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Diabetic ketoacidosis (DKA) is the main cause of death and disability in children with type I diabetes mellitus (T1DM). Children’s mortality from T1DM reaches 1% in developed countries and 13% in developing countries. The main cause of death in DKA is cerebral edema, clinical manifestations of which develop in 0.5–0.9% of children with DKA, while mortality riches 24%.Objective. Developing recommendations to prevent life-threatening complications of children with DKA using analysis of literature data and consolidated opinion of experts on the issues of intensive care in children with T1DM.Materials and methods. We analyzed and discussed studies in diagnosis and treatment of DKA in children with type 1 diabetes and 1200 literature sources since January 1970, published in Russian peer-reviewed scientific journals and international publications presented in the online repository Medline (Pubmed). The search for publications was carried out using the keywords: «children», «DKA», «DM1», «dehydration», «cerebral edema».Results. We considered issues of epidemiology, pathogenesis, clinical manifestations, diagnosis, intensive care for DKA, as well as clinical and diagnosis, treatment, prevention of cerebral edema issues in children. Limitations of the study were the small number of modern studies with a high level of evidence (randomized controlled trials, meta-analyses) over the past 5 years on DKA in children.Conclusion. Taking into account the national and international experience, joint recommendations on a consensus format were developed and formulated for the diagnosis of DKA, its leading complications and treatment recommendations for children with T1DM and DKA. Timely and accurate diagnosis of DKA, intensive therapy options based on proven therapeutic efficacy, laboratory and clinical monitoring are warranted to interrupt the DKA pathogenesis, prevent the development of life-threatening conditions, and improve treatment outcomes for children with DKA.

Currently, the number of publications on specific features of the clinical course and outcomes of new coronavirus infection COVID-19 in children is steadily increasing, but there are practically no works demonstrating the effectiveness of intensive care interventions, which served as the basis for the present analysis.The objective is to assess the effectiveness of primary intensive care interventions in children with a severe course of new coronavirus infection.Subjects and Methods. 94 patients were examined. Evaluation of intensive care measures was carried out upon admission to ICU.Results. It was found that corticosteroids were used only in 55 (58.5%) patients (χ2 = 5.254, p = 0.022, Pearson conjugation criterion = 0.130). A moderate correlation was established between the unjustified prescription of prednisolone and the unfavorable disease outcome (χ2 = 27.98, p < 0.001, Pearson conjugation criterion = 0.296). The moderate strength of the association between the prescription of antibacterial drugs and the disease outcome was noted (χ2 = 34.01, p < 0.001, Pearson conjugation criterion = 0.331). In all lethal cases, there was volume overload due to excessive intravenous fluid administration (χ2 = 5.14, p = 0.024).Conclusion: individual therapeutic strategies do not have a direct significant impact on outcomes of new coronavirus infection in children, however, the delivery of comprehensive intensive care presented in clinical guidelines is associated with the patient's recovery.

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities.The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children.Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes.Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points.Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5.

The study objective is to evaluate the effectiveness and safety of the original and non-original sevoflurane during urological operations in children.Materials and methods. Patients of urological profile 3—6 years old without comorbid pathology underwent surgery lasting no more than 40 min under inhalation anesthesia: in group 1 — original sevoflurane (n = 11), group 2 — non-original sevoflurane (n = 11). The depth of anesthesia was evaluated using bispectral index monitoring.Results. In the group of non-original sevoflurane, the excitation syndrome before the beginning of anesthesia and in its introductory period was noted in 54.5 and 72.7 % respectively, the reaction to the introduction of a laryngeal mask — in 36.4 % of patients in the absence of these reactions in the group of the original drug. There was a higher depth of anesthesia in non-original drug with the achievement of statistically significant differences in the indicator at 15 and 20 min: 44 (42; 46) vs 50 (49; 54; p = 0.0001) and 42 (40; 46) vs 50 (47; 56; p = 0.003) respectively, as well unstable level of depth of anesthesia of the group of non-original sevoflurane compared to the original during the period of maintaining anesthesia.Conclusion. Despite the same formula of the original and non-original sevoflurane, the non-original drug was characterized by a greater frequency of excitation syndrome and reaction to the introduction of a laryngeal mask and unstable depth of anesthesia.

Non-invasive respiratory support by continuous positive airway pressure (CPAP) is the most common management technique of the respiratory distress syndrome in newborns. Goal: to evaluate efficiency of non-invasive respiratory support by CPAP in mature newborns depending on the start of therapy. Materials and methods. 39 newborns were enrolled into the study. Depending on the start of respiratory support infants were divided into 2 groups: Group 1 (n = 14) – therapy was started during the first 10 minutes after birth, Group 2 (n = 25) – therapy was started after transfer to Newborns Intensive Care Department. Results. Group 1 had lower rates of SpO2 intermediately after birth and higher rates of oxygen and carbon dioxide tension in blood. In Group 2 the correlation (r = 0.559; p < 0.05) has been found between the number of disorders of the newborn and duration of stay in Newborns Intensive Care Department . No significant differences in the outcome were found between the groups. Conclusion: The start of the non-invasive respiratory support during first 30 minutes after the birth results in the positive clinical effect and favorable impact on the outcome of the disease.

Purpose: to investigate of mortality from respiratory diseases of children aged 0-19 at Rostov region during 2004-2013.Materials and methods: official statistics annual reports of Rostovstat were analyzed.Results: the mortality from respiratory diseases took 8th place in 2013 among all causes of mortality (25 from 779 dead; 3,2% or 2,983 per 100 000 population aged 0-19).Conclusion: children 1st year of life accounted for the majority of them – 64%. The leading cause of mortality was pneumonia; pneumonia without of specifying the pathogen accounted for majority of them. It was found dynamic of decreasing of mortality from respiratory diseases on 72,3% from 11,636 (48 children) till 3,224 (16) per 10 000 live birth. The leading cause was pneumonia without of specifying the pathogen. Decreasing of mortality was from 10,182 per 10 000 live birth (42 dead) till 2,821 (14).

The leading causes of children’s mortality in the world, Europe and Russian Federation and the ways of decreasing of quantity of lethal outcomes were researched. The role of healthcare system in prevention of mortality causes among the children and adolescents is discussed.

One of priority tasks of modern health care is to provide people with high-technology help. The problem of practical training of the staff to work with high-technology equipment is very important. Modern requirements for practical training of a physician dictate revision of training ideology. Global tendencies towards perfection of training technologies place emphasis on wide introduction of virtual simulators and manikins. Traditional system of practical training in the sphere of health care has some shortcomings. Acquisition of practical skills is realized on patients with the risk to their health. The way, which has been used for many years by our western colleagues – development of simulation centres, inevitably opens in front of our health care.

Purpose: To investigate quality of prehospital intensive care of traumatic shock in children with severe road-traffic injuries.Materials and Methods: It was analyzed 61 medical reports of children with severe road-traffic injuries, who were primary hospitalized in the intensive care departments of Rostov region.Results: Majority of all were transported to the hospitals during 1 hour after disasters (73,8% - 45) by emergency teams (42,6%). Duration of prehospital period was 30 minutes in 41% (25), from 30 minutes till 1 hour – in 32,8% (20), from 60 till 120 minutes – in 18% (11), and more than 120 minutes – in 8,2% (5). Craniocerebral injuries had 96,7% patients, skeletal – 41%, thoracal and abdominal – 36,1% and 21,3%. Infusion prepared in 11,4%, analgesia – in 22,9%, respiratory therapy – in 17,1% and immobilization – in 11,4%.

Objective: to study stepwise differences in the severity and pattern of severe traumatic injuries due to road traffic accidents in patients during the qualified and specialized stages of medical care in the age groups of 1 month to 18 years in the Rostov Region. Material and methods. The 2004—2009 case reports were used to make a retrospective comparative assessment of the condition of victims with severe road traffic injury at care stages in 2 groups: 1) one-month- to 18-year-old children who had been primarily admitted to the qualified-stage intensive care units (n=61); 2) one-month-to 18-year-old patients from the intensive care unit of the Regional Children’s Hospital, referred from the qualified-stage intensive care units (n=133). Results. The number of specialized-stage children in grave and extremely extensive grave condition at the specialized stage was 14.7% more than that at the qualified stage (100 and 85.3%, espectively). Concomitant injury was encountered more frequently (by 13%) in the specialized-stage patients (73.7 and 60.7%, respectively). The severity of road traffic injury was determined mainly by brain injuries at the qualified irnd specialized stages (96.7 and 96.1%), by skeletal injuries (11.6% more frequently) and thoracic ones (9.8% more frequently) at the specialized stage. The prevalence of abdominal injuries at the qualified stage was 9.8% higher. The pattern of brain injury in the specialized-stage patients showed a preponderance of brain contusion and epidural hematomas by 18.5 and 6.5%, respectively. Conclusion. Severe thoracic and brain injuries (craniocerebral injuries, brain contusion, and intracranial hematomas) are an indication for patient referral to the specialized care stage in order to perform high-technological diagnostic and therapeutic methods. Key words: children, road traffic accidents, severe injury, medical care stages.