Vol 25, No 8 (2023): Детские болезни

One of the main problems in pediatrics and pediatric oncology is early diagnosis of malignancies in children. It makes a provision for high surveillance more than 90% and ability to restrict an anti-cancer treatment, which define a high quality of life with low incidence of acute reactions and complications of anti-cancer therapy especially delayed. At the same time, even today up to 75% of patients are check into a specialized hospital with advanced disease stages and large tumor mass. The main reason of it is the absence of cancer alterness in first patients contact doctors: pediatricians, highly specialized non-oncological doctors. Identification of high tumor risk children, knowledge of symptoms for differential diagnosis with oncological disorders, abidance by principium of cancer alterness, optimal patients logistics and teamwork of all doctors involved in patients with cancer are the recipe for successful treatment.

Aim. To determine the course features of the post-COVID syndrome in children with chronic nonspecific lung diseases (cystic fibrosis, congenital bronchial and lung malformations, asthma).

Materials and methods. The study was conducted at the clinical base of the Department of Pediatrics and Pediatric Rheumatology of the Filatov Clinical Institute of the Sechenov University – National Medical Research Center for Children's Health from November 2020 to April 2023. The bi-directional single-center study included patients aged 1 month to 17 years 11 months who had a new coronavirus infection. The analysis included 69 patients with concomitant chronic nonspecific lung diseases: cystic fibrosis, congenital bronchial and lung malformations, and asthma. All patients were assessed at an average of 1 year (±2 months) after the new coronavirus infection using the ISARIC COVID-19 standardized questionnaire for children. The prevalence of post-COVID syndrome, the frequency of persistent symptoms, and the consequences of the new coronavirus infection in the group of children with concomitant chronic nonspecific lung diseases were determined. The rate of underlying disease exacerbations before and 1 year after COVID-19 was also retrospectively assessed.

Results. One year after COVID-19 infection, patients with chronic nonspecific lung diseases do not consider themselves fully recovered from the disease and experience several persistent symptoms affecting various spheres of life: fatigue, physical activity, loss of appetite, as well as cognitive impairment, including difficulty concentrating, memory impairment, slip in speech, disrupting the daily life of the child and his family members and causing learning difficulties. To improve the quality of care for children with chronic nonspecific lung diseases who survived the COVID-19, programs for rehabilitation and treatment for post-COVID syndrome are needed, considering the possibility of developing both physical and neurocognitive disorders.

Background. The prevalence of childhood obesity has increased significantly over the past three decades worldwide, and in this regard, the frequency of diseases associated with obesity, including disorders of carbohydrate metabolism, has increased. The involvement of insulin resistance and insulin deficiency in the development of prediabetes in obesity has been established. However, the significance of each pathological mechanism in the development of prediabetes in childhood and adolescence has not been established. In this regard, in children's practice, there is no reliable data on methods of prevention and treatment of prediabetes in obesity.

Aim. To study the role of insulin resistance in the development of prediabetes in obese adolescents.

Materials and methods. The study involved 95 adolescents with obesity. Inclusion criteria: SDS BMI≥2.0, Tanner stage ≥II, age <18.0 years, exclusion criteria: diabetes mellitus. The sample was divided into prediabetics (n=40, mean age 14.0±1.53 years; SDS BMI 3.09±0.54, boys n=23) and non-prediabetics (n=55, mean age 14.6±1.67 years; SDS BMI 3.11±0.54; boys n=32). Both groups were matched on age, SDS BMI, sex (p=0.082, p=0.975, p=0.947, respectively). The research consisted of estimates of BMI, insulin, C-peptide, fasting venous blood glucose, HbA1c, cholesterol, low-density lipoprotein, high Density Lipoprotein, triglycerides, alanine aminotransferase, aspartat aminotransferase, HOMA-IR and TyG indices, results of oral glucose tolerance test at 0 and 2 hours after glucose load, ultrasound of the hepatobiliary system. Prediabetes in adolescents was diagnosed using American Diabetes Association criteria. Data was analyzed by using SPSS Statistics for Windows, Version 26.0.

Results. Prediabetes was diagnosed in 42.1% (40/95) of cases. There were statistically significant differences between the indices of groups with prediabetes and normal glucose metabolism: fasting plasma glucose – FPG (mean 5.63±0.49; 95% confidence interval – CI 5.48–5.79 vs 5.03±0.42; 4.92–5.15 mmol/L; p<0.001); 2hPG (mean 7.04±0.93; 95% CI 6.74–7.34 vs 6.23±0.82; 6.01–6.46 mmol/l; p<0.001); HbA_1c (mean 5.5±0.31; 95% CI 5.39–5.59% vs 5.2±0.25; 5.15–5.29%; p<0.001); cholesterol (4.47±0.73; 95% CI 4.23–4.72 vs 3.96±0.92; 3.73–4.24 mmol/l; p=0.004), low-density lipoprotein (2.89±0.96, 95% CI 2.55–3.20 vs 2.46±0.89, 2.21–2.71 mmol/l; p=0.036). There were no significant differences in fasting insulin, C-peptide, triglycerides, high density lipoprotein, aspartat aminotransferase, alanine aminotransferase, HOMA-IR index and TyG, were also no significant differences in the frequency of hepatic steatosis (47.5% vs 52.7%; p=0.532).

Conclusion. Teenagers with obesity, with prediabetes, and without disorders of carbohydrate metabolism had a similar level of peripheral tissue sensitivity to the action of insulin. There are additional factors leading to the formation of prediabetes with obesity in the child population that have to be learned in future researches.

Breast milk meets the needs of a 6-month-old child in macronutrients (proteins, fats, carbohydrates) almost entirely, while in minerals and trace elements only partially. Complementary feeding is the stage of development of the child's eating behavior when its diet expands due to the introduction of additional products. The model of human eating behavior is formed in infancy and early childhood when stable taste preferences and attitudes to eating (regimen, serving size, table culture) are established. The European and North American Nutrition Committees, in their resolution (2008), noted that the timing of the introduction of complementary foods for breastfed and bottle-fed infants should be the same: no earlier than week 17 and no later than week 26. The age to introduce complementary foods in Russia is 4-6 months and 5.5 months in breastfed infants. Due to the intensive growth and increased physical activity of the child, it is advisable to use milk porridges as one of the main types of complementary foods necessary for children at 4–5 months to provide an additional (relative to human milk or its substitutes) amount of protein, energy, minerals, and vitamins. In recent years, ready-to-use liquid cereals have become popular. Due to the carbohydrate component of cereals, which promotes longer satiety, they can be given to young children before bedtime.