Sudden cardiac death is a serious problem that accounts for approximately 50% of deaths due to cardiovascular diseases. This review provides information about the known mechanisms that prolong the QT interval in patients with complete atrioventricular block. It also presents evidence of the significance of changes in repolarization processes for the development of life-threatening ventricular tachyarrhythmias, including in children. The variety of factors affecting myocardial repolarization in patients with complete atrioventricular block significantly worsens the course of the disease and prognosis and complicates approaches to the treatment of patients, especially in young children. It is important to determine predictive values of repolarization parameters in children for the prevention of the development of arrhythmogenic syncope and sudden cardiac death.

Currently, interest in the field of metabolomics of allergic diseases, including bronchial asthma, is quite high. However, there is insufficient data aimed at uncovering the mechanisms of pathogenesis of the atopic march and the development of bronchial asthma, including those confirmed in different populations of children. Metabolomic studies can reveal early biochemical changes that can predict the development of bronchial asthma.

The aim of the study is to analyze the results of cohort studies aimed at studying metabolic markers that can predict the risk of developing bronchial asthma in the context of the atopic march.

Materials and methods. Search for publications in Medline databases and Scientific Electronic Library. Publication dates: January 2015 - May 2025; cohort studies aimed at finding metabolomic markers that can predict the risk of developing bronchial asthma in the context of the implementation of the atopic march were included.

Results. This review includes 6 publications. The data on changes in metabolic profiles associated with the development of bronchial asthma in children are summarized.

Conclusion: Changes in the metabolism of lipids, amino acids, bile acids, and energy metabolism detected in umbilical cord blood, blood plasma, and urine of newborns and young children precede the clinical manifestations of atopic diseases and can serve as a basis for predicting the risk of developing bronchial asthma.

With the increasing number of military conflicts, acts of terrorism, and the use of modern weaponry, the problem of gunshot and mine-blast trauma (MBT) in children has acquired exceptional medical and social significance. Children constitute up to 20-50% of mass casualties victims, and the mortality rate for such injuries, according to various sources, reaches 57.1%. This review summarizes the keynote presentations of the symposium "Gunshot Wound," held as part of the XIII All-Russian Scientific and Practical Forum "Emergency Pediatric Surgery and Traumatology" (February 2025). Based on an analysis of the presented experience (including cases from Belgorod, Sevastopol, Moscow, and the Donetsk People's Republic), fundamental principles of providing care are identified. These include: a clear organization of staged medical evacuation based on effective triage of victims according to the «three streams» principle (red, yellow, green), and a presentation of the "golden hour" concept. A multidisciplinary approach, integrating the efforts of surgeons, traumatologists, ICU staff, psychologists, and rehabilitation specialists at all stages, is recognized as the cornerstone of the study. Particular attention is paid to combating wound infection, criticizing irrational antibiotic prevention and recommending the use of modern physical debridement methods, particularly low-temperature argon plasma, which demonstrates a pronounced antimicrobial effect and stimulates reparative processes. Early initiation of comprehensive physical and psychological rehabilitation to prevent contractures, chronic pain syndrome, and post-traumatic stress disorders is considered essential for a successful outcome. Thus, the problem requires a comprehensive multidisciplinary approach combining highly qualified surgical care with a well-established organizational system at all levels. The presented experience serves as the basis for the development of unified clinical guidelines aimed at increasing survival and improving the quality of life of children affected by military conflicts and emergency situations.

Early neonatal adaptation is a critical stage of the transition to extrauterine life, requiring early verification of markers of severe conditions to reduce the risk of adverse outcomes.

The aim of the study. To assess the incidence and prognostic significance of multiple organ failure (≥2 points) using the NEOMOD scale in premature monochorionic diamniotic twins depending on the course of the antenatal period, and to describe the structure of multiple organ dysfunction in the first hours of life.

Materials and methods. We retrospectively analyzed clinical and laboratory signs of multiple organ dysfunction in premature monochorionic twins aged 220–366 weeks. Based on the presence/absence of antenatal complications, the following groups were identified: twin-to-twin transfusion syndrome (n=223); selective fetal growth restriction syndrome (n=168); and uncomplicated antenatal period (n=357). The groups were comparable for the main parameters.

Results. Multiple organ failure, assessed using the modified NEOMOD (Neonatal Multiple Organ Dysfunction) scale, was more frequently recorded in cases of antenatal complications (79,3%) compared to uncomplicated pregnancies (49,9%; p<0,001). Severe multiple organ failure (≥5 points) was more common in twins who had twin-to-twin transfusion syndrome (p<0,001). The highest NEOMOD values (9 points) were observed in infants who died within the first day of life.

Conclusion. The risk and severity of multiple organ failure in monochorionic twins are associated with extremely low birth weight, perinatal infection, and specific antenatal complications. The leading contribution to the severity of the condition is made by respiratory, microcirculatory and hemodynamic disorders, which determine the level of NEOMOD and the length of stay in the neonatal intensive care unit.

Craniosynostoses (ICD - 10: Q75.0) is a heterogeneous group of pathologies characterized by premature fusion of cranial sutures, including isolated (non-syndromic) and syndromic forms associated with genetic syndromes and multiple developmental abnormalities.

The aim of the study was to identify clinical markers of craniosynostosis for timely diagnosis, determination of medical support tactics and improvement of prognostic criteria.

Materials and Methods. A retrospective analysis of the data of 31 children with a verified diagnosis of craniosynostosis was performed. The patients were divided into 2 groups: Group I – 20 children with non–syndromic and group II - 11 people with syndromic forms of craniosynostosis. A comparative analysis of anamnestic, anthropometric data, gender and age characteristics, the presence of craniofacial dysmorphism, and concomitant pathology was carried out.

Results. Non-syndromic forms of craniosynostosis were characterized by an isolated lesion of one cranial suture (90% of cases), male patients predominated among this group (60% of cases). For the syndromic forms of craniosynostosis, polysynostosis turned out to be pathognomonic (81,8% of cases) with the obligatory involvement of a coronary suture (90,9%), female patients prevailed (63,6%). Malformations of the central nervous system were diagnosed exclusively in group II (100% of patients), and abnormalities of the genitourinary system were diagnosed only in group I (40%). Limb defects were more common in group II compared with group I (72,7% and 10—15%, respectively). Pathology of the perinatal period in group II is respiratory disorders due to congenital pneumonia. A molecular genetic study showed that in group II, 10 children had mutations in the FGFR2 gene, and one child with the Pfeiffer phenotype had a mutation in the FGFR1 gene.

Conclusion. The differential diagnostic criteria of the syndromic forms are polysynostosis, malformations of the central nervous system and limbs in combination with pathology of the perinatal period. The detection of concomitant anomalies in patients with cranial deformity is an indication for an in-depth medical and genetic examination.

The increasing incidence of speech development disorders is one of the most significant issues in pediatrics and child neurology.

The aim of the study. To identify statistically significant differences in the influence of perinatal risk factors on the occurrence of specific and nonspecific speech development disorders.

Materials and methods. The longitudinal study included 525 children with specific and nonspecific speech development disorders (324 boys, 201 girls, born between 2005 and 2021). The group with specific speech disorders consisted of 322 children, while the group with comorbid disorders included 203 children. The authors analyzed anamnesis data related to the prenatal and perinatal periods of development, the results of neurological examinations during the first year of life, and their relationship with data on the children's motor and subsequent speech development. A comparative analysis was conducted in the groups.

Results. Statistically significant differences (higher incidence in the group with comorbid disorders) were revealed for the following risk factors: in vitro fertilization (p=0.02); threatened miscarriage (p<0.00001), especially in the third trimester (p=0.0002); infectious diseases during pregnancy (p<0.00001), especially acute respiratory viral infections (p<0.00001) and influenza (p=0.002); sexually transmitted diseases (p=0.001); antibiotic therapy in the 3rd trimester of pregnancy (p=0.04); cerebral ischemia in the neonatal period (p=0.04); perinatal damage to the central nervous system in the form of pyramidal insufficiency syndrome (p<0.00001) during the first year of life; hyperbilirubinemia (p<0.00001), including prolonged variant, with bilirubin levels above 200 µmol/L (p<0.00001).

Conclusion. Pediatricians and neurologists should be vigilant in identifying these risk factors when assessing the development of a child under three years of age, since they may be harbingers of further delays in psychomotor development, and promptly refer children for neuropsychological diagnostics for the purpose of early intervention in the habilitation process.

The problem of diagnosing asthenic syndrome (AS) after infectious diseases does not lose its relevance. The aim of the study was to analyze the relationship between cerebral blood flow disorders and the development of asthenic disorders in children after acute respiratory viral infections, as well as to develop a model for predicting the development of asthenic syndrome in children during the period of COVID-19 convalescence. Materials and methods. 203 children aged 7 to 17 years were examined. The 1st group consisted of 147 children who had COVID-19; the second group consisted of 30 chil- dren who had a rhinovirus infection; 26 healthy children made up the control group. All children were assessed at baseline and after 30 days: the frequency and severity of AS on the L.D. Malkova scale, transcranial duplex scanning (TDS) of cerebral vessels with the determination of the reactivity index (IR). Results. A higher incidence of AS was found in group 1 compared with group 2 (p<0.001), both at baseline (96.6% and 23.3%) and after 1 month (91.9% and 23.3%) with a decrease in IR, which this indicated tension and exhaustion of autoregulatory mechanisms. When studying the frequency of IR violations, the same patterns were revealed. Conclusion. The course of viral infections caused by SARS-CoV-2 and rhinovirus in children is characterized by a similarity of clinical manifestations, however, the development and degree of asthenic and somatovegetative syndromes depend on the etiology of the pathogen, its tropicity to the nervous tissue and vascular endothelial cells. The established relationship between the presence of asthenic disorders and indicators of cerebrovascular blood flow in children during convalescence 1 month after coronavirus infection makes it possible to predict the risk of developing asthenic disorders at the early stages of the pathological process using a highly effective model with an accuracy of 95,9%.

The search for highly sensitive biomarkers and predictors of early diagnostics of renal damage in chronic progressive kidney diseases is due to the increasing incidence of chronic kidney disease in children. The article presents our own scientific results on the clinical and paraclinical characteristics of chronic kidney disease in children and the development of pathogenetic markers for the diagnosis and prognosis of chronic kidney disease in childhood. Based on the assessment of risk factors for progression, inflammatory mediators and fibrogenesis, modern pathogenetic approaches to the early diagnostics of chronic kidney disease in children are scientifically substantiated. The study demonstrates the high diagnostic value of assessing the kidney injury molecule 1 (KIM-1), vascular endothelial growth factor - VEGF, monocyte chemoattractant protein-1 (MCP-1) in combination with the level of interleukin 18 (IL-18) for identifying the initial stages of chronic kidney disease in childhood.

Updated information about local antimicrobial susceptibility data is extremely important in prescription of empiric antibacterial therapy.

Aim: dynamic monitoring of local data on the etiological structure of pathogens causing urinary tract infections in children and the level of antibacterial drugs resistance of isolated microorganisms.

Materials and methods: this retrospective study evaluated urine analysis from 550 female and male patients aged 1 month to 18 years with urinary tract infections at the I.N. Grigovich Children’s Republican Hospital in Petrozavodsk, during 2018, 2022, 2023 years.

The results of the study. The study analyzed 301 isolates in 2018, 207 in 2022, 42 in 2023. Enterobacteria were isolated most frequently – 43–71%, of which Escherichia coli – 69–78%, Klebsiella – 14–19%. Escherichia coli resistance to ampicillin has almost doubled by 2022 - from 57% to 88%, p=0.028, in 2023 - 40%. Аmoxicillin/clavulanate - a high level of resistance remains - 2018 and 2022 - 16% and 55%, 2023 - 10% (95% CI, ±11.142). The level of resistance to third- and fourth-generation cephalosporins has almost doubled over 5 years: cefepime from 23% to 42%, in 2023 - 10% (95% CI, ±11.142), cefotaxime from 24% to 39%, in 2023 - 13% (95% CI, ±12.612). The lowest level of resistance throughout all years to meropenem, nitrofurantoin, fosfomycin, amikacin, gentamicin.

Conclusion. The primary local uropathogen is Escherichia coli. Local administration of ampicillin is not permissible in treatment of pediatric urinary tract infections, the use of III-IV generations cephalosporins should be restricted.

Pneumocystis is a well-studied disease that usually develops in immunocompromised patients, especially in patients with HIV infection, and also in patients with systemic rheumatic diseases, organ transplant patients, including glucocorticosteroids and biological drugs, leading to an increased incidence of opportunistic infections, including Pneumocystis pneumonia. This is a serious complication with high mortality. In recent years, there has been an increase in the number of cases of pneumocystis in immunocompetent children without concomitant diseases. Timely diagnosis and treatment of Pneumocystis pneumonia in children depend on the vigilance of general practitioners, pediatricians and infectious disease specialists, as well as their knowledge of the clinical picture of the disease. The article describes a rare clinical case of generalized pneumocystosis with lung and intestinal damage in a 5-year-old child.

Congenital liver cysts are a rare pathology, however, due to the modern availability of visual diagnostic methods, primarily ultrasound, cases of their detection have become more frequent. Children in whom a cystic liver formation was detected during antenatal ultrasound screening should be observed dynamically after birth with laboratory and instrumental examination methods, and the issue of the timing of surgical intervention should be decided. Differential diagnostics of congenital liver cysts with other cystic lesions of the abdominal organs can be difficult even when several visual examination methods are used. In our clinical observations, based on the data of instrumental studies, the diagnosis of a congenital choledochal cyst seemed most likely, however, an isolated liver cyst with its morphological verification was diagnosed intraoperatively.

Conclusions. Congenital liver cysts are a rare pathology, which is now increasingly detected antenatally, which allows for timely excision of the cyst, preventing possible complications and malignancy.

According to the classification of the International Society for the Study of Vascular Anomalies (ISSVA), vascular anom- alies include a wide range of pathologies classified as vascular tumors or vascular malformations. This classification, last updated in 2018, is intended to explain the biological basis of vascular anomalies and help doctors in their treatment. In vascular tumors, proliferative changes in endothelial cells are observed, while vascular malformations are mainly struc- tural vascular anomalies. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, both isolated and in combination with each other. Radiological examination plays a key role in the treatment of children with these diseases. This clinical example describes the stages of diagnosis and treatment of a child with arteriovenous malformation of the soft tissues of the back of the neck.

Traditional Chinese Medicine methods such as acupuncture, reflexology massage, and others, as independent interventional measures, demonstrate a positive effect in improving muscle tone, motor functions, and adaptation to daily living conditions in children with cerebral palsy.

The aim of the study. To enhance the effectiveness of comprehensive rehabilitation for children with spastic forms of cerebral palsy by incorporating Gua Sha therapy and reflexotherapy into the medical rehabilitation program during the inpatient stage of medical care.

Results: Of the 81 children with cerebral palsy included in the study groups, 44 (54.3%) were boys and 37 (45.7%) were girls. The children's ages ranged from 1 year to 6.5 years. The children were divided into two groups: the study group and the comparison group. To assess effectiveness, the Ashforth Spasticity Scale, the Gross Motor Function Measure (GMFM-88), goniometry, coordination testing, the Harkavi Index, and the WeeFIM were used. The study group utilized modern rehabilitation methods in combination with traditional Chinese medicine (Gua Sha and reflexology), while the comparison group utilized modern rehabilitation methods alone.

Results: To assess adaptation using the Harkavi Index, it was found that rehabilitation interventions did not negatively impact the adaptive capacity of children in either group. After completion of rehabilitation measures and six months after their completion, the study group showed a persistent improvement in GMFM-88 scores (p=0.001), decreased tone on the Ashworth scale (p=0.001), improved balance (p=0.003), and improved functional independence (p=0.001). No clear improvements were observed in the comparison group.

Conclusion. Thus, incorporating Traditional Chinese Medicine methods into the rehabilitation program for children with cerebral palsy is advisable.

The main focus of neurorehabilitation is the prevention and correction of functional impairments in a child's organs or systems following neuroinfectious diseases.

The aim of the study. To scientifically substantiate the application of a comprehensive rehabilitation program based on reflexotherapy for children with sequelae of meningitis and encephalitis during the inpatient stage.

Materials and Methods. The study involved 63 children aged 1 to 14 years with viral or bacterial meningitis or viral encephalitis, including 29 girls (46.0%) and 34 boys (54.0%). The control group received standardized rehabilitation, while the main group additionally received reflexotherapy.

Results. Outcomes in both groups were assessed before and after rehabilitation, and at 3 and 6 months using the following measures: the Gross Motor Function Measure (GMFM-88) – recovery of motor functions in the main group significantly exceeded that in the control group (at 6 months: χ2-Pearson=42.995, p=0.001); the Modified Ashworth Scale – improvement in the main group was statistically significantly greater than in the control group for the upper extremities (χ2-Pearson=10.233, p=0.017). Also, according to the results received from the Visual Analogue Scale during the investigation: in the main group, after 6 months, there was a significant decrease in the number of children complaining of headaches - when compared with the indicators in the comparison group, the result was statistically sig- nificant (χ2-Pearson=8.627, p=0.003).

Conclusion. Reflexotherapeutic approaches contribute to improved coordination, increased range of motion in joints, reduced muscle tone, decreased levels of asthenia and headache intensity, as well as enhanced motor functions in children after meningitis or encephalitis. Incorporating reflexotherapy into the rehabilitation program increases the effectiveness of rehabilitation measures and improves the child's quality of life.

Cardiovascular diseases are one of the most common causes of disability and mortality in the young working age population worldwide. Atherosclerosis is a key pathological process that leads to early cardiovascular catastrophes, including heart attacks, strokes and ischemic heart disease. Timely diagnosis of dyslipidemia can ensure the initiation of effective treatment and prevention. Hereditary forms of lipid metabolism disorders are particularly dangerous and require close attention, starting from childhood. One of the effective methods for diagnosing dyslipidemia is screening of blood cholesterol levels. The world practice includes several types of screening, but the most commonly used are selective and universal. In the Russian Federation, until now, measurement of cholesterol levels has not been included in any examination of a child as part of dispensary monitoring. The new resolution pays special attention to children from risk groups and the measurement of total cholesterol from capillary blood at the ages of 6 and 10 years.

Primary sclerosing cholangitis (PSC) is a progressive, chronic liver disease characterized by destruction of the intra- and extrahepatic bile ducts. Much remains unknown about primary sclerosing cholangitis, including its underlying cause. However, available data suggest a multifactorial etiology, where the interaction of a combination of genetic predisposition, environmental factors, gut microbiome imbalance, and immune dysregulation triggers activation of cholangiocytes and peribiliary myofibroblasts that function in concert to cause progressive fibroinflammatory destruction of the bile ducts. This article discusses the association of primary sclerosing cholangitis and inflammatory bowel disease and diagnostic methods for these conditions.