32Оригинальная статья ние специфической профилактики рахита не рекомендо-валось ввиду «достаточной» инсоляции в этот период года. Пасмурное лето, особенно в северных регионах страны, могло стать показанием к проведению специфической про-филактики и в летние месяцы. При наличии факторов риска (дети, родившиеся от женщин с акушерской и хронической экстрагенитальной патологией, с синдромом мальабсорб-ции, врожденной патологией гепатобилиарной системы, часто болеющие, из двоен, от повторных родов с малы-ми промежутками между ними, на раннем искусственном несбалансированном вскармливании, получающие проти-восудорожную терапию) суточную дозу витамина D реко-мендовано было увеличить до 1000-1500 МЕ в те же сроки и сезоны года (осень, зима и весна, с 3-4-й нед жизни). Для лечения рахита предлагали использовать лечебные дозы витамина D, которые в 4-10 раз превышали профилактиче-ские: 2000-5000 ME/сут в течение 30-45 сут. После дости-жения терапевтического эффекта лечебную дозу витами-на D заменяли профилактической, которую ребенок должен был получать ежедневно, в течение первых 2 лет и в зимний период на 3-м году жизни. Однако в настоящее время пас-мурное лето, проживание в экологически неблагоприятном регионе, северных областях России и недостаточное пребы-вание на солнце могут стать показанием к отказу от летнего перерыва и назначения профилактической дозы витами-на D (500 МЕ) и в летние месяцы.Как на самом деле обстоит дело с профилактическим назначением витамина D у детей в России, точно оце-нить невозможно. Работы, посвященные изучению статуса витамина D у российских детей в зависимости от региона проживания и времени года, возраста и вида вскармлива-ния на первом году жизни, отсутствуют. Назрела необходи-мость создания новых национальных рекомендаций, отра-жающих современные подходы к профилактике и лечению недостаточности витамина D у детей.Кафедрой педиатрии Российской медицинской ака-демии последипломного образования (Москва) в 2013 г. было организовано и проведено фармакоэпидемиологи-ческое исследование РОДНИЧОК (исследование по оцен-ке обеспеченности детского населения младшей воз-растной группы витамином D в Российской Федерации и анализ фармакотерапии недостаточности витамина D в широкой клинической практике), целью которого было изучить обеспеченность витамином D детского населения младшей возрастной группы и адекватность фармакоте-рапии/профилактики недостаточности витамина D в раз-личных регионах Российской Федерации. МЕТОДЫ План (дизайн) исследованияМультицентровое проспективное когортное исследование. Критерии соответствияОтбор детей осуществлялся по очередности поступле-ния в лечебно-профилактические учреждения на основа-нии следующих критериев включения:• возраст от 1 мес до 3 лет; • дети без органической патологии и генетических син-дромов; • постоянные жители регионов, участвующих в проекте.В исследование не включали детей с установленным диа-гнозом рахита, нарушением печеночной и почечной функции (желтуха, диарея), нарушением психического развития. Условия проведенияДля формирования репрезентативно...

Background. Mycoplasma pneumoniae is included in the group of atypical pathogens of acute respiratory diseases. Mycoplasma pneumoniae is characterized by a tendency to prolonged course with progressive changes in the lungs. Main value in the confirmation of mycoplasma infection has microbiome in biosubstrates selection and serological diagnostics: the determination of specific immunoglobulins IgM or IgG in the dynamics to M. pneumoniae. Antibacterial therapy of mycoplasma pneumonia is prescribed based on the sensitivity of the pathogen to them. The duration of antibiotic treatment of mycoplasma pneumonia is determined by the dynamics of clinical and radiological data. Materials and methods. The article describes the features of the clinical course of mycoplasma pneumonia in a patient with tubinfection proceeding with bronchoadenitis and obstruction of the bronchus, which necessitated a differential diagnosis with tuberculosis of the intrathoracic lymph nodes and the appointment of repeated courses of antibiotic treatment.Results. In the described clinical case, the duration of Mycoplasma infection exceeded 3.5 months, during which time the patient received several courses of antibiotics. Mycoplasma pneumonia had a prolonged course, accompanied by bronchoadenitis.Conclusion. Our observations show the need to study the effectiveness of extended courses of antibiotics from the azalid group in the treatment of prolonged and complicated forms of Mycoplasma pneumonia.

Pneumonia is one of significant problems among infections of low airways in children. Morbidity of common-acquired pneumonia (CAP) continues to go in last year’s. Data available in the literature show, that pneumonia with empyema possibly associated with high risk of chronic obstructive pulmonary diseases, asthma and recurrent case of pneumonia in last life. Fatal pneumonia or developing chronic obstruction lung diseases occur mainly in children after severe and complicated forms of pneumonia, this information is presented in native and foreign literature. Currently pneumonia with the heavy and complicated current is a major cause of infant mortality or promotes development of a chronic obstruction lung diseases. Mortality from pneumonia is 3-19% according to different authors. The risk of respiratory diseases in the 3-6 months after pneumonia increased in children who underwent pneumonia. After complicated CAP the complete resolution of the inflammatory happens on 6-9 month. After not complicated САР forms at 10-30% of children radiological changes within 2-6 weeks were noted. In one research it is reported that the full recovery from slow resolving pneumonia at 96% of children has come on 6-8 month of the dispensary period. Some authors in the scientific works use immunomodulators and vaccinations to reduce the residual variation in the lungs and improve recovery time dramatically of pneumonia. In follow up study the important task is a identifying and elimination of risk factors for improvement of treatment and dispensary period for slow resolving pneumonia, recurrent case of pneumonia, sever pneumonia.

Aim. Assessment of electrocardiographic indicators in infants born on time with delayed intrauterine growth and mild development. Materials and methods. Under the supervision of 164 infants. From mothers with an aggravated somatic and obstetric-gynecological history, 139 children were born: 71 (gr. 1) with delayed intrauterine growth and development of mild severity, 68 (gr. 2) without delayed intrauterine growth and development. The control group (gr. 3) consisted of 25 practically healthy children born to practically healthy mothers. All children were born full-time. They were examined in dynamics at the age of 1 (n=154), 3 (n=142), 6 (n=133), 12 (n=130) months. A comprehensive analysis of the data of history, physical examination, electrocardiography was carried out. There was no medical intervention. The duration of the study is 3 years. Heart rate, incidence of early ventricular repolarization syndrome and nonspecific disorders of the repolarization process were evaluated; in the II standard retraction, morphology, amplitude in millimeters and width in seconds of the tooth P; duration in seconds of PQ interval (PR), QRS complex and QT interval; morphology, amplitude in millimeters of tooth T. Non-parametric methods of statistical analysis were used. Results. The median amplitude of the tooth P on day 23 in children of subgr. 1b, compared with children of gr. 3, is 0.2 mm less; 1 month in children of gp. 1 (1b), compared with children of gp. 3, less by 0.1 mm; at 3 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.35 mm, in children of subgp. 1b, compared with children of gp. 3, more by 0.2 mm; at 6 months in children of gp. 1 (1a and 1b), compared with children of gr. 3, more by 0.2 mm; at 12 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.2 mm, in children of subgp. 1b, compared with children of gr. 2, more by 0.2 mm, in children of gp. 1 (1a), compared with children of gr. 3, less by 0.2 (0.5) mm, and, compared with children of gr. 3, less by 0.2 mm. From 3 to 6 months increased in children of subgp. 1a by 0.35 mm. In children of gp. 1st (1a), a slowdown from 23 days to 1 month of intradermal conduction by 0.01 s, from 1 to 3 months of intraventricular conduction by 0.01 s, from 3 to 6 months of intradermal conduction by 0.01 s. Electrical systole in children of gr. 1 slowed from 1 to 3 and from 3 to 6 months by 0.01 s; in children of subgp. 1a from 1 to 3 months increased by 0.01 s, from 3 to 6 months decreased by 0.01 s, from 6 to 12 months increased by 0.01 s. Median tooth amplitude T on 23 days, 1 month in children of gp. 1 (1a and 1b), compared to children of gr. 3, more by 0.4 mm and 0.3 mm, respectively; at 3 months in children of subgp. 1a, compared with children of subgp. 1b, less by 0.35 mm, and, compared with children of gr. 2, less by 0.2 mm, in children of subgp. 1b, compared with children of gr. 2 more by 0.15 mm, in children of gp. 1 (1b), compared with children of gr. 3, more by 0.3 (0.45) mm; at 12 months in children of subgp. 1b, compared with children of gr. 2, more by 0.4 mm, in children of gp. 1 (1a), compared with children of gp. 3, less by 0.3 mm. From 23 days to 1 month in children of gp. 1 (1a) increased by 0.8 mm. Conclusion. Certain peculiarities of electrocardiogram in dynamics of growth and development of the organism of infants born on time with delay of intrauterine growth and development of mild severity related to volume overload of atrium, enlargement of interventricular septum, hypoxia, sympathetic activity, requiring corrective events are revealed.

BACKGROUND: Cystic fibrosis is one of the most frequent monogenic diseases, in which, in addition to medical measures, measures for the prevention of the infectious process in the lungs are of great importance, which is provided by a clear organization of the work of any medical institution where patients are observed and where medical and rehabilitation measures are carried out. AIM: The article describes the experience of the childrens Center in St. Petersburg to prevent cross-infection of patients with cystic fibrosis who have the different luge microbiome. MATERIALS AND METHODS: The measures taken included a system for monitoring and dynamic control of the seeded pathogenic microflora with a strict separation of patients with cystic fibrosis, who had the isolation and carriage of various pathogens. The system provided for the separation of flows of patients with cystic fibrosis and the prevention of cross-infection, as well as a number of activities related to the disinfection of equipment. RESULTS: The methods adopted and put into practice have ensured the prevention of cross-infection of patients with cystic fibrosis, excreting various pathogenic bacteria from sputum. The patient management system made it possible to halve the number of hospitalizations of patients with Pseudomonas aeruginosa infection per CF patient per year: from 1.3 in 2001 to 0.6 in 2021, reduce the risk of cross-infection, reduce the number of relapses, hospitalizations and the average length of stay of a patient in a hospital. CONCLUSIONS: The developed system of assistance has shown its effectiveness and can be implemented in one form or another in the work of cystic fibrosis treatment centers in the Russian Federation.