EDITORIALS 

Background: Vagal techniques constitute the first line of medical care for terminating paroxysmal supraventricular tachycardia in children and adults due to ease of application, relative safety and possibility of avoiding injection of antiarrhythmic drugs. Effectiveness of vagal techniques depends on the method of execution, as well as a range of clinical and electrophysiological factors, which require study and specification. Objective: Our aim was to study effectiveness of the modified Valsalva test for terminating paroxysmal tachycardia in children. Methods: Effectiveness of the Valsalva test for terminating paroxysmal tachycardia induced in the course of a transesophageal electrophysiological examination in children aged 7–18 years was studied retrospectively. Results: Data of 306 children (mean age — 13.1 ± 3.2 years) were analyzed; 130 of them (42.5%) suffered from paroxysmal AV nodal reentrant tachycardia (PAVNRT), 176 — from paroxysmal AV reentrant tachycardia involving an additional AV connection (PAVRT). Valsalva test was effective in 88 children (28.8%) — 44 children (33.8%) with PAVNRT and 44 children (25.1%) with PAVRT. In most cases, tachycardia was terminated by means of anterograde block: PAVRT — in 65.5% of the cases, PAVNRT — in 92.7% of the cases. Children with ineffective Valsalva test featured longer duration of the disorder (p = 0.035), higher rate of the initial sinus rhythm before a tachycardic paroxysm (p = 0.043) and higher rhythm rate during tachycardia (p = 0.019), as well as high level of AV node conduction (p = 0.038). Conclusion: Valsalva test terminates paroxysmal tachycardia in not more than 1/3 of children with paroxysmal AV reentrant tachycardia. Test effectiveness depends on duration of the disorder and electrophysiological characteristics of AV node conduction. Valsalva test is especially effective in the onset of tachycardic paroxysm and terminates it by means of anterograde AV node block in most cases. 

Background: Methotrexate is the first-line drug for treating patients with juvenile idiopathic arthritis (JIA). If it is ineffective or intolerable, prescription of genetically engineered biopharmaceuticals is indicated. Objective: The study was aimed at assessing effectiveness and safety of genetically engineered biopharmaceutical adalimumab for treating children with JIA. Methods: A retrospective cohort study was conducted to analyze results of treating patients with JIA aged 2–17 years. Adalimumab would be prescribed biweekly in the dose of 24 mg/m2 (body surface) subcutaneously (if body weight is under 30 kg) or in the dose of 40 mg/m2 (if body weight is > 30 kg). Effectiveness and safety would be assessed after 4–12–24–48–96 weeks. Results: We analyzed treatment results of 17 patients (15 children with active joint syndrome, 2 — with active uveitis). All patients with active joint syndrome had been receiving adalimumab for 12 weeks, 12 patients — for 24 weeks, 8 — for 48 weeks, 5 — for 96 weeks. 30/50/70% improvement in terms of the ACRpedi criteria was observed in 15/11/4 children after 4 weeks, after 12 weeks — in 15/13/11 patients, after 48 weeks — in 7/6/6 patients. The status of inactive disease was established in 5 patients (33%) after 12 weeks, after 24 weeks — in 9 children (75%), after 48 weeks — in 7 children (70%), after 96 weeks — in 4 (80%) children. Active uveitis was terminated in all 5 patients with signs of eye damage in the treatment onset. 1 patient suffered from exacerbation of the disease after 48 weeks of therapy; the drug was withdrawn. Tubercular infection without local manifestations was established in 1 patient after 96 weeks (positive Mantoux test, papule — 10 mm). Adalimumab injection was terminated for the period of chemotherapy. Conclusion: Adalimumab has a sufficiently high effectiveness and safety for long-term (up to 2 years) treatment of children with JIA. 

Background: Assessment of quality of life of a food-allergic child’s family members requires developing special instruments or adapting the existing ones. Objective: The study was aimed at developing a specialized questionnaire “The Food hypersensitivity family ImPact“ (FLIP) in Russian for assessing quality of life a food-allergic child’s family members and evaluating its psychometric properties. Methods: Linguistic and cultural adaptation of the FLIP questionnaire in Russia involving parents/legal representatives of children with food allergies was performed prospectively. We confirmed reliability and constructive validity of the questionnaire in Russian. Results: Polling involved parents/legal representatives of 131 children with food allergies aged 1–18 months. Results of evaluation of the questionnaire’s psychometric properties demonstrated an average level of internal consistency of the questionnaire (Cronbach’s > 0.72 in different age groups). The questionnaire evaluation results depend on the degree of manifestation of disease symptoms (p = 0.033), pharmacotherapy duration (p = 0.033), breastfeeding for 6 months or more (p = 0.033), time or diet broadening and strictness of elimination diet observation (p = 0.033), number of foods eliminated from the diet (p = 0.010) and number of diagnostic events (p = 0.033). Conclusion: The FLIP questionnaire in Russian was developed; it underwent assessment of psychometric properties. We demonstrated dependence of quality of life of food-allergic children’s family members on disease characteristics and therapy effectiveness. 

The article is dedicated to the issue of intoxication in children. Acute accidental intoxication appears to be especially relevant for pediatric practice. Drugs, various chemicals frequently used in everyday life and in farming, as well as animal poisons, including snake poisons, may have a toxic effect on children. Specialists of professional associations of physicians “Russian Society of Emergency Medicine” and pediatricians “Union of Pediatricians of Russia” formulated and briefly described the main causes of acute intoxication in children, clinical manifestations and the most significant laboratory indicators of toxic manifestations for various substances, as well as therapy principles and algorithms for such conditions in compliance with principles of the evidence-based medicine. The article presents pathognomonic symptoms and peculiarities of drug intoxication, provides a description of mediator symptoms of intoxication with various substances, as well as the symptoms that may indicate toxic effect. The article contains a description of principles of correction of vital body functions, measures for removing toxic substances from the body and information on the main antidotes. Special attention is given to the most frequent types of intoxication (with organic acids, lye, naphazoline, paracetamol, snake poisons [viper bite]). The article lists stage of medical care rendering to children suffering from acute intoxication and presents prognosis and further management of pediatric patients suffering from such conditions. 

Hemorrhagic vasculitis is a hematological disorder, which is often accompanied by abdominal pain syndrome and blood in stool, which is why it requires differential diagnosis with acute surgical pathology. The article presents clinical follow-up of a patient with hemorrhagic vasculitis complicated by intestinal intussusception and developed mesenteric thrombosis, which required emergency surgical intervention. 

The article presents a case of using genetically engineered biopharmaceutical tocilizumab in a child with systemic juvenile idiopathic arthritis. On the initial stage, the treatment was characterized by resistance to high doses of glucocorticoids and cytostatic drugs. Successful termination of visceral and articular manifestations of systemic juvenile idiopathic arthritis and normalization of laboratory indicators of disease activity in the setting of use of interleukin 6 receptor blocker were described. We observed stable improvement of the child’s condition during a year-long follow-up in the setting of the selected anti-inflammatory therapy pattern. 

The review is dedicated to the analysis of contemporary therapies and efficacy thereof for treating children autoimmune nephric diseases. The authors describe peculiarities of using the conventional therapy in children and discuss alternative treatments using cyclosporine, tacrolimus, budesonide and ursodeoxycholic acid, as well as the need in using the second-line drugs for treating patients with resistant autoimmune nephric diseases. The review touches upon the promising approaches to the treatment of this category of patients. 

It is known that neurosurgical operations are characterized by blood loss requiring hemotransfusion. At the same time, world practice oversees a tendency towards restricted use of donor blood components for this purpose. This has become possible through the use of various blood saving methods, including use of erythropoietin-based drugs. This review is dedicated to analysis of the modern research data on preoperative use of erythropoietin-based drugs in combination with iron preparations in patients with nonsyndromic craniosynostosis requiring surgical correction. It has been demonstrated that preoperative (2–3-week-long) administration of erythropoietin allows limiting hemotransfusion and reducing the amount of intraoperatively transfused donor blood. Based on these data, we assume that erythropoietin is an effective and safe alternative to the “standard” means of blood saving, such as normovolemic hemodilution, controlled hypotension, automatic blood sampling and reinfusion of the patient’s erythrocytes. 

High prevalence of iron-deficiency conditions (IDC) in children dictates the need in searching for sensitive, accurate and simple methods of identifying such diseases on early stages of development. New methods of laboratory screening diagnosis are especially needed. The article presents an analysis of new methods of IDC laboratory diagnosis — hematological and biochemical. It presents a discussion of role of a new parameter — mean reticulocyte hemoglobin content (CHr) — for IDC diagnosis and treatment effectiveness control. The article presents data on CHr sensitivity and specificity as compared with the other hematological parameters frequently used for IDC diagnosis. 

Despite the availability of a national consensus document describing in detail modern approaches to feeding infants, pediatricians keep on giving most diverse recommendations on the time of supplemental feeding introduction. The article presents a brief historical review, as well the modern view on the issue of introduction of supplemental feeding to children. In the previous century, it was common both in Russia and most European countries to introduce supplemental feeding to children at the age of 2 or even 1.5 months. In 2002, the World Health Organization put forward an initiative in support of breastfeeding and recommended not to introduce supplemental feeding before the age of 6 months. A certain “golden mean” has apparently been achieved on the basis of results of studies and a longterm discussion among the specialists in feeding from different countries — all scientific communities and national recommendations of most countries define the optimal age for supplemental feeding introduction as “from 4 (completed) months to 6 (completed) months” with certain individual approach. 

XIХ CONGRESS OF PEDIATRICIANS OF RUSSIA WITH INTERNATIONAL PARTICIPATION “АCTUAL PROBLEMS OF PEDIATRICS” 

NATIONAL PROGRAM OF FEEDING OPTIMIZATION AMONG CHILDREN AGED 1–3 YEARS IN THE RUSSIAN FEDERATION 

EXPERT COUNCIL RESOLUTION ON THE DEFINITION OF TACTICS OF MANAGING PATIENTS WITH HYPOPHOSPHATASIA FOLLOWING THE MEETING OF NOVEMBER 21, 2015, MOSCOW