No 3 (2024)

Children's outpatient departments provide children with preventive, consultative, diagnostic, and therapeutic care. Newborn care is a special program created by the state to monitor the condition of a newborn child and a new mother and assess the socio-economic conditions of the family as a whole. Screening shortly after a child's birth plays an important role and is aimed at the timely detection of congenital and hereditary diseases. Neonatal, audiological, and cardiac screening is put into practice. Since December 31, 2022, neonatal screening throughout the Russian Federation has been carried out for 36 groups of medical conditions. Since 2019, cardiac screening has been carried out in our country for all children after 24 hours of life in maternity hospitals to detect congenital heart defects. Audiological screening is performed at the age of 3–4 days or before discharge from the maternity hospital. One of the most important tasks of the district service in the observation of young children is the promotion of breastfeeding. It is necessary to inform mothers and their families about the benefits of breastfeeding and to teach pregnant women and nursing mothers the practical aspects of breastfeeding. The Office of a Healthy Child, a structural unit of the outpatient department, has a crucial role in working with young children. It is engaged in preventive work aimed at preserving the child's health, as well as its optimal development and effective upbringing.

One of the most common drug-related side effects is hepatotoxicity. The most common cause of severe drug-induced liver injury is acetaminophen (paracetamol), as it is an over-the-counter drug. Paracetamol is safe and effective in children and adolescents at therapeutic doses; however, it is the leading cause of acute liver failure in children (21% of cases) and adults (40%) with overdose. The clinical presentation of toxic liver damage depends on the time elapsed after taking paracetamol and its dose. Symptoms of liver damage are not always obvious but can develop rapidly from day 2 to day 5 after poisoning. The article presents a clinical case of an unintentional overdose of paracetamol in a teenage girl due to non-compliance with the dose and regimen.

The upbringing and teaching of toilet skills to young children is an important stage in the physiological development of the child. Control over urination and defecation in infants develops gradually, starting with a completely reflexive process and moving on to conscious control. This process is of great importance in the formation of a healthy and independent personality, preparing the child for the next stages of growing up and acquiring new skills. The article presents historical aspects of the formation of toilet skills among different peoples and at different stages of society development. Interesting facts about potty training in different countries of the world, anatomical features of urination and defecation, signs of readiness for potty training and toilet training, the age recommended for potty training, and what a potty should be like are shown. Approaches to teaching this level of independence are important not only for the child’s physical health, but also for understanding his psychological readiness, social development, and adaptation in children’s groups.

Background. Due to the progressive increase in childhood obesity, the effect of iron levels in the body on carbohydrate and lipid metabolism disorders and the relationship between these conditions are actively studied. It is proven that obesity in children is often associated with dysregulation of iron metabolism. The correlation between the body mass index and iron deficiency (ID) in children and adolescents was reported. Therefore, implementing preventive measures to correct the iron deficiency state (IDS), including the enrichment of the diet with foods containing easily digestible iron, is relevant and can be considered as one of the principles of an integrated approach to the treatment of obesity in childhood.

Aim. To evaluate the effectiveness of dietary supplements "Kidz Tasty iron" for IDS prevention in obese children.

Materials and methods. Thirty children aged 7–14 with exogenous constitutional obesity were followed up, 14 (47%) females and 16 (53%) males. All patients received a dietary supplement (DS), "Kidz Tasty iron," 10 mL once daily with meals according to the label for 1 month. The follow-up included data on signs and symptoms, medical history, evaluation of anthropometric data, evaluation of current nutrition status with the software "Optimal Nutrition 5.0", bioimpedance analysis of body composition, questionnaire on the assessment of ID symptoms and quality of life, general hematology and blood chemistry tests, validated for childhood.

Results. The diets of obese children in the study had low iron content (33.3% of patients), which justifies the need for additional iron supplementation. While taking the dietary supplement "Kidz Tasty Iron," there was a positive clinical trend: decreased symptoms related to ID and clinical signs of ID, improved overall well-being, and increased quality of life. The improvement of the body composition of the studied children was represented by preservation and an increase (20% of patients) in the active cell mass in the studied children. Laboratory tests of iron metabolism improved in 9 children (30%). Most children reported the good organoleptic properties of the product. Adherence to the DS was 96.7%.

Conclusion. The study results show the "Kidz Tasty iron" dietary supplement to be tolerable, safe, and effective, supporting its use in the complex therapy of children and adolescents with obesity, including for IDS prevention.

Aim. To study the effect of ω-3 polyunsaturated fatty acids (PUFAs) on the cognitive functions of children with lipid metabolism disorders of different ages.

Materials and methods. The study included 87 children aged 6 to 17 years who had not previously received ω-3 PUFA supplements. All subjects were tested twice, with an interval of 6 months, to determine the ω-3 erythrocyte index by gas chromatography-mass spectrometry and to study attention span and focusing using the correction task method (Bourdon test). The cohort was randomly divided into two groups: the main group, which included 60 children who received the ω-3 supplements, and the control group, which included 27 children who did not receive any nutritional supplements.

Results. In children of the main group, after receiving the Norwegian fish oil NFO® at 1000 mg for 6 months, an increase in the erythrocyte ω-3 index was observed, while in the control group, it did not change significantly. A statistically significant correlation was found between the adequacy of ω-3 PUFA and the attention span and focusing.

Conclusion. The results of the study showed the effectiveness of ω-3 PUFA supplementation at 1000 mg/day for 6 months and confirmed the positive effect of ω-3 PUFA on the cognitive sphere of children and adolescents. High-quality food supplements with ω-3 PUFAs at 1000 mg/day can be recommended to develop intellection, memory, and attention span and focus in children and adolescents.

Consumption of low-alcohol products by young people is due to the erroneous opinion that they are safe for health. However, against the background of taking low-alcohol drinks, addiction quickly forms and complications develop, including lipid metabolism disorders. Studies show that consumption of low-concentration ethanol-containing drinks changes the structure and ratio of serum lipoproteins. Changes in serum lipids provoked by alcohol intake are involved in the pathogenesis of a number of chronic non-infectious diseases, including alcoholic fatty liver disease and atherosclerotic cardiovascular diseases. According to the data of an anonymous online survey, which involved 155 young people aged 17–20 (18±0.76) years, 17.4% of them consume low-concentration alcohol more than once a week, and 5.8% consume both low-alcohol drinks and strong alcohol daily. Comprehensive efforts are needed to prevent the spread of alcohol addiction among children and young people: raising the age at which it is possible to purchase alcoholic beverages, increasing penalties in the area of illegal alcohol trafficking, and working in the area of anti-alcohol propaganda.

Background. Primary ciliary dyskinesia (PCD) is an orphan disease, and diagnosis is difficult because there is no gold standard for diagnosis.

Aim. Clinical, laboratory-instrumental, genetic characteristics of PCD in children.

Materials and methods. From 2009 to 2024, 31 patients with a genetically confirmed diagnosis of PCD were observed as part of a multicenter, open-ended, descriptive pilot longitudinal study. Examination methods: clinical and anamnestic method; X-ray examination and computed tomography of the chest organs and paranasal sinuses, tracheobronchoscopy; sputum/aspirate cultures of the tracheobroncheal tree with determination of sensitivity to antibiotics; transmission electron microscopy, high-speed video microscopy of the ciliated epithelium, cytological examination of bronchoalveolar lavage; monitoring computer pulse oximetry, echocardiography, audiometry, spirometry with bronchodilator test.

Results. Respiratory symptoms in the neonatal period have 80% of children with PCD, lateralization defects – 35%, congenital heart defects – 13%, bronchiectasis – 68%, purulent endobronchitis – 62%, year-round rhinitis – 84%, hearing loss, otitis – 65%. The average age of onset of symptoms was 1 [1; 1] weeks, and the verification of diagnosis was 6 [2,5; 8] years. The main pathogens of chronic respiratory infection with PCD are Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. The most common cause of PCD was biallelic variants of the DNAH5 gene.

Conclusion. The diagnosis of PCD should be based on the application of the maximum number of diagnostic tests.

Primary immunodeficiencies with impaired humoral link are genetically determined diseases characterized by impaired antibody formation. The article presents information about an orphan disease – hyperimmunoglobulinemia E syndrome (hyper-IgE), or Job’s syndrome, which is characterized by elevated IgE levels in the blood serum, recurrent infections and various clinical manifestations (specific abnormalities of connective tissue, skeleton, tooth enamel, neurological disorders, etc.). Historical aspects of Job’s syndrome are described, the importance of immunoglobulins E in the human immune system is shown. It is noted that genetic testing, including sequencing of the STAT3 and DOCK8 genes, plays a decisive role in confirming the diagnosis. Low prevalence of Job’s syndrome is the reason for late diagnosis. Clinical cases of Job’s syndrome, a variant of primary immunodeficiency confirmed genetically, are presented.

Correction of vesicoureteral reflux in children with neurogenic bladder (NB) and myelodysplasia is rather challenging due to the presence of two aggravating factors. The first is the trabecularity of the bladder due to chronic ischemia and dysfunction of the closing contraction of the ureteral orifice up to complete deconfiguration of the ureterovesical junction, and the second is the neurogenic hyperactivity of the detrusor with hypertonicity, intravesical hypertension, and a significant decrease in the effective volume of the bladder. These pathophysiological mechanisms reduce to zero the effectiveness of open reimplantation of the ureter to create an anti-reflux mechanism, becoming, on the contrary, the cause of reflux aggravation and the development of ureterohydronephrosis. As a result, the correction of reflux in NB becomes impossible without stabilization of detrusor contractility, elimination of intravesical hypertension, and correction of spastic changes in the bladder. Clinical follow-up of a patient with this disorder for 10 years convincingly proves the effectiveness of step-by-step correction of NB and vesicoureteral reflux while adhering to the order of treatment methods.

Background. Fractures of the femur, especially its diaphysis, are quite common in pediatric practice. One of the priorities in the treatment of hip fractures in children is elastic stable intramedullary osteosynthesis with flexible titanium rods (ESIN/TEN), however, the frequency of using conservative methods also remains high.

Aim. To differentiate the approach to the treatment of femoral fractures in children aged 0–7 years.

Materials and methods. The immediate results of treatment of femoral fractures in 118 children aged 0 to 7 years (mean age 3.3±1.8 years) were studied. The main group consisted of 62 children who underwent surgical treatment of diaphyseal femoral fractures, while ESIN osteosynthesis was performed in 56 patients. The reference group was formed by a retrospective analysis of the medical records of 56 children who received conservative treatment of hip fractures.

Results. Compared with conservative methods, with ESIN, the overall rate of early complications (skin reaction) was significantly lower, there were no complications from the internal organs (kidneys, lungs), and there were 3 (4.8%) cases of fixative migration. The severity of pain after 3 weeks from the start of treatment in the main group decreased to 2.4±0.1 points (mild pain), and in the reference group – to 4.5±0.3 points (moderate pain; p=0.013). The average length of stay of patients in the hospital in the main group was 7.3±2.4 days, in the reference group – 21.2±5.9 days (p=0.008).

Conclusion. ESIN is the optimal method of stabilization for diaphyseal fractures of the femur in children aged 0 to 7 years. The advantages of ESIN over conservative methods are lower morbidity, greater pain relief, and shorter hospital stays for children.