Annotation. The protective forces of newborns born prematurely, with low body weight under conditions of infection, are not capable of an adequate response. The aim of our study was to study some of the features of premature infants with low birth weight at the background of intrauterine infection. The first group consisted of 67 stories of premature babies born with low birth weight (LBW) from 1500 to 2500 g and gestational age 32–35 weeks (average gestational age — 34±2 weeks). It was revealed that a feature of the temperature homeostasis of children of group I is the establishment and maintenance of a temperature gradient, that is, the difference between central and peripheral temperatures, which ranged from 1,100 C to 1,500 C at the age of 6–7 days. It was found that the dynamics of the temperature gradient in the neonatal period is very often depended on the presence of perinatal pathology, namely, hypoxic-ischemic damage to the central nervous system. The regularities of temperature homeostasis in children of the second group are characterized, which amounted to 27 newborns with gestational age 38–40 weeks of gestation, birth weight 2600–3200 g without a clinic of respiratory disorders and neurological symptoms. On the 4th–5th day after birth, these children were discharged home under the supervision of a family doctor. In group II children who, after 1.5–2.5 months, were admitted to the neonatal pathology department diagnosed with acute respiratory viral infections: acute rhinopharyngitis or bronchitis, the temperature gradient ranged from 2.100 С to 3.500 С. In children, an increase in central temperature or a decrease in peripheral temperature was observed. It was found that with effective treatment on days 4–6, the temperature gradient was always constant and amounted to 1.500 С to 1.700 С. To identify the cause of the disease in the I and II groups, studies of blood, mucus from the pharynx and nose, and secretions from the trachea were performed. For this, we used the method of polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA) and bacteriological methods of research. The effect of intrauterine infection, the colonization of pathogenic intestinal microflora was evaluated, a low Apgar score of 1 and 5, the presence of respiratory disorders, hyporeflexia, a decrease in thymus, leukocytosis of more than 10 thousand, leukopenia of less than 4 thousand, neutrophilia with a shift to the left, which are very dangerous, were taken into account for premature babies and require respiratory support, colonization of the intestines with bifidobacterium and the use of immunocorrective therapy (venoimun at a dose of 0.4 ml / kg every other day for 3–5 days), which gives good results for nursing preterm infants.
Причини дитячої захворюваності та віддалені наслідки є важливим питанням сучасної педіатричної науки. Зважаючи на анатомічні та функціональні особливості недоношених немовлят, вони потребують мультидисциплінарного підходу до догляду та лікування. Діти, народжені передчасно або маловагові щодо терміну гестації, мають зростаючий ризик ураження нирок у наступні періоди життя, оскільки отримують лікарські засоби, що здатні потенціювати пошкодження ниркових тканин. У статті описаний клінічний випадок хвороби сечовидільної системи у 8 місячної дитини, народженої в терміні гестації 32-33 тижні з малою масою тіла. Період новонародженості у неї асоціювався із розвитком характерних ниркових транзиторних станів, короткостроковим природним вигодовуванням, також вона потребувала респіраторної підтримки та теплового захисту на етапі постнатальної реанімаційної допомоги. Фізичний розвиток за кривими зростання Фентона до 50 тижнів скорегованого віку коливався в межах 10 го та 90 го перцентиля. У віці 8 ми місяців, після перенесеної інфекції верхніх дихальних шляхів, у дитини з'явилися блювання, лихоманка, порушення харчування, олігоурія. При об'єктивному обстеженні було виявлено стигми дизембріогенезу, затримку психомоторного та порушення фізичного розвитку. Дані лабораторно інструментальних досліджень засвідчили наявність анемії першого ступеня, лейкоцитоз із зсувом лейкоцитарної формули вліво, дизелектролітні зміни у крові; порушень первинного та вторинного гемостазу не виявлено. У загальному аналізі сечі були зміни мікроскопії осаду та фізико хімічних властивостей. За даними ультразвукового дослідження нирок у дитини діагностовано збільшення розмірів лівої нирки та підвищення ехогенності ниркової тканини, також у дитини виявлено гіперплазію тимусу. Сукупність клінічних та додаткових досліджень дала можливість діагностувати інфекцію сечовивідних шляхів-гострий пієлонефрит, з приводу чого дитина отримувала лікування. З метою скорочення термінів верифікації клінічного діагнозу сімейними лікарями у недоношених дітей слід акцентувати увагу на наявність стигм дизембріогенезу, порушень фізичного та психомоторного розвитку, особливості перебігу неонатального та грудного періодів життя, клінічні симптоми та дані додаткових методів досліджень. Дослідження виконані відповідно до принципів Гельсінської Декларації. Протокол дослідження ухвалений Локальним етичним комітетом (ЛЕК) установи. На проведення досліджень було отримано поінформовану згоду батьків дитини. Автори заявляють про відсутність конфлікту інтересів. Ключові слова: недоношена дитини, грудний вік, ниркові пошкодження.
The aim of this study is to investigate the features of clinical manifestations of somatoform disorders (SD) from the side of gastrointestinal tract (GIT) and urinary system (US) and their relationship with affective conditions in children. We examined 123 children with SD from the side of gastrointestinal tract and 52 children with SD from the side of the urinary system. The average age of children was 13.6±2.2 years (M±σ), of which boys were 33.2% (n=58) and girls were 66.8% (n=117). It was used the Spielberger test to investigate anxiety. The Child Depression Questionnaire M. Kovacs (1992) was used to diagnose depression. The probability was evaluated using the Student’s t-test. Functional dyspepsia (FD) occupies the first place with 60.1%, irritable bowel syndrome (IBS) with second place (20.3%), functional diarrhea in 3.25% and functional constipation in 16.2%. Elderly children are 1.7 times more likely to suffer from IBS. IBS with constipation was found 3.8 times more frequent than diarrheal type. The diarrheal type of IBS is 5.1 times more common in boys than in girls. FD was more common in girls — 2.7 times with prevalence in children aged 10–14 years. In 31.7% of children with SD from the part of the gastrointestinal tract was found depression and in 84.6% of children there is clinically expressed anxiety. Among the children with SD, the number of young adolescents was 69.2%. The hyperreflective form of the bladder was found in 34.6%, the hyperreflex — in 26.9% of children. Enuresis occurred in 38.5% of children. 38.4% of children were diagnosed with depression and 88.5% expressed anxiety in patients with US. Depressive disorders as well as anxiety disorders can be one of the key factors in the occurrence of SD in children and manifest themselves in a variety of somatic masks in the form of functional disorders of organs and systems complicating the diagnosis, disease course and effectiveness of treatment. There was significant prevalence of anxiety (2:1 and 1.8:1, respectively) and depressive (3.3:1 and 4:1, respectively) disorders in women on both the GIT and US. Accordingly, female gender can be considered one of the main risk factors for the development of SD and emotional disorders in children.
Annotation. Mitral valve prolapse (MVP), as a manifestation of connective tissue dysplasia, is of great interest in the field of medicine. It occupies an important place in the structure of diseases of the cardiovascular system, which is mainly due to its high incidence and possible complications. MVP is detected in almost 2–3% of the population. In addition, this pathology with a genetic predisposition is a manifestation of a connective tissue defect and is rare in newborns and at an early age, which characterizes it as a progressive disease. At the moment, the features of cerebral hemodynamics in children with MVP are not well understood. The aim of our study was to study cerebral hemodynamics in children with primary mitral valve prolapse using quantitative indicators of rheoencephalography (REG). The study included patients with primary MVP. Under our supervision, there were 106 children aged 13 to 17 years. The control group included 23 healthy children at the same age. All children underwent a REG with quantitative indicators. In children with MVP, there is a variability in the results of REG in the cerebral hemispheres. Vascular elasticity is significantly reduced due to anacrot time increase (p<0.001), which, in fact, is characteristic of the hypertonic type of blood flow (57.5%). It can be argued that in children there is a hypovolemic type of blood flow in the form of a decrease in the rheographic index relative to the control group (p<0.05). There is a tendency to vascular tone tension of all calibers according to the absence of statistically significant deviations of the corresponding indicators (dictrotic index and the ratio of the duration of the ascending phase to the duration of the entire pulse wave). The same picture is observed with venous blood flow, according to the values of the dystolic index in the carotid artery basin. In the basin of the vertebral artery there is a tendency to increase the tone of small vessels and venous vessels. Thus, in children with mitral valve prolapse, cerebral blood flow changes in the form of hypovolemia in the carotid artery basin and normovolemia in the vertebral artery basin according to REG parameters; in this group of children with MVP, there is a tendency to tension in the tone of blood vessels of all calibers according to the absence of statistically significant deviations of the corresponding indicators (dictrotic index and the ratio of the duration of the ascending phase to the duration of the entire pulse wave). Also, patients with MVP should be constantly monitored by narrow specialists (cardiologists, neurologists) for timely and adequate recovery.
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