МЕДИКО-СОЦИАЛЬНЫЕ ПРОБЛЕМЫ ВСПОМОГАТЕЛЬНЫХ РЕПРОДУКТИВНЫХ ТЕХНОЛОГИЙ С ПОЗИЦИИ ПЕДИАТРИИ

The article presents a literature review over the last few years devoted to the health status and development peculiarities of children born using assisted reproductive technologies (ART) procedures. The statistics shows an explosive increase in the frequency of ART application as a fertility treatment method. The presented data analysis reflects the perinatal outcomes after ART in children, the frequency of congenital malformations and genetic diseases in this population, possible long-term malconditions and pathologies in children born using ART. The overwhelming majority of investigators consider the adverse effect of ART on a child’s body to be the result of prematurity and multiple pregnancy (transfer multiple embryos followed by partial reduction). It is stated that the widespread introduction of ART may contribute to the vertical transmission of parental infertility factors in the population. The application of ART procedures in some cases is associated with controversial ethical and legal issues (surrogacy, oocyte donation). Further improvements in ART procedures (preimplantation training, medical and genetic diagnosis, reducing the frequency of multiple pregnancy) cannot be stated as an alternative to the general medical and social prevention of reproductive disorders in adolescents and youth. В статье представлен анализ данных литературы последних лет, посвященной особенностям состояния здоровья и развития детей, родившихся с помощью вспомогательных репродуктивных технологий (ВРТ). Данные статистики свидетельствуют о лавинообразном увеличении частоты применения ВРТ как метода лечения бесплодия. В обзоре литературы отражены исходы перинатального периода у детей после ВРТ, частота врожденных пороков развития и генетических заболеваний в этой популяции, возможные отдаленные патологические состояния у детей, родившихся с помощью ВРТ. Подавляющее большинство исследователей связывают неблагоприятные влияния ВРТ на организм ребенка с недоношенностью и многоплодием (трансфер нескольких эмбрионов с последующей частичной редукцией). Указывается, что широкое внедрение ВРТ может способствовать вертикальной передаче факторов родительского бесплодия в популяции. Применение ВРТ в некоторых случаях сопряжено со спорными этическими и правовыми проблемами (суррогатное материнство, донорство ооцитов). Дальнейшее совершенствование технологий ВРТ (предимплантационная подготовка, медико-генетическая диагностика, сокращение частоты многоплодий) не является альтернативой для широкой медико-социальной профилактики нарушений в репродуктивной сфере у подростков и молодежи.

ОЦЕНКА НУТРИТИВНОГО СТАТУСА НЕДОНОШЕННЫХ ДЕТЕЙ МЕТОДОМ ВОЗДУШНОЙ ПЛЕТИЗМОГРАФИИ: ПЕРВОЕ РОССИЙСКОЕ ПРОСПЕКТИВНОЕ НАБЛЮДЕНИЕ

In this article results of first Russian study on premature infants body composition in association with trend of their physical development within the first month and according to way of feeding. 30 preterm newborns without signs of intrauterine hypotrophy at birth with gestational age less than 35 month were examined by air body plethysmography. The infants were examined reaching term corrected age. Less levels of fat-free mass and increased percentage of fat were found in premature infants. The negative association between gestational age and the specific content of fat was found. This increases the risk of long-term metabolic diseases in preterm infants. It is found that preterm infants fed by fortified human milk have a more optimal body composition (less body fat levels) than infants fed by formula. The found consistent patterns confirm the necessity of supplying preterm infants with human milk for more adequate formation of plastic processes. Представлены результаты первого отечественного исследования состава тела недоношенных детей во взаимосвязи с динамикой их физического развития на первом месяце жизни и в зависимости от характера вскармливания. С помощью воздушной бодиплетизмографии обследовано 30 недоношенных новорожденных с гестационным возрастом 35 и менее недель, не имевших при рождении признаков внутриутробной гипотрофии. Дети обследовались по достижении ими постконцептуального возраста 38–42 нед. У недоношенных детей установлены меньшие показатели безжировой массы тела и увеличенное процентное содержание жира. Обнаружена отрицательная корреляция между гестационным возрастом и удельным содержанием жировой ткани, что увеличивает риск отдаленных метаболических расстройств у маловесных недоношенных детей. Установлено, что недоношенные дети, вскармливаемые грудным молоком с обогатителем, имеют наиболее оптимальный состав тела (меньше жировой массы), чем дети, получающие специализированную смесь. Выявленные закономерности подтверждают необходимость обеспечения недоношенных детей грудным молоком для наиболее адекватного становления пластических процессов.

INTESTINAL COLIC IN NEWBORNS AND INFANTS: FROM DIAGNOSTICS TO THE DIFFERENTIATED CORRECTION

Functional disorders of digestion are the most widespread disturbances of adaptation in infants. The article presents classification of colic in newborns and infants, characterizes their etiology and pathogenesis depending on maturity of a child, presence of perinatal pathology, defects of nursing and nutrition. Authors describe main principles of intestinal colic correction including diet and medicamental treatment in infants. «Mild» drugs (herbal therapy) have some advantages in treatment of colic. The results of an observation of 47 mature and premature infants treated with Plantex are presented.Key words: infants, intestinal colics, dietotherapy, herbal therapy.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (2): 137–140

REALIZING OF BREAST FEEDING IS NECESSARY OBJECTIVE OF A PEDIATRICIAN

The article analyzes several problems of breast feeding existing. The data on composition of breast milk in different groups of women, recommended terms of beginning and duration of breast feeding are presented. Authors discuss principles of effectiveness evaluation and advantages of prolonged breast feeding on the basis of comparative estimation of physical and psychical development and morbidity of children with different types of feeding. Methods of breast feeding optimization including modern electronic breast pump use are described.Key words: infants, breast feeding, breast pumps.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 86–91

CORRECTION OF INTESTINAL COLIC IN INFANTS

The article describes the contemporary vision of the causes, pathogenesis, diagnostic criteria and clinical manifestation of intestinal colic in infants. The article also provides a detailed description of to correction of the gastrointestinal tract in the infants. Also the article opens a discussion about the benefits of using vegetable medications with a soft spasmolytic effect for this purpose.Key words: infants, intestinal colic, gastrointestinal tract dysfunction.</strong

PREVENTIVE AND THERAPEUTIC AGENTS FOR SKIN CARE IN PRETERM INFANTS

Proper care for a baby’s skin is extremely important for the adequate functioning of an infant’s skin and health. Care agents must be selected in accordance with age and purpose of application. In addition, each ingredient contained in a cosmetic or therapeutic agent for external application must be safe. The article describes the experience of leading neonatology physicians in using preventive and therapeutic agents for skin care in newborn infants, including preterm infants.Key words: newborn infants, skin, care

DIET CORRECTION OF GASTROINTESTINAL TRACT DYSFUNCTIONS OF INFANTS AFTER CEREBRAL ISCHEMIA

The article analyzes mechanisms of occurrence of gastrointestinal tract dysfunctions of infants after cerebral ischemia. It describes the clinical symptomatology of gastrointestinal impairment, particularly associated with vegetovisceral impairment, lactase deficiency, cow's milk protein intolerance. It gives recommendations about diet correction of gastrointestinal tract dysfunctions of infants.Key words: infants, gastrointestinal tract dysfunctions, dietotherapy.</strong

PREVENTIVE AND THERAPEUTIC AGENTS FOR SKIN CARE IN PRETERM INFANTS

Proper care for a baby’s skin is extremely important for the adequate functioning of an infant’s skin and health. Care agents must be selected in accordance with age and purpose of application. In addition, each ingredient contained in a cosmetic or therapeutic agent for external application must be safe. The article describes the experience of leading neonatology physicians in using preventive and therapeutic agents for skin care in newborn infants, including preterm infants.Key words: newborn infants, skin, care