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Neonatal respiratory distress syndrome is the leading cause of neonatal acute respiratory failure. Despite the successes achieved and the existing international recommendations, in some cases there is a severe course of this disease, which requires a personalized approach to the patient and intensive care measures. The article presents a case of successful treatment of acute respiratory distress syndrome in a full-term newborn complicated by pulmonary barotrauma using monobronchial administration of exogenous surfactant under X-ray control. In order to assess the course of the disease and the effectiveness of treatment, a retrospective analysis of medical documentation was carried out. From the first minutes of life, the child had respiratory disorders, which was the basis for non-invasive mechanical lung ventilation nCPAP (nasal continuous positive airway pressure). Progression of hypercapnia and hypoxemia was revealed over time, and therefore tracheal intubation was performed and convective mechanical ventilation was started with FiO2 = 1,0. Monobronchial administration of exogenous surfactant was a key element of the therapy that allowed to achieve stabilization of the condition and regression of gas exchange disorders with complete recovery of the patient. Monobronchial administration of surfactant in acute respiratory distress syndrome with heterogeneous lung involvement is an effective treatment option and can be used in clinical practice for refractory hypoxemia.

BACKGROUND: The mortality rate of children operated on in the early neonatal period remains high, despite the combined efforts of surgeons, anesthesiologists, clinical pharmacologists, and many other specialists. AIM: to determine the risk of death of children in the period of birth, after surgical interventions carried out in the period of the neonatal period. MATERIALS AND METHODS: A retrospective study was conducted between two groups of children treated at the Perinatal Center of the Pediatric University. The main group included 77 newborns operated on in the early neonatal period and died in the first 28 days of life. The control group included 287 children operated on in the perinatal period and survived 28 days. RESULTS: In the main group, the percentage of defects detected prenatally was statistically significantly lower; statistically significantly more often multiple congenital malformations and congenital malformations of the cardiovascular system were diagnosed. Risk factors for the death of newborns after surgery performed in the perinatal period have been established: features of the somatic status of mothers (chronic nicotine intoxication, hypertension and arterial hypertension, chronic serum hepatitis B and C, pathology of the urinary system and thyroid gland, cervical ectopia), obstetric gynecological history (chronic inflammation of the organs of the lower floor of the genital tract, two or more abortions in multiparous women, placental insufficiency in history during a previous pregnancy, previous delivery by caesarean section), course of pregnancy (threatening abortion, acute respiratory viral infections, exacerbations of chronic infectious diseases, early toxicosis, carriage of Cytomegalovirus and Herpes simplex types 1 and 2, asymptomatic bacteriuria, gestational anemia, circulatory failure, fetal malnutrition, abnormalities in the amount of amniotic fluid diagnosed by ultrasound study in the 3rd trimester of pregnancy), childbirth (breech presentation of the fetus and meconium staining of amniotic fluid), afterbirth conditions (chlamydial and ascending infection). CONCLUSIONS: In pregnant women with prenatally diagnosed congenital malformations of the fetus, it is necessary to conduct bacteriological studies, emergency histological examination of the placenta to identify possible microbial damage, as well as timely examination and treatment of newborns and upcoming / undergone surgery.

Rare severe insulin resistance syndromes such as Donohue syndrome, RabsonMendenhall syndrome, and type A insulin resistance are caused by mutations in the insulin receptor (INSR) gene. Donohue and RabsonMendenhall syndromes are caused by biallelic mutations in the - and / or -subunits of INSR, are characterized by a severe course with severe clinical symptoms and an unfavorable prognosis. The difficulty of managing and treating these patients is associated with a low incidence, lack of practice in managing such patients, as well as a lack of experience in surgical interventions in these patients. All insulin resistance syndromes are characterized by a significant increase in the level of insulin in the blood plasma in the absence of obesity, progressive diabetes mellitus and an excess of androgens. Polycystic ovary syndrome or stromal hyperthecosis develops in adult patients with syndromic forms of insulin resistance. We present a rare clinical case of a complicated course of Donohue syndrome, diagnosed in a 2-month-old patient. A feature of this clinical case was the giant growing multifollicular ovaries, which became an absolute indication for organ resection surgery. The experience of treatment and observation of this patient reflects the importance of early verification of the diagnosis, timely appointment of adequate therapy, allows you to objectively assess the effectiveness of the treatment, helps in choosing medical tactics and predicting the course and outcome of the disease.

It is known from the literature that premature amniotic fluid expulsion in 22 weeks 27 weeks 6 days gestation is very dangerous, as it is accompanied by high morbidity and mortality in newborn infants. Clinical observation. This article presents the results of observing two women with premature amniotic fluid expulsion at 22 and 24 weeks gestation, respectively. In the first case, the woman was immediately admitted to the perinatal center; in the second observation, she was admitted after 3.5 weeks of treatment at another institution. In both cases, pregnant women had manifestations of oligo and endotoxemia, a protective inflammatory response in the mother-placental-fetal system (more pronounced in the second observation) against a background of urogenital infection. In the course of complex treatment, the patients underwent detoxification, of efferent therapy in the form of repeated consecutive sessions of plasmapheresis, hemosorption (one operation each), external photomodification of blood with ultraviolet, laser beams with prolongation of pregnancy by 10 and 8 weeks. The deliveries in both cases were operative with live babies with body weight of 1600 g and 1840 g, respectively. In the first case the infant did not need intensive care, was breastfed, in the second observation the newborn received active respiratory support for 9 days, in the dynamics his condition normalized. No septic complications in mothers and fetuses were observed. The concluding efferent therapy in course of therapy were effected by prolongating of pregnancy with of good the results for mothers and them of fetus.

Children get sick less often than adults with a new coronavirus infection (in the Russian Federation, they account for 7.6% of registered cases of COVID-19), with less severe clinical symptoms, they require hospitalization less often, their disease is milder. The frequency of severe and extremely severe cases of COVID-19 in children does not exceed 1%. A clinical case of the course of COVID-19 in a child aged 2 years 4 months is presented. with acute lymphoblastic leukemia. A feature of the presented case is the development of an extremely severe new coronavirus infection in a child with secondary immunodeficiency caused by a long-term course of malignant, treatment-resistant of acute lymphoblastic leukemia. Slow, within 3 months, the development of the infectious process with long-term preservation of normal indicators of the function of the respiratory system led to the formation of viral-bacterial pneumonia with the development of respiratory distress syndrome. Despite the modern complex of therapeutic measures, severe comorbidity led to the development of DIC and multiple organ failure, which was the direct cause of the childs death. A possible therapy strategy is discussed in a patient with severe comorbidity against the background of secondary immunodeficiency and long-term persistence of SARS-CoV-2 in the presence of IgG antibodies to SARS-CoV-2 in the blood. For the first time, data on morphological changes in the lungs with a long course of COVID-19 (more than 100 days) in a young child are presented.

Background: Dichorionic diamniotic twin pregnancy resulting from IVF can lead to isthmic-cervical insufficiency with concomitant complications. Against the background of the initial genital chronic infection in a woman there is a threat of septic complications for the mother-fetal couple. The complex pathology is accompanied by an accumulation of toxic substances in the mother-placenta-fetus system that requires pathogenetic treatment measures. Clinical Cases: This paper presents data on the results of efferent therapy in two pregnant women with dichorionic diamniotic twin pregnancy complicated by fetal bladder prolapsing into the cervical canal up to the external pharynx (1 case) and with premature amniotic fluid outflow of the first fetus (2 cases). The patients received preserving therapy at the hospital and then were transferred to the perinatal center with the clinical signs of threatening abortion, endotoxemia, and moderate inflammatory response, which were treated with efferent therapy in the form of medium-volume membrane plasmapheresis combined with photodilution with ultraviolet and laser beams. There were no complications during efferent therapy. In 1 and 2 observations the pregnancies of women in the perinatal center were prolonged by 45 and 34 days with operative delivery at 27 and 31 weeks, respectively. There were no septic complications in women and children. The newborn premature infants after therapeutic and rehabilitative measures had good prospects for a full life. Conclusion: The efferent therapy methods are safe and, in cases of IVF-infant foetuses with complicated isthmic-cervical insufficiency, are a pathogenetic measure; they help to prolong pregnancy and prevent infectious complications in the mother and fetus.

Population reproduction is a priority task of social policy and a factor of Russias national security. The review presents the stages of recording the perinatal mortality indicator, which is closely related to the frequency of preterm birth. In the first stage, the criteria for registering preterm birth were 28 weeks of pregnancy, and in the second, since 2012, 22 weeks. At both stages, due to underreporting of low birth weight babies (their transfer to the miscarriage group), stillbirths, including full-term babies, prevailed in the preterm birth indicator structure. The authors of the article stressed that the main cause of preterm birth (including iatrogenic) is the formation of endotoxemia syndrome, or systemic effects of aggressive metabolites in the mother placenta fetus system. In this etiopathogenetic therapeutic means are methods of efferent therapy in the form of plasmapheresis, etc. These technologies in many obstetric pathologies (thrombophilia, preeclampsia, Rh-conflict, isthmic-cesmic and chronic placental insufficiency, etc.) sanitize the mother placenta fetus system and allow to prolong pregnancy with a reduction of perinatal mortality index. The authors cite their own data on the use of efferent therapy methods in 102 women presenting at 2228 weeks of pregnancy to the Perinatal Center of Saint Petersburg State Medical University from other institutions after unsuccessful treatment according to the Protocols for various obstetric complications. Pregnancies were prolonged by 215 weeks; all 123 children (20 twins, 1 triplet) were born alive, did not require long-term intensive care, survived and were not disabled. Six newborns died and the perinatal mortality rate was 48 : 1000, which is an order of magnitude lower than that quoted in the literature for similar pathologies and gestational ages. In conclusion of the article, it is suggested that in order to reduce perinatal mortality in Russia, all large institutions should arrange efferent therapy rooms to treat sick pregnant women using the safe, low-cost technologies developed by the authors, using domestic equipment.

This review examines the main aspects of the course of a new coronavirus infection in patients with metabolic syndrome, provides up-to-date statistics on morbidity and mortality. Abdominal obesity, insulin resistance, arterial hypertension and dyslipidemia, which form the metabolic syndrome, are independent factors of a severe course of infection with a high risk of developing SARS, various complications, mainly the development of acute respiratory distress syndrome, extrapulmonary systemic inflammation and, finally, death. During the period of anti-epidemic measures, children turn out to be the most vulnerable in terms of losing the rational, healthy stereotypes of nutrition, regulation of screen time, responsible planning of study time and leisure, regular and intense physical activity. It requires increased attention of doctors, teachers and rehabilitation specialists to the problem maintaining the commitment of children and parents to a healthy lifestyle. Based on the formed concept of the presence of common links in the pathogenesis of the development of metabolic disorders and the infectious process, the authors identified the most significant issues of therapy and rehabilitation of this category of patients. Taking into account the need of patients for psychological adaptation of the past illness and increasing their resistance to stressful situations, within the framework of providing a personalized approach to the management of patients, may require timely diagnosis of anxiety-depressive disorders with the appointment of appropriate therapeutic measures.

The report presents the results of successful treatment of a married couple. A patient with multiple somatic pathology (varicose veins of the lower extremities, cholelithiasis, chronic cholecystitis) had 2 normal births in her first marriage. In the second marriage (the husband of 62 years revealed hypogonadism, cryptozoospermia, retrograde ejaculation) in 2018, ICSI was performed, which ended in an undeveloped pregnancy with curettage of the uterine cavity, in 2019, with the 4th pregnancy (CryoET), cesarean section (CS) at 28th week of pregnancy for chronic placental insufficiency with severe blood flow disorders in the placenta, nonimmune fetal dropsy. The child died on the 7th day of life. In 2020, due to the failure of the postoperative scar on the uterus after cesarean section, laparoscopy, hysteroscopy, and metroplasty were performed. The real, 5th pregnancy occurred after IVF with her husbands sperm taken from post-ejaculatory urine. At 39th week of pregnancy, a planned Сaesarean section was performed, a boy was born at 3710 gr, 52 cm long with an Apgar score of 8/9 points. There was no bleeding during childbirth, the patients postoperative period was smooth. She was discharged home on the 5th day after delivery in a satisfactory condition with normal tests with a baby receiving breastfeeding.

COVID-19 infection usually occurs in children in a mild form, but some of them in a delayed period (one or several weeks after acute infection with COVID-19) may develop a severe inflammatory disease with clinical manifestations similar to toxic shock syndrome (Kawasaki disease), classified as multisystem inflammatory syndrome in children (MISC). It is possible that the syndrome has only a temporary connection with the COVID-19 infection. In the future, new associations of such clinical manifestations with other infectious (or non-infectious) diseases may appear. But currently, all children in the described cohorts with MISC have an association with COVID-19 infection. It is believed that the syndrome is initiated by an excessive adaptive immune response with the formation of autoantibodies. Treatment is based on anti-inflammatory, including steroid therapy, the possible use of intravenous immunoglobulin, aspirin, interleukin 1 and 6 receptor antagonists. The article analyzes current views on Kawasaki-multisystem inflammatory syndrome in children in the delayed period of COVID-19 coronavirus infection in the aspects of diagnosis, pathogenesis, clinical manifestations (with a discussion of foreign and Russian studies) and approaches to therapy and possible prevention, including the possibility of using plasmapheresis in complex therapy.

Background. It is known that the earlier a persons body weight exceeds the normal range, the metabolic disorders associated with obesity will form at an earlier age. The progressive increase in the prevalence of obesity and metabolic syndrome in different countries is primarily associated with the so-called human risk factors, which include: physical inactivity, excessive consumption of food rich in fats and carbohydrates, stress, smoking. In this regard, it is extremely important to regularly monitor the body weight of children and adolescents in order to early identify a tendency to increase body weight for the making recommendations for maintaining weight within the normal range. Aim. To evaluate the frequency of obesity and overweight in children, adolescents and adults from among the residents of St. Petersburg, to conduct a comparative assessment of the data obtained. Materials and methods. The work was attended by students of St. Petersburg schools (children and adolescents) and patients (adults) who are being treated in St. Petersburg State Medical Institution Elizavetinskaya Hospital. The sample was random: when collecting data from children and adolescents, data from one of the classes in each parallel from 4th to 11th grade were taken into account, when collecting data from adults 2 people from each ward of the gastroenterology department of the St. Petersburg State Medical Institution Elizavetinskaya Hospital. Data collection was carried out in the period: AugustDecember 2020. Statistical processing was performed out using the computer software package SPSS 8.0. Estimation of anthropometric parameters (age, body weight, height) and calculation of body mass index (BMI) were performed in 74 children (age 912 years), 137 adolescents (age 1318 years) and 55 adults (mean age 49.12 17.03). Results. An increase in body weight was detected in 6.8% of children (5.4% overweight and 1.4% obese of the 1st degree), 14.6 % of adolescents (11.7% overweight and 2.9% obese of the 1st degree) and 62% of adults (36% overweight, 13% obese of the 1st degree, 7% obese of the 2nd degree, 6% obese of the 3rd degree). During the correlation analysis, it was observed that the proportion of overweight people in the observed age categories increased with age (p 0.05). Conclusions. Overweight and obesity begin to be detected already in children, in a fairly large percentage of cases already occur in adolescents and are observed in more than half of the adults surveyed in St. Petersburg. Therefore, it is necessary to carry out activities among parents of preschoolers and schoolchildren, as well as, if possible, the children themselves, to form motivation to maintain a healthy lifestyle in order to prevent the early development of overweight.

The article presents the medical, scientific, and pedagogical activities of the Honored Scientist of the Russian Federation Albert Vazgenovich Papayan (19362002), Head of the Department of Faculty Pediatrics (19742002), Dean of Foreign Students (19691985), Vice-Rector for International Relations (19992002) of the Leningrad Pediatric Medical Institute, then the St. Petersburg State Pediatric Medical Academy. Professor A.V. Papayan is an outstanding scientist who formed the largest pediatric nephrology school within the walls of the SPbSMA, as the founder of the study of the hemostasis system in kidney diseases in children, as a teacher who brought up several generations of pediatricians and nephrologists, as a doctor who restored the health of thousands of sick children. Professor A.V. Papayan is the author of over 400 scientific papers, including 14 monographs and chapters in 14 manuals. Under the guidance of Professor A.V. Papayan completed and defended 62 dissertations of the Candidate of Medical Sciences, with scientific advice 1 dissertation of the Doctor of Medical Sciences. Honored Scientist of the Russian Federation Albert Vazgenovich Papayan is the pride of the national pediatric science, education and health care. The editorial presents medical, scientific, pedagogical activity academician of the Russian Academy of Medical Sciences, Honored Scientist of the Russian Federation.

BACKGROUND: Perinatal death is the death of the fetus, starting from 22 weeks of pregnancy and in childbirth, as well as the death of a newborn in the first seven days of life. Despite the fact that reducing perinatal losses is one of the most important tasks of contemporary medicine, the level of perinatal mortality in Russia in recent years has been about 7.5 . AIM: The aim of this study was to analyze documentation related to the legal aspects of perinatal loss. MATERIALS AND METHODS: The article analyzes the main federal laws, agency regulations, orders, methodological letters, recommendations, and materials on the Internet concerning the main aspects and questions that most often arise among doctors, as well as postpartum women who have undergone perinatal loss and their family members. RESULTS: The article provides data on: the medical criteria for birth, basic documentation issued in case of stillbirth, the birth of a live child who died in the perinatal period, and the rules for their issuance; the rules and procedure for notifying state bodies in case of perinatal death, the rules for registering a stillborn and a child who died in the first 168 hours of extrauterine life; the types of perinatal death certificate; the rules for conducting a pathological autopsy and the possibility of refusing it; the issues of burial of children who died perinatally; the rules for handling material obtained during termination of pregnancy up to 22 weeks. CONCLUSIONS: The legislative framework was analyzed and answers were given to the most frequently asked questions regarding the legal aspects of perinatal loss.

BACKGROUND: Chronic pain is a common problem that exerts a significant impact on individuals and society as a whole. Pain syndrome is one of the most common explanations for patients need for medical care, and it causes major suffering in humans. Thus far, chronic pain lacks a generally accepted terminology and classification. The review aimed to present the current terminology and classification of chronic pain. MATERIALS AND METHODS: Two independent researchers searched for publications for the period of January 2010 to October 2020 in the databases PubMed, MEDLINE, EMBASE, The Cochrane Library, Google Scholar, and the International Association for the Study of Pain. The last search query was performed on October 25, 2020. The search identified 423 studies, and 397 of them were excluded because they described the pathophysiology and treatment of chronic pain syndromes. The remaining 26 publications formed the basis of this review. RESULTS: The review presents the current terminology and classification of chronic pain, which is defined as pain that lasts for 3 months or more after the underlying pathology is cured. The work presents the description of terms such as chronic primary pain, chronic secondary pain, cancer-associated chronic pain, chronic postoperative or post-traumatic pain, chronic neuropathic pain, chronic secondary cephalgia or orofacial pain, chronic secondary visceral pain, and chronic secondary musculoskeletal pain. Additional characteristics of chronic pain, including the intensity of pain, the severity of suffering, and physical dysfunction, are also given. CONCLUSION: The presented modern terminology and classification of chronic pain will contribute not only to the correct formulation of diagnosis established in a patient with chronic pain but also to the implementation of multimodal analgesia, epidemiological studies and, ultimately, the choice of proper strategy for addressing chronic pain by healthcare organizers. The result is also expected to lead to adequate funding for resolving this intricate problem.

The article is devoted to the research of the development of motor skills of premature babies on the background of medical rehabilitation in an outpatient-polyclinic and the determination of the age standard (scale) for the development of motor skills of premature babies. The research includes 137 premature babies with the gestational age from 26 to 37 weeks, birth weight from 800 to 2600 grams. The main group of the research consisted of 117 premature babies who had already took a part in the early and complex rehabilitation, the control group which consisted 20 children who were included in the research because of a history of prematurity and who applied to the rehabilitation department with already established disabilities (the health status of premature babies in the control group was studied retrospectively). Premature babies in the control group began medical rehabilitation after 6 or more months of life and did not receive it in full. The assessment of the motor skills of premature babies was carried out in dynamics on the monthly basis. Of the 117 premature babies of the main group 2.5% had motor disorders that led to disability, the premature babies of the control group reached disability in 100% of cases. The research of motor development of premature babies revealed that with a delay in applying for medical rehabilitation, even for one day, the integrated indicator of the relative deviation of actual skills development from the standard increases by 0.9%.

Mumps currently is a vaccine-preventable infections. However, mumps still remains an urgent problem all over the world, due to periodic increases in the incidence in older children (including the vaccinated ones against this infection), in adults (the disease often does not go smoothly with involving various organs in the pathological process and systems). The literature describes the various adverse effects of male mumps, including infertility, testicular atrophy, testicular tumors, impotence, gynecomastia, etc. The article provides information on the incidence of mumps in the Russian Federation and St. Petersburg, the clinical manifestation of the infection. It was noted that in adolescent boys and men, the presence of orchitis (orchoepididymitis) is a frequent symptom of the disease. It is shown in the article, that testicular inflammation rate increases with age of patients. A brief description of modern methods of laboratory diagnostics and therapy is given in accordance with clinical recommendations and treatment standards. A clinical case of mumps, combined severe form (mumps + orchoepididymitis), in a 17-year-old boy is presented in this article. The features of the course of the disease, the results of laboratory and instrumental examination and treatment have been analyzed in this item. Conservative therapy (antiviral and antibacterial) of mumps, as well as timely surgical treatment of orchoepididymitis, led to a complete clinical and laboratory recovery of the patient.

One of the trends for ensuring the safe operation of sealed inhabited objects is the creation of hypoxic gas environments, suitable for breathing and reducing the risk of fires. The aim was to test the effect of normobaric hypoxic environments of various compositions on a person, to select envitonments that are potentially applicable to improve fire safety of inhabited sealed objects. Methods. The randomized controlled study involved 60 men aged 20-55 years, divided into 3 groups (20 people each) depending on the composition of the gas environment in which they were kept for 4 hours. The composition of the tested gas environments: No. 1 - oxygen = 1617 %, nitrogen - the rest; No. 2 - oxygen = 14-15 %, nitrogen - the rest; No. 3 - oxygen = 14 %, argon = 35 %, nitrogen - the rest. The functional state of the subjects was assessed using complaint forms, physiological criteria and functional tests. Results. The most pronounced negative changes in subject's functionality were found when the subjects were in the gas environment No. 2, and the most of the indicators showed significant (p < 0.05-0.001) differences compared to other groups. The revealed facts indicate the inadmissibility of using such environments. The stay in gas environments No. 1 and No. 3 was accompanied by comparable and acceptable changes in the functional state of the subjects, despite the significantly lower oxygen content in the argon-containing medium (No. 3). Conclusions. 1. To increase the fire safety of inhabited pressurized objects, it is permissible to use gas environments No. 1 and No. 3. 2. Addition of argon to hypoxic environments reduces the negative effects of oxygen deficiency, which makes it possible to use gas environments with a higher degree of hypoxia and, therefore, more effective for ensuring fire protection of inhabited sealed objects.

The key to shaping the health of the future generation are the start timing of breastfeeding. In a single-center observational study in the Department of physiology of the newborn Perinatal Center, the nature of breastfeeding and problems in breast-feeding in mothers of healthy newborns in the first days after birth were evaluated. An analysis of the promotion and support of breastfeeding in 103 pairs (mother infant) during hospital stay in accordance with WHO recommendations was conducted. Women were polled on socio-demographic issues (age, marital status, education, method of delivery), gestational age of infants, antropometry, Apgar score and infant feeding method. 71% of newborn were exclusively breastfed. Problems with breastfeeding were found in 41.7% of women. The most often meet: hypogalactia (17.48%) and cracked nipples (8.74%). All women received advice on how to eliminate their causes. The importance of providing permanent specialized professional support in breastfeeding to overcome the difficulties of matters after discharge from the hospital has been proved.

Congenital sodium diarrhea (P78.3 according to ICD 10) is a rare autosomal recessive disease, clinically and genetically heterogeneous. The sodium absorption defect is caused by disruption of the intestinal sodium-proton “pump” in the non-syndromic form and in the epithelial sodium channels in the syndromic form. Mutations in 3 genes, SPINT2 (localization 19q13.2; OMIM code 270420) – syndromic form; GUCY2C (localization 12q12.3; OMIM code 601330) and SLC9A3 (localization 5p15.33; OMIM code 616868) – non-syndromic form, can cause congenital sodium diarrhea. The frequency of the disease is unknown, since it is rare, so far only 50 cases have been described. The classic non-syndromic form of congenital sodium diarrhea is manifested by polyhydramnios, severe secretory diarrhea, severe metabolic acidosis, alkaline pH of feces >7.5 and hyponatremia. The syndrome of congenital sodium diarrhea is also manifested by choanal and/or anal atresia, hypertelorism and erosion of the cornea. Typical laboratory data include metabolic acidosis and alkaline pH of feces (fecal pH >7.5), low Na + concentrations. The concentration of Na + in the stool is increased. Prenatal ultrasound diagnosis allows you to identify gidroamnion and expansion of intestinal loops, starting from the third trimester of pregnancy. The diagnosis is confirmed by genetic studies. Treatment: complete parenteral nutrition with correction of water-salt metabolism. The forecast is unfavorable.

The editorial presents medical, scientific, pedagogical activity academician of the USSR Academy of Medical Sciences, Honored Scientist of the RSFSR Mikhail Stepanovich Maslov (18851961). Mikhail Stepanovich Maslov Founder and Head of the Pediatrics Department of the Leningrad pediatric medical Institute (19301961). Academician of the USSR Academy of Medical Sciences Michael Stepanovich Maslov has made a great contribution in the development in domestic pediatrics. The head of the Department of faculty Pediatrics of LPMI, аcademician M.S. Maslov went down in history as a great scientist, one of the founders of the Russian scientific pediatric school, as a teacher who brought up several generations of pediatricians and scientific personnel, as a doctor who restored the health of hundreds of thousands of sick children. Academician M.S.Maslov is the author of more than 200 scientific works, including 16 monographs and 8 textbooks. Under the guidance of academician M.S. Maslov, 36 dissertations of the candidate of medical Sciences were completedand defended, 10 dissertations of doctors of science were prepared with scientific advice. The great scientist, teacher, doctor and public figure Mikhail Stepanovich Maslov is the pride of Russian pediatric science, education and healthcare.

Aim. To assess the results of a perinatal audit of the Northwestern Federal District and to identify opportunities for a decrease in perinatal mortality. Methods. The audit of perinatal loss was conducted in two stages: (1) remote audit audit of perinatal mortality indicators; (2) medical history audit audit of cases of perinatal death of a child based on medical documentation. Held the copy of the data from the 925 medical records for 220 cases of perinatal death. The perinatal audit of the Northwestern Federal District used the Nordic-Baltic perinatal death classification. The following statistical methods were used for statistical data processing: incidence rate of a trait was determined by using frequency tables, the statistical significance of differences was tested by using contingency tables, the Chi-square criterion, along with the Pearson correlation coefficient. The statistical significance of differences in quantitative indicators was assessed by using Student's t-Test. The significance level was set at p 0.05. Results. It was found that in the Northwestern Federal District pregnancy losses III category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) is 27.5%, intranatal losses VI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) 7.4%, the loss of newborns VIIIXI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) 16.9%. Among children who died during the perinatal period, children of gestational age over 28 weeks significantly predominate (p=0.003). In the nosological structure of stillbirth, most of the diseases are associated with respiratory disorders (85.9%), infectious complications are 14.1%. The main causes of death of newborns in the early neonatal period are respiratory disorders 40.0% and infectious diseases specific to the perinatal period 36.0%. The assessment of the sexual prevalence of pregnancy losses did not reveal a statistically significant difference (p=0.29). The assessment of the sexual characteristics of intranatal losses showed that boys significantly predominate (p=0.003). Conclusion. The perinatal audit revealed that, in the Northwestern Federal District, the level of the mobile reserve of perinatal losses associated with managed causes is 51.8%.

The coronavirus pandemic (COVID-19) has become a challenge to higher education worldwide, affecting roughly over 90% of the student community. Due to the pandemic issues, it was essential to adjust the educational process to changing circumstances. Efforts to curb the spread of the disease, including social distancing and self-isolation, have led to the need of initiating a new approach of education and developing effective communications in medical education with the organization of online education from 23.04.2020. The Saint Petersburg state pediatric medical University of the Ministry of health of Russia has adopted the Discord platform for distance learning. Training courses have been organized for physicians working in hospitals that have been sorted out to operate with patients with coronavirus infection using the Moodle platform with access to register and monitor trainees as well. Instructing teachers to work in these Internet scopes required fewest time, which allowed them to switch to distance learning in due time. In order to attest the timeliness and adequacy of the response of the higher medical education system in the context of the COVID-19 pandemic, in this article, the experience of the transfer of the Department of infectious diseases of adults and epidemiology to running educational activities in remote mode. The possibility of conducting online classes not only theoretical, but also practical in the specialties of infectious diseases and epidemiology with students, residents, postgraduates and physicians was demonstrated.

Coronavirus infection (CVI) is a group of acute ubiquitous infectious diseases known since the 60s 19 century. The clinical picture of CVI is characterized by damage to the respiratory system from mild forms of acute respiratory viral infection to the development of a severe acute respiratory syndrome, as well as involvement of other organs in the pathological process of the gastrointestinal tract. For a long time, coronaviruses were not given attention, since it was believed that they were able to cause only mild respiratory diseases. It is known that children and adolescents are less susceptible to infection than adults. In the etiological structure of acute respiratory viral infections among hospitalized children, coronaviruses account for 69%. The introduction of multiplex polymerase chain reaction (PCR) with the inclusion of coronaviruses in practice has shown their role in the occurrence of severe diseases of the lower respiratory tract. Since 2002, outbreaks of coronavirus infection caused by previously unknown pathogens (SARS-CoV, MERS-CoV, SARS-CoV-2) have been observed in the world. New coronaviruses have genetic features and are relatively highly resistant in the environment. The diseases they cause are distinguished by the predominance of severe forms with high mortality due to the development of acute respiratory distress syndrome and sepsis. In December 2019, an outbreak of pneumonia caused by the SARS-CoV-2 virus began in China; in February 2020, the disease was called COVID-2019. In connection with the trend towards the global spread of new infections March 11, 2020, the World Health Organization announced a pandemic. The lecture covers the issues of epidemiology, pathogenesis, clinic, diagnosis and treatment of coronavirus infection, taking into account the emergence of new pathogens.

The objective of the study: evaluation of the effectiveness of clinico-epidemiological and laboratory diagnostics of HIV infection in pediatric practice. Materials and methods. Under the supervision of pediatricians of the Department of motherhood and childhood of the St. Petersburg AIDS Center, there were 388 HIV-infected children aged from one month to 17 years inclusive. Due to the reasons of late detection and HIV dissidence of parents, 18 children (4%) died cumulatively among the children observed in St. Petersburg center for AIDS. The object of the immunohistochemical study was randomly selected HIV-infected children who applied to the center for prevention and control of AIDS for return visits. Material for testing for the presence of HIV-1 P24 antigen was taken from the back wall of the nasopharynx. Results. When analyzing the ways of HIV infection in children registered at the maternity and childhood Department of the Saint Petersburg AIDS Center, it turned out that 363 children were infected perinatally (93,6%), 23 (5,9%) sexually infected and 2 children through injecting drugs (0.5%). The proposed method of immunocytochemistry for the diagnosis of HIV infection in children can find its application, especially for primary diagnostics, which may simplify and reduce the cost of laboratory diagnostics.

The aim of the study is to compare the results of using innovative normobaric hypoxic training to increase individual's resistance to exogenous hypothermia. Methods: This randomized controlled trial was performed using two groups of men aged 22-34 years. Group 1 (n=9) was exposed to argon-hypoxic training consisting of a 2-hour continuous stay of the test subjects in a gas environment with the composition: Ar 33 % vol., 02 12 % vol., N2 55 %. Group 2 (n=9) was exposed to a normobaric hypoxic training: a 2-hour continuous stay in a nitrogen-containing gas environment, the oxygen content of which decreased from 17 % vol. (1st session) up to 13 % vol. (5th session), after which the composition of the gas environment was not changed. The total number of sessions- 20 conducted daily or after 1-2 days. Training schedules were identical in the two groups. Hypothermic resistance of the subjects was evaluated using 3-minute standard aerocryothermic tests. The activity of the mechanisms of nonspecific protection of the subjects was evaluated by the indicator of serum fibronectin. Results: An improved resistance to hypothermia was observed in both groups. The changes were more pronounced in Group 1. So, with the best subjective resistance to hypothermia exposures in group 1 (p = 0.010-0.014), rectal temperature decrease (p = 0.019) was significantly greater in group 1 than in group 2. Hypereactivity of systemic circulation indicators decreased in Group 1 to a greater extent (p = 0.010-0.038). In addition, with a significant increase in the level of fibronectin in both groups, these changes were significantly (p = 0.014) more pronounced in Group 1. Conclusions: Normobaric hypoxic training in the original regime is a safe and effective method of increasing human resistance to hypothermia. The effectiveness of this method can be improved by conducting argon-hypoxic training developed by the authors.

Objective. Assessing the relationship between health indicators in infants born with intrauterine growth retardation (JGR) of hypoplastic type of mild severity among themselves, compared with infants born without IGR, and with practically healthy infants from practically healthy mothers. Materials and methods. Under the supervision were 109 infants. From mothers with a burdened somatic and obstetric-gynecological history, 84 children were born: 15 (gr. 1) – with mild of hypo-plastic type IGR, 69 (gr. 2) – without IGR. The control group (gr. 3) consisted of 25 healthy children born to healthy mothers. All observed babies were born full-term. They were examined in dynamics at the age of 1 ( n = 104), 3 ( n = 98), 6 ( n = 92), 12 ( n = 94) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of electrocar-diography and cardiointervalography. Distribution-free statistical analysis methods. Results. A correlation was found at 2–3 days between weight and body length ( r = 0.63), body weight and stress index ( r = –0.56), sympathetic activity and stress index ( r = 0.84), intraatrial and atrioventricular conductivity ( r = 0.64); at 1 month between sympathetic activity and stress index ( r = 0.62); at 3 months between weight and body length ( r = 0.79), sympathetic activity and stress index ( r = 0.87), sympathetic activity and intraventricular conduction ( r = 0.67), intraatrial and atrioventricular conduction ( r = 0.71); at 6 months between weight and body length ( r = 0.81), body weight and intraatrial conduction ( r = 0.65), body weight and electric systole ( r = –0.58), sympathetic activity and stress index ( r = 0.92); at 12 months between body length and intraatrial ( r = 0.74), body length and atrioventricular conduction ( r = 0.76), sympathetic activity and stress index ( r = 0.94), sympathetic activity and electrical systole ( r = –0.71), stress index and intraventricular conduction ( r = 0.68), stress index and electric systole ( r = –0.69), intraatrial and stress index ( r = 0.9), atrioventricular conduction and electric systole ( r = 0.63). Conclusions. The revealed correlation communications between of some studied parameters allow doctors to allocate groups of dispensary observation, to diagnose changes at early stages of the pathological process, conduct correctional actions with assessment of their efficiency.

According to the World Health Organization (WHO), viral diseases form serious public health problem. WHO announced that the disease caused by the new virus named coronavirus disease 2019 or Coronavirus disease 2019 (COVID-19), and the virus causing the infection was named SARS-Cov-2 by the International Committee on Taxonomy of Viruses. Children usually have asymptomatic or mild forms. However, children with comorbidity are in risk of developing severe forms of COVID-19. The review presents modern ideas about the amount of laboratory tests in cases of suspected presence of the SARS-CoV-2 virus, methods of radio diagnostic (computer tomography, x-ray, thorax ultrasound), features of the clinical course of infection in children depending on the severity of the of infection and indicated detailed criteria for severe forms of coronavirus infection. Special attention is focused on the clinical monitoring of children in a non-core hospital: the detection of leukopenia and lymphopenia, CRP level control, monitoring of coagulation disorders, providing tests on other respiratory viruses. Specific recommendations, comprehensive to date, on the use of drugs for the treatment of children with COVID-19 upon admission to a non-core hospital are given. The organisational issues of treatment children infected with COVID-19 in a non-core hospital are described in details. Special attention is focused on the compliance of strict safety rules by staff working with infected patients entering and leaving the Red zone. Thus, the proper organisation of the units for the treatment of children infected with COVID-19 in a non-core hospital, taking into account the features of their disease, will make it possible to provide complete and high-quality treatment of infection during the pandemic.

Objective. Establish the relationship between the action of antiangiogenic factors sFLT-1 and endoglin, as well as marinobufagenin in the formation of symptoms of preeclampsia in the clinic and experiment. Materials and methods. In the first experimental phase, preeclampsia-like state was simulated in pregnant rats, the changes in the content of substances reflected in the target tissues were studied, as well as the effect on their concentrations of anti-marinobufagenin antibodies. In the second (clinical) phase, changes in the content of sFlt-1 and endoglin-1 in placental tissues, as well as marinobufagenin in blood plasma and activity of Na+/K+-ATPase of erythrocytes in pregnant women with preeclampsia were studied. Results. In rats, an increase in systolic blood pressure, and marinobufagenin plasma levels was observed during the formation of a preeclampsia-like condition. Administration of antibodies to marinobufagenin caused a decrease in blood pressure. Found that during the formation of a preeclampsia-like condition, there is an increase in the content of sFlt-1 in the placenta and thoracic aorta and endoglin in the placenta. In patients with preeclampsia, it was found that the increase in blood pressure occurs against the background of an increase in the content of marinobufagenin in blood plasma, as well as a decrease in the activity of Na+/K+-ATPase of erythrocytes. The formation of preeclampsia is accompanied by a significant increase in the level of antiangiogenic factors endoglin and sFlt-1 in the placenta. Summary. In patients with preeclampsia, the development of clinical symptoms is accompanied by an increase in the placental tissues of the content of antiangiogenic factors endoglin and sFlt-1 and the content of marinobufagenin in blood plasma. The obtained data are confirmed by the results of an experiment performed on pregnant rats with modeling of preeclampsia-like condition.

Objective. To study the pathogenesis of clinical and laboratory syndromes of preeclampsia-like condition and the possibility of influencing them through the introduction of specific antibodies to marinobufagenin. Materials and methods. 36 pregnant rats were used in the experiment. 24 rats from 12 to 19 days of pregnancy were prescribed a 1,8% NaCl solution to simulate a preeclampsia-like condition. Subsequently, this sample was divided into 2 groups. In one group (12 animals, the second group), preimmune rabbit serum was administered intraperitoneally as an immune agent. In another group (12 animals, the third group), a single intraperitoneal administration of polyclonal anti-marinobufagenin antibodies was performed. After the antibody injection, a comprehensive clinical and laboratory evaluation was performed. Results. Against the background of a hypersol diet, an increase in systolic blood pressure was found, as well as the concentration of marinobufagenin in blood plasma. The introduction of antibodies to marinobufagenin caused a decrease in blood pressure. In addition, the formation of a preeclampsia-like condition showed an increase in endoglin and sFlt1 in the placenta, as well as an increase in sFlt1, collagen-1 and a decrease in Fli-1 in the thoracic aorta. The appointment of antibodies to marinobufagenin led to an increase in the content of Fli-1 to the level in the control group. Summary. In the formation of a preeclampsia-like condition, an increase in the level of marinobufagenin in blood plasma leads to an increase in the content of antiangiogenic factors in the placenta and in the thoracic aorta. Intraperitoneal administration of antibodies to marinobufagenin contributes to a significant increase in the content of Fli-1.

Objective. To assess the length of the body in infants from mothers with a burdened somatic and obstetric-gynecological history, including with a delay in the growth of the fetus of various types of mild severity, in comparison with each other, with healthy children from practically healthy mothers and with children from mothers with an aggravated somatic and obstetric-gynecological history, but without delayed fetal growth. Material and methods. 166 new-borns were monitored since birth, including 72 infants born after abnormal pregnancies with mild foetus growth and development retardation (gr. 1), and 69 infants born after abnormal pregnancies, but without any retardation (gr. 2), born by mothers with previous somatic and gynaecological disorders. The symmetrical intrauterine growth and development retardation was diagnosed in 15 infants (20.83%) (subgr. 1b), whereas the dissymmetric retardation was diagnosed in 57 children (79.17%) (subgr. 1a) from gr. 1. Practically healthy infants born by practically healthy mothers after normal pregnancies made up gr. 3 (25 subjects). Children are full-term, looked round in 1 (154), 3 (138), 6 (131), 12 (119 children) months. Comprehensive analysis of history, inspection, body height. Distribution-free statistical analysis methods. Results. The differences (p 0.01) in body length (Me, cm) in children at birth between the subgr. 1b (48) and gr. 2 (52); in 1 month between subgr. 1a (53) and 1b (52.5); in 3 months between subgr. 1a (60) and gr. 2 (62); in 6 months between subgr. 1a (66.5) and 1b (65.5); in 12 months between subgr. 1a (74.25) and 1b (73), subgr. 1a and gr. 2 (76), subgr. 1b and gr. 2. Increase of body length to 1 month in children subgr. 1a (4) and 1b (4.5) in comparison with children gr. 2 and 3 by 1 and 1.5 cm respectively more; to 3 months in children subgr. 1a (7) and gr. 2 (7) are comparable and more than children subgr. 1b. by 0.5 cm, gr. 3 by 1 and 0.5 cm respectively; to 6 months in children subgr. 1a (6.5) and 1b (6.5) more than the gr. 2 by 0.5 cm, less than the children gr. 3 by 0.5 cm; to 12 months in children subgr. 1a and 1b; gr. 1, 2 and 3 are comparable. To 12 months in children subgr. 1b in relation to children gr. 2 and 3 less by 0.5 cm. Conclusion. The established difference in body-length should be taken into account during the dispensary observation in order to decide whether to carry out corrective measures.

In the article presents data on the management of a 48-year-old patient with HIV infection, urogenital infection with pregnancy, which occurred as a result of IVF, with premature effusion of amniotic fluid at 23 weeks of pregnancy with the syndrome of growth retardation of 2 fetus in monochoric diamniotic twins. After the discharge of the amniotic fluid, the patient was treated for six days in an infectious hospital, then transferred to the perinatal center, where blood tests noted moderatemanifestations of endotoxicosis, increased levels of aminotransferases and an inflammatory reaction of the body. The course of treatment included detoxification methods (plasmapheresis, hemosorption, photomodification of blood with ultraviolet, laser rays), which contributed to the normalization of blood tests, prolongation of pregnancy for another three weeks in the absence of septic complications after operative childbirth in the mother and in newborn girls. At birth, 1 childs weight, body length and Apgar score were 750 g., 29 sm. and3/5points, respectively, in 2 children 590 g., 30 sm. and1/3points, respectively. The children required treatment from resuscitators, at the second stage of nursing, from rehabilitation specialists.

An important role in the normal development of the fetus and the successful outcome of pregnancy is played by the state of health of pregnant women. One of the significant factors of perinatal risk is anemia of pregnant women. In order to assess the level and dynamics of the incidence of anemia in pregnant women, official statistical reports and publications of the Federal State Statistics Service for 2005-2017 and Central Research Institute for Organization and Informatization of Health of the Ministry of Health of the Russian Federation for 2012-2018 were analyzed. Using a trend analysis using a trend method, a prognosis was made for the incidence of anemia in pregnant women up to 2021 in the Russian Federation as a whole and separately in the North-West Federal District. In order to assess the impact of the predictor “anemia of pregnant women” on the infant mortality rate, data from primary medical documentation was copied to 250 children who died before the age of 1 year in the North-West Federal District. It has been established that the incidence of anemia in pregnant women in the North-West Federal District significantly exceeds the average level in the Russian Federation. Provided that factors affecting the course of pregnancy remain unchanged, the incidence of anemia in pregnant women by 2021 on average in the Russian Federation will decrease to 32.2% of the number of women who have completed pregnancy, and in the North-West Federal District will increase to 37.5%. During pregnancy, the incidence of anemia in women whose child died before the age of 1 year in the North-West Federal District amounted to 44.16 ± 0.39% of the number of women who completed the pregnancy, which significantly exceeded the average figure in the district, which in 2017 was equal to 35.90 ± 0.35% (p < 0.05). A direct correlation has been established between the predictor “anemia in pregnant women” and the infant mortality rate.

The aim of the study was to determine the capabilities of magnetic resonance morphometry and diffusion tensor imaging in the diagnosis of bilateral spastic forms of cerebral palsy in children. The main groups were 33 children aged from 1 year to 4 years 5 months. with bilateral spastic forms of cerebral palsy, the comparison group – 11 children who did not have movement disorders. The patients underwent magnetic resonance morphometry, diffusion tensor imaging. A comparison was made between the volumes of brain structures and diffusion values between groups. Significant differences (p < 0,05) were found in the volumes of the right lateral, 3rd ventricles, white matter, thalamuses, globus pallidus, putamen, hippocampus. Significant differences (p < 0,05) in diffusion values in the thalamuses and in the posterior limb of internal capsules were also identified. The correlation of the identified changes with the clinic of the disease was demonstrated. The obtained data demonstrate wide possibilities and high diagnostic value in the detection of bilateral spastic forms of cerebral palsy in children.

The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.

Insulin-like growth factor is one of the regulators of fetal growth in the intrauterine period, and is responsible for its further development. Purpose. To study postnatal growth in relation to insulin-like growth factor-1 and somatotropic hormonelevels in infants born to obese mothers. Materials and methods. The prospective study included 18 children (16 full-term and 2 premature infants of gestational age 31-35 weeks) born to mothers who were obese before pregnancy (group 1) and 18 children (17 full-term and 1 premature baby of gestational age 34 weeks) from mothers with normal body mass index before pregnancy. Weight and height were estimated at birth, at 3 and 6 months. Serum levels of insulin-like growth factor-1 and somatotropic hormonewere determined by ELISA at birth in umbilical cord blood at 3, 6 and 12 months. Results. During the neonatal period, at 3 and 6 months, height and weight did not have significant differences in both groups. At the age of 1 year in group 1 weight and height were higher than in group 2 (p < 0.05). Indicators of insulin-like growth factor-1 (128.71 ± 74.29 and 21.33 ± 15.21 ) and somatotropic hormone (4.3 ± 1.5 and 1.84 ± 0.36) was also higher in children of group 1 aged 1 year. Conclusion. Changes in the somatotropic hormone – insulin-like growth factor-1 axis in children born to obese mothers may form the basis of metabolic syndrome in the future.

Due to development of new methods for the treatment of Duchenne muscular dystrophy (DMD), aimed at suppressing inflammatory activity in skeletal muscles, there is a necessity for objective instrumental methods for assessing the effectiveness of the therapy. This method could be selective excitation of the water T2 signal. Aim of the study: to determine the possibility of applying the method of selective excitation of water T2 signal as a quantitative biomarker of the effectiveness of steroid treatment in patients with DMD at different stages of the disease. The study involved 34 DMD boys, who were divided into three groups: ambulant patients taking steroid treatment (n = 14), steroid-naive ambulant patients (n = 10), steroid-naive non-ambulant patients (n = 10) and a control group (n = 10). MRI of the pelvic girdle, thighs and lower legs with multi-slice-multi-echo (MSME) sequences has been done for all subjects. Calculation of the water T2 values has been done by the three-exponential method. Results: There was a significant difference (p 0.01) between the three study groups, the highest inflammatory activity was determined in the steroid-naive patients and signal intensity was 39.4 1.0 ms for the pelvic girdle muscles, 37.3 1.1 ms for the thighs muscles and 38.1 1.8 ms for the legs muscles. Thus, using of the technique of selectively determination of the signal from water on T2 weighted images can be quantitative biomarker of inflammatory activity and the effectiveness of steroid treatment in patients with Duchenne muscular dystrophy in different stages

Improving the cardiopulmonary resuscitation quality in the delivery room is one of the most pressing issues in modern neonatology. Despite the fact that in recent years the number of surviving infants with low and extremely low birth weight has been steadily increasing, the nursing outcome is not enough favourable with unsatisfying quality of life. The cardiopulmonary resuscitation protocols have been regularly updated and upgraded (every five years in the last twenty years). This helps to improve resuscitation outcome. In 2015 the American Heart Association and the European Resuscitation Council issued the new edition of the guidelines on basic and advanced cardiopulmonary resuscitation in children, including infants. The guidelines are believed to improve the quality of resuscitation care in the delivery room and to contribute to a better neurological outcome.

Objective. To estimate adaptation of an organism of the babies born with different types of light severity of a delay of pre-natal growth and development. Material and methods. 609 children are examined. Since the birth under observation 141 children, from them are born in the result of the complicated pregnancy and childbirth, including with asymmetric type of light severity of a growth inhibition and development of a fruit – 57 (Group 1a) and with symmetric – 15 (Group 1b) and without that – 69 (Group 2) from mothers with the burdened somatic and obstetric and gynecologic anamnesis. Children are full-term, mature, looked round in 1 (131), 3 (118), 6 (109), 12 (110 children) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of cardiointervalography and body adaptation to the environment. Distribution-free statistical analysis methods. Results. At children in Groups 1a and 1b satisfactory adaptation of an organism to conditions of the environment took place at the birth of 28. 07 and 26. 67%, in 1 month of 32. 69 and 35. 71%, in 3 months of 31. 11 and 25%, in 6 months of 51. 16 and 46. 15%, in 12 months of 48. 78 and 36. 36%. Tension and an overstrain of adaptation is recorded at 22. 81 and 40%, 36. 54 and 28. 57%, 33. 33 and 41. 67%, 30. 23 and 23. 04%, 19. 51 and 18. 18%. Unsatisfactory adaptation is defined at 42. 11 and 13. 33%, 21. 15 and 21. 43%, 24. 44 and 16. 67%, 11. 63 and 23. 04%, 21. 95 and 18. 18%. Failure of adaptation is revealed at 7. 02 and 20%, 9. 62 and 14. 29%, 11. 11 and 16. 67%, 6. 98 and 7. 69%, 9. 76 and 9. 09% of children respectively. Conclusion. Study of characteristics of body adaptation to the environment in the scientific community is a perspective area, and any practical application (starting with perinatal centres) of assessment of body adaptation to the environment with follow-up groups identification and further determination during critical periods of growth and development (outpatient monitoring) justify patient-specific approach to outpatient follow-up of infants born with different types of mild intrauterine growth and development retardation.

The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.

Aim. To determine the content of heat shock proteins with molecular weight 70 kDa (HSP 70) and antibo dies to them in blood and nasal secretion in patients with allergic rhinites and infectious rhinosinusites of different etiology. Materials and methods. The paper presents the results of examination of 10 patients with allergic rhinitis and 30 patients, infected with rhinosinusites(the age range 25–35 years). The patients with infectious rhinosinusites were divided into 3 groups according to nosologic form of disease. The control group included 10 practically healthy persons in the ratio, comparable by their gender and age with sick persons. Results.The analysis showed that in the nasal secretion of all patients, HSP 70 level significantly raised compared to the control. Maximum values were registered in patients with bacterial rhinosinusitis and were higher than in patients with viral and fungous ones by 1.9 times (p = 0.015) and 2.9 times (p = 0.001), respectively. In blood serum, HSP 70 concentration compared with the control increased in patients with allergic rhinitis and bacterial rhinosinusitis by 103.67 % (p = 0.015) and 32.11 % (p = 0.049), respectively; these values in the last two groups exceeded the latter in patients with fungous RS by 2.37 times (p = 0.01) and by 1.54 times (p = 0.035). Conclusions. It was detected that in the group of patients with allergic rhinitis and chronic bacterial rhinosinusitis in the nasal secretion and blood serum, HSP 70 values were the highest. In the nasal secretion, HSP 70 level was higher than in blood. The amount of autoantibodies to HSP 70 in blood grew in allergic rhinitis, fungous and viral forms of rhinosinusites that reflects the immunological effect of chaperone proteins.

This article contents the results of computed tomography with intravenous bolus contrast media administration data analysis in children with transposition and congenitally corrected transposition of the great arteries with the consequental performing of the multiplanar heart-axis-oriented reformations. Among 148 examined children transposition of great arteries was detected in 13 patients (9 boys and 4 girls aged 1-144 day of life); congenitally corrected transposition was found in 4 cases of children aged from 6 months to 15 years and 6 months (2 boys and 2 girls). In this article comprehensive anatomical criteria of each heart chamber morphology are presented and reformations where these criteria can be seen are shown. Also in the article is given comparative characterization of heart and great arteries structures in transposition and congenitally corrected transposition in every certain heart-axis-oriented reformation. By the results of consequently performed heart-axis-oriented reformations data analysis the peculiar anatomical signs of transposition and congenitally corrected transposition are determined. The results of data analysis show that from the list of offered reformations the peculiar anatomical signs of both kinds of transposition are significantly determined in long-axis of right ventricle inflow tract reformation, left heart chambers reformation, supply ventricle division reformation, short-axis reformation at the level of great arteries. Computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for planning of surgical treatment in congenital heart diseases.

Congenital disorders of glycosylation (CDG) is a genetically heterogeneous and clinically polymorphic group of diseases caused by defects in various enzymes, the synthesis and processing of N-linked glycans or oligosaccharides into glycoproteins. Approximately half of all proteins expressed in cells are glycosylated to achieve their full functionality. Basically there are 2 variants of glycosylation: N-glycosylation and O-glycosylation. N-glycans are bound to the amide group of aspartine, whereas O-glycans are bonded to the hydroxyl group of serine or threonine. Synthesis of N-glycans occurs in 3 stages: the formation of nucleotide-linked sugars, assembly (in the cytosol and endoplasmic reticulum) and treatment (in the Golgi apparatus). Synthesis of O-glycans occurs mainly in the Golgi apparatus. The most frequently identified types of CDG are associated with a defect in the N-glycosylation pathway. CDGs are typically multisystem disorders with varying clinical manifestations such as hepatomegaly, cholestasis, liver failure, developmental delay, hypotonia, convulsions, facial dysmorphism and gastrointestinal disorders. Also histological findings showed liver fibrosis, malformation of the ducts, cirrhosis, and steatosis. CDGs typically present in the first months of life, and about 20% of patients do not survive to 5 years. The first line of CDG screening is based on the analysis of N-glycosylation of transf ferin. Exome sequencing or targeted gene panel is used for diagnosis. Several CDG subtypes are amenable to teraphy with mannose and galactose.

Development context of scientific thought in the early 20 century let us see the origins of many ideas, that became fundamental in Russian philosophical anthropology. Ukhtomsky’s theory about dominant – the one of the most important in the psycho-physiological development of the 20th century. His ideas useful not only for theoretical physiology, anthropology, psychology, but also in practice, for labor, science and creative activity optimization. Dominant principle – is not only the main way of brain centers cooperation, but also all nervous system and body as a whole. It gives an opportunity to learn the contradictory and hard structure of human behavior, of a moral and creative person components, describes way of human attitude to the external environment as an active, not passive observer. Dominant connects rather elements in a single unit, moving in one direction, and present not only in physiology, but also in psychic experience, literature and art. In the philosophical-ethical attitude A.A. Ukhtomsky was developing the conception of “dominant on the other face”. It addresses on original person, see Interlocutor in his identity and uniqueness. The concept of morality of A.A. Ukhtomsky is based on the definitions of “honored interlocutor” and “double”. Deserve the Interlocutor – means to see in him something bigger, than own reflection. In the science work of A.A. Ukhtomsky we see systematic approach to the study of physiological discoveries and solving real-life problems. In an effort to understand, what a person is, how his mental development takes place, he doesn’t only makes actual discoveries, but also try to give them general scientific significance, to enter them into the general scientific system of knowledge. The systematic scientific approach is particularly relevant at the present time, when the amount of various information is growing exponentially, and the general concept of scientific knowledge, which allows to combine work in various fields of science, doesn’t exist. In our opinion, its base can give us the A.A. Ukhtomsky’s dominant principle.

Infants with severe and moderate bronchopulmonary dysplasia (BPD) are characterized by long-term persistence of apnea of prematurity and often have a pulmonary hypertension (PH). Respiratory pauses, accompanied by intermittent hypoxia, do not clinically manifest themselves, therefore cardiorespiratory monitoring (CRM) is required. We hypothesized that the persistent of apnea, as the cause of hypoxemia episodes, may be associated with the persistence of PH in infants with BPD. The aim of the study was to evaluate the dynamics of cardiorespiratory parameters and to study the relationship between obstructive apnea and PH during the first year of life of premature infants with BPD + PH. Materials and methods. CRM was performed in 58 infants were born at 26 0/7-31 0/7 weeks gestation and with birth weight less than 1500 grams, before discharge from the hospital (35-44 weeks of post menstrual age). 14 infants did not have BPD (group without BPD). 44 infants had BPD and 17 of them had a complication of this disease PH (BLD + PH group). Other infants with BPD did not have PH (BLD-PH group). Eight infants with BPD also underwent a study at home (aged 9 to 10 months of life). Results. Preterm infants with BPD + PH were more significant decrease in the average SpO2, higher desaturation index and more a number of desaturation episodes of 1/hour is higher in the group BPD+LH.

The paper portrays the elaboration and characters of digital hardware and software complex targeted at automatic forming, registration and processing of biomedical object images for non-invasive diagnostics based upon digital microscopy and endoscopia. Digital hardware and software complex is collecting, preliminary analyzing and compressing video-information for transmission along telecommunication channels. Complexes of this kind may serve as a basis for elaboration and introduction of new prospective medical technologies like visual and digital databases for education programs and atlases for discrimination of pathological cells and states. For a starter an aggregation of clinical and laboratory diagnostics systems has been chosen utilizing images from the outputs of digital microvisual and endoscopical systems for elaboration of optical digital diagnostics complexes. Microvisional digital multispectral analysis system ensures forming and visualization of biological tissues’ and medical slides’ microimages. The videoendoscopic system is intended for endoscopic examination of gastrointestinal tract with forming and visualization of endoscopic images, documenting and archiving of data. This system is networked according to TCP/IP protocol. The microvisional and vi deoendoscopic systems grant distant access to images and control functions for remote users from local networks or through WEB-interface.

The paper presents results of some analyzed statistical indicators of infant mortality and stillbirth in the North-Western Federal District of Russia. The following indicators are considered: availability of medical personnel and inpatient beds, morbidity of pregnant women, the number of abortions, as well as some socio-economic indicators. The negative correlation between infant mortality rate in the region and availability of obstetricians-gynecologists, pediatricians, neonatologists was revealed. Stillbirth rates in the region were found to be related to the provision of pregnant pathology beds, to the proportion of these beds in the total number of obstetric beds, to provision of the population with obstetricians and gynecologists. In addition, both factors are equally dependent on such index of work of women's family planning counseling services as the number of abortions per 100 live and stillbirths. A comparative analysis of the pregnant women morbidity, together with the investigated medical care provision in the region, emphasized the effective organization of the child protection and child delivery service activity in the North-Western Federal District, on the one hand. On the other hand, it determined that, in the search for a reserve of reducing fetal and infantile losses in North-Western Federal District, the priority area is a differentiated study of the pregnant women morbidity aimed at developing an appropriate comprehensive prevention program to reduce of the pregnant women morbidity.

Because of the necessity of objective instrumental methods for assessing the state of skeletal musculature in patients with Duchenne muscular dystrophy, the aim of our work was to evaluate the correlation between manual methods of assessment of the muscle strength and the results of magnetic resonance imaging (MRI) of the skeletal muscles of lower limbs. We have examined 15 corticosteroid-naive patients with Duchenne muscular dystrophy. Patients were divided into 2 groups: ambulant patients (average age 8.1 years) and non-ambulant patients (mean age 12.7 years). Muscle strength of lower extremities of all patients has been evaluated by Medical Research Council scale and MRI of skeletal muscles of the pelvic girdle, thighs and lower legs has been performed. The following results have been obtained: ambulant patients have been characterized by a high correlation of MRC scale and MRI of the lower extremities in the evaluation of the pelvic girdle and thighs muscles and the total score (pelvic girdle, thighs and lower legs) and salient correlation in the evaluation of the lower legs muscles. Non-ambulant patients have been characterized by moderate correlation in the evaluation of pelvic girdle and thighs muscles, as well as the total score of lower limbs. There was no correlation between MRC and MRI results in the muscles of the lower legs. Magnetic resonance tomography is able to reliably estimate the degree of fatty infiltration in Duchenne muscular dystrophy and is the method of choice in the diagnosis and evaluation of the severity of this disease.

Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and development of severe neurological disorders that determine the quality of life of these children. In developed countries, the frequency of detection of hypoxic-ischemic encephalopathy (HIE) among full-term newborns is 1-6 per 1.000 live births. In our country, hypoxic-ischemic brain damage is observed in 15-30% of full-term newborns. The term HIE is a clinical diagnosis combining neurological disorders and biochemical changes caused by perinatal HI (hypoxiа-ischemia). The pattern of acute brain damage depends on the degree of cerebral maturity, the severity and duration of hypoxiа-ischemia. The most vulnerable regions are the structures of the brain with high level of metabolism. Such structures in term infants include cortical neurons and neurons of basal nuclei, a subcortical white matter. MRI allows to diagnose brain lesions in term infants in the acute period of HIE. Safety, non-invasiveness and large diagnostic capabilities of MRI allow this method to be considered the gold standard of neuroimaging in neonatology. In this review we described the main MRI patterns of brain injury in term neonates following HIE.

The article describes the main historical periods of the study of hemorrhagic disease of newborns. Clinical observations, describing bleeding of newborns, which occurs without visible damage, known since the seventeenth century and are found in the works of Francois Mauriceau and Georg Wolfgang Wedel. The role of the liver injury in the development of bleeding of infants noticed English physicians John Huxham (1672-1768) and John Cheyne (1777-1836). In 1871 Ludwig Grandidier conducted differential diagnosis between umbilical bleeding of neonates and the hemophilia clinic. Later I.P. Pavlov showed, that the clotting time of dog’s blood significantly prolongs when you turn off the liver from the blood circulation. In that way, partly began to understand the etiology of hemorrhagic syndrome, but the pathogenesis of this suffering, in diseases of the liver remained unknown. Charles Wendell Townsend in 1894, describing 50 cases of coagulopathy of newborns, at the first time paid attention to the connection between breastfeeding and development of bleeding and offered to call this nosological form as "hemorrhagic disease of newborns". In the late 20s of the last century Henrik Dam have identified the unknown substances from green lucerne leaves and described them as the fat-soluble vitamin K (coagulation). In 1943 H. Dam and E. Doisy received the Nobel prize for the discovery and establishment of the chemical structure of vitamin K. In 1943, a group of Soviet biochemists have synthesized a water-soluble analogue of vitamin K (K3, vicasolum), quickly introduced into clinical practice and showed their high efficiency in patients with hypovitaminosis K. In 1945 Yu.F. Dombrovskaya suggested that haemorrhagic disease of newborns caused by deficit of vitamin K. Further researching of the development of haemorrhagic disease of newborns is associated with the study of the biochemistry of the pathogenesis of the disease, identify its various forms and development of treatment techniques and prevention, depending on the identified features.

The aim of the study was an assessment of risk of long-term adverse health effects for research volunteers caused by their preceding continuous (for 60 days) stay in normobaric argon containing hypoxic gaseous environment (ArHGE) with oxygen content of 14 %, argon - 30-35 %, carbon dioxide - 0.03-0.8 %, nitrogen - the rest. Such environment is planned to create at manned hermetically sealed facilities to increase their fire explosion safety. 6 man aged 26-52 who had taken part in the above mentioned tests were examined, and then, 10 months after the end of the tests they were examined again for possible development of long-term adverse health effects, functional state and capability caused by stay in ArHGE. The study has revealed that within 10 months after the tests none of the examined persons has shown any distress of physical and mental health, unacceptable reduction in a quality of life, physiological and psycho-physiological reserves of the organism, physical and mental (including operating) capability. The obtained results confirm feasibility and safety for a human in creation such environment in inhabited hermetically sealed facilities to increase their fire explosion safety.