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...

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Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.

The article presents modern approaches to the use of balanced formulas for nutrition and diet correction in children with various forms of food allergies. The guidelines are based on all available up to date evidence on the efficacy, safety and utility of using such innovative medical technology as specialized amino acid formulas. This formula is the targeted medical intervention for food allergies and confirmed cow's milk protein allergy, and particularly for patients with reduced physical growth and development (growth rates included). The material is based on methodological guidelines on the amino acid formulas usage previously developed by specialist experts of the Union of pediatricians of Russia in 2020.

Modern approaches for the management of children with gastrointestinal pathologies include optimal nutritional support that makes it possible to replete energy failure and restore essential nutrients balance. The article presents key information on gastrointestinal diseases in which modern amino acid formulas can be used to regulate nutritional status. The authors have conducted the extensive analysis of all available for now evidence on the efficacy, safety and utility of using such innovative medical technology as special elemental formula in gastrointestinal tract pathological conditions. This material is the basis for guidlines on the use of amino acid formulas developed by expert specialists of the Union of Pediatricians of Russia in 2020.

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation > 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.