Objective. To determine the diagnostic criteria of morphological changes in children with perinatal hypoxic brain injury. Patients and Methods. The study included 58 full-term newborns with severe hypoxic brain damages who, according to MRI of brain performed on 2–10 days of life, had low rates of diffusion processes of the white matter of the cerebral hemispheres – diffusion coefficient (Ds) of less than 1.35 × 10–3 mm2/s. Children received treatment in the intensive care unit of the regional perinatal center of Krasnodar Children's Clinical Hospital. Follow-up MRI was performed at the 4th week of life. Observation of children was carried out up to 2 years of age. Results. Denominated destructive changes in the nervous tissue with multicystic encephalomalacia were identified in 23 (40%) newborns (group 1). The range of values of Ds of the white matter of cerebral hemispheres in children of the 1st group was 0.60–1.11 × 10–3 m2/s. In the remaining 35 (60%) children (group 2), hypoxic brain damage was manifested by the expansion of the subarachnoid space, the interhemispheric fissure, and the lateral ventricles. These changes were reflected in a decrease in the volume of brain parenchyma with the persistent neurological deficiency in the future (disorders of psycho-speech development, cerebral palsy, structural epilepsy). The range of values of the Ds of the white matter of the cerebral hemispheres in children of the second group was 1.14–1.35 × 10–3 mm2/s. Conclusions. Using the modern high-tech methods of neuroimaging makes it possible to determine the diagnostic criteria for damaging effects of hypoxia in children with perinatal brain injury and in early stage to identify morphological changes in brain tissue. Key words: hypoxia, brain, children, magnetic resonance imaging, neurological outcome

Background. Congenital hyperinsulinism (CHI) is a hereditary disorder presenting with the hypersecretion of insulin by pancreatic beta cells and further development of hypoglycaemia. CHI is an orphan disease. According to the European sources, its incidence averages to 1:30,000– 1:50,000 newborns. Clinical Cases Description. This article describes two clinical CHI cases in girls. Case 1: a girl, born on 20.06.2017, was admitted to a paediatric unit of the Children’s Territorial Clinical Hospital for a seizure syndrome. CHI was diagnosed in the age of one month. At 5 months, the girl was confirmed a focal CHI with adenomatous focus localised in pancreatic head; a subtotal head resection has been performed facilitating a compensation. The girl was discharged in a satisfactory condition for a local residence outpatient follow-up. Case 2: the patient was diagnosed with CHI at 1 year 4 months upon admission to an endocrinology unit of the Children’s Territorial Clinical Hospital. The girl was redirected to the National Medical Research Centre for Endocrinology, where CHI was confirmed and indicated for a proglycem treatment. The child was followed-up at the Centre to adjust therapy. In July 2020, a fasting test with background proglycem therapy of 2.9 mg/kg/day (62.5 mg/day) revealed a medicated compensation. The patient was discharged with improvement for a resident endocrinologist follow-up with a recommendation of proglycem at a prescribed dosage upon vital indications. Conclusion. The clinical cases illustrate that, despite rarity and a marked heterogeneity, CHI can be timely diagnosed and properly treated in children. An adequate therapy can facilitate the disease compensation and prevent lifetime neurological complications.

XXVIII) НАЦИОНАЛЬНЫЙ ДИАБЕТОЛОГИЧЕСКИЙ КОНГРЕСС С МЕЖДУНАРОДНЫМ УЧАСТИЕМ «САХАРНЫЙ ДИАБЕТ И ОЖИРЕНИЕ -НЕИНФЕКЦИОННЫЕ МЕЖДИСЦИПЛИНАРНЫЕ ПАНДЕМИИ XXI ВЕКА» СБОРНИК ТЕЗИСОВ 204 САХАРНЫЙ ДИАБЕТ 1 ТИПА У ДЕТЕЙ КРАСНОДАРСКОГО КРАЯ В ПЕРИОД ПАНДЕМИИ SARS-COV-2 Черняк И .Ю .¹, Головенко И

Aim. To determine the frequency of structural damage to the pyramidal tract in the region of crus posterius capsulae internae in children with a birthweight of less than one and a half kilograms with perinatal hypoxic damage to the nervous system using the value of fractional anisotropy according to diffusion-tensor magnetic resonance imaging at 39 weeks of post-conceptual age (PCA).Materials and methods. The study included 68 children born with a very low birthweight and 59 children with an extremely low birthweight demonstrating brain structural changes at 39 weeks of postconceptual age according to neurosonography. At 39 weeks of postconceptual age, the children included in the study underwent diffuse tensor magnetic resonance imaging (DT MRI) with the determination of fractional anisotropy.Results. At 39 weeks of PCA, all children had impaired neurological status. During DT MRI, the area of interest was crus posterius capsulae internae. Significant differences in the nature of structural damage to the pyramidal tract in the area of interest between children born with a very low and extremely low birthweight were not observed.Conclusion. Damage to the pyramidal tract was observed in 22.0% of children born with an extremely low birthweight, and in 13.2% of children born with a very low birthweight; partial destruction of the pathways was noted in 47.5% and 45.6% of children, respectively. Intact pyramidal tracts were visualized in 30.5% of children born with an extremely low birthweight and 41.2% of children born with a very low birhtweight.

Aim. To analyse the psychomotor development of children with different outcomes of perinatal hypoxic brain injury and to assess the effectiveness of nootropic therapy in terms of formation of speech skills and cognitive activity. Materials and methods. The study included 136 children having suffered from asphyxia during labour and/or intrauterine hypoxia. The analysis of the neurological pathology and psychomotor development in the children was carried out during the first two years of their life. Neurological deficit was formed in 55 (40.4%) children; the remaining children exhibited functional disorders of the nervous system. The evaluation of the children’s psychomotor development was carried out using the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/ CLAMS). The level of motor development in the children with cerebral palsy was determined using the System for Assessing Global Motor Functions. Results. Functional disorders of the nervous system were manifested in the hyperactivity syndrome, tempo-retarded development and dissociation of speech, cognitive and motor functions. The global nature of hypoxic brain damage in children with neurological deficit determined the predominance of severe disorders in motor functions, cognitive activity and speech development. According to the study, neurological deficit was more often formed in premature babies, but severe impairments in motor functions due to pronounced destructive changes in the brain prevailed in mature babies. The study showed the effectiveness of nootropic drugs in children with functional disorders of the nervous system, as well as in children with neurological deficit without pronounced structural changes in the brain. Conclusion. An analysis of psychomotor development and assessment of the effectiveness of nootropic therapy in young children with perinatal hypoxic brain damage allows the adequacy of the rehabilitation for correction of the revealed violations to be determined.

Aim. To study the allergic reactions in children with minimal brain dysfunctions and features their treatment. Materials and methods. Eighty two children with allergic reactions and minimal brain dysfunctions include on research. Results. The article presents data on the pathogenesis of allergic reactions in children with minimal brain dysfunction. The authors share their own experience with hydroxyzine having anxiolytic and antihistamine action in children with allergic reactions at the minimal brain dysfunction. Conclusion . Hydroxyzine has the high efficiency and safety for treatment allergic and neurotic symptoms in children.

Aim. Estimate the efficiency of improved complex therapy of premature with surgical pathology. Materials and methods . 374 medical histories of premature infants were studied. The number of medical histories for 2011 was 169, and the number of medical histories for 2016 was 205. Results. There is an increase in the number of premature with surgical pathology. The number of premature infants increased with a gestation period of less than 28 weeks and decreased among children with a gestation period of 32-34 weeks. The percentage of deceased children with a gestation period of 32-37 weeks has significantly decreased. Decrease in lethality of premature with surgical pathology in 2 times. Conclusion. Results of this study confirmed effectiveness of the improvement of complex therapy of premature with surgical pathology.

The article presents various manifestations of gastrointestinal dysfunction in children with severe perinatal brain lesion. The observation included thirty infants at the age of one to six months and thirty three infants at the age of six to twelve months. The effect of the specialised therapeutic formulas on the functional state of the digestive organs, physical development in infants of first year of life was studied and assessed.

Настоящими исследованиями показано наличие трансформации фенотипа и дефекты фагоцитарной функции нейтрофильных гранулоцитов (НГ) у иммунокомпрометированных детей с возвратной ассоциированной вирусной респираторной и герпетической инфекциями и хроническими заболеваниями ЛОР-органов. Пролонгированная и адекватная интерферонотерапия в комбинации с иммунотерапией демонстрирует высокую клиническую эффективность, сопровождающуюся перестройкой функционирования системы НГ в виде реорганизации мембранной экспрессии функционально-значимых рецепторов (CD64, CD32, CD16, CD11b) и модулированием фагоцитарной активности НГ.

The article presents advantages of use of diffusion-weighted magnetic resonance imaging (DW MRI) for revealing hypoxic-ischemic brain lesions in neonates. The trial included 97 neonates with perinatal brain lesion who had been undergoing treatment at a resuscitation department or neonatal pathology department in the first month of life. The article shows high information value of diffusion-weighted images (DWI) for diagnostics of hypoxic-ischemic lesions in comparison with regular standard modes. In the event of no structural brain lesions of neonates, pronounced increase in signal characteristics revealed by DWI indicated considerable pathophysiological alterations. Subsequently, children developed structural alterations in the form of cystic encephalomalacia with expansion of cerebrospinal fluid spaces manifested with pronounced neurological deficit. DW MRI has been offered as a method of prognosticating further neurological development of children on early stages.

The article presents advantages of use of diffusion-weighted magnetic resonance imaging (DW MRI) for revealing hypoxic-ischemic brain lesions in neonates. The trial included 97 neonates with perinatal brain lesion who had been undergoing treatment at a resuscitation department or neonatal pathology department in the first month of life. The article shows high information value of diffusion-weighted images (DWI) for diagnostics of hypoxic-ischemic lesions in comparison with regular standard modes. In the event of no structural brain lesions of neonates, pronounced increase in signal characteristics revealed by DWI indicated considerable pathophysiological alterations. Subsequently, children developed structural alterations in the form of cystic encephalomalacia with expansion of cerebrospinal fluid spaces manifested with pronounced neurological deficit. DW MRI has been offered as a method of prognosticating further neurological development of children on early stages.

Потенциальные возможности нейтрофильных гранулоцитов (НГ) в реализации и поддержании иммунного гомеостаза затрагивают осуществление ими в первую очередь эффекторной, а также регуляторной функции. Настоящими исследованиями показано, что представление о функциональном состоянии НГ может дать определение фенотипа субпопуляционного состава НГ при оценке одномоментной экспрессии цитотоксических (CD64, CD16, CD32) и адгезионных (CD11b) мембранных маркеров с учетом плотности экспрессируемых молекул. Ремоделирование фенотипа мажорной и минорной субпопуляций НГ свидетельствует об активном или дефектном включении НГ в иммунный ответ при воспалении. Особенно информативным и ранним критерием тяжести инфек-ционно-воспалительного процесса при врожденной пневмонии у глубоко недоношенных новорожденных является изменение фенотипических характеристик НГ (количества субпопуляции и плотности экспрессии мембранных рецепторов) минорной субпопуляции - CD64 +CD16 + CD32 + CD11b + НГ.

The treatment of immunocompromised children with high-frequency of recurrent associated viral infections is very difficult. We had studied 2 groups of children with recurrent acute respiratory viral infections, combined with mono- and mixed-herpes viral infection, revealed significant defects in phagocytic and microbicidal activity NG, deficit serum IFN alpha and IFN gamma. We had created the program of therapy which included for one group of patients recombinant IFN alpha, izoprinozin and for another group of patients - recombinant IFN alpha, izoprinozin and additional - licopid. Adequate doses of recombinant IFN alpha promoted significant increase in levels of IFN alpha and IFN gamma, application of licopid restored disturbed functions of NG. The developed program optimized interferon-and immunotherapy had a high clinical efficiency.

The article presents data on the pathogenesis of allergic reactions in children with minimal brain dysfunction. The authors share their own experience with hydroxyzine having anxiolytic and antihistamine action in children with allergic reactions at the minimal brain dysfunction. The authors show the high efficiency and safety of hydroxyzine for treatment allergic and neurotic symptoms in children.