aceponate for treating itching dermatosis in children.

Background: Development and maintenance of registries of patients with rare diseases helps to determine the prevalence thereof, assess quality of medical care rendering, develop possible ways of optimizing patient management and calculate the necessary budget.

Objective: Our aim was to study validity of including pediatric patients to the federal osteogenesis imperfecta registry and to determine disease characteristics, current or previous treatment.

Methods: We conducted a retrospective study of the data on patients with ost eogenesis imperfecta included in the federal registry of the Ministry of Health of Russia. We provide results of the first registry audit. We analyzed the clinical and laboratory data provided in the medical documentation.

Results: Validity of inclusion of patients with osteogenesis imperfecta in the registry was confirmed for 323 (96.4%) patients out of 335. In most cases (> 90%), bone fractures take place at the age of 6 months or later. Conclusion: It is reasonable to develop an electronic individual record form for patients with osteogenesis imperfecta for long-term monitoring of health condition and the conducted treatment.

The article presents a clinical case of successful use of adalimumab (monoclonal antibodies to TNF ) as a drug of choice for treating continuously recurrent chronic bilateral uveitis complicated with a cataract that developed in the onset of juvenile idiopathic arthritis long before articular syndrome in the absence of humoral activity in a child who developed the disease at the age of 12 years. Adalimumab therapy launch induced uveitis remission 12 weeks after initiation.

Background: Automated accounting and controlling system “1C: Enterprise” is widely used in Russia for optimizing the system of controlling materials and technical resources. Medical organizations modify them in line with their primary activity objectives. For many years, the Scientific Center of Children’s Health has been successfully using a 1C-based medical information system including electronic patient records. An innovative product — an additional block for accounting equipment and supplies (E&S) — was developed in 2014.

Objective: Our aim was to conduct a sociological analysis of results of the first stage of modified multicomponent system “1C: Enterprise” implementation.

Methods: The cross-sectional full-design study was conducted from October 2014 to June 2015. We used the analytical method, the opinion poll method and the expert method. We developed a special questionnaire for the purposes of the poll. We assessed opinions of clinic employees, departments and services indirectly or directly working with the system.

Results: The study results demonstrate that multifunctional and adapted towards peculiarities of activities of the Scientific Center of Children’s Health system “1C: Enterprise” provides more efficient control over the use of drugs, expendables and other E&S in patient terms. It also allows simplifying and automatizing operation of the E&S accounting system by the employees and generating financial statements for a given period in terms of patient/department/clinic. At the same time, the poll revealed problematic technical, informational and motivational aspects. This is confirmed by the degree of involvement/personal interest of employees in the end result, as well as by the priorities of motivation for quality work.

Conclusion: Analysis of attitude of accountable persons to the modification of accounting policy of the Scientific Center of Children’s Health served as the basis for developing measures of optimizing system operation by the employees. These measures include additional on-site training and a personified incentive system.

12 декабря 2015 г. в Москве состоялся первый Экспертный совет, посвященный современному подходу к диагностике и ведению пациентов с дефицитом лизосомной кислой липазы.

31 октября 2015 г. на базе Научного центра здоровья детей (Москва) состоялся Совет экспертов по разработке клинических рекомендаций по вакцинопрофилактике заболеваний, вызванных вирусом папилломы человека.

19 декабря 2015 г. в Научном центре здоровья детей Минздрава России прошло очередное заседание Общественного Координационного совета по изучению пневмококковых инфекций и организации противопневмококковой вакцинации в России.