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Pediatric pharmacology

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Vol 15, No 4 (2018)
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EDITORIALS

286 532
Abstract
Dear colleagues! Dear friends!

ORIGINAL ARTICLES

287-299 1329
Abstract

Background. After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children. Methods. The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established. Results. In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media. Conclusion. The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination.

300-309 1783
Abstract

It is assumed that the severity of the multiple organ dysfunctions syndrome (MODS) in children who have experienced critical conditions in the neonatal period may influence the prevalence of chronic diseases in the preschool age. The aim of the study was to study the relationship between the severity of organ dysfunction in children who had undergone critical conditions in the neonatal period, and the prevalence of chronic diseases in preschool age. Methods. The study included children with MODS, the severity of which was assessed on the NEOMOD scale (moderate dysfunction ≤4 points, severe ≥5 points). Data on the prevalence of chronic diseases were obtained from the history of the child’s development (form № 112/y), a card for preventive medical examination of a minor (form № 030-PO/y-12), objective examination data, laboratory and instrumental survey methods, examination data by narrow specialists. Results. The study included 198 children, 100 of them with severe manifestations of SPON and 98 with moderate manifestations of SPON. The groups were comparable by sex, age, social factors (age and level of education of parents), place of residence (city/ village). Chronic diseases in preschool age occurred in 54% and 26% of cases, respectively, p<0.001. The most frequent were psychiatric and behavioral disorders: 40% and 16%, p<0.001, including coarse psychomotor development delay (PDD) of 18% and 1%, p <0.001; diseases of the nervous system: 30 and 14%, p=0.010, including cerebral palsy (CP) 25% and 8%, p=0.002; diseases of the eye: 28% and 24%, p=0.517, including amblyopia 8% and 3% of cases, p=0.113, respectively. Disability occurred in 19 (19%) cases in the main group, and in 5 (5%) cases in the comparison group (p=0.003). The conclusion. Severe manifestations of MODS in the neonatal period are associated with a higher frequency of coarse PDD and CP in preschool age than mild manifestations of MODS, severe manifestations of MODS are not associated with an increase in the frequency of pathology of the eye.

310-317 1130
Abstract

The physical development (FR) of children is one of the main criteria for the health status of the child population, reflecting the effect on the body of endogenous and exogenous factors. The purpose of the study is to study the physical development of schoolchildren living in the southern regions of the Kyrgyz Republic. Methods. Measurements of growth, weight, and circumference of the thorax were taken in urban and rural schoolchildren residing in the southern regions of the Kyrgyz Republic. The study period was from October 2015 to January 2017. Results. According to the results of the studies, the smallest increases in length and body weight were observed between the ages of 7 and 8 in schoolchildren of both sexes. The rate of weight gain was from 1.0 to 1.2 kg and growth was from 3.0 to 3.3 cm. The greatest difference in the growth rate among schoolchildren was found at the age of 11 and 12 (p<0.001), in girls at the age of 11, 12 and 16 years of age (p<0.001). The annual average increase in body length at the age of 7–17 in urban and rural boys was 4.4 and 2.9 cm, respectively, in girls — 2.8 and 27 cm. The growth retardation of boys was observed at 17 years with a growth rate of 1.3%, and in girls aged 15 years — 1.8%. The greatest increase in weight in urban schoolchildren of both sexes was observed between the ages of 10 and 11 (5.6%), and in rural aged 12–13 years (5.3%). The annual average increase in the chest circumference at the age of 7–17 years in urban schoolchildren was 2.5 cm, in girls — 2.2 cm, and in rural schoolchildren this indicator was at the level of 2.0 and 2.1 cm, respectively. The conclusion. The studied data of anthropometric indicators was used in the development of standards for the physical development of urban and rural children (7–17 years) of school age in the southern region of the Kyrgyz Republic, and their physical development was assessed.

318-323 956
Abstract

Reduced skin barrier properties in patients with atopic dermatitis (AtD) are largely caused by microbiome changes and extensive Staphylococcus aureus colonisation of the skin. In this regard, the integument of patients with AtD requires constant care and the use of various emollients. The inclusion of lysates of non-pathogenic microorganisms and prebiotics in the composition of emollients ensures the normalisation of the microbiome composition and the immunological barrier of the skin. The article presents the results of our own observations on the application of two cosmetic scin-care products for damaged skin with vitamin F in children with AtD complicated by a secondary infection, while the composition of one of the products is additionally enriched with ceramides and prebiotics. The safety and high efficacy of both products have been shown, however, the presence of ceramides and prebiotics in the emollient composition makes it possible to achieve a marked decrease in the degree of S. aureus colonisation of the skin.

REVIEW

324-332 3951
Abstract

Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is an X-linked hereditary disorder associated with a deficiency of iduronate2-sulfatase (IDS). IDS deficiency provokes the accumulation of dermatan sulfate and heparan sulfate in different tissues. Clinical manifestations of MPS II are heterogeneous and involve different organs. Two phenotypes are distinguished: attenuated or severe; classification is based on central nervous system impairment signs. The review provides data on the current treatments opportunities for Hunter syndrome and perspectives for development of new therapeutic approaches. Current treatment includes intravenous enzyme replacement therapy (ERT), hematopoietic stem cell transplantation, and symptomatic treatment. Intravenous enzyme replacement therapy does not promote the enzyme to penetrate the blood-brain barrier which leads to the treatment failure for neurological signs and symptoms; hematopoietic stem cell transplantation has high risk of post-transplantation complications but can improve some neurological problems. Intrathecal ERT, substrate reduction, pharmacological chaperones, and gene therapy are currently under investigation as therapies for severe form of MPS II. Development of new approaches to treatment of Hunter syndrome and other hereditary diseases is extremely vital.

333-342 5366
Abstract

Background. Physical development is one of the leading criteria for assessing the health status of children. The body mass index (BMI) is a reliable sign of physical development disorders. The possibility of diagnosing childhood obesity, a significant problem of modern healthcare service, is of particular value. Our aim was to assess the prevalence of obesity, overweight, and underweight in students aged 11 and 15 years attending educational institutions in the regions of the Russian Federation. Methods. The data is based on a prospective assessment of the screening of children. A total of 2,540 children were examined, the study included data of 2,023 schoolchildren of both sexes aged 11 and 15 years. The BMI calculation was assessed using SDS tables and centile scales (WHO, 2007). Results. When assessing the body mass index in 11-year-old boys in the regions of Russia according to SDS, obesity was determined in 18.6% of cases, overweight — in 15.4% of cases, and underweight — in 5.4% of cases. In 15-year-old boys, obesity was detected in 10% of cases, overweight — in 11.5% of cases, and underweight — in 8.5% of cases. In girls aged 11 and 15 years, obesity was detected in 9.2% and 3.6% of cases, overweight — in 14.3% and 10.5% of cases, underweight — in 10.5% and 8.9% of cases, respectively. Conclusion. In the Russian Federation, cases of underweight or overweight were detected, but these indicators do not exceed the number of children with normal parameters. A high proportion of obese boys is detected mainly due to 11-year-olds. More cases of obesity were registered in girls aged comparing with 15-year-old girls.

For Pediatricians' Practice

349-353 847
Abstract

Background. An effective system for management of pediatric dermatological care in Russia requires taking into account the peculiarities of regional morbidity. According to modern literature, this issue is not sufficiently developed. Our aim was to study the characteristics of variability in the incidence of skin and subcutaneous tissue diseases of children aged 0–14 years in the Russian Federation. Methods. The data of the state medical statistics on 83 territorial entities of the Russian Federation for 2009–2015 was used. The analysis implemented the risk aggregation method. The degree of variability in regional morbidity was assessed by the range of variation and the coefficient of variation. Region rankings were carried out by the annual incidence. The Spearman’s rank correlation coefficient was used to study the stability of regions belonging to a certain ranked place. Results. In 2009, the incidence of skin and subcutaneous tissue diseases of children aged 0–14 years in the Russian Federation had a pronounced variability: the range of variation was 7.7 times, the coefficient of variation was 28%. The annual region rankings were carried out. In 2010–2015, the annual variability indices remained high. The coefficients of rank correlation when distributing regions by morbidity were in the range of 0.75–0.94 compared to 2009. Quintiles of regions with different levels of pediatric dermatological morbidity were singled out. Conclusion. The incidence of skin and subcutaneous tissue diseases in children aged 0–14 years in the territorial entities of the Russian Federation during 2009–2015 had a pronounced variability. Regions had a stable preference for a certain ranking place. The division of territorial entities of the Russian Federation into groups of pediatric dermatological morbidity are presented.

DEBATABLE ISSUES OF PHARMACOTHERAPY

343-348 792
Abstract

What can become the basis for the decision making when prescribing a medicine, choosing one instead of another? Words and their combinations ‘randomised controlled study’, ‘double blind’, ‘meta-analysis’, ‘relevant difference’ have a kind of hypnotic effect on the doctor and often it is enough to make a positive impression and convince of the need to prescribe a medicine. Indeed, randomisation and a double-blind method of enrolling patients are the main ways to avoid systematic errors in research. However, this is not enough to decide what medicine to choose. When analysing the results of clinical trials, it is necessary to know a number of details that are important, sometimes critical, without regard to which it is possible to make false or incorrect conclusions about the efficacy of medicines. The article is devoted to the peculiarities of clinical trials which need to be paid no less attention than randomisation, double-blind method, and statistical significance of the obtained results.

IN MEMORY OF

 
354 453
Abstract

Krasavina Natalia Alexandrovna.



ISSN 1727-5776 (Print)
ISSN 2500-3089 (Online)