SOVREMENNAYA PEDIATRIYA № 7 – 2013
Resolution XI All-Ukrainian scientific-practical conference with international participation «Issues of immunology in pediatrics».
Meshkova E. M., Anoprienko E. V.
Center for medical and psychological, social and rehabilitation care of the national children's specialized hospital «OHMATDET».
In the article the work directions of the Center for Medical and Psychological, Social and Rehabilitation Care created on the basis of the National Children's Specialized Hospital «OHMATDET» (Kiev) are shown. Comprehensive medical and social care for sick children provides an early rehabilitation, psychotherapy and prevention of psychosomatic complications, psychological rehabilitation of seriously ill children and their parents, helps to improve the quality of life and social integration and return to an active life and learning.
Key words: complex medical and social care, quality of life, Center for Medical and Psychological, Social and Rehabilitative Care.
Kasati M., Pikka M., Marinello R., Kvartarone D.
Safety of use, efficacy and the level of parental satisfaction by Otrivin Baby nasal aspirator in the treatment of children nasal congestion.
Kokorkin D. N., Skarabagatyi V. V., Zheltov A. Ya.
Our experience of use of «Meralis» nasal spray in the treatment of children with acute and chronic otitis media.
Objective: To study the effectiveness of different methods of pre-and postoperative management of patients with acute (OM) and chronic suppurative otitis media (CSOM).
Patients and methods. A total of 50 children with acute (OM) and 30 children with chronic suppurative otitis media (CSOM) were under observation for pre-and postoperative stage. The CO diagnosis was confirmed by the results of otomicroscopy, tympanometry and tonal audiometry. For five days prior to operation was used the method of irrigation therapy (IT) of the nasal cavity and nasopharynx with an isotonic solution in combination with antiseptics (polyvidone — iodine) as a basic therapy. Treatment regimen supplemented nasal spray «Meralis» and nasal steroids (mometasone furoate); in the placebo group was used saline.
Results. Due to the significant improvement in well-being, from further operations declined 21 patients, the 16 (22.8%) of them had a spontaneous cure of OM which was stated on the 7th day from the start of treatment. Spray with mometasone in comparison with saline was more effective in the treatment of postoperative otorrhea. Within three months after surgery full recovery of hearing and spontaneous «discharge of shunt» was noted in 88 % of children. Nasal Spray «Meralis» successfully added treatment regimen of CSOM. Use of the preparation allowed eliminating long-lasting suppuration in 70 % of cases.
Conclusions. The use of irrigation therapy and «Meralis» spray in children with hyperplasia of pharyngeal lymphoid tissue ring, acute and chronic disorders of the nose and paranasal sinuses in conjunction with secretory and chronic suppurative otitis media had shown significantly better outcomes than in the placebo group and by efficacy appeared to be commensurable with nasal topical steroids.
Key words: acute otitis, chronic suppurative otitis media, irrigation therapy, nasal spray, treatment.
Ermakova I. N., Mizernitskiy Yu. L., Krivosheina E. L.
An impact of mucoregulators on the state of local immunity of the respiratory tract and the level of cell-cell interactions in a complex treatment of acute respiratory viral infections in children with bronchial asthma.
The authors carried out a clinical study of the effectiveness and safety of the drug Fluditec, whose active ingredient is carbocysteine («Laboratoire Innotech International», France). Fluditec was used in a complex treatment of 100 children with bronchial asthma aged from 2 to 17 years who had acute respiratory viral infection (ARVI). Changes of local immunity and the level of cell-cell interactions (formation of endogenous autorosettes (AR) and thrombocyte aggregates (ТА)) in peripheral blood were studied. Considerable intensification of leukocyte AR formation, higher blood ТА levels, increased local immunological defense of the respiratory tract and a lower frequency of BA exacerbations was noted in children of the main group who received complex ARVI therapy including Fruditec. The findings have showed that this drug is an effective mucolytic and mucoregulating agent with immunocorrecting action.
Key words: children, bronchial asthma, acute respiratory viral infection, treatment, carbocysteine, local immunity.
Konovodova E. N.
Iron deficiency state: when and for whom to administer Totema?
Buriak A. G.
Assessment of the overall state of newborns with respiratory distress during the critical conditions by SNAP II and SNAPPE II scales.
Objective: To assess the severity of the condition and the estimated risk of fatal outcome in newborns with respiratory disorders during the critical conditions and to identify the main factors of aggression which may lead to an increase in mortality rates among this cohort of children in conditions of the ITU of newborns.
Patients and methods. The study included 84 infants with severe respiratory failure in the setting of the different neonatal pathology. The severity of state of newborns was evaluated by Score for Neonatal Acute Physiology (SNAP II and SNAPPE II) with the following calculation of perceived risk of mortality outcome development. An adaptive capability of newborns was assessed by the use of the Apgar score. It is also studied the oxidative modification of proteins oxygen, the activity of neutrophilic blood granulocytes and capillary blood gas composition.
Results. There is quite a high rate of mortality among the infants with presumed respiratory failure in the conditions of the ITU which was 3.8 %. The main negative factors that can lead to the growth of this indicator are: the use of higher concentrations of oxygen during the ALV; severely impaired adaptation of the child after birth; decrease of capillary blood oxygenation; development of oxidative stress with activation of peroxide oxidation of proteins.
Conclusions. In neonatal practice is advisable to apply a standardized scale of condition severity score with the aim of prognosis of treatment outcomes and objective selection of medical tactics.
Key words: newborns, condition severity score, SNAP II and SNAPPE II, aggression factor.
Dzigal R. P., Verba N. V.
Application of Biosporin for the treatment of acute intestinal infections in pregnant women.
Objective: Optimization of the treatment of acute intestinal infections (AII) in pregnant women; the study and integration of data on clinical efficacy of the use of «Biosporin — Biopharma» preparation at presence of this diseases in pregnant women.
Patients and methods. A total of 48 pregnant women in the age from 19 to 32 years with the period of pregnancy from 6 to 32 weeks who had clinical signs of AII of moderate course were under observation. Complex therapy of all patients included: diet № 4, enterosorbents, electrolytes, disintoxication intravenous therapy. For 18 pregnant women of the main group with the period of pregnancy for 16 weeks was administrated «Biosporin — Biopharma» by 2 doses 2 times a day for 7–10 days; 30 patients of the comparison group received other probiotics and intestinal antibacterial agents (nifuroxazid or alpha-normix with minimal indicators of intestinal and placental reabsorption). In appropriate cases (bacterial intestinal infection) were used broad-spectrum antibiotics.
Results. Clinical efficacy of therapy was marked in 100 % of pregnant women of the 1st group and in 87 % of pregnant women of the 2nd group. Control bacteriological swab in the comparison group was in two times higher.
Conclusions. The use of «Biosporin — Biopharma» preparation allow reducing medical burden on pregnant women, to prevent and eliminate manifestations of dysbiosis, avoid toxic side effects of antibacterial agents on the fetus through an alternative monotherapy by self-eliminating antagonist (especially in the early stages of ontogenesis), to prevent recurrent bacterial infections that is allow recommending its appointment as in monotherapy for uncomplicated course of AII in early pregnancy so in the complex therapy.
Key words: acute intestinal infection, pregnant women, monotherapy, Biosporin, self-eliminating antagonists, dysbiosis.
Ventskivsky K. O.
Prevention of perinatal complications in pregnant with associated HIV-herpes infection.
Objective: To study the effectiveness of introduction of herbal immunostimulative preparation "Liasten" to the complex treatment of pregnant women with associated HIV-herpes infection.
Results. A decrease of the viral load level in the course of pregnancy, more pronounced due to the proposed therapy is shown. Conclusions. The reducing of the frequency of intrauterine infection of newborns was marked among those patients who had receiving present therapy.
Key words: HIV-infection, herpes infection, viral load, perinatal complications.
Berezhnoi V. V., Kozachuk V. G.
Efficiency of antifebrile preparations in the treatment of febricity in children.
The types of febricity and the methods of it therapy in children are examined. The data of evidence-based medicine indicate about a high safety and efficacy of ibuprofen during the fever of any origin. Ibuprofen preparation «Nurofen for Children» characterized by high efficiency, optimal profile safety and usability that is turn it into first choice preparation in the treatment of pain and febricity in pediatrics.
Key words: fever, children, antifebrile means, ibuprofen.
Volanska L. A.
Acute rhinosinusitis in children in the practice of general practitioner and rational antibiotic therapy at presence of its bacterial nature.
The primary objectives during the treatment of acute rhinosinusitis in pediatric practice are a balanced approach to the diagnosis, determination of disease etiology and the rational choice of antibiotic and its dosage. The review of researches and current recommendations on this issue are given out.
Key words: rhinosinusitis, etiology, diagnosis, antibiotic therapy.
Kozackevich V. K.
Current principles in the adaptation of infant milk formula.
The review presents various guidelines that individualize and upgrade the quality of artificial feeding in infants. The basic principle in the design of infant milk formulas now is not only to maximally approximate them to the composition of breast milk, but also to reproduce its functional properties. The current adapted milk formulas that have the qualitative and quantitative compositions adequate to the specific features of the baby's organism may be recommended for healthy babies.
Key words: babies, feeding, infant milk formulas, adaptation.
Kornev V. V.
Application of synbiotic «Laktiale» in the complex therapy of vegetative dysfunction in children and adolescents.
Summary. The literature review about the possibilities of use of synbiotic «Laktiale» in the complex treatment and prevention of vegetative dysfunction (VD) manifestations in children and adolescents and also in combination with a variety of disorders in the digestive system is shown. The composition of the prepa-
ration is analyzed. The results of studies of Ukrainian scientists concerning the prospects of use of Laktiale not only with the aim of normalizing the composition of intestinal microflora, but also for vitamin balance correction are shown. The set of present data allow proving the feasibility of use of synbiotic «Laktiale» in the treatment of VD and the digestive system disorders in children of the different age groups.
Key words: vegetative dysfunction, children, adolescents, irritable bowel syndrome, dysbiosis, obesity, synbiotic, Laktiale.
Pisarev A. A.
The state of hemostatic system of newborns from mothers with herpes virus infection.
Purpose: To evaluate the characteristics of the state of hemostatic system of newborns from mothers with herpes virus infection.
Patients and methods. A total of 320 newborns, 280 from them (main group) the children born from women infected with herpes viruses (herpes simplex virus type 2, cytomegalovirus or by its combinations). The control group consisted of 50 newborns from somatically healthy women. For 157 (56.1%) from 280 children was made a diagnosis of intrauterine infection (IUI), in remaining 123 the diagnosis of IUI was not confirmed. Study of the hemostatic system data (platelet and coagulation unit and also clotting time) was carried out at the end of the first day of life.
Results. In newborns from mothers with herpes virus infection with confirmed IUI was hypercoagulation in the setting of increased risk of thrombotic events. This is testifies to the negative impact of herpes virus infection in the mother on the hemostatic system state in her newborn baby.
Conclusions. High frequency of disorders of the adaptation period in newborns with intrauterine herpes virus infection is caused not only by the direct negative influence of infection and impaired immunity but also by the imbalance of adaptive systems.
Key words: newborn, herpes virus infection, intrauterine infection, hemostasis system.
Pisarev A. A.
State of the haemostatic system in newborns from mothers infected with herpes virus.
Summary. The state of the haemostatic system (platelet and coagulation factor, clotting time) has been studied among 280 newborns from mothers infected with herpes virus (herpes simplex virus type 2, cytomegalovirus). An imbalance of the haemostatic system, namely, hypercoagulation against the increased risk of developing thrombosis background has been established in newborns with fetal infection.
Keywords: newborn, herpes virus infection, fetal infection, haemostatic system.
Tokarchuk N. I., Skakun Z. A.
Optimization of medical treatment of molluscum contagiosum in children.
Objective: To study the effectiveness of the complex treatment of molluscum contagiosum in children with the use of isoprinosine and proteflazidum preparations.
Patients and methods. A total of 300 children (143 boys and 157 girls) with varying degrees of spread of molluscum contagiosum lesions were under observation. The study was conducted during two years. Age of children at the time of the survey was 3–17 years. Among examinees were 187 boys and 113 girls who were in outpatient treatment at the Vinnytsia Regional Children's Hospital. Immune-stimulating preparations isoprinosine and proteflazidum with antiviral action were used in the age dosage during the month. Outdoor therapy included the processing by misalignment antiseptic, antiviral creams and special creams on large areas of damaged skin.
Results. The combination of preparations with immune-stimulating and antiviral action and local therapy had shown high clinical efficacy and safety. During the sustained, lingering cases of diseases a positive result was achieved after two, sometimes three courses of therapy. Relapse of disease after treatment is not registered.
Conclusions. Treatment of molluscum contagiosum by present scheme is feasible in children age and eliminates the painful manipulation.
Key words: molluscum contagiosum, children, complex treatment.
Chopyak V. V., Potemkina G. A., Bilyanskaya L. N., Kril' I. I., Mzurak M. V., Lishchuk — Yakimovitch K. A.
Examination of regulatory immune mechanisms in friqantlly ill children and their correctability.
Objective: To evaluate the impact of «Fluvir» symbiotic on regulatory performance of the immune system of the frequently ill children (FIC) of the primary school age in the period of unstable remission of respiratory diseases.
Patients and methods. A total of 40 children in the age 6–11 years (26 (65%) boys and 14 (35%) girls) were under observation, who on the basis of anamnesis data, the results of clinical, instrumental and laboratory examination were assigned to the dispensary group of FIC. Preparation «Fluvir» (for kids) was administered to all patients by one sachet twice a day before meals by the course of one month.
Results. Fluvir application during the month allowed improving the general condition and the regression of clinical manifestations in 70 % of patients; enhancing mucosal, anti-infective, including antiviral, immunity, regulatory capacity of the adaptive immune response; stabilization of antigen-presenting processes, reduction of inflammatory process activity and autoimmune alarm of the protective systems of the body.
Conclusions. The level of effectiveness of Fluvir during the treatment of FIC can be assessed as moderate with the positive dynamics of the studied parameters of the immune system. In spite of carried out treatment in children observed reduction in the amount of regulatory CD4 + / CD25 +- lymphocytes (25.0 %) and increasing concentrations of IL -17 (30 %), which may be predictor of the autoimmune diseases development. Therefore, it is advisable to use Fluvir within 2-3 months under the control of immunological parameters.
Key words: frequently ill children, regulatory immunological mechanisms, mucosal immunity, symbiotic Fluvir.
Lezhenko G. A., Pashkova E. E., Pantyushenko L. I.
Rational antibacterial therapy of respiratory diseases in children.
Objective: To examine the role of Streptococcus pneumoniae as an agent of acute respiratory diseases in children – citizens of Zaporizhzhia and Zaporizhzhia region and on the basis of the given data to optimize the causal treatment.
Patients and methods. The study included 563 children aged from 3 to 14 years, who were under the treatment at the Zaporizhzhia RCCH for the period January — November 2013y. All children underwent physical, instrumental and bacteriological examinations of expectorations and secretions from the nasopharynx.
Results. It is found that Streptococcus pneumoniae was presented as an agent of ARD only in 15.3 % of cases. Analysis antibiogram had shown the highest sensitivity of the present agent according to the III generation cephalosporins, vancomycin and ciprofloxacin. A high antibiotic resistance of Streptococcus pneumoniae to clindamycin (50.0 %) and penicillin (96.8%) is marked. Leading role in ARD incidence in children of Zaporizhzhia belongs to Haemophilus bacteria.
Conclusions. Taking into account the changes in the microbial spectrum and increase of resistance of the main pathogens of respiratory infections to antibacterial preparations at the present stage is reasonable to use cefpodoxime proxetil as a starting antibacterial preparation for ARD treatment in children.
Key words: acute respiratory diseases, children, Streptococcus pneumoniae, cefpodoxime proxetil.
Nadraga O. B., Gladchenko O., Obertinskaya O. V.
Contemporary aspects of aetiology of acute stenosing laryngotracheitis in children.
Objective: To clarify the etiological factors of acute stenosing laryngotracheitis in children.
Patients and methods. The study involved 42 children in the age 6 months — 5 years who were hospitalized with ARVI which is flowing with the clinical picture of acute stenosing laryngotracheitis (ASLT, 37 children) and acute laryngitis (10 children). Virological testing of nasal has been conducted for all children in addition to the routine clinical, laboratory and bacteriological studies.
Results. In 65 % of children with ASLT and in 80% of children with acute laryngitis in the mucus from the upper respiratory tract respiratory virus genome is found. Bokavirus was one of the most frequently detected viruses, PCR results were positive in the most children who were for the first time diseased by croup. Mixed infection was detected significantly more often in children with stenosing laryngotracheitis than in children of similar age with acute laryngitis, the association of the pathogens most often defined in older children in comparison with younger children.
Conclusions. A considerable proportion of bokavirus in diseases of the upper respiratory tract in children during the first five years of life is found. Bokavirus often acts in association with other viruses furthermore the viral associations occur significantly more often in patients with high viral load and more severe
respiratory symptoms observed in patients with bokavirus which is marked as monopatogen in comparison with children who had bokavirus in association with other agents. The main symptoms of children with respiratory tract diseases and the positive results of PCR studies on bokavirus of the first type are a cough, pyrexia, hypoxia or the need for oxygen therapy, tachypnea, pharyngitis and other respiratory symptoms. The main symptom of bokavirus infection is stentorious (Vizing).
Key words: children, acute stenosing laryngotracheitis, acute respiratory viral infections, bokavirus.
Marushko Yu. V., Moskovenko O. D., Duda O. V., Ananchenko N. B., Chabanovich O. V.
Experience of the use of combined preparation lysocim and dequalinium chloride in children with acute respiratory infections and ulcerative stomatitis.
Objective: To study the effectiveness of the use of lysocim combined preparation and dequalinium chloride («Lizak») in the complex therapy of stomatitis in children with acute respiratory infections (ARI).
Patients and methods. A total of 58 children (30 boys and 28 girls) aged from 4 to 12 years with clinical manifestations of acute and moderate respiratory infections and stomatitis were under observation. General clinical examination, culture from the nasopharynx and from the aphthaes of oral mucosa (OM) was conducted for all patients at the time of admission. In the complex therapy Lizak was administered by one lozenge three times a day for the purpose of oral rehabilitation.
Results. During the study of nasal swabs viruses were identified in 39,7% of children. Application of Lizak allowed reducing manifestations of acute respiratory infections and also decreases the pain during the eating, edema and hyperemia of the oral mucosa, rapid purification and epithelialization of aphthaes.
Conclusions. «Lizak» is an effective and safe means of local therapy during the ARI and stomatitis in children.
Key words: acute respiratory infection, stomatitis, children, complex therapy, Lizak.
Unified clinical protocol of medical care to children with cholelithiasis.
Tkacheva M. Yu., Krivoruchko M. E., Chernousova S. N., Mikhaylenko E. P.
Safe and effective entheroprotective therapy of rotavirus infection in children (review).
Summary. The role of rotavirus infection and mortality of the children's population is highlighted. The effectiveness and safety of «Enterogermina» probioen-theroseptic in the complex treatment of intestinal diseases is proven.
Key words: rotavirus infections in children, Enterogermina.
Bobrova V. I.
Clinical and morphological features chronic gastritis in children.
Objective: To study the clinical and morphological peculiarities of the various forms of chronic gastritis in children.
Materials and Methods: Under our supervision there were 89 children aged 8 to 16 years. For verifaing the diagnosis, all children were performed endoscopy upper gastrointestinal tract, intragastric pH-metry, histological and bacteriological examination of the mucous membrane of the stomach (gastric mucosa).
Results: According to the results of the study were identified clinical symptoms of different forms of chronic gastritis. The majority of patients 8–10 years was established in autoimmune gastritiss of disease duration less than 1 year, be pronounced inflammation in the fundal part of the stomach, with stromal — epithelial gastric mucosa restructuring. As a results of our study was formed patients group who need diagnostic infection H. pylori, which include children of secondary school age anintensiv pain in the pyloroduodenal area with erythematous changes of gastric mucosa and normal acidity. Atrophic gastric were diagnosed in children aged 14–16 years. The signs of astenovegetative syndrome in the patients were always observed. Atrophic changes in the gastric mucosa were diagnosed in children with low levels of acidity. In the patients of reflux gastritis we had established paroxysmal pain in the pyloroduodenal region, eructation, erosion in gastric mucosa, low levels of acidity, the pronounced degree of inflammation and degenerative changes in epithelial cells were observed.
Conclusion: identified specific clinical symptoms is pathognomonic for children with various forms of chronic gastritis and give us to be watchful for diagnosis of degenerative changes of gastric mucosa at the stage of clinical examination of the child. The study showed the necessity of perfoming morphological study during endoscopy in children with chronic gastritis.
Keywords: children, chronic gastritis, diagnosis.
Marushko R. V.
Features of bowel cytoprotection in infants with functional and chronic inflammatory bowel diseases.
Objective: The study of intestinal preepithelial mucosal barrier in infants with functional and chronic inflammatory bowel diseases.
Patients and methods. The 150 children aged from 6 months to 3 years were under observation: 50 children with chronic non-specific non- ulcerative colitis (CNNC), 50 children with functional constipation (FC) and 50 children with functional diarrhea (FD). The control group consisted of 30 apparently healthy school-age children. Verification of diagnosis was performed on the basis of anamnesis, clinical and laboratory results, including bacteriological and instrumental studies.
Results. It is found that infants with functional bowel disease (FC and FD), and especially in condition of CNNC course occur expressed violations of the qualities of the preepithelial mucosal barrier quality which are accompanied by destructive changes of its metabolism. Children with FC have more expressed disorders in the structure of the mucous barrier than children with FD. During the CNNC become the rise of in sialic-and fucoglycoproteins components and reduction of sulfoglycoproteins. During the functional bowel diseases such changes are less pronounced.
Conclusions. Changes of structure of the mucous barrier in a condition of chronic inflammation are one of the pathogenetic mechanisms of formation and manifestation of this pathology and during the functional diseases — as a risk factor of deeper lesions in the intestinal mucosa.
Key words: infants, chronic non-specific non- ulcerative colitis, functional diarrhea, functional constipation, mucins.
Olkhovskaya O. N.
Optimization of infusion treatment of intestinal infections in infants.
Purpose of the work — to improve the pathogenetic treatment of intestinal infections in children by examining the effectiveness of the use of "Sterofundіn" solution.
Patients and methods. A total of 39 children aged from one month to three years were under observation, the (13 children — 33.33%) of them with severe forms of shigellosis, with Salmonella (15 children — 38.46%), with Escherichiosis (11 children — 28.21%). Next to clinical laboratory tests determined the main indicators of the central and peripheral hemodynamics by the method of echocardioscopy with the use of standard technique. Investigations were carried out in the early hours of hospitalization, after the infusion and in the following days before the stabilization of hemodynamic indices. In the complex treatment of 15 children who were the constituent part of the main group of observation "Sterofundin Isotonic" was administered intravenously at a dose of 20 ml / kg of body weight once a day at a rate of 5 ml / kg / year by the course of 2-3 days. Children of the control group (24 children) had infusive therapy with the use of traditional solutions — physiological salt solution, Ringer's solution, lactate solution and 5% glucose solution (P + P + D).
Results. It is found that the use Sterofundin positively impact on the process of clinical cure, promotes rapid and sustained improvement of hemodynamics. Sterofundin quickly adjustment of circulating blood volume, significantly improves ejection fraction of the left ventricular.
Conclusions. The use of Sterofundin solution is a perspective way of improvement of pathogenetic rehydration treatment of intestinal infections in children.
Banadyha N. V.
Differential ways in diagnostics and corrections of pancreatic insufficiency.
The aim: to diagnose pancreatic insufficiency in children with disorders of the digestive system and to test methods of correction.
Patients and methods: The study involved 82 children with disorders of the digestive system between the ages of 3 to 18 years and 30 children of similar age who didn't have any chronic diseases. The comprehensive survey was conducted according to existing standards. For the assessment of exocrine pancreatic function the levels of amylase in blood and urine have been determined; the provocative tests with Neostigmine have been made, the levels of serum — elastase-1 have been investigated.
Results: major clinical syndromes in children were: pain (96.34%), dyspepsia (86.58%), intoxication (67.07%). While the children were detailing in complaints it was found that 36.58% of patients were troubled by pain in the left upper quadrant. There are different answers of exocrine system on provocation Neostigmine, with a significant prevalence of pathological (78.48%) types. Diagnosed reliably high level of elastase-1 levels ((136,75 ± 6,65). 103 U / L), and 1/3 of the patients had the level was twice as high,which shows destabilized function of pancreas. In 41.46% of the patients revealed pancreatic insufficiency, and the rest (58.54%) — functional disorders of the sphincter of Oddi by pancreatic type. Correction treatment included: the use of antispasmodics (duspatalin) and enzymes (Creon) depending on the type of pancreatic insufficiency.
Conclusion. Findings motivates to consider the type of violations of exocrine pancreatic insufficiency (functional or organic nature) in the preparations of a treatment complex.
Key words: pancreatic insufficiency, children, diagnosis, correction.
Popov N. N., Olenich V. B., Savvo A. N., Piontkovskaya O. V., Sukhonosova O. Yu.
Influence on cortexin according to the data of the CNS functioning in children with MBD, who had suffered from perinatal lesions of the CNS.
Objective: To investigate the efficacy of the use of Cortexin in the treatment of minimal brain dysfunction (MBD) in children, who had suffered from perinatal lesions of the CNS.
Patients and methods. A total of 40 children with MBD in the age 163 years were under observation. Children had received the course of basic treatment including nootropics and sedative preparations. Patients of the main group (20 people) additionally received Cortexin by 10 mg intramuscularly for 10 days. In the dynamics in all patients assessed neurologic status, was carried out electroencephalography and ultrasonic Doppler examination.
Results. The study had shown the ability of Cortexin to provide specific activating effect on the integral functions of the brain, to strengthen cortico- subcortical interaction and a positive influence on the tone of cerebral vessels.
Conclusions. Application of Cortexin promotes more rapid recovery of cerebral disorders in patients with MBD, who had suffered from perinatal lesions of the CNS. That gives grounds to recommend this preparation for the treatment of this pathology in children.
Key words: perinatal lesion of the CNS, minimal brain dysfunction, children Cortexin.
Izyumets O. I., Laiko L. I., Gomont R. A., Dobizha M. V., Nezhivenko T. P., Shamrai I. E.
Hypoxic-ischemic damages of the central nervous system in newborns.
Summary. In the article shown the main risk factors of the perinatal period which are leading to hypoxic-ischemic brain damage in newborns with subsequent child disability, which occupies 35–40 % of the pathology of the central nervous system. Searching and reasonable use of preparations which has regulatory value and no adverse effect on nerve cells is an important problem of rehabilitation of the central nervous system in infants.
Key words: hypoxic-ischemic demerges of the central nervous system, infants, therapy.
Kalashnikova R. V., Rudenko N. N., Romaniuk A. N., Galagan V. A., Emets I. N.
Structure of congenital development abnormalities in operated for congenital heart diseases children.
Objective: To analyze the structure of congenital anomalies development in operated children with CHD and to determine the proportion of syndromic forms of CHD.
Patients and methods. The study group consisted of 618 (8 %) patients with extracardiac development abnormalities who underwent surgical correction of CHD. In accordance with the type of genetic syndrome were found three groups of patients: with chromosomal syndromes (n = 408, 66 %), with non-chromosomal syndromes (n = 93, 15 %) with undifferentiated multiple congenital development syndromes (n = 117, 19%).
Results. Large extracardiac development malformations had 57 % of patients. In the group with chromosomal syndromes diagnosed 19 variants of CHD and the most ubiquitous extracardiac anomalies were musculoskeletal, urinary, respiratory systems and brain malformations. Patients with non-chromosomal syndromes ( monogenic and with the unclear type of inheritance) had 15 variants of CHD among which prevailed complex combined anomalies, the most ubiquitous extracardiac abnormalities were malformations of the urinary system and the central nervous system. Structure of congenital malformations in children with undifferentiated multiple congenital development syndromes was presented by 14 variants of cardiac abnormalities (39 % of which were complicated combined defects and the most ubiquitous was tetralogy of Fallot & 20%); by the high threshold of stigma and a broad spectrum of complex extracardiac malformations in 80 % of cases.
Conclusions. Multiorgan pathology in children with CHD and extracardiac development abnormalities stipulate the necessity of the complex approach during the diagnosis and require the use of specific and high-tech research methods and attracting narrow medical specialists (geneticists, radiologists, etc.). Accounting for all the anatomical and physiological characteristics of noncardiac defects is an important prerequisite for effective surgical treatment of CHD in these patients, which allows to predict, prevent and reduce the incidence of complications in the postoperative period.
Key words: extracardiac development malformations, congenital heart disease, genetic syndromes.
Boguta L. Yu., Rudenko N. N., Emets І. N.
Surgical treatment of congenital heart diseases in infants.
Objective: To evaluate the scope and the immediate results of surgical treatment of CHD in infants in the SI «Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine» (Center) for the period from development of institution in September 2003 year till December 2012 year.
Materials and Methods. The analysis of 9449 surgeries performed in patients of all age groups during the study period is conducted. The 4692 from surgical operations were carried out to newborns and infants.
Results. It is found the increase of the number of operations in 2.4 times (from 292 in 2004 to 713 in 2012 ) carried out by the patients of the first year of life, with simultaneous reducing of the level of mortality in almost 5.5 times (from 11.3 % in 2004 year to 2.1% in 2012 year ).
Conclusions. The results of surgical treatment of CHD in infants in the Center reached the highest world standards. Despite the increase in the absolute num, ber of operations in infants, their share in the overall structure remains unchanged. This is certifies about the need of early diagnosis improvement of CHD.
Key words: congenital heart diseases, surgical treatment, newborns, infants.
Kurkevych A. K., Pavlova А. O., Ostras O. V., Babliak O. D., Yemets I. M.
Prenatal ultrasound diagnostics of complex congenital heart diseases and its influence on perinatal tactics.
Objective. To analyze the diagnostic value of prenatal diagnosis of complex CHD, its impact on perinatal tactics and results of surgical interventions in infants at Ukrainian Children's Cardiac Center (UCCC).
Material and Methods. Clinical study material was 1106 cases of prenatal ultrasound diagnosis of complex CHD for 2004–2012 at our center. Diagnostic value of prenatal echocardiography was evaluated with sensitivity and specificity. Comparative analysis was performed between the two periods: before (2004–2009) and after (2010–2012) the improvement in protocol of ultrasound examination of the fetal cardiovascular system.
Results. With an improved protocol sensitivity and specificity in prenatal diagnosis of complex CHD rose to 98.5% and 99.3% respectively. From 2005 to 2012, the number of cardiac surgery for infants increased from 376 to 883 procedures. Due to the changing in perinatal tactics the percent of operated infants with prenatal diagnosis of complex CHD grew from 6.9% to 21.3% and in absolute terms — from 26 to 188 children. Along with the increase in the number of operations for infants an overall mortality in this group decreased from 5.1% to 1.6–2.0%.
Conclusions. The development and improvement in prenatal diagnosis resulted in an increased amount of diagnosed complex CHD and changing in perinatal tactics that contributed to the overall increase in surgical interventions for infants by 2.4 times with a decrease in mortality by 2–3 times.
Key words: prenatal diagnosis, complex congenital heart disease, perinatal tactics.
Kuzmenko Yu. L., Maksimenko A. V., Dovgalyuk A. A., Hrusch M. P., Boyko E. P., Rudenko N. N.
Experience of endovascular interventions during the critical congenital diseases.
Purpose: To show the clinical manifestations and the main methods of diagnosis of critical congenital heart disease (CHD) in infants; to present own experience of endovascular interventions during the critical CHD. Patients and methods. The cases of critical CHD in children hospitalized to the Centre and the results of interventions for the period 2006–2012 years are analyzed.
Results. For the period of study total of 4833 catheterizations were conducted in the Center, in 2451 (50%) of cases were used different endovascular interventions. For 925 (37%) newborns was conducted critical defect elimination or stabilization of the state by means of X-ray surgery methods: balloon atrioseptostomy at transposition of great vessels (n = 487, mortality — 6.6%), balloon valvuloplasty at critical pulmonary artery stenosis (n = 123 mortality — 0 %) and aortarctia (n = 58, mortality — 10.3%), balloon angioplasty at critical coarctation of the aorta ( 227 , mortality — 1.3% ) and perforation of the valve at pulmonary atresia (n = 30 , mortality — 6.6 %). The overall mortality from these interventions was 2,7% (n = 25).
Conclusions. Endovascular surgery during the critical CHD is a quite effective intervention that allows completely eliminate the defect or to prepare infant for the next stage of treatment. Despite the difficult state of the patients at the time of admission to the hospital, endovascular surgery due to it low trauma allow to conduct correction of the defect with a low mortality.
Key words: critical heart disease, aortic stenosis, pulmonary atresia, transposition of the great vessels, coarctation of the aorta, pulmonary artery stenosis, intact interventricular septum.
Yalinskaya T. A., Raad Tammo, Rokitskaya N. V., Bablyak O. D., Ershova E. B.
Modern methods of diagnosis of congenital heart diseases.
The article discusses up-to-date problems in the diagnostics of congenital heart disease using multidetector computed (MDCT) and magnetic-resonance tomography (MRI). Article also focuses on peculiarities of obtaining MRI and MDCT imaging in neonates and children under 5 years. We list indications for heart MRI and MDCT imaging and systematic approach to image evaluation. Current protocols are based on international Guidelines and own experience of heart MRI and MDCT performed on 7516 patients.
Key words: congenital heart disease, multidetector computed tomography, magnetic resonance imaging, diagnostics.
Khanenova V. A., Rudenko N. M., Аrtemenko E. О., Meshkova М. S., Кurkevych А. К., Boyko О. P.
Right ventricle function evoluation in patients after atrial switch operation (Senning).
Review. After the Senning operation (SO) due to transposition of the great arteries (TGA), right ventricle (RV) remains systemic. Assessment of RV function by conventional echocardiographic methods has some limitations because of anatomical, volumetric and functional peculiarities. The modern era is searching period for new noninvasive chocardiographic quantitative methods which could correlate with MR — gold standart of RV function assessment. The aim of this study was to assess systolic function of systemic RV function after SO by complex of noninvasive diagnostic methods. We investigate 84 patients with mean age 8 y. 8 mon. ± 2 y. 7 mon. (from 11 months to 20,5 y.). Mean follow-up was 7,8+3,7 y. (from 6 months to 20,5 y.). Statistically we find a high correlation between evaluation of RV function by Echo and MRI results. This complex method of RV function evaluation is very informative and could be recommended for practice.
Кey words: transposition of great arteries, atrial switch operation (Senning), systemic right ventricle, echocardiography, tissue Doppler Imaging, continiuos Doppler imaging, magnetic resonance imaging.
«Rattle in ears»: toy history.