The clinical and social impacts of persistent infections remain relevant. The main aspects of this pediatric problem are the epidemiology and pathogenesis of persistent infections, their clinical manifestations, possibilities for their treatment and prevention, and prediction of the active reproduction of infectious agents. The issues of the human body’s interaction of persistent viruses with viruses that cause acute infectious diseases remain inadequately studied. There is no answer to the question as to the nature of this (synergistic, competitive) interaction or lack thereof. It is unclear how the persistent viruses interact with the host genome. The family and interfamily types of persistent infections, which is of key value in infection prevention in not only a baby, but also in a fetus, have not been adequately explored. This paper focuses on the most important and interesting medical and biological aspects of the problem of persistent infections and gives answers to some of them.

Congenital cytomegalovirus infection is an infectious disease that results from antenatal transplacental transmission of cytomegalovirus to a fetus. The above virus is the most common cause of congenital infections worldwide. Congenital cytomegalovirus infection may develop both after primary infection of a seronegative pregnant women (primary) and due to reactivation of the virus or reinfection with other virus strains during pregnancy (non-primary). In the neonatal period, 85-90% of children infected in utero are observed to have an asymptomatic or subclinical course of the disease. In other cases, the clinical picture is characterized by lesions of various organs and by frequent CNS involvement. In its severe course, the disease is treated with antiviral drugs that are so far referred to as an “off-label” group. Even in the absence of symptoms in the neonatal period, the babies infected with CMV in utero may develop late sequels, with hearing loss being most common. Preschool hearing control and ophthalmologic and neurologic monitoring are recommended for the timely treatment and rehabilitation of late manifestations of congenital cytomegalovirus infection. The important strategy to reduce the incidence of congenital cytomegalovirus infection is its prevention in pregnant women, by disseminating information about the disease in the publicly accessible sources of information and by teaching simple hygienic practices.

The paper analyzes the literature on glomerulonephritis and nephrotic syndrome, which are associated with herpesvirus types 1/2, 4, 5, and 7 infection, in children. The main pathogenetic mechanisms and clinical and morphological characteristics of herpesvirusassociated glomerulonephritis and nephrotic syndrome are considered. These diseases are shown to be frequently accompanied by immune disorders involving innate and adaptive immunity and interferonogenesis. Virus-associated glomerulonephritis and nephrotic syndrome are characterized by transient resistance to therapy with prednisone and cytotoxic agents and by a serious prediction. Clinical and immunological studies have proven that immunostimulatory (interferon-α2) and antiviral (acyclovir, ganciclovir) therapies result in restoration of prednisolone sensitivity and in complete or partial remission of virus-associated glomerulonephritis and idiopathic nephrotic syndrome in children. It is recommended that cytotoxic therapy should be prescribed if there is no activation of herpesvirus (types 1/2, 4, 5) infection, which has been achieved by antiviral and immunostimulatory therapies.

The review discusses the effect of vitamin D on the tolerogenic modulation of an immune response, its relationship to cells of the monocyte-macrophage series, including dendritic cells, monocytes, and macrophages, in the context of the impact of the expression of anti-inflammatory proinflammatory cytokines in some autoimmune diseases (rheumatoid arthritis, systemic scleroderma, multiple sclerosis, type 1 diabetes mellitus, systemic lupus erythematosus, and Crohn`s disease). It discusses the role of vitamin D in the development of innate and adaptive immunity. Despite some conflicting evidence, the immune regulatory function of vitamin D is generally directed toward inhibition of the components of innate and acquired immunity, which are responsible for the induction of autoimmune reactions; in this connection there are a growing number of publications devoted to the issues of vitamin D supplementation in patients with autoimmune diseases, the preventive effect of vitamin D intake on the risk of an abnormality and that of therapeutic doses of the vitamin on its course. The maintenance of the threshold value for serum 25(OH)D3 at least 30 ng/ml, which is achieved by the intake of about 2000 IU of vitamin D, is shown to be required for its immune regulatory function. The data given raise the question as to whether it is necessity to revise the Russian recommended daily dietary allowances for vitamin D through its infant food fortification.

The developmental origins of health and disease hypothesis suggests that the conditions for the development of the organism in the prenatal and early postnatal periods thus affect the expression of genes that program the early onset of cardiovascular and metabolic diseases. Experimental studies demonstrate the major role of epigenetic mechanisms (gene methylation) in this scenario. The review provides data showing that perinatal programming can accelerate aging processes, resulting in early onset of these diseases. It considers the importance of fetal hypoxia as a factor leading to the birth of babies at increased risk for abnormalities of the brain, heart, liver, and kidney, as well as for hypertension and metabolic disorders in later life. The role of oxidative stress and reactive oxygen species in the processes of perinatal programming is discussed.

The article presents data on contemporary views of the prevalence, causes, circumstances of sudden cardiac death, and its prevention measures in children and adolescents during sports activity. It notes a difficulty in defining the epidemiology of the above condition because the data are primarily based upon mass media news coverage. The incidence of sudden cardiac death is approximately 1 per 100,000 young athletes; more than 90% boys die. The sports, during which sudden cardiac death often occurs, include (both American and European) football, basketball, and hockey. Sudden cardiac death due to cоmmоtio cordis (life-threatening cardiac arrhythmias resulting from a blow with a blunt instrument to the area of the heart during the vulnerable phase of the cardiac cycle) is considered separately. Children who die suddenly during sports are frequently detected to have hypertrophic cardiomyopathy or myocarditis; but no changes are found in more than 50% of cases at autopsy, which is suggestive of primary arrhythmogenic death. The basis for prevention is the early detection of diseases that can cause sudden death during sports, regular examination, knowledge of ECG characteristics in athletes, and first aid techniques, including the use of automated external defibrillators.

Aim of the study to determine the frequency and nature of brain lesions by the neuroimaging techniques (MRI and NSG) determining Objective: to establish the frequency and nature of brain lesions that cause CNS functional and irreversible disorders in newborn infants with malformations of internal organs in the perioperative period, by applying neuroimaging techniques.

Materials and methods. 243 case histories of neonatal patients with congenital malformations of internal organs were analyzed. Their gestational age was 32 to 41 weeks (37.9±1.4 weeks). All the patients underwent neurosonography three times (within the first 24 hours after birth or in the preoperative period, in the postoperative period, and 1 week after surgery); their neurological status was evaluated. Neurological changes and structural disorders, as evidenced by neurosonography, served as an indication for brain magnetic resonance imaging (MRI) in 15 (6.2%) neonates.

Results. In the perioperative period, more than 40% of children (n=102) had neurological changes as both temporary and organic hypoxic-ischemic encephalopathy, as confirmed by neuroimaging techniques. In 53 (52%) cases, pathological changes revealed by neurosonography and brain MRI were seen as an extension of the outer and inner cerebrospinal fluid spaces (n=36), cerebral cysts of various locations (n=1), intrathecal (n=3) and intraventricular (n=42) hemorrhages, and acute cerebrovascular accident (n=1).

Conclusion. Newborn infants with congenital abnormalities of internal organs need a comprehensive examination aimed to timely identify risk factors for perinatal organic and transient lesions of the nervous system at the stages of the perioperative period.

Objective: to study the time course of clinical, electrocardiographic (ECG), and echocardiographic changes during the first year of life in babies having different gestational ages who have a history of transient myocardial ischemia. 

Subjects and methods. A total of 46 infants, including 22 preterm and 24 full-term newborn babies with posthypoxic myocardial dysfunction, were examined. The time course of clinical, ECG, and echocardiographic changes during the first year of life in babies having different gestational ages who had a history of transient myocardial ischemia in the early neonatal period was traced. Reexamination one month later revealed differences in the ratio of atrial diameters that were significantly higher in the group of preterm infants. The left ventricular systolic functional parameters were also lower than those in the babies in the control group both after birth and at the end of the neonatal period. The most stable cardiac disorders that persist in the infants during the first year of life include a set of ECG changes in the process of ventricular repolarization concurrent with grade 1 diastolic dysfunction. A relationship was found between of the detected myocardial dysfunctions and the babies’ gestational age.

To develop a topical diagnostic algorithm, the authors analyzed surface ECG in 243 children, including 139 boys, with ventricular arrhythmia. The children’s age was 5 to 17 years (mean 13.4±3.1 years). The found ECG features were compared with the results of endocardial mapping and radiofrequency ablation. Based on the most informative criteria, the authors developed an algorithm for the ECG diagnosis of ventricular arrhythmias in children, which could locate the arrhythmia focus prior to interventional treatment. The most informative electrocardiographic characteristics for the topical diagnosis of ventricular arrhythmias in children were the morphology of the QRS complex in lead V1 and its duration in lead V2. The morphology of the QRS complex in lead I, its duration in lead II, the amplitude of the R wave in lead III, and the ratio of R/S wave amplitudes in lead V3 were proposed to be used as additional characteristics. The algorithm for the ECG diagnosis of ventricular arrhythmias in children makes it possible to assume the localization of the arrhythmogenic focus with an accuracy of 90% and to carry out a directed endocardial mapping, which reduces the duration of radiofrequency ablation and the radiological burden sustained by the child and the staff.

A total of 50 patients from 45 unrelated families diagnosed with Alport’s syndrome were examined. The diagnosis was based on molecular genetic testing or kidney biopsy. To assess changes in the aortic root, its volume was examined (calculation methods were given). Most patients with Alport’s syndrome were found to have cardiovascular disorders, such as hypertension; dilatation of the ring of the aortic valve; dilatation of the sinuses of Valsalva; some patients had dilatation of the sinotubular junction; dilatation of the ascending aorta; enlargement of the left ventricle; mitral and aortic insufficiency. In the patients with Alport’s syndrome, the median value of aortic root volume is 9.9 Z3, which substantially exceeds the permissible upper normal limit according to the general population data, which is 2.82 Z3. The rate of aortic root dilatation (volume increase) in the patients with Alport’s syndrome rises with an increase in the surface area of the body. In Alport’s syndrome, aortic root dilatation is unrelated to the presence of hypertension that occurs with a relative frequency of 0.52. Dilatation of the ascending aorta in Alport’s syndrome is diagnosed with a relative frequency of 0.37 and significantly more frequently diagnosed in male subjects (the statistical significance of a two-sided test is p=0.056; Fisher’s test is p=0.097; risk posed for men is OR = 7.2; 95% CI, 1.63-31.72. Changes in the cardiovascular system are also detected in female carriers of X-linked Alport’s syndrome; therefore they should be followed up by a cardiologist.

Objective: to determine impairments in cell energy metabolism (the levels of amino acids and carnitine) in children with connective tissue dysplasia, such as mitral valve prolapse, and to evaluate the efficiency of energy-rich therapy.

Subjects and methods. High-performance liquid chromatography- mass spectrometry was used to determine the levels of carnitines and amino acids in dried blood spots from 57 children with mitral valve prolapse (1–2 variants without regurgitation) and in 38 children having Health Groups 1 and 2. The clinical efficiency of prolonged (12-month) combined use of energy-rich medications (L-carnitine, coenzyme Q10) was evaluated.

Results. As compared with the controls, the children with mitral valve prolapse showed a significant change, although not beyond the normal range, in the values of free and bound carnitine and amino acids (primarily methionine). There was a significant increase of these indicators in the blood during 12-month combined energy-rich therapy.

Conclusion. The findings suggest that that there are moderate, but significant tissue metabolic changes in children with mitral valve prolapse. The found changes are a rationale for the use of energy-rich therapy in this category of children. Analysis of dried blood spots by liquid chromatography tandem mass spectrometry is recommended for the early diagnosis of cellular energy metabolic disturbances in children with signs of connective tissue dysplasia, such as mitral valve prolapse.

In this investigation, karyological (cytologic) examinations using the micronucleus test were conducted to further study the influence of a radiation factor on the health of first- and second-generation residents exposed to radiation. The most changes were established to be pronounced in first-generation individuals (mothers) with neoplasms. Karyological changes in their children were similar to maternal ones although there was no evidence of neoplasms in these children at the time of examination. The increase in the number of binucleated cells is an indicator for the toxic effect of radiation factors and an additional prognostic sign of their potential carcinogenic activity. To deepen the understanding of the mechanisms of action of the radiation factor on the health of residents exposed to radiation, the NanoString method was used to study the expression of the gene network of p53 protein that plays an important role in protecting the body against cancer. Twenty-four 24 genes statistically significantly changing the expression of the p53 protein gene network were identified; among them there were 5 genes that had undergone the maximum expression changes, which suggests that indicates there is an increased risk for malignant tumors in these residents. The study may indicate the transgenerational oncogenic transmission of the specific effects of radiation and, consequently, the risk of cancer.

Objective: to provide the comparative characteristics of changes in the height, weight, and body mass index (BMI) of children from the Voronezh Region in 1997–1999 and 2011–2014 on the basis of the WHO standards in order to assess trends in the physical development of a pediatric population.

Methods. The data of medical examinations made in healthy children aged 1–15 years in 1997–1999 (Group 1) and 2011–2014 (Group 2) were used. The Z-scores for height-for-age, weight-for-age, and BMI-for-age were calculated using the software WHO AnthroPlus.

Results. Groups 1 and 2 included 10,247 and 4,940 children, respectively (mean age, 7.5±3.8 and 8.0±4.0 years). The mean Z-scores for height-for-age in Group 2 (0.24±1.02) were higher than those in Group 1 (0.14±1.9) and more in line with the WHO standard distribution (р<0.0001). Those for weight-for-age in Group 2 (0.41±0.98) were higher than in Group 1 (0.22±1.10) and more different from the WHO values (p<0.0001). The BMI values in today’s children were close to the WHO standards (0.27±1.31 and 0.18±1.02 in Groups 1 and 2, respectively). The height, weight, and BMI were higher in the boys in Group 2 than in the girls (p<0.05).

Conclusion. Regular studies of physical development indices can reveal changes and evaluate the impact of various factors in order to develop measures for improving the health status of children.

Anthropometric measurements at birth reflect the characteristics of fetal development and largely determine the harmonious development in the later years of the child’s life. A total of physical development charts were studied in newborn infants (904 girls and 928 boys) born at 22 to 36 weeks’ gestation over 2009–2013. Indicators, such as weight, height, head circumference, chest circumference, and weight/height ratio (Quetelet index), were determined. The findings were used to compile sigma tables and physical development charts for premature babies born in the city of Voronezh and its region. The given illustrative graphs are of great importance for assessing the health status of children at birth and in subsequent years. The physical development charts can be used not only by physicians, but also by parents, teachers, and social workers.

The paper gives an update on the etiology and pathogenetic mechanisms for developing renal infection in children. It describes the clinical features of urinary tract infection. The diagnostic criteria based on the data of comprehensive studies confirming the source of urinary tract infection, as well as structural and functional criteria for changes in tubulointerstitial tissue, by involving the pyelocaliceal system and renal blood and lymph vessels are discussed. The authors propose an etiologic approach to diagnosis and treatment in terms of the pathogenetic mechanisms of urinary tract infection and a morphofunctional approach to predicting the course and to choosing the management tactics for children with renal infection.

The paper gives the comparative characteristics of the mechanism of action of fermented milk drinks and probiotic foods. It deals with the results of investigations of the efficacy of probiotic microorganisms in infant nutrition. The issues of supplementing the Russian infant foods with probiotic Bifidobacterium BB-12 strains are considered. The paper presents the data that show that despite the considerable similarity of the mechanisms of action of probiotic foods and fermented mild drinks, their high nutritional value, and organoleptic properties, their final clinical effect may vary greatly. It also gives the results of a number of studies of the comparative clinical efficacy of fermented milk drinks and probiotic foods in 3–14-year-old children with acute enteric infections, which in combination with the data available in the literature suggest that there is a need for personalized recommendations on the use of the above foods in infant nutrition.

Objective: to assess the vitamin status of preschoolers according to the results of one-hour urinary vitamin excretion and the data of actual nutrition.

Subjects and methods. A survey was conducted in winter 2016, covering 33 children (19 boys and 14 girls) aged from 2 to 7 years who went to a Yekaterinburg preschool educational institution. The amount of essential nutrients was calculated according to the data of actual nutrition during 5 days. The vitamin status was evaluated from the urinary excretion of thiamine, riboflavin, and 4-piridoxyl acid, by testing a morning fasting urine portion.

Results. Determination of urinary excretion revealed deficiency of vitamin B2 in 24.2% of the examinees, and that of vitamins B1 and
B6 in significantly more children (in 66.7–69.7%). According to the actual nutrition data, inadequate intakes of vitamins B2, A, and C were detected in 27.3–30.3% of the examinees, those of niacin and vitamin B1 in 54.5 and 69.7%, respectively. The proportion of the coincidental data obtained by two methods for assessing the vitamin status was 63.6% for vitamin B1 and 69.7% for vitamin B2.

Conclusion. The findings suggest that the two methods to assess the supply of vitamins B1 and B2 are interchangeable and the children need additional vitamin intakes.

The impact of a somatic disease on the status of the hard tissues of the teeth and periodontium and the level of individual oral hygiene were evaluated during one-year follow-up of the dental status in 59 children (31 boys, 28 girls) aged 5 to 7 years, of whom 34 children had diabetes mellitus. Upon completion of oral cavity sanation, the children used R.O.C.S. «Kids» toothbrushes with extra-soft bristle and R.O.C.S. PRO Kids «Wild berries» toothpaste for oral care. The children with type 1 diabetes mellitus were established to more frequently suffer from inflammatory periodontal abnormality than the healthy children and dental caries in the former was more intensive than in the children without somatic diseases. To maintain their dental health, the diabetic children should undergo quarterly professional therapeutic and prophylactic measures, by using oral care products in accordance with the patients’ age.

The paper gives an update on the pathogenesis of acute respiratory diseases, the basis for which is inflammation of the airway mucosal lining. It reflects the results of a comparative clinical trial of the efficacy and safety of the anti-inflammatory drug fenspiride used in the combination therapy for respiratory diseases in children. The findings allow one to recommend the use of fenspiride to treat this condition in children.