No 4 (2025)

Research on the urine microbiome dates back approximately 150 years. Historically, the prevailing view was that the urinary system of a healthy individual is sterile. This paradigm, which seemed unshakable, defined approaches to diagnosing and treating urinary tract infections. Only in the last few decades has the scientific community's opinion on this issue changed radically. Progress in microbiological research has enabled the use of advanced culture and novel molecular genetic methods to identify microorganisms inhabiting the urinary tract. Finally, the well-established dogma of the urine sterility in a healthy person was shattered. Not only bacteria but also viruses and fungi are found in the urine. There is currently no consensus on which composition of the urine microbiota should be considered normal. However, the accumulated data indicate that changes in the urobiome's taxonomic composition can serve as predictors of various pathological processes. The underlying pathogenetic mechanisms remain to be further studied. A correlation has been identified between altered urinary microbiota and the development of both inflammatory and non-inflammatory diseases, in particular, benign prostatic hyperplasia, interstitial cystitis/painful bladder syndrome, urolithiasis, overactive bladder, urinary incontinence, and even bladder cancer. Of particular relevance in pediatric practice is the search for methods to prevent and treat urinary tract infections, thereby preserving and maintaining the diversity of microorganisms colonizing this system. One such method is the use of combined herbal medicinal products, such as Canephron N, which has diverse effects due to its active components. A distinctive feature of this herbal medicinal product, along with its multifaceted therapeutic effect, is its antimicrobial activity without inhibiting the commensal microbiota of the urinary tract. Canephron N is a valuable tool in the pediatrician's arsenal, helping maintain the fragile balance of the urobiome and prevent several pathological conditions.

Background. Despite a decline in the overall incidence of tuberculosis, the diagnosis and treatment of extrapulmonary forms remain challenging. The rarity of these manifestations, combined with limited clinician awareness, reduces pediatricians' and related specialists' vigilance, hindering timely detection. Diagnosis of extrapulmonary forms of the disease is difficult due to their oligobacillary nature and the difficulty of obtaining samples suitable for culture and molecular genetic confirmation. Extrapulmonary localizations of tuberculosis are secondary manifestations of the disease. When pulmonary forms are detected, the possibility of concomitant involvement of other organs and systems is often underestimated. In the Russian and international literature, single clinical cases of ENT organ tuberculosis are presented, mostly in the context of the development of generalized severe forms.

Aim. To actualize the problem of ENT organ tuberculosis in children, drawing the attention of specialists to its clinical importance, despite the overall decrease in the incidence of tuberculosis.

Materials and methods. A retrospective review of medical records from 668 patients aged 0 to 3 years who were treated in the therapeutic pulmonary pediatric department of the Moscow Research and Clinical Center for Tuberculosis Control over the past 15 years was conducted.

Results. ENT organ tuberculosis was diagnosed in 10 children (1.5% of the cohort). Patient ages ranged from 1 month 21 days to 1 year 9 months (mean 12 ± 1.85 months), with nearly twice as many boys as girls (7 boys, 4 girls). All patients exhibited generalized disease: one patient (0.15%) had involvement of two organs, six patients (0.9%) had involvement of three organs, and, in rare cases (0.15% each), four or five organs were involved. Contact with a tuberculosis patient was identified in seven children (1.05%), with the mother as the source in five cases (0.07%) (including two mothers with concurrent HIV infection) and other relatives (father, uncle) in two cases. The source of infection was not identified in three patients. BCG-M vaccination was given to 6 children (0.9% of the total sample); the remaining patients had a medical exemption or parental refusal. Middle ear involvement was the most common clinical manifestation, observed in seven patients (1.05% of the total sample and 70% of the group with ENT organ tuberculosis), and was mainly complicated by anthritis or mastoiditis in four patients (0.6% of the total sample and 40% of the group with ENT organ tuberculosis). In the remaining three cases, tuberculosis of the larynx and pharynx was detected.

Conclusion. Suspicion of tuberculosis necessitates a comprehensive evaluation, including a detailed history of BCG vaccination, contact with tuberculosis patients, and risk factors, as well as follow-up monitoring of disease progression, radiographic findings, and immunodiagnostic testing. Diagnosis of ENT tuberculosis should be established as early as possible, ideally within one month of symptom onset. It is essential to obtain samples for morphological analysis, assess the rate of tissue destruction, and determine the sequence of structural involvement in the pathological process. It is necessary to promptly include tuberculosis in the differential diagnosis, especially in cases of slowly progressing lesions of any localization that are not responding to standard treatment.

Aim. To study the perinatal period of children born to mothers with chronic viral hepatitis B, identifying the leading risk factors contributing to the development of chronic HBV infection.

Materials and methods. An observational study was conducted involving 52 newborns with perinatal HBV exposure and their mothers. Patients were divided into two groups depending on the manifestation of chronic HBV infection. Group 1 included 23 patients with active chronic HBV infection, Group 2 included 29 children with perinatal HBV contact, and Group 3 (control group) included children born to healthy mothers. The duration of observation was 18±3 months. In children, weight, body length, Apgar score, and features of the neonatal period were assessed, comparing with the pregnancy course, and the birth period in mothers with chronic HBV infection. Statistical analysis of the data was performed using the Kruskal–Wallis test, and the percentages in the analysis of multivariate contingency tables were compared using the Pearson χ² test.

Results. The average body length of newborns in Group 1 was 1.5 cm less (p=0.891). At birth, patients in Group 1 (37.5%) had signs of mild asphyxia, which statistically significantly differed from children in Groups 2 and 3 (p_1–2<0.001; p_2–3<0.001). In the early neonatal period, Group 1 infants were significantly more likely to have congenital pneumonia (p_1–2<0.001). A significantly lower number of pregnancies was noted in the group of women whose children subsequently developed chronic HBV infection (Group 1; p<0.008); no statistical difference was found in the method of delivery (p=0.564). During delivery, mothers from Group 1 significantly more often had their membranes opened, and 59% had an anhydrous interval of more than 12 hours.

Conclusion. The perinatal period in newborns who have developed chronic HBV infection due to vertical transmission was complicated by a lower body length, a significant decrease in the Apgar score at 1 and 5 minutes, and the development of congenital pneumonia. It was found that mothers with chronic HBV hepatitis had significantly lower number of pregnancies and their fetal membranes were more often opened during the delivery.

Background. Bronchopulmonary dysplasia (BPD) is a chronic interstitial lung disease and has a multifactorial nature of formation and development. The important clinical significance of the disease for the health of young children remains.

Aim. To identify risk factors for the development of BPD in children based on the data of medical and social indicators of parents and to develop objective criteria for predicting the course of the disease.

Materials and methods. The analysis of retrospective medical and social history data of 126 pairs of children and their parents was carried out by filling out a questionnaire of 222 parameters combined into sections. The main group consisted of children diagnosed with BPD (n=52) and the comparison group consisted of children without bronchopulmonary pathology (n=74). Using multiple regression equations, representative risk factors, their weighting coefficients of significance, and boundary coefficients for the predicted development of BPD were determined.

Results. Significant risk factors for the development of BPD have been identified: single-parent families, poor housing conditions, small living space, and lower average income per person. On the part of the mother's medical history and her health, the risk factors were: living in the area in the III–IV generation; burdened obstetric and gynecological history (presence of abortions, ectopic pregnancy, pregnancy parity of 4 or more, recurrent candidiasis, ovarian tumors); extragenital pathology (hypertension, chronic cystitis); occupational hazards before (transport loads, night work) and during pregnancy (physical exertion, stress during work); drinking wine, long walks during pregnancy. Risk factors from the father's health are diseases of the heart and blood vessels, respiratory organs.

Conclusion. The study showed a wide range of risk factors from the medical and social sphere of parents' lives in children with BPD. Multifactorial data analysis revealed significant correlations between the studied phenomena. A model and program for predicting the risk of BPD during the antenatal period of ontogenesis have been developed.