Aim: To analyze the content of requests for telemedicine consultations (TMC), received by the National Medical Research Center for Children's Health, and suggest possible steps to perfect it.

Design: Retrospective study.

Material and methods. We analyzed the content of 167 TMC requests for patients with “general pediatric profile” received in 2021 and 2022.

Results. Among requests for TMC the majority (43.1%) were for “non-explainable” fever in adolescents 9–17 years of age — with clear signs of a fictitious fever. Similar number of requests were for children with a low grade fever (37,0–37,5°C) that had been vainly investigated to find out the disease causing it. Of 4 children with Kawasaki syndrome only in one it had been suspected at the late stage. Requests for respiratory disease (37.1%) were mostly for their chronic forms. Pediatricians seem not to be conversant with chronic food aspiration syndromes’ diagnosis and management, including that in patient with neurologic conditions. Rare disease and/or unusual symptoms, as well as management of problem patients with known disease were less often the subject of TMC (12 и 7.8% respectively).

Conclusion. We could state that pediatric hospitals have extensive diagnostic potential — except bacteriology that has to be upgrade. At the same time there is a tendency of pediatricians to conduct in problem cases multiple non-directional analyses and investigations, incorrectly interpret their results, as well as voluntarily formulate diagnoses. There is a need to do away with excessive and non-recommended use of antibiotics, IV infusion of “desintoxication” solutions, as well as polypharmacy. For the improvement of TMC it seems important to foresee the inclusion into TMS requests data on the disease progression as well as on the dynamics of relevant clinical and paraclinical parameters; the results of analyses and instrumental investigations should be put into addendum. There should be a feedback mechanism — a response to TMC with an appraisal of its effectivity.

Aim: To determine the coverage, efficacy and tolerability of pneumococcal vaccination in young children with cardiovascular disease associated with chronic heart failure.

Design: Retro- and prospective randomized comparative study.

Materials and methods. The study included 250 patients at the age of 2 months to 5 years with confirmed chronic cardiac failure caused by cardiomyopathy or congenital heart disorder. Within the scope of a specialised laboratory and instrumental examination, all children underwent an assessment of specific immunoglobulin (Ig) levels to the most common pneumococcal serotypes (1-5, 6B, 7F, 8, 9N, 9V, 10A, 11A,12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F) using VaccZyme Anti-PCP IgG test system. During consultations and vaccination schedule development, pneumococcal vaccination coverage and the reasons for long-term medical exemptions or refusals were analysed. Provided the primary disease was stable, there were no contraindications and a parent gave their consent, patients were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV13).

Results. When questioning the parents of patients, it was revealed that before admission to the department, only 97 (38.8%) patients received at least 1 dose of pneumococcal vaccine, while the remaining 153 (61.2%) were not vaccinated. During hospitalization, 65 (42.5%) of 153 unvaccinated patients under 5 years of age who had not received a single pneumococcal vaccine received the first dose (V1) of PCV13; of 97 children vaccinated, 20 (20.6%) received a second dose, 18 (18.6%) — pneumococcal booster. There was a significant difference in the levels of antibodies to Streptococcus pneumoniae between the group of patients who received a full course 16 | | Vol. 22, No. 3 (2023) of immunization according to age and the group of unvaccinated children: 108.1 ± 58.4 vs. 12.14 ± 7.8 mg/l (p < 0.05). In children with an incomplete course of vaccination, the levels of specific IgG to pneumococcal serotypes were lower. In groups of children who received only one dose of the vaccine in the first or second year of life, they amounted to 42.2 ± 11.7 and 40.2 ± 16.2 mg/l, respectively. Children who received at least two doses of vaccine without revaccination (starting before 12 months) had a relatively higher level of 68.2 ± 6.3 mg/L. But, despite a clear trend, there was no significant difference between these groups in our study. In the post-vaccination period, no serious complications were recorded in the examined children.

Conclusion. Vaccination against pneumococcal infection in children with chronic heart failure is effective, safe and should be carried out as close as possible to the schedule of the national vaccination calendar, with a limited set of contraindications.

Aim: Genetic, clinical, laboratory-instrumental and morphological characteristics of genetic dysfunctions of the surfactant system in children, therapy and outcomes of the disease.

Design: Multicentre, ambispective, open-label, descriptive pilot longitudinal study.

Materials and methods. We observed 17 children from 16 families with identified mutations in the SFTPC, ABCA3, NKX2-1 genes. Methods used: genealogical, Sanger sequencing, clinical exome sequencing, computed tomography and histological examination of the lungs.

Results. The study included 8 children with congenital deficiency of surfactant protein C, 8 children with brain-lung-thyroid syndrome and 1 patient with congenital deficiency of protein ABSA3. Based on the results of a genetic examination of patients, nucleotide variants c.218T>C were identified in 2 out of 8 patients with a mutation in the SFTPC gene, which is the most common according to the literature. In 5 children, the mutations were hereditary. Congenital deficiency of surfactant protein C, ABCA3 protein and brain-lung-thyroid syndrome were characterized by clinical, computed tomography, and morphological signs of interstitial lung disease. Despite complex respiratory, anti-inflammatory therapy, the frequency of deaths in congenital deficiency of surfactant protein C was 37.5%.

Conclusion. Children with severe respiratory distress syndrome of newborns, interstitial lung disease with the development of severe chronic respiratory failure, burdened with a family history should undergo genetic testing to detect mutations in the genes SFTPB, SFTPC, ABCA3. The patient's combination of respiratory symptoms with congenital hypothyroidism and neurological pathology is the basis for genetic examination for NKX2-1 gene mutations to exclude the brain-lung-thyroid syndrome

Aim: To evaluate the effect of carbocysteine on cough and the level of secretory immunoglobulin A (sIgA) in saliva in children with acute respiratory viral infections (ARVI) and the presence of a correlation between the level of sIgA in saliva and the total cough index.

Design: Multicentre observational study.

Materials and methods. 156 children older than 2 years (4.4 ± 1.2 years) with ARVI were included in the study. All patients received carbocysteine at the age dosage. The total cough index and the concentration of sIgA in saliva were measured on days 1–2 and on days 7–10 from the onset of ARVI. Results. The total cough index significantly decreased in 98.7% of patients by the 7–10th day of illness. The level of sIgA in saliva was initially 26.49 (8.94; 56.51) µg/ml, in dynamics — 30.07 (8.52; 60.40) µg/ml (no significant differences were found). An increase in the level of sIgA in dynamics was noted in 43.6% of patients, and in the vast majority of them the increase was significant — 20% or more. A decrease in the concentration of sIgA in dynamics was noted in 55.8% of patients. A significant correlation was found between sIgA concentrations in saliva at the first and second visits (p < 0,001). There was no significant correlation between the total cough index and sIgA levels.

Conclusion. A significant positive dynamic of cough was noted in patients with ARVI during treatment with carbocysteine. The concentration of sIgA in saliva varies within a wide range. A multidirectional change in the level of sIgA in saliva over time was noted in children with ARVI. Further study of the mechanisms of local mucosal immunity can help in the development of new approaches to the treatment and prevention of ARVI.

Aim: To present the relevant information on the new approaches to the management of obliterating bronchiolitis in children, based on the data generated by foreign researchers.

Key Points. Obliterating bronchiolitis is a non-reversible chronic obstructive lung disease associated with respiratory insufficiency, significant deterioration in the quality of life, and steady signs of disability. Despite the fact that this topic is of high interest, the management of patients and efficient therapy algorithms are a burning issue. A risk of side effects from systemic corticosteroids necessitates the search for alternative therapies. This overview presents information on a combined use of inhaled corticosteroids, azithromycin, monteleukast, and N-acetylcysteine.

Conclusion. Further development of alternative therapies for chronic obliterating bronchiolitis can help in achieving efficient control of this disease.

Aim: To evaluate the reference/normal breathing parameters in healthy children aged 6 to 18 years using a respiratory sound recorder.

Design: Prospective, open-label, non-randomized clinical trial.

Materials and methods. The function of external respiration was assessed in practically healthy children without respiratory pathology using a respiratory sound recorder. 165 practically healthy children from 6 to 18 years old were examined. Mean age — 11.4 ± 1.9 years, of which 86 (52%) boys and 79 (48%) girls. The indicators of the acoustic component of the work of breathing in the low-frequency P1 (200–1200 Hz), mid-frequency P2 (> 1200–5000 Hz) and high-frequency P3 (> 5000 Hz) ranges and the total acoustic work of breathing (P total on inhalation and exhalation) were determined.

Results. When examining children, data were obtained for the acoustic component of the work of breathing on inspiration for the low-frequency range — 16.1 (9.8; 20.4) milliPascal (mPa), the mid-frequency range — 5.84 (4.1; 9.4) mPa and the high-frequency range — 2.26 (1.3; 2.5) mPa, on exhalation — 23.9 (16.2; 30.1), 8.35 (5.6; 12.2) and 2.57 (2.0; 3.3) mPa, respectively. In the study of the general acoustic component of the work of breathing, the following values were obtained: on inhalation P total — 23.8 (16.5; 32.8) mPa, on exhalation — 35.6 (24.5; 47.6) mPa. There were no statistically significant gender differences and differences between children of different ages (p > 0.05).

Conclusion. The respiratory sound recorder — is a promising device that can be used to diagnose various respiratory pathologies in children of all age groups.

Aim: Based on the study of a large amount of available information, to create an idea of the use of magnetic resonance imaging (MRI) in hypoxic-ischemic brain lesions in newborns, to present the available research algorithms, classifications, the scope of the technique and its information content in the named pathology.

Key points. MRI has long been a common practice in a neuropediatric hospital. To date, examination by this method has absolute significance in the diagnosis of perinatal hypoxic-ischemic brain lesions. In addition, MRI data help to objectify the effectiveness of therapeutic interventions and predict the further development of a child with perinatal brain damage. There are several classifications of MRI changes in hypoxic-ischemic brain lesions in newborns. These classifications have varying degrees of sensitivity to the initial hypoxic-ischemic changes in the child's brain, however, allow us to roughly represent the process of their formation in dynamics in the morphological aspect according to the scheme “periventricular white matter — subcortical ganglia and thalamus — subcortical structures of the hemispheres and cerebral cortex”. Thus, the target structures of hypoxic ischemic lesions allow us to identify its main patterns: lesions of neuronal structures, leukopathy, and their combination.

Conclusion. Studies of MRI phenomena as predictors of developmental pathology show that an increase in detail increases the accuracy of the prognosis. However, the available data do not currently allow us to form a spatial model for the development of hypoxic-ischemic changes in the brain of a newborn. It seems necessary to create such a model depending on the time and intensity of the impact of the ischemic process. This will allow developing a morphological and pathophysiological classification of perinatal encephalopathies.

Aim: To evaluate the psychological peculiarities of mothers of preterm and term birth infants, and their attitude to breastfeeding before and after childbirth.

Design: Observational study.

Materials and methods. The subjects of the research were a pregnant woman at 12-week gestation randomly selected from 5 maternity hospitals in Yerevan. 268 pregnant women were eligible for inclusion in this observational study and created a total group. After birth, mothers were divided into groups of full-term (n = 239) and premature (n = 29) babies. We analysed baseline demographics, health information of the mother, history of pregnancy and delivery, as well as health information of babies. We assessed the presence of depressive symptoms with a Beck Depression Inventory and situational and individual anxiety levels with the Spielberger State-Trait Anxiety Inventory.

Results. Assessment of the psychological status demonstrated a high level of state anxiety: 26.7 ± 1.4 and 45.8 ± 1.5 points in mothers of full-term and premature babies, respectively; in mothers of premature babies, the value was significantly higher (р < 0.05). Personal anxiety was relatively inert, there were no significant differences between the groups (p > 0.05). Depressive symptoms were also more pronounced in preterm mothers (moderate depression) than in term birth mothers (mild mood disturbance): 22.5 ± 0.8 points vs. 11.4 ± 0.9 points (p < 0.01). The majority of women (68.3%) who had preterm delivery had a high level of state anxiety (р < 0.01 vs. mothers of full-term babies). Women who were ready to breastfeed longer after the baby is born had more marked signs of depression. In mothers full-term and premature babies, the attitude to breastfeeding before delivery demonstrated direct correlation with the level of depression on Beck depression inventory (r = 0.75, p = 0.02 and r = 0.68, p < 0.01, respectively). The degree of state anxiety in mothers of premature babies correlated with hospitalisation duration (r = 0.9, p = 0.008).

Conclusions. Mothers of preterm infants need psychological care based on high level of situational anxiety and depressive symptoms. Breastfeeding is a good biological tool for improved interaction of the mother with her baby; it boosts psychological comfort and reduces anxiety and depression.

Aim: To analyze modern research on the variants and frequency of epigenetic effects on fetal development.

Key points. Epigenetic influences provide operational adaptation to the conditions of existence. Immediately after fertilization, the first wave of demethylation, “erasing” of methylation marks of parental gametes. After implantation, the first wave of methylation in blastocyst is carried out. The second wave of demethylation takes place at the beginning of the development of gametes. We know three types of epigenetic effects in the process of ontogenesis: direct influences of life experience refers to changes that occur in human life and caused by “direct life experience” of its adaptation to the conditions of existence. External indirect influences (transgenerations) are an impact of epigenetic changes that have developed in previous generations (both intrauterine and postnatally). Obviously, external indirect influences have a faster route for the transfer of hereditary information in comparison with the genetic mechanisms of inheritance.

Conclusion. Thus, the expansion of our ideas about the epigenetics allows you to see in it the most important mechanism for the adaptation to the conditions of the external environment both on the organism and in the population levels.

Aim: To study the specific functional condition of the cardiovascular system in primary school-aged children who experienced stress from military actions.

Design: Prospective cohort non-randomised study.

Materials and methods. There were 730 children under observation: 239 children of the main group lived in the territories where active hostilities took place; the younger schoolchildren of the control group (491 children) lived in territories where military operations were not carried out. The functional state of the cardiovascular system was studied by calculating and determining the parameters of the Martinet– Kushelevsky sample.

Results. The study showed that the recovery of heart rate after the Martinet–Kushelevsky test in younger schoolchildren who were in peaceful living conditions occurred faster than in children who experienced the stress of military operations (p < 0.05). The initial study of children who experienced the stress of military operations allowed us to establish not only a longer recovery time of blood pressure (p < 0.001), but also gender differences. The study conducted repeatedly, against the background of the integrated integration program, revealed a significant (p < 0.05) decrease in pulse blood pressure values in all subgroups.

Conclusion. In younger schoolchildren who have experienced the effects of active hostilities, the ability of the cardiovascular system to recover after dosed physical activity is sharply reduced; the identified features of the functioning of the CCC in children must be taken into account during physical education lessons at school.

Aim: to study the features of social and metabolic indicators in adolescents with arterial hypertension (AH), to assess their informative significance and the magnitude of their contribution to the risk of developing this pathology.

Design: a comparative clinical study of patients.

Materials and Methods: The object of the study was adolescents aged 12–17 years (boys and girls) with and without AH. The 1st stage included the analysis of biomedical, social and metabolic indicators, the 2nd stage included an assessment of the informative significance and degree of participation of indicators as risk factors for AH. Methods: questioning, laboratory, clinical and functional, statistical. Examination program: verification of AH and its severity; association of AH with functional somatic disorders; features of biomedical, social and metabolic indicators; assessment of the significance and contribution of indicators as risk factors for AH.

Results. Of the 504 examined, AH was diagnosed in 86 (17.06%) adolescents, of which 47.7% (41 people) had grade 1 AH and 52.3% (45 people) had grade 2 AH. Social risk factors for hypertension associated with family characteristics: the degree of marriage of parents — temporary cohabitation (OR = 3.36), father's profession — worker (OR = 3.14), father's education — secondary special (OR = 2.25), deviant family (OR = 2.78), family at medical and social risk (OR = 1.87). Metabolic predictors of the risk of AH: the presence of DLP (OR = 1.95), HChS (OR = 2.62), HTG (OR = 2.21), Hyper-β-CHS (OR = 1.87) and Hyper-pre-β-ChS (OR = 2.14). Conclusion. Along with traditional ones, it is necessary to identify and correct socially determined and metabolic risk factors for AH in order to optimize the diagnosis and prevention of this pathology in adolescents.

Aim: To assess the possibility of using Tanoshi nappies and pants for the prevention of diaper dermatitis, their safety and tolerability by newborns and babies under 2 years of age.

Design. Prospective cohort study.

Materials and methods. The study included 50 children with the weight 2 to 28 kg under 2 years of age without any signs of skin diseases, including nappy (pants) area. Proposed items were used for 14 days subject to timely change 4–7 times daily after bowel movement and during hygienic procedures 1–2 times daily. Skin was visually assessed by a children’s doctor on day 1, day 7, and day 14 of the study (M. Odio skin assessment tool).

Results. On day 1, day 7, and day 14, all children had 0 points for their skin assessment of waist, buttocks, genitals, anal region, inguinal fold (M. Odio skin assessment tool). Assessment of the skin in the nappy and pants area after 14 days of use did not show any signs of dryness, irritation, oedema, and erosions from the contact with a nappy.

Conclusion. All 50 newborns and babies under 2 years of age who used disposable Tanoshi nappies and pants in the real clinical practice over 2 weeks did not show any signs of diaper dermatitis. It proves that the nappies are safe and well tolerated by children under 2 years of age with proper skin care. Tanoshi nappies and pants can be recommended for children under 2 years of age who do not have any skin conditions and diseases.

Aim: To describe the known and expected effects of breast milk oligosaccharides (BMOs) on immune system modulation and allergy prevention; to present results of the studies of medicated formulas with the addition of a combination of two BMOs in babies with cow's milk protein allergy (CMPA).

Key Points. The period of infancy is a window of opportunities for allergy prevention. Breast milk contains immune system modulating components, including BMOs, which protect an infant during this critical period. Recently, a number of BMO impacts over immune system maturity have been found, including their ability to modulate microbiota composition, to enhance expression of short-chain fatty acids, to directly bind to pathogenic agents, and to interact with intestinal epithelium and immune cells. In addition, it is assumed that BMOs can be used for prevention of paediatric allergies.

Conclusion. BMOs have a significant contribution to the positive effect of breast milk over a child; they ensure healthy microbial colonisation of intestines, inflammation inhibition, immune protection, and intestinal barrier maturity. Currently BMOs are considered one of the most important bioactive components of breast milk, since they act both as antimicrobials, antiviral agents and modulators of intestinal epithelial cells, as specific prebiotics, intestinal microbiota effectors and immunomodulating factors. Nevertheless, additional studies of the effect of some BMOs and their combinations on clearly defined clinical and immune outcomes are required, including tolerance and therapeutic potential in CMPA.

Aim: demonstration of a clinical case of the successful use of etanercept in a child with еnthesitis-аssociated аrthritis.

Key points. Еnthesitis-аssociated аrthritis is one of the clinical variants of juvenile idiopathic arthritis. The initial therapy of еnthesitisаssociated аrthritis includes nonsteroidal anti-inflammatory drugs (NSAIDs) and non-biological disease-modifying drugs, the ineffectiveness of which is an indication for the appointment of genetically engineered drugs, in particular, the inhibitor of tumor necrosis factor-α etanercept.

Conclusion. Currently, for the treatment of еnthesitis-аssociated аrthritis, if the use of NSAIDs and non-biological disease-modifying drugs is ineffective, genetically engineered drugs should be prescribed, in particular etanercept, which allows to achieve drug remission.