Herald of the National Children's Medical Center
Specific features and treatment of acute community-acquired pneumonia in young children with congenital cleft palate and lip defects
Aim. To study the clinical features and treatment approaches of acute community-acquired pneumonia in young children with congenital cleft palate and lip defects. Materials and Methods. This study included 40 children with congenital cleft palate and lip defects (main group) and 44 children without such defects who had focal confluent pneumonia requiring inpatient treatment (control group). Results. Acute pneumonia in children with congenital cleft palate and lip defects was characterized by a more severe course. In these patients, gastrointestinal disorders were frequently observed, which aggravated the course of pneumonia. Conclusion. The use of the Enterogermina preparation in combination with standard therapy demonstrated high clinical efficacy.
Cellular immunity and its markers as predictors of the severity of community-acquired pneumonia in children
Aim. To determine the diagnostic and prognostic significance of cellular immunity markers (CD3+, CD4+, CD8+, and the CD4/CD8 index) in assessing the severity of community-acquired pneumonia in children. Materials and Methods. The study included 80 children, of whom 40 had a mild form of community-acquired pneumonia and 40 had a severe form. Levels of CD3+, CD4+, and CD8+ lymphocytes were measured in all patients, and the immunoregulatory index (CD4/CD8) was calculated. Statistical analysis included the F-test for equality of variances, the Mann–Whitney U test, and Welch’s t-test. Effect size was assessed using Cohen’s coefficient. Results. The analysis demonstrated that CD4+ lymphocyte levels and the immunoregulatory index (CD4/CD8) showed significant differences between the groups, indicating suppression of the regulatory component of the immune system in severe disease. An increase in CD8+ lymphocytes reflected enhancement of the cytotoxic response; however, the diagnostic significance of this parameter remained limited. CD3+ values did not demonstrate stable differences between the groups. At the same time, the immunoregulatory index proved to be the most sensitive integral marker reflecting the imbalance of the T-cell immune response. Conclusion. CD4+ lymphocytes and the immunoregulatory index (CD4/CD8) are reliable markers of the severity of community-acquired pneumonia in children. Their inclusion in diagnostic algorithms may improve the accuracy of risk stratification and the effectiveness of clinical monitoring. CD3+ and CD8+ indicators should be considered as part of a comprehensive assessment of immune status, especially when calculating the immunoregulatory index, which allows for a more complete evaluation of the balance within the T-cell immune system.
Diagnostic significance of humoral immunity markers in stratifying the severity of community-acquired pneumonia in children
Aim. To conduct a comparative analysis of humoral immunity markers (IgA, IgM, IgG, and CD19+ B-lymphocytes) in children with different severity levels of community-acquired pneumonia. Materials and Methods. The study included 80 children, of whom 40 had a mild form of community-acquired pneumonia and 40 had a severe form. Levels of IgA, IgM, IgG, and CD19+ B-lymphocytes were measured in all patients. Statistical analysis included the F-test for equality of variances, the Mann–Whitney U test, and Welch’s t-test. Results. Effect sizes were calculated using Cohen’s coefficient. The analysis revealed significant differences in IgA levels (p=0.005; d=–0.26) and CD19+ B-lymphocyte levels (p=0.000; d=0.59 and d=0.50). In severe cases, IgA levels were elevated, reflecting activation of mucosal immunity. In contrast, CD19+ B-lymphocyte levels were reduced, indicating suppression or redistribution of B-cell activity. IgM and IgG levels demonstrated only a slight upward trend that did not reach statistical significance. Conclusion. IgA and CD19+ B-lymphocytes are reliable markers of the severity of community-acquired pneumonia in children. Their inclusion in diagnostic algorithms may improve the accuracy of risk assessment and the effectiveness of therapeutic monitoring. Although IgM and IgG did not reach statistical significance, they remain valuable as additional components of the immunological profile, complementing the comprehensive characterization of the humoral immune response.
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The Role of Inflammatory Markers and Innate Immunity in Predicting the Severity of Community-Acquired Pneumonia in Children
Aim. To evaluate the diagnostic and prognostic value of inflammatory markers and innate immunity indicators in children with varying severity of community-acquired pneumonia. Materials and methods. The study included 80 children (40 with mild CAP and 40 with severe CAP). A statistical analysis of key indicators of inflammation and innate immunity (leukocytes, lymphocytes, CD16+, CD64+, phagocytosis, procalcitonin, C-reactive protein) was performed. To assess differences, the t-test and U-test were applied, and the strength of differences was evaluated using Cohen’s d criterion. Results. The most significant differences were identified in the levels of leukocytes, lymphocytes, procalcitonin, C-reactive protein, CD64+, and phagocytosis. These indicators were reliably associated with severe disease progression. CD16+ did not show statistical significance but may still be useful in comprehensive assessment. Conclusion. The inclusion of these markers in risk stratification algorithms and patient monitoring enhances diagnostic accuracy and therapeutic effectiveness.
The Role of Iridodiagnostics in the Predisposition of Children to Psychoneurological Disorders
Aim. The aim of this study was to determine the diagnostic potential of iridodiagnostics in detecting the risk of psychoneurological instability in children and adolescents. Materials and methods. A total of 30 children and adolescents treated at the ophthalmology department of TashPMI were examined, in addition to iridodiagnostic data from 36 deceased individuals after completed suicides and 17 individuals after suicide attempts. Examinations were performed using the EH 900 V IRISCOPE device. Parameters such as iris type, density, relief, pupillary margin, autonomic ring, and pigment spots were evaluated. Results. In healthy students, radial-wavy and radial-homogeneous iris types predominated (87%), reflecting strong constitution. In individuals with psychoneurological instability, radial-lacunar and lacunar types were more frequent, accompanied by weak iris density (5–6 grades), deformations of the autonomic rings, and pigment spots, particularly localized on the “11:00–13:00” meridian corresponding to the pituitary projection. These changes correlated with symptoms including hyperactivity (86%), emotional lability (71%), and anxiety (28%). Conclusion. The findings confirm that iridodiagnostics can serve as an additional method for early identification of children and adolescents at risk of psychoneurological disorders, enabling timely preventive interventions and monitoring.
Assessment of the Adequacy of Volume Load in Craniotomies for Brain Lesions in Children
Craniotomy for primary brain lesions in children is considered one of the specific challenges of anesthesia. One of the main goals of anesthesia is to optimize intracranial pressure and maintain cerebral perfusion pressure. This ensures adequate oxygen delivery to brain tissue and, at the same time, prevents secondary brain injury. In neurosurgery, optimizing intraoperative infusion therapy has a significant effect on early awakening, hemodynamic stability, and postoperative recovery. Studies on the use of pulse pressure variation (PPV) in neurosurgical patients remain insufficient, and its impact on infusion therapy, hemodynamic stability, and tissue perfusion under central venous pressure monitoring has not been fully evaluated. Neurosurgical operations for brain tumor removal may carry a risk of hypovolemia for various reasons, including inadequate control of fluid infusion, physiologically compensated arterial hypertension, and treatment with osmotic diuretics. Formula-based fluid management is considered ineffective in neuro-oncological surgeries. Individualized “goal-directed infusion therapy” has been proven to improve postoperative outcomes (Gan T.J., Sopitt A., Maruf M., El-Moalem H., Robertson K.M., Moretti E. Anesthesiology. 2022;02(4):820–26).
Breakthrough CAR-T Therapy in Refractory B-Cell Lymphoma: MIOT International Chennai, India Case Study
CAR-T cell therapy has emerged as a promising treatment for relapsed/refractory B-cell non-Hodgkin lymphoma (R/R B-NHL), especially in patients with limited therapeutic options. We report the case of a 60-year-old male with primary chemotherapy-refractory diffuse large B-cell lymphoma (DLBCL) and comorbidities including diabetes, hypertension, and stable coronary artery disease, treated with anti-CD19 CAR-T cell therapy (NEXCAR19) at MIOT International, Chennai. Following disease progression after seven cycles of R-CHOP chemotherapy and consolidation radiotherapy, lymphocyte apheresis was performed, yielding sufficient starting material for CAR-T cell production. The patient received fludarabine–cyclophosphamide conditioning followed by infusion of 100 mL of NEXCAR19 CAR-T cells, which was well tolerated without cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. PET-CT at day +29 demonstrated a marked metabolic response (Deauville score 4). Low-dose nivolumab maintenance therapy and IMRT- based consolidation radiotherapy to residual abdominal nodes were introduced to enhance remission durability and CAR-T sensitization. This case illustrates the feasibility, safety, and promising early efficacy of anti-CD19 CAR-T therapy in chemo-refractory DLBCL and highlights the potential benefit of integrating immunotherapy with targeted radiotherapy. Long-term follow-up will determine relapse risk and sustained response.
Congenital and Acquired Microcephaly: Etiopathogenesis, Clinical Course, Diagnosis and Recommendations Based on Clinical Case Observations
Aim. The aim of this study was to describe the etiopathogenesis, clinical course, and diagnostic features of congenital and acquired microcephaly through the presentation of clinical case observations. Materials and methods. Two pediatric patients with microcephaly were analyzed. Clinical evaluation included history, anthropometry, neurological assessment, and instrumental investigations such as MRI, EEG, biochemical tests, and genetic analysis by next-generation sequencing (NGS). Results. The first case revealed a homozygous pathogenic mutation in the ASPM gene, confirming primary microcephaly type 5. The second case demonstrated a PAH gene mutation associated with phenylketonuria, resulting in secondary microcephaly. Both patients showed delayed psychomotor and speech development, symptomatic epilepsy, and neurological impairment. Conclusion. Microcephaly represents a heterogeneous group of disorders with both congenital and acquired origins. Genetic testing plays a crucial role in early diagnosis and family counseling. Clinical case observations highlight the importance of molecular genetic studies in Uzbekistan to improve diagnostic accuracy, provide genetic counseling, and develop rehabilitation strategies for affected children.
Antibioticresistant infection and hydrocephalus: successful resolution of complications and consequences of traumatic brain injury (Case study)
The brain is especially protected by the cranial vault, meninges, and blood-brain barrier. Surgical aggression increases the risk of cerebrospinal fluid leakage, which facilitates the penetration of viral and bacterial infections with subsequent meningoencephalitis. We have presented an example of the management of antibiotic-resistant meningoencephalitis and subsequent hydrocephalus by surgical correction. The experience gained, in our opinion, will complement the arsenal for combating this category of disease.
These will be removed by our Editorial Office. Аssessment of the effectiveness of hodgkin’s lymphoma treatment in children using 18F-FDG PET-CT: А clinical case
Aim. To evaluate the effectiveness of Hodgkin’s lymphoma treatment in children by conducting a PET/CT scan with 18F-fluorodeoxyglucose (18F-FDG) after chemotherapy courses, based on a clinical case. Materials and methods. The study utilized a clinical case analysis to evaluate the effectiveness of Hodgkin’s lymphoma treatment in a child using positron emission tomography combined with computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG). The approach consisted of an initial PET/CT scan to determine the disease stage and extent of involvement before treatment, followed by courses of chemotherapy and a subsequent PET/CT scan to assess the therapeutic response. The Deauville scale was used to standardize the interpretation of the results and to assess the metabolic activity of the tumor. Results. The initial PET/CT scan on October 16, 2024, revealed extensive involvement of Hodgkin’s lymphoma, affecting the supraclavicular, mediastinal, and abdominal lymph nodes, as well as both lungs; this condition was rated as 5 points on the Deauville scale, indicating high metabolic activity. After courses of chemotherapy, a follow-up PET/CT scan on December 18, 2024, documented a complete metabolic response, as the pathological isotope uptake in the previously affected areas was no longer observed, and the result was rated as 1 point on the Deauville scale. Conclusion. The presented clinical case demonstrates the high informational value and clinical significance of PET/CT with 18F-FDG in assessing the effectiveness of Hodgkin’s lymphoma treatment in children. This technique is the "gold standard"for evaluating therapeutic response in this disease and allows for the timely and accurate determination of a complete metabolic response. This, in turn, makes it possible to reduce the toxic burden on a growing organism by avoiding unnecessary radiotherapy and modifying treatment regimens, which ultimately improves the patient’s quality of life and chances of recovery. Therefore, the widespread implementation of PET/CT in pediatric oncology should be a priority for modern diagnostic standards.
Ultrasound assessment of hemodynamic parameters for early detection and prediction of life-threatening conditions
Aim. To systematize current data on the potential of ultrasound assessment of hemodynamic parameters in preterm infants, with a focus on the use of cerebral Doppler and targeted neonatal echocardiography (TNE) for the early detection of critical conditions. Materials and methods. A review was conducted of publications in peer-reviewed journals from 2018 to 2025, including systematic reviews, clinical guidelines, and original studies addressing the assessment of cerebral blood flow (parameters RI, PI, PSV) and functional echocardiography for the diagnosis of cardiovascular instability. The analysis included data on the application of innovative technologies such as NeoDoppler and protocols for dynamic ultrasound monitoring in neonatal intensive care units. Results. The summarized evidence confirms the high prognostic value of cerebral Doppler in detecting the risk of ischemic and hemorrhagic brain injuries, as well as the effectiveness of TNE for assessing cardiac output, pulmonary hypertension, and patent ductus arteriosus. Integrating these methods enables the creation of a comprehensive model for hemodynamic monitoring in preterm infants. Conclusion. Ultrasound assessment of hemodynamic parameters, including cerebral Doppler and targeted echocardiography, is a promising tool for the early prediction and prevention of life-threatening conditions in preterm infants. Further clinical studies are needed to standardize normal parameter values, develop unified protocols, and integrate innovative technologies into routine neonatal intensive care practice.
Vitamin D Deficiency and Its Clinical Correlates in Children with Dermo-Respiratory Syndrome: A Prospective Study
Aim. Dermo-respiratory syndrome (DRS) in children is a multifactorial condition frequently associ- ated with allergic manifestations and recurrent respiratory diseases. Vitamin D deficiency has been proposed as a contributing factor to immune dysregulation in this patient population, yet its role remains insufficiently defined in the pediatric setting. Materials and methods. This prospective study included 151 children aged 3–15 years diagnosed with DRS and 50 age-matched healthy controls. Anthropometric measurements, body mass index (BMI), serum 25(OH)D levels, and relevant biochemical and hematological markers were evaluated. Subgroups were analyzed based on vitamin D status, severity of clinical manifestations, and frequency of exacerbations. Statistical analysis included ANOVA and X² tests to assess differences between groups. Results. Vitamin D deficiency (<20 ng/mL) was detected in 72.2% of children with DRS, compared to 18% in controls (p<0.001). Children with severe deficiency demonstrated higher BMI values (p<0.05), increased frequency of respiratory exacerbations (mean 5.1 ± 1.3 per year), and more pronounced dermatological symptoms. Correlation analysis revealed a significant inverse relationship between serum 25(OH)D levels and both exacerbation frequency (r = –0.56) and BMI (r = –0.43). Implementation of vitamin D supplementation over a 6-month follow-up resulted in improved clinical scores and reduced exacerbation frequency by 38%. Conclusion. Vitamin D deficiency is highly prevalent among children with dermo-respiratory syn- drome and correlates with disease severity and comorbid obesity. Routine screening and correction of vitamin D status should be considered as part of the comprehensive management strategy for pediatric DRS.
Surgical Treatment of Congenital Lung Malformations in Children
Aim. To improve the outcomes of surgical treatment by developing new diagnostic approaches and introducing minimally invasive organ-preserving interventions in children with congenital lung malformations (CLM). Materials and Methods. The study is based on the results of examination and treatment of 146 pediatric patients with CLM, aged from birth to 18 years, who underwent inpatient treatment between 2004 and 2024 at the clinics of TashPMI and the National Children’s Medical Center (NCMC). Clinical and instrumental methods were applied (X-ray, MSCT, bronchoscopy, echocardiography, angiography), bronchography to determine the volume of surgery, intraoperative visual assessment, and surgical treatment including resections and bronchial sealing with biopolymer. Results. Surgical treatment of CLM in children (VATS lobectomy and bronchial sealing) yielded positive outcomes in 92.7% of patients. VATS lobectomy and sealing provided better functional results and fewer complications, with preserved ventilatory capacity. Conclusion. Comprehensive diagnostics is essential for evaluating CLM. VATS lobectomy and bronchial sealing, as organ-preserving methods, are effective, reduce surgical trauma, hospitalization time, and the risk of disability.
Our Experience with Pelvic Osteotomy in Bladder Exstrophy
Aim. To analyze the effectiveness of pelvic osteotomy in bladder exstrophy. Materials and Methods. The study analyzed data from 30 patients with bladder exstrophy who received treatment in the Department of Pediatric Urology at the National Children’s Medical Center between October 2022 and June 2024. The age of patients ranged from 3 months to 10 years. Among them, 21 were boys (69%) and 9 were girls (31%), with a gender ratio of 2:1. Out of these 30 patients, 25 underwent surgical correction with Salter pelvic osteotomy using different fixation methods. In 13 patients, osteotomy and pelvic fixation were performed with pins and plaster cast, while in 12 patients, osteotomy and external fixation were applied. One patient underwent posterior osteotomy, and 4 patients underwent modern surgical correction of bladder exstrophy without pelvic osteotomy. Results. Briefly summarize the main findings of the article. Conclusion. Pelvic osteotomy in bladder exstrophy, performed during primary closure, provides several advantages: approximation of the symphysis with reduced tension during abdominal wall closure without the need for fascial flaps; placement of the posterior vesico-urethral complex deep within the pelvic ring, which increases the bladder’s outlet resistance; and approximation of the major pelvic floor muscles to the midline, where they can support the bladder neck and ultimately contribute to urinary continence.
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Microbial Landscape and Antimicrobial Therapy of Sepsis/Septic Shock in Children and Neonates
Aim. To present an overview of current approaches to antimicrobial therapy for sepsis and septic shock in children and neonates, based on international guidelines and the microbiological characteristics of the pediatric population. Materials and methods. A systematic review of scientific literature from the past 10–15 years was conducted using PubMed, eLibrary, Google Scholar, and ScienceDirect databases. The analysis focused on pediatric sepsis, antimicrobial therapy, and intensive care. Particular emphasis was placed on the Surviving Sepsis Campaign (2020–2021) guidelines and findings from major multicenter studies. Results. The etiological profile of pediatric sepsis varies by age and underlying conditions. Gram- negative and gram-positive bacteria remain predominant pathogens, with an increasing prevalence of resistant strains. Early initiation of antibiotic therapy (within 1–3 hours) is associated with improved clinical outcomes. Empirical therapy should be broad-spectrum initially, followed by de-escalation guided by microbiological data. Special attention must be paid to the individualization of dosage and treatment duration. Conclusion. Blood culture remains the primary diagnostic tool for sepsis, although the absence of bacteremia does not exclude the diagnosis when clinical and laboratory criteria are present. A single positive culture identifying pathogens such as Staphylococcus aureus (MRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, or fungi is sufficient for confirmation. Timely initiation of antibiotic therapy—ideally within one hour of diagnosis—should be the goal for children with septic shock. For patients without overt signs of shock, antimicrobial therapy should be initiated as early as possible, with a diagnostic window of up to three hours. Decisions on continuation, narrowing, or discontinuation of therapy should be guided by clinical judgment and indirect evidence, taking into account the infection site, risk factors, and adequacy of clinical improvement.
Continuous three-stage method for the treatment of ventricular septal defects complicated by severe pulmonary hypertension
Aim. To evaluate the effectiveness of a three-stage medical-surgical method for treating ventricular septal defect (VSD) with severe pulmonary hypertension (PH) in children, aimed at improving hemodynamics and reducing mortality. Materials and Methods. The study included 112 patients (aged 3 months to 3 years, mean age 14.4 ± 0.6 months) with VSD complicated by severe PH, from the Department of Cardiac Surgery of the National Children’s Medical Center (December 2022 – December 2023). Diagnosis was confirmed by clinical findings, chest radiography, and echocardiography. The three-stage medical-surgical method included: first stage — 4-week conservative therapy (furosemide 1–3 mg/kg, captopril 0.1–0.3 mg/kg, cefazolin 1.0 g, sildenafil 0.3–1 mg/kg); second stage — radical surgery in 61 patients (54.5%) (38 — classic VSD patch repair, 23 — optimized repair using a patch holder); third stage — postoperative therapy (furosemide, digoxin, dopamine/dobutamine, captopril, cefazolin). Surgeries were performed under cardiopulmonary bypass with hypothermia (32°C). Results. Hemodynamic stabilization was achieved in 61 (54.5%) of 112 patients who subsequently underwent surgery: 38 classic repairs and 23 optimized repairs. The remaining 51 (45.5%) continued with repeated therapy. The optimized method reduced CPB time by 12.4% (12.5 minutes) and aortic cross-clamp time by 16.9% (10.2 minutes). No complications occurred; mortality was 3.3%. Conclusion. The continuous three-stage medical-surgical method for treating VSD complicated by severe PH in children shows high effectiveness. It stabilizes preoperative hemodynamics, prevents progression of heart failure, and reduces mortality. The optimized VSD repair technique with a patch holder simplifies the procedure and shortens operative time. Hospital mortality was 3.3%, with deaths related to preoperative condition rather than surgical technique. No recurrences were recorded during three months of follow-up. Further studies are required to confirm long-term safety and efficacy, particularly in younger children.
Transcatheter ventricular septal defect closure in infants under 10 kg using only arterial access: a single center experience
Aim. Transcatheter closure of ventricular septal defect (VSD) in infants under 10 kg is technically challenging due to small patient size, vascular access limitations, and increased risk of complications. Exclusive arterial access may offer procedural advantages by simplifying the approach. This study evaluates the safety, efficacy, and mid-term outcomes of transcatheter VSD closure using only arterial access in infants under 10 kg. Materials and methods. Twenty infants (9 males [45%], 11 females [55%]) with a median age of 14.5 months (IQR 10–21.5) and median weight of 8.95 kg (IQR 8–9) underwent transcatheter VSD closure via arterial access alone. Median VSD size was 4.5 mm (IQR 3.5–4.95), and device diameter ranged from 7×5 to 8×6 mm (median 7×5). Median fluoroscopy dose was 19 mGr (IQR 13–29.5), and median procedure time was 50 minutes (IQR 40–60). The median follow-up duration was 15 months (IQR 12–22). Results. Procedural success was 100%. Residual shunt at 1 year was observed in 15% of patients. Tricuspid regurgitation occurred in 30%, with no aortic regurgitation reported. No major complications or mortality were documented. Conclusion. Transcatheter VSD closure in infants under 10 kg using only arterial access is a feasible and safe approach with favorable mid-term outcomes. This technique may reduce procedure time and contrast load, making it an attractive option for small infants.
Author’s Modification of Tip-M in Distal Forms of Hypospadias in Children: Scientific Justification and Technical Description of the Innovative Method
Aim. To develop and validate TIP-M modification for distal hypospadias repair. Materials and methods. Prospective cohort study of 56 patients (mean age 6.4±3.8 years) with distal hypospadias treated using TIP-M technique. The modification involves limiting urethral plate incision depth to 2mm with defect replacement using vascularized flap from inner prepuce. Results. Early complications occurred in 26.8% patients, late complications in 7.1%. Excellent overall results achieved in 73.2% cases. Normal voiding restored in 100% patients with excellent cosmetic outcomes in 94.6%. Reoperation rate was 5.4%. Mean urethral plate width increase was 35.2±8.7%. Conclusion. TIP-M modification demonstrates superior outcomes compared to classical techniques, providing universal applicability regardless of anatomical conditions. The technique can be recommended as first-choice method for distal hypospadias repair.
Comparative Effectiveness of Crystalloid and Blood-Based del Nido Cardioplegia in Children with Septal Congenital Heart Defects
Aim. To assess the frequency of myocardial ischemic injury in young children with septal congenital heart defects (CHDs) undergoing open-heart surgery, depending on the method of cardioplegic protection. Materials and methods. A prospective study included 95 patients aged 1 to 3 years who underwent surgery under cardiopulmonary bypass at the National Children’s Medical Center. Patients were divided into two groups: the control group (n = 42) received crystalloid pharmacohypothermic cardioplegia (CC), and the study group (n = 53) received modified blood-based del Nido cardioplegia. Results. Troponin I levels at 6 and 24 hours postoperatively, ejection fraction, mechanical ventilation duration, and ICU stay were the main outcome measures. Elevated troponin I 10 times the upper limit of normal was observed in 31.3% of the del Nido group and 62.5% of the CC group (p < 0.001). Ejection fraction decreased by 30.7% in the CC group and by 18% in the del Nido group at 24 hours post-surgery. Conclusion. Blood-based del Nido cardioplegia provides superior myocardial protection and reduces the incidence of myocardial injury in the early postoperative period in children with CHDs.
Early extubation and reduced icu stay as markers of effective infusion support in children after congenital heart defect repair
Aim. To assess the impact of different initial infusion strategies, including the use of balanced Ringer’s solution, on the early postoperative course in children after surgical correction of congenital heart defects. Materials and methods. This prospective cohort study included 70 pediatric patients who underwent radical correction of tetralogy of Fallot. The patients were divided into two groups: the control group (0.9% NaCl) and the study group (balanced Ringer’s solution). Acid-base status, electrolyte levels, hemodynamic parameters, echocardiographic findings, as well as the time to extubation and duration of stay in the intensive care unit (ICU) were analyzed. Results. The study group demonstrated significantly higher pH values, less pronounced hyperchloremic acidosis, stable plasma osmolality, improved cardiac output (higher ejection fraction and lower end-diastolic volume). Mean arterial pressure after 24 hours was higher, and central venous pressure remained more stable. Time to extubation and ICU stay were reduced by 31.3% and 26.6%, respectively, in the study group. Conclusion. Optimization of infusion therapy using balanced crystalloid solutions improves myocardial function and accelerates recovery in pediatric patients after cardiac surgery, as evidenced by earlier extubation and shorter ICU stay.
The Results of Nephroblastoma Treatment in Children: Experience of the National Children’s Medical Center and Prospects for Personalized Therapy
Background. To evaluate the effectiveness of combined therapy for nephroblastoma in children, including chemotherapy, surgical intervention, and radiotherapy, and to examine prognostic factors affecting patient survival. Materials and methods. The study was conducted as a retrospective cohort analysis involving 45 pediatric patients with histologically confirmed nephroblastoma, treated at the National Children’s Medical Center from January 2021 to March 2025. All patients underwent diagnostics using ultrasonography, multi-slice CT, PET/CT, and MRI. Treatment included radical nephrectomy with lymphadenectomy and adjuvant chemotherapy according to international protocols. Results. The 3- and 5-year overall survival rates were 85.6%. Disease recurrence was observed in 2.2% of patients. Metastasis occurred in 15.5% of cases, including isolated lung involvement (6.6%) and retroperitoneal lymph nodes (4.4%). The mortality rate was 15.5%, with 71.4% of deaths associated with poorly differentiated tumors (G3). Poorly differentiated tumors (G3) were associated with an increased risk of metastasis (OR=3.8, p=0.021). Early-stage disease was associated with better outcomes. Conclusion. Combined therapy for nephroblastoma, including surgery, chemotherapy, and selective radiotherapy, provided a high survival rate (85.6%) in children. However, poorly differentiated tumors are linked to a worse prognosis and a higher risk of metastasis. Early detection of the disease, as well as a personalized approach based on molecular genetic profiling, can improve treatment outcomes.
Criteria for choice of treatment and diagnosis of combined chest injuries in children
Background. To analyze the features, advantages and disadvantages of integrated methods and systems used to assess the severity of community-acquired pneumonia. Materials and methods. This review is devoted to the study of the most common methods for assessing the severity of community-acquired pneumonia in patients. The article discusses the use of integrated assessment systems for forecasting and diagnosis in pediatrics, including young children. This is aimed at improving the results of diagnosis and treatment of patients with community-acquired pneumonia in both global and domestic healthcare practice. Results. Currently, several scales have been developed and proposed, but the most popular of them are the scales of the pneumonia severity index PSI (Pneumonia Severity Index) and CURB (Confusion, Urea, Respiratory rate, Blood). There are also a number of scales that have not been widely implemented in practice, such as the American Thoracic Society scale, the Australian SMART-COP scale, the Spanish CURXO-80 scale and the Japanese A-DROP scale, which are used to determine the severity of community-acquired pneumonia. Conclusion. As a result of the analysis, it was found that in order to improve the early diagnosis of community-acquired pneumonia, it is necessary to continue research in this area, develop new methods and approaches, and train medical personnel in modern standards of diagnosis and treatment, which will reduce morbidity and mortality among children.
Peculiarities of the influence of low birth weight on the course of bronchopulmonary pathology in full-term infants.
Objective. To study the bronchial-pulmonary function and related pathologies in preterm low-birth- weight infants and to develop measures to alleviate disease conditions based on these studies. Materials and Methods. Review and analysis of foreign articles and literature. Results. Based on the literature analysis, it was found that bronchial-pulmonary pathologies associated with this condition progress more severely in preterm low-birth-weight infants compared to full-term infants. Conclusion. Preterm birth significantly impacts bronchial-pulmonary function and may cause long-term respiratory issues, as identified through literature analysis. The scarcity of research in this area highlights the need for systematic studies and data collection. Future research will pave the way for effective treatment of bronchial-pulmonary pathologies in such infants.
Peculiarities of surgical practice and priority of intraoperative navigation system in patients with congenital atresia of the external auditory canal
This article is devoted to the creation of an effective method of complex functional rehabilitation of patients with acquired atresia and stenosis of the external auditory canal, its implementation into practice, and assessment of the feasibility of a navigation system (NS) during surgical intervention. In 2024, with the support of the KOFIH Charity Foundation, we examined 55 children aged 6 to 18 with congenital atresia of the unilateral and bilateral external auditory canal. With the help of an electromagnetic navigation system, neuromonitoring, the atresia of the external auditory canal was simultaneously eliminated and tympanolastic surgery was performed. Of these patients, 10 children had the opportunity to undergo surgery using a navigation system (NS). During long-term observation, results of consistency in the formation of the external auditory canal were achieved, with an average bone-air gap of 15-20 dB during audiological examination.
Diagnostic and therapeutic features of refractive amblyopia in children with cerebral palsy
Background. To identify the clinical and functional characteristics of refractive amblyopia in children with cerebral palsy (CP) and to evaluate the effectiveness of a comprehensive ophthalmological correction program combining traditional and adapted therapeutic methods. Materials and methods. A prospective clinical study included 39 children (78 eyes) aged 3 to 12 years diagnosed with CP and confirmed refractive amblyopia. Visual impairment was assessed using adapted diagnostic techniques that took into account motor and cognitive limitations. Treatment included individually prescribed optical correction, occlusion therapy, hardware-based methods (Amblyotron), as well as speech and psychological support. Results. Following a six-month course of therapy, a statistically significant improvement in visual acuity (from 0.31 to 0.47; p<0.01), fixation stability, and oculomotor coordination was observed. More pronounced positive dynamics were noted in younger children and those with preserved cognitive function. It was also found that the severity of neurological deficits is a significant prognostic factor for therapeutic success. Conclusion. The findings highlight the necessity of a multidisciplinary approach and early intervention in the management of patients with CP and amblyopia.
Immunological and serological profiles in subacute sclerosing panencephalitis: insights from igg and igm analysis in cerebrospinal fluid
Background. Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disor- der caused by persistent measles virus infection. Immunological and serological changes, particularly the presence of measles-specific IgG and IgM in cerebrospinal fluid (CSF) and serum, play a critical role in diagnosis and disease progression. Materials and methods. This study analyzed IgG and IgM levels in the CSF and serum of 45 SSPE patients (32 males, 13 females) using enzyme-linked immunosorbent assay (ELISA). A systematic review of PubMed, Scopus, and Google Scholar was conducted to compare findings with existing literature. Statistical correlations between immunoglobulin levels and patient characteristics were evaluated. Results. IgG levels remained consistently elevated across all patients, while IgM levels varied signif- icantly. A weak correlation between IgG and IgM was observed, suggesting independent immune response mechanisms. Comparisons with previous studies confirmed the role of intrathecal IgG production and measles-specific antibody presence as key diagnostic markers. Conclusion. The findings support the clinical utility of IgG and IgM profiling in SSPE diagnosis. While IgG is a stable diagnostic marker, IgM variability may indicate ongoing immune activation. Further research is needed to explore immunogenetic factors influencing disease progression.
A Systematic review comparing outcomes of laparoscopic and transvesicoscopic ureteroneocystostomy
Background. We have examined and compared the results of the articles on LEVUR and TVUR in this systematic review and meta-analysis. Materials and methods. To find all the studies about TVUR and LEVUR in the pediatric population, we examined the databases. Exclusions were review articles, unfinished articles, duplicate publica- tions, and robot-assisted publications. To determine patient information, reflux grades, laterality, length of operation, time to discharge, success rate, and complications, a systematic review was carried out. Results. 23 articles -13 on TVUR and 10 on LEVUR - were included after a total of 45 articles were screened. In TVUR grade 5 VUR was substantially larger (11.9%, p = 0.001) than in LEVUR (2.2%). When comparing TVUR to LEVUR, the percentage of bilateral reimplantation was considerably higher (p = 0.001). 96.7% was the success rate of LEVUR, a considerable increase above TVUR 93.7% (p = 0.007). Unilateral/bilateral TVUR took significantly longer duration of surgery (155/194 min vs 107/161 min) compared to LEVUR (p = 0.001). The mean (s.d) time to discharge was longer at 3.2 (1.6) days for TVUR compared to 1.6 (0.4) days for LEVUR (p = 0.001). The complication rate was comparable, 7.35% for TVUR and 5.35% for LEVUR (p = 0.167). Conclusion. With regard to success rates and side effects, LEVUR and TVUR appear to be reason- able substitutes for open ureteric reimplantation. Compared to TVUR, which was recommended for bilateral UR and grade 5 VUR patients, LEVUR was more preferable for unilateral, grades 1-4 cases, had higher success, and required a shorter hospital stay. Although the types of complications varied according to the procedure, there was no discernible difference in the complication rate between LEVUR and TVUR.
Multimodal opioid-free analgesia in pediatric abdominal surgery: safety and speed of recovery.
Background. To evaluate the efficacy, safety, and recovery rate of multimodal non-opioid analgesia (MBA) compared with an opioid regimen in children after abdominal surgery. Materials and methods. A prospective clinical study included 131 patients (5-17 years old) undergoing elective surgery. The IBA group (n=101) received paracetamol and ibuprofen, the comparison group (n=30) -morphine. Pain intensity (Wong-Baker scale), inflammatory biomarkers (IL-6, CRP), side effects, time to extubation and parental satisfaction were evaluated. Results. The IBA group showed: less pain (0.9±1.2 vs. 4.2±2.0, plt;0.001), lower need for additional analgesia (36% vs. 81%, plt;0.001), minimal side effects (nausea 5% vs. 50%), lower IL-6 and CRP (plt;0.01), shorter time to extubation (42±8 vs 66±11 min, plt;0.001) and higher parental satisfaction (9.3±0.5 vs 7.8±1.1, plt;0.01). Conclusion. IBA provides better pain control, lower complication rates, and faster recovery compared with opioids. The method is recommended for wide application in pediatric surgery.
Criteria for the choice of treatment and diagnosis of combined chest injuries in children
Background. To predict the feasibility of applying video-assisted thoracoscopic surgery (VATS) in children with chest trauma using the Allgower shock index. Materials and methods. From 2012 to 2023, 63 children with chest injuries of varying severity and localization were treated at the Pediatric Surgery Center of Samarkand State Medical University. Of these, 39 children had combined chest trauma. Thoracotomy was performed on 8 patients, and video-assisted thoracoscopic procedures on 22. The patients were aged 3 to 15 years. Results. The patients were classified into four groups based on the Allgower shock index. Surgical decisions were made considering the severity of the patient’s condition and the shock index. The feasibility of using VATS was evaluated accordingly. Survival after chest trauma was assessed using the BBTRISS scale, which correlated with the degree of shock and trauma severity. Conclusion. The retrospective analysis demonstrates that the Allgower shock index is a reliable predictor for the use of VATS in pediatric patients with combined chest trauma. It directly correlates with survival rates assessed by BBTRISS.