Intrauterine hypoxia and asphyxia during childbirth are among the leading causes of neonatal deaths in the structure of «Separate conditions arising in the perinatal period» according to the Ministry of Health of the Russian Federation. The main causes of asphyxia are chronic intrauterine hypoxia and acute fetal hypoxia (most often in the intrapartum period). The article observes current data on antenatal and intrapartum risk factors for the development of asphyxia in newborns. Risk factors (modifiable and non-modifiable) triggering intrauterine hypoxia are discussed, as well as methods of management and prevention of asphyxia to prevent the subsequent development of hypoxic-ischemic encephalopathy. The importance of the problem under consideration is due to the need to find promising «tools» for managing neonatal and infant mortality, as well as preventing the long-term consequences of hypoxic brain damage.

Chronic kidney disease in pediatric and adult patients is an overarching global problem. Stratification of chronic kidney disease C1–5 severity by classifications of the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) (2002) and Kidney Disease: Improving Global Outcomes (KDIGO) (2012) carried out in pediatric patients over the age of 2 years old, taking into account the low glomerular filtration rate at the age of 0 to 2 years. Differences were found in the prognosis of cardiovascular complications and the progression of renal failure in adult patients with chronic kidney disease at stages С3а and C3b according to KDIGO (2012). The literature data demonstrate different risks of cardiovascular complications and progression of renal functions by stages of chronic kidney disease in accordance with the NKF-K/DOQI (2002) and KDIGO (2012) classifications in pediatric patients. The results indicate that children with chronic kidney disease in the pre-dialysis stages C2–4 form a high-risk group, while those on C4–5 dialysis form a group of very high risk of cardiovascular complications.

Chronic kidney disease is an urgent problem of childhood getting more and more interest on the one hand due to the higher incidence among children and the increased public health expenditures, and on the other hand due to the expanding opportunities for early diagnosis and prevention of the progression of this condition. Renoprotection means a set of measures of accompanying therapy that helps to preserve renal function, and in the case of advanced chronic renal failure — to maintain their residual function. The renoprotective strategy in children differs from that in adults, which is associated with the peculiarity of the causes of chronic kidney disease and the age-related characteristics of the physiology and pathology of body systems.

At the end of 2019, an outbreak of a new coronavirus, SARS-CoV-2, occurred in China. This virus is highly contagious, transmitted by different routes, such as airborne and contact, but most likely among children it is also transmitted by the fecal-oral route. The disease caused by a new strain of coronavirus is COVID-19. An acute infectious disease has become a pandemic and persists to this day. Currently available data suggests that symptoms of COVID-19 in the adult population may be mild, moderate, or severe. But among children, the course of the disease is very different from that in adults with a milder course. The severe course of COVID-19 among children has been associated with the development of multisystem inflammatory syndrome or Kawasaki disease. In addition to the epidemiological history, laboratory and instrumental analysis, the gold standard for the etiological diagnosis of COVID-19 is the identification of the genetic material — the ribonucleic acid of the virus using reverse transcription polymerase chain reaction. Due to the risk of radiation, a chest CT scan in the pediatric population is only recommended when there is a suspicion of COVID-19. For the prophylaxis and prevention of future epidemics, studying the transmission of SARS-CoV-2 among children is especially important, since the majority of asymptomatic cases of the disease occur in this population. So, the purpose of our study is to review the main clinical manifestations and diagnostic methods of COVID-19 in children.

Sarcopenia is a condition of progressive loss of muscle mass, moststudied in patients of senile age. Sarcopenia is described in children with oncological diseases, severe surgical pathology, in  the perioperative period with liver transplantation, immobility in children with cerebral palsy. Sarcopenia is associated with adverse disease outcomes. This article discusses the problem of sarcopenia using the  example of patients with stable dysmotility and posture. In addition to limited mobility, among the causes of  sarcopenia are impairment of the ability to eat, the availability of basic nutrients and vitamin D, and a change in the intestinal microbiome. Nutritional support combined with physical rehabilitation has been shown to be effective in reversing sarcopenia.

Purpose. A comparative characterization of  clinical forms and outcomes in  patients with Alport syndrome with different types of inheritance.

Characteristics of patients and research methods. We have conducted a retrospective controlled comparative non-randomized single-center longitudinal study that included 60 patients who were admitted to nephrology department of the Russian Children’s Clinical Hospital of the Pirogov Russian National Research Medical University from 2004 to 2020: there were 22 (37%) girls and 38 (63%) boys from 2 to 18 years of age. The median age (Me) was 8,7 [5,4; 13,7] years old. The patients were divided into 2 groups: Group 1 received with cyclosporine A and nephroprotectors, Group 2 received nephroprotectors only.

Results. We identified 75% X-linked, 20% autosomalrecessive, and 5% autosomal dominant types of inheritance among our patients. 45% manifested with combined hematuria with proteinuria, 43% of patients — with isolated hematuria, and 12% — with isolated proteinuria. Hearing damage was detected in 45% of patients, eye damage — in 5%. Nephrotic syndrome developed in 22% of patients, arterial hypertension — in 15%. In patients with X-linked Alportsyndrome, there was a statistically significant(p=0,002) reduction of proteinuria during the first 6 months of treatment in Group 1 compared to Group 2. The difference in proteinuria decrease during therapy is not statistically significant among differenttypes of inheritance. According to survival data, patients with autosomalrecessive inheritance of disease proceed more severely in comparison with other types of inheritance, and this difference tendsto be statically significant(p=0,065).

Conclusion. Timely diagnosis and proper management of patients with Alport syndrome can improve the disease outcome. To determine the prognosis, it is important not only to collect detailed patient’s history and conduct morphological examination, but also to provide genetic testing to determine the type of inheritance.

Purpose. This study analyzes changes in the concentration of elements — magnesium, selenium, strontium — in plasma and RBCs of peripheral blood in parturient women with a history of threatened miscarriage and their newborns. In addition, the difference in cell-membrane permeability indices for each element was determined.

Characteristics of children and research methods. 97 pairs of full-term newborns and their mothers were under observation. The main cohort (Group 1) consisted of 57 mother–child pairs under a threat of miscarriage. The control group (Group 2) consisted of 40 conditionally healthy pairs. Concentrations of chemical elements were determined in plasma and RBCs using mass spectrometry with inductively coupled plasma. Statistical processing consisted of two stages. Initially, the authors determined parameters with a significant change in the concentration of elements, in the presence of a threat of abortion. Then the values of the relationships between all parameters for each element were calculated.

Results. There is an increase in the concentrations of magnesium and selenium in the body of parturient women with a history of threatened miscarriage in comparison with healthy women in labor. The concentration of strontium does not change. In newborns, the concentration of magnesium also increases, and strontium decreases. The concentration of selenium in newborns does not change.

Conclusion. The study findings indicate that the threat of termination of the current pregnancy is accompanied by a change in the elemental status of mothers and their newborns.  

Purpose. The study aims at testing selected lipid metabolism indicators in newborns born to multiple pregnancies.

Characteristics of children and research methods. The study included 99 newborns born to multiple pregnancies. The study set comprised 36 twins and 9 triples. Triglycerides and cholesterol were measured.

Results. The content of blood triglycerides in children born of multiple pregnancies varies widely. The study found that 32% of newborns from twins and triplets have low perinatal TG production. For 12,5% of premature babies born 2nd or 3rd from twins or triplets, a critically low TG content (0,01–0,1 mmol/l) is characteristic. The TG content in the blood is not always the same in children at birth. Hypotriglyceridemia is associated with perinatal hypoxia, acute respiratory failure and the development of complications in the early neonatal period.

Conclusion. Children born of a multiple pregnancy, at birth, tend to present with metabolic disorders of triglycerides and blood cholesterol of various degrees. The most characteristic pairs are: a very low TG content (less than 0,2 mmol/L) in one child and an average (0,21–05 mmol/L) in the other. All children from the triplet have different blood triglycerides, regardless of the order of birth. In the course of the early neonatal period the contents of triglycerides and blood cholesterol stabilize, but the triglyceride production rates are different. The most intensive rise is observed in twins with a low content of triglycerides at birth.  

Purpose. Study of perinatal and neonatal outcomes in newborns born to mothers with preeclampsia.

Characteristics of children and research methods. Perinatal outcomes were analyzed in 559 mother–newborn pairs divided into 2 groups: Group 1 included 200 children to mothers with preeclampsia (143 with moderate and 57 with severe preeclampsia). Group 2 was composed of 359 newborns to mothers with a physiological course of pregnancy. The medical history, features of the course of pregnancy, delivery, and the early neonatal period were analyzed. The condition of newborns was assessed on the Apgar scale at 1 and 5 minutes, the assessment of physical development — using centile tables for full-term and premature newborns (INTERGROWTH-21st), the assessment of neuromuscular and physical maturity on the Ballard scale.

Results. The study showed that children born to mothers with preeclampsia are significantly more likely to have metabolic and hematological disorders, a higher risk of developing infectious and inflammatory diseases, and a direct correlation with the period of manifestation and severity of preeclampsia. The higher occurrence of these conditions and the structure of pathological changes in the neonatal period led to a longer stay of children of this group after birth at newborn intensive care units, and also required observation at the second stage of nursing.

Conclusion. Preeclampsia is a risk factor for neonatal complications. The identified features of adaptation in newborns from patients with preeclampsia and the structure of pathological conditions in the early neonatal period should determine the management tactics and timeliness of treatment and diagnostic measures aimed at improving the provision of medical care to the pregnant woman and subsequently the newborn.  

Transient tachypnea of the newborn is a parenchymal lung disease characterized by respiratory distress in the first hours after birth. The consequences of underestimating the severity of the disease, incorrectly chosen respiratory support technique or its untimely use at the stage of the delivery room are the increase in respiratory failure, transfer to the intensive care unit, and the need for more invasive and expensive methods of treatment. In the study, we set the task to determine the risk factors that allow us to predict the severity of the course of transient tachypnea of the newborn at the stage of the delivery room.

Purpose. Analysis of risk factors that determine the severity of transient tachypnea in the newborn and predicting the tactics of their treatment.

Methods. Retrospective analysis of full-term newborns (n = 201) diagnosed with transient tachypnea of the newborn in 2020, who received any type of respiratory support in the first hours of life.

Results. Most patients with transient tachypnea of the newborn required respiratory support at the stage of the delivery room, which we associate with a combination of risk factors in the history of pregnancy and childbirth. A high incidence of cerebral pathology in the studied newborns was revealed. According to our data, the following factors can be considered as predictors of the severity of the condition and hospitalization in the intensive care unit from the delivery room of patients with transient tachypnea of the newborn: delivery by Casarean section, low Apgar score at 1 and 5 minutes, Downs scale score of 4–5 points, and the need for respiratory support during the delivery room stage.

Conclusions. The results of the study proved a high frequency of transient tachypnea of the newborn registered in full-term infants, allowed to identify risk factors for a severe course of transient tachypnea of the newborn and hospitalization in the intensive care unit.  

Presently, authors of scientific publications pay much attention to the study of individual neuromarkers of damage to the central nervous system in newborns. One such marker is the growth protein neuromodulin.

The aim of the study is to estimate the concentration of neuromodulin in the first day of life in preterm infants with perinatal damage to the central nervous system and compare it with the clinical indicators of newborns in the early neonatal period.

Characteristics of children and research methods. 81 extremely preterm newborns were examined, which were divided into groups depending on the presence of intraventricular hemorrhages: Group 1 — 48 preterm infants in whom intraventricular hemorrhage was verified during the observation in the early neonatal period; Group 2 — 33 preterm infants without intraventricular hemorrhage. Determination of the concentration of the GAP-43 protein in the blood serum was carried out by enzyme immunoassay. The groups were comparable in terms of weight and height parameters, gestational age, the degree of respiratory failure at birth, and the need for mechanical ventilation (p<0,05).

Results. Group 1 had a significantly lower Apgar score at the end of the 1st (p=0,034) and 5th minutes of life (p=0,037) compared to Group 2. A comparative analysis of the concentration of neuromodulin revealed that in preterm infants of Group 1, the values of neuromodulin were significantly higher than in preterm infants of Group 2 (1,469 [1,284; 1;966] and 0,541 [0,461; 0,595] ng/mL, respectively; p<0,001). The degree of intraventricular hemorrhage (r=0,771; p<0,001), the minimum amplitude of the amplitude-integrated electroencephalography (r=–0,404, p=0,004), the Ballard score (r=–0,614, p=0,019) were statistically significantly correlated with serum neuromodulin concentration.

Conclusions. Characteristics of the concentration of GAP-43 in preterm infants with perinatal lesions of the central nervous system are given depending on the presence of intraventricular hemorrhage and the gestational age on the first day of life, significant correlations between clinical data and the level of the studied protein are revealed.  

The most severe consequence of a spinal hernia, affecting the entire life of a person, is a spinal neurogenic bladder. Its symptoms limit the child’s socialization, and the problem of urination needs constant use of various aids. At the same time, despite many studies in neurology, there are no significant shifts in the possibility of restoring the function of urination in spinal patients.

Purpose. The aim of study is to analyze the long-term results of correction of neurogenic bladder in children treated depending on the type of dysfunction with a history of surgery for spinal hernia.

Characteristics of children and research methods. 100 patients with spinal neurogenic bladder aged 1–15 years were examined, urodynamic studies were used. Depending on the state of the detrusor and sphincter, groups of patients were identified, in each of which treatment lasting at least a year was selected.

Results. With a differentiated approach to the choice of therapeutic tactics, depending on the type of neurogenic bladder, the presence of vesicoureteral reflux, urinary tract infection, it was possible to reduce the level of detrusor hypertension, if any, or activate the function of the atonic bladder. Individual options for urinary diversion were developed. With long-term therapy that stabilizes detrusor, a change in the type of neurogenic dysfunction occurred within a year in 98 patients, which required repeated urodynamic examination to change treatment tactics.

Conclusion. Clinical manifestations of spinal neurogenic bladder do not always accurately indicate the type of dysfunction. During the growth of the child, as well as under the influence of treatment, there is a change in the type of neurogenic bladder. Urodynamic examination makes it possible to determine the state of the detrusor and sphincter — and to select a pathogenetically justified treatment option. In case of impaired urination, neurogenic bladder should be corrected with customized self-catheterization. Urodynamics should be controlled in spinal patients at least once a year to correct treatment. 

Premature infants with bronchopulmonary dysplasia-associated pulmonary hypertension have a longer persistence of apnea of prematurity and periodic breathing. We hypothesized that apnea of prematurity and periodic breathing may be associated with the persistence of pulmonary hypertension in infants with bronchopulmonary dysplasia.

The aim of the study was to determine the characteristics of apnea episodes and periodic breathing in premature infants with bronchopulmonary dysplasia-associated pulmonary hypertension.

Characteristics of  children and research methods. Cardiorespiratory monitoring was conducted on 27 premature infants born at 22 0/7 — 29 0/7 weeks of gestation with a body weight of <1000 grams. All infants had bronchopulmonary dysplasia, and 14 infants with severe bronchopulmonary dysplasia were diagnosed pulmonary hypertension (main cohort).

Results. The group of infants with bronchopulmonary dysplasia + pulmonary hypertension had lower average SpO₂, higher desaturation index and apnea/hypopnea index as compared to infants without pulmonary hypertension. Four infants from the main cohort had obstructive apnea index of ˃1 events/hour and had high values of 1,1; 2,5; 5,8, and 8,6/hour. In the comparison group, only one infant had a high obstructive apnea index (1,1/hour). Eleven infants(78%) with pulmonary hypertension had episodes of periodic breathing, at the same time only six infants (46%) in the group without pulmonary hypertension had such episodes. Periodic breathing episodes with a drop of SpO₂ <90% were registered in 82% of cases in the main cohort and in 67% of cases in infants of the comparison group.

Conclusion. Premature infants with bronchopulmonary dysplasia and pulmonary hypertension had more significant decrease in mean SpO₂, increased desaturation index and apnea/hypopnea index and tend to have obstructive apnea index >1/hour and longer periodic breathing than infants without pulmonary hypertension.

Purpose. To determine the clinical and laboratory features of the course of acute pyelonephritis in children with a history of COVID-19 and to determine the risk of developing chronic kidney disease.

Material and methods. The main cohort consisted of 36 patients with the debut of acute pyelonephritis, who had previously suffered COVID-19, the average age was 7,5 years. The comparison group included 47 patients with the onset of acute pyelonephritis and a normal level of IgG antibodies to SARS-CoV-2, the average age was 7,0 years. Laboratory tests included full blood count and urinalysis, blood biochemistry, procalcitonin, urine microalbumin, urine creatinine, Zimnitsky urine test, bacteriological urine test, glomerular filtration rate, coagulogram, and Lipocalin-2 associated with neutrophil gelatinase (NGAL) in the urine.

Results. Patients with a history of COVID-19, at the onset of acute pyelonephritis, demonstrated a higher incidence of apostematous pyelonephritis, a higher degree of damage to the tubulointerstitial kidney tissue, a high frequency and a higher level of hematuria, proteinuria, hyperfiltration, hypostenuria, as well as a more significant increase in fibrinogen, CRP, procalcitonin, and uNGAL/Cr levels than children of the comparison group. It was shown that almost half of the children with acute pyelonephritis who had had COVID-19 retained urinary syndrome during examination 3–4 months after the onset of the disease.

Conclusion. Thus, long-term effects of the SARS-CoV-2 virus on the renal parenchyma were confirmed, even in asymptomatic children. The high level of uNGAL/Cr in children with acute pyelonephritis who had had COVID-19, which was almost 8 times higher than in the comparison group, reflects more pronounced damage to the tubulointerstitial kidney tissue. The risk of developing chronic kidney disease in this group was 3,5 times higher.

It is known the blood pressure in children at rest depend on height, but this fact has not been considered during the exercise stress test.

Purpose. To determine the maximum value of blood pressure in young elite athletes, depending on the height and gender.

Characteristics of children and research methods. The study examined 2313 young elite athletes, members of the national teams of the Russian Federation in 40 sports disciplines (average age — (15,5 ± 1,4) years; 45% of young men). All subjects underwent PWC170 cycle ergometry, blood pressure was measured manually at each stage of testing, and its maxima were registered throughout the testing.

Results. The maximum blood pressure values in boys were higher than in girls: systolic blood pressure (195 ± 25) vs (175 ± 20) mmHg, p<0,001, diastolic blood pressure (80 ± 11) vs (80 ± 10) mmHg, p<0,05. There was relationship between the maximum value of the blood pressure on exercise and height (r=0,55; p<0,001). There were proposed normative tables for the maximum values of systolic blood pressure during exercise, depending on height.

Conclusion. In the young elite athletes, the maximum value of blood pressure during stress test depends not only on the gender, but also on the height. The maximum values of systolic blood pressure during exercise in tall young elite athletes can reach 250 mmHg in boys and 210 mmHg in girls.

Stimulating scientific activity in students of higher medical educational institutions is one of the important tasks of the current healthcare system. However, should this be limited to student journals and conferences only? Can students apply for publication in major scientific journals on an equal basis with renowned scientists? In our work, we determined how often medical students publish articles in peer-reviewed pediatric journals and whether the scientometric indicators of their work differ from the general array of articles. We manually selected 2,618 publications of the journals «Practical Pediatric Problems» and «Russian Bulletin of Perinatology and Pediatrics» using the information analysis system of the Scientific Electronic Library, of which 74 articles (2,8%) were written with the participation of students. They do not differ significantly from the total number of publications based on to the main scientometric indicators, such as the total number of citations of publications, the average number of citations per article, and the number of articles cited at least once. This indirectly suggests that these materials comply with the accepted standards of publishing practice typical for peer-reviewed scientific journals. We believe that, under the guidance of experienced teachers, future pediatricians can not only contribute to the collection of materials for research and their statistical processing, but also, possibly, offer new ideas based on advanced medical knowledge.

The urgency of the problem is due to the prevalence and clinical heterogeneity of hereditary cystic kidney diseases. The phenotypic diversity of nephronophthisis and nephronophthisis-related syndromes, which in most cases are characterized by an autosomal recessive type of inheritance, suggests the necessity of genotype diagnosis to personalize the choice of therapeutic means, taking into account the individual (genetic) characteristics of the disease in a particular patient. The article provides a review of the literature on the characteristics of the clinical phenotype and genotype of nephronophthisis and nephronophthisis-related syndromes that developed as a result of mutations in the TMEM67 gene (Meckel—Gruber 3 syndrome, Bardet—Biedl 14 syndrome, Joubert 6 syndrome, COACH 1 syndrome, RHYNS syndrome). On the example of a proband with prenatally identified renal cysts and nephrogenic arterial hypertension (AH) from birth, the features of the course and diagnosis of nephronophthisis-11 due to mutations in the TMEM67 gene were demonstrated. Difficulties in differential diagnosis in patients with a negative family history confirm the importance of molecular genetic testing.

Streptococcus equi subsp. ruminatorum is a zoonotic disease that can cause serious morbidity in immunocompromised people. The first case of infection in human was described in 2007. We describe a case of infection in a 9-year-old child with a history of liver transplantation, who was hospitalized for differential diagnosis of high fever on continuous immunosuppressive therapy with Tacrolimus. The examination revealed an increase in the level of systemic inflammatory response markers, cholestasis and cytolysis syndrome markers, which indicated cholangitis. Acute graft rejection was excluded. Streptococcus. equi subsp. ruminatorum was identified in the patient’s blood cultures, which made it possible to diagnose a generalized zoonotic infection (the child was often in contact with horses) with a possible focus in the bile ducts, which required antibiotic therapy in combination with short-term, within 1 day, withdrawal and then a lower dose of immunosuppressive therapy (temporary adjustment of tacrolimus dosage). During the treatment, clinical and laboratory signs of the infectious process improved, and the functional state of the liver graft normalized. Therapy was stopped after negative blood cultures were obtained. This case confirms that S. equi subsp. ruminatorum can cause human disease. We emphasize the utility of molecular biological tests and MALDI-TOF mass spectrometry to be performed in patients with infections caused by group C streptococci.

PRKAG2 syndrome is a rare genetic disease that isinherited in an autosomal dominant fashion and is caused by mutationsin the PRKAG2  gene. Clinical symptoms include early onset, ventricular preexcitation, cardiac hypertrophy, and progressive atrioventricular block.  The PRKAG2 syndrome is characterized by genetic heterogeneity, which makes early detection difficult; genophenotypic correlations  have been documented. In this article, we provide an overview of the literature data and experience from the cardiology department of the  National Medical Research Center for Children’s Health of the Russian Ministry of Health in the diagnosis and management of patients  with PRKAG2 syndrome, and present the clinical and genetic characteristics of the p.R302Q and p.H383R variants of the PRKAG2 gene.

The pandemic of a new severe infection, announced by the World Health Organization last year, is still spreading. To a certain extent, the epidemic has affected the pediatric population. Children have not been left out of the spread of COVID-19, and this applies even to newborns. The lecture presents summary data on the results of clinical observations both in the Tushino Children’s City Clinical Hospital in Moscow and scientific sources. A new disease is really new. This applies to its pathogenesis, diagnosis, treatment tactics with the use of modern medicines. For the first time, pediatricians are faced with the incredible situation where adults are more severely affected than children. It was noted that due to the limited period and scarce observations, all recommendations existing at this stage are temporary and undoubtedly subject to clarification. Most information regarding the impact of COVID-19 on a child is in clinical trials and is en route to be introduced into pediatric practice.