Bronchopulmonary dysplasia prevention and treatment from evidence-based medicine position

Improved methods of newborns with very low and extremely low birth weight care leads to their increased survival and growing number of children with bronchopulmonary dysplasia (BPD). The review provides modern recommendations for BPD prevention and treatment, based on cohort, randomized clinical trials, systematic reviews and meta-analyzes results. According to evidence-based medicine methodology, it describes recommendations, interventions and medicines with proven efficacy for infants with BPD (early CPAP, INSURE, LISA, artificial lung ventilation, oxygenation monitoring and oxygen therapy, methylxanthines, systemic steroids, inhaled bronchodilators, palivizumab). © 2015, Pediatria Ltd. All rights reserved

Bronchopulmonary dysplasia prevention and treatment from evidence-based medicine position

Improved methods of newborns with very low and extremely low birth weight care leads to their increased survival and growing number of children with bronchopulmonary dysplasia (BPD). The review provides modern recommendations for BPD prevention and treatment, based on cohort, randomized clinical trials, systematic reviews and meta-analyzes results. According to evidence-based medicine methodology, it describes recommendations, interventions and medicines with proven efficacy for infants with BPD (early CPAP, INSURE, LISA, artificial lung ventilation, oxygenation monitoring and oxygen therapy, methylxanthines, systemic steroids, inhaled bronchodilators, palivizumab). © 2015, Pediatria Ltd. All rights reserved

The effect of immunoprophylaxis of respiratory syncytial viral infection with palivizumab on the development of bronchial asthma in children with bronchopulmonary dysplasia

Prematurity, bronchopulmonary dysplasia (BPD), and respiratory syncytial virus (RSV) infection are risk factors for bronchial asthma (BA) development. Palivizumab is effective in preventing severe cases of RSV infection in children. Objective of the research: to determine the effect of Palivizumab immunization on the risk of BA development in children with BPD. Materials and methods: out of 510 patients with BPD, 34 were diagnosed with BA on the basis of PRACTALL criteria (Practical Allergology Pediatric Asthma Group) with mandatory allergological confirmation, 263 children received from 1 to 5 injections of Palivizumab during the annual epidemiological season of RSV infection. Results: among children with BPD that did not have BA, 222 patients (90,2%) out of 246 received a complete (≥3 injection) course of immunoprophylaxis, while in patients with BA, only 3 (18%) of 17 (p<0,001). Conclusion: BA development in children with BPD is statistically significantly associated with an incomplete course (<3 injections) of prophylaxis of severe RSV infection with Palivizumab, while a full course of immunoprophylaxis (≥3 injections) statistically significantly reduces the risk of BA (p<0,001). © 2020, Pediatria Ltd. All rights reserved

Actual problems of neonatal pulmonology

The article presents discussion questions, problems and achievements in newborns pulmonology and contribution of Russian researches to this section of neonatology and pediatrics. Authors assess prospects of obtained results implementation and their scientific and practical significance. The article discusses in detail the most common newborns lung diseases-respiratory distress syndrome, bronchopulmonary dysplasia (BPD) and pneumonia. It illuminates the actual problem of complications and differential diagnosis of BPD with other chronic and interstitial newborns lung diseases, occurring under its «disguise». © 2016, Pediatria Ltd. All rights reserved

Actual problems of neonatal pulmonology

The article presents discussion questions, problems and achievements in newborns pulmonology and contribution of Russian researches to this section of neonatology and pediatrics. Authors assess prospects of obtained results implementation and their scientific and practical significance. The article discusses in detail the most common newborns lung diseases-respiratory distress syndrome, bronchopulmonary dysplasia (BPD) and pneumonia. It illuminates the actual problem of complications and differential diagnosis of BPD with other chronic and interstitial newborns lung diseases, occurring under its «disguise». © 2016, Pediatria Ltd. All rights reserved

Частота, факторы риска, особенности бронхиальной астмы у детей с бронхолегочной дисплазией и ведение коморбидных пациентов

Bronchopulmonary dysplasia (BPD) and bronchial asthma (BA) are the most common chronic lung diseases in children, but the relationship between these diseases has not been fully defined. The incidence of atopic diseases (atopic dermatitis, allergic rhinitis, and BA) in children with BPD are significantly different according to national and international studies. There is not enough data on risk factors for the development, clinical and laboratory features of the course and treatment of BA in children with BPD. Material and methods. The case histories of 1104 patients (2004-2017) with BPD criteria were analyzed at the Department of Pediatrics at the RUDN University. On the basis of clinical and anamnestic data, allergological examination, and study of respiratory function, the frequency of asthma was determined. The comparative study was conducted in patients with isolated diseases - BPD (without BA) and BA (without BPD) - to determine the risk factors and characteristics of BA in children with BPD. Results and discussion. The frequency of BA was 7%, atopic dermatitis - 3.8% and allergic rhinitis - 3.6%. The risk factors for the development of BA in children with BPD were determined for low birth weight (LBW) (p=0.0037), late prematurity (p=0.0007), family history of allergy through asthma (p=0.0334), concomitant atopic dermatitis (p=0.0018) and allergic rhinitis (p=0.0022). Severe BPD (p=0.0002), episodes of bronchial obstruction in the first 3 years of life (p=0.0272). It was found that BA in children with BPD, compared with children without BPD is statistically significant. It characterized by an earlier onset (p=0.0168), a mild intermittent course (p=0.0003), a rarer need for inhaled bronchodilators (p=0.0034) and more frequent administration of inhaled corticosteroids as basic therapy (p=0.0399). Conclusion. We suggested that BA in children could be a respiratory consequence of BPD and a comorbid disease with a separate phenotype. The management of children suffering from BA and BPD should include the registration and evaluation of epidemiology, risk factors, clinical and laboratory features. It would be necessary to implement the clinical and allergological examination and the development of an individualized management program for patients.Бронхолегочная дисплазия (БЛД) и бронхиальная астма (БА) являются самыми частыми хроническими заболеваниями легких у детей, однако связь между данными заболеваниями до конца не определена. Частота развития атопических заболеваний (атопического дерматита, аллергического ринита и БА) у детей с БЛД существенно отличается; по данным отечественных и зарубежных исследований, немногочислены данные о факторах риска развития, клинико-лабораторных особенностях течения и терапии БА у детей с БЛД. Материал и методы. Были изучены истории болезней пациентов с БЛД и БЛД в анамнезе, наблюдавшихся на кафедре педиатрии ФГАОУ ВО «Российский университет дружбы народов» (Москва) на базе консультативно-диагностического отделения с дневным стационаром ГБУЗ «Детская инфекционная клиническая больница № 6» Департамента здравоохранения г. Москвы с 2004 по 2017 г. Среди этих больных на основании клинико-анамнестических данных, аллергологического обследования и исследования функции внешнего дыхания определена частота БА, проведено сравнительное исследование с пациентами с изолированными заболеваниями: БЛД (без БА) и БА (без БЛД) для определения факторов риска и особенностей БА у детей с БЛД. Результаты и обсуждение. Проанализировано 1104 медицинских карт пациентов, удовлетворяющих критериям диагноза БЛД, определена частота развития у них атопических заболеваний. Частота БА составила 7%, атопического дерматита - 3,8%, аллергического ринита - 3,6%. Определены факторы риска развития БА у детей с БЛД: низкая масса тела при рождении (р=0,0037), поздняя недоношенность (р=0,0007), отягощенный семейный аллергоанамнез по БА (р=0,0334), сопутствующие атопический дерматит (р=0,0018) и аллергический ринит (р=0,0022), тяжелая БЛД (р=0,0002), эпизоды бронхиальной обструкции в первые 3 года жизни (р=0,0272). Установлено, что БА у детей с БЛД по сравнению с детьми без данного хронического заболевания легких новорожденных статистически значимо чаще характеризуется более ранним началом (р=0,0168), легким интермиттирующим течением (р=0,0003), более редкой потребностью в ингаляционных бронхолитиках (р=0,0034) и более частым назначением ингаляционных глюкокортикоидов в качестве базисной терапии (р=0,0399). Заключение. БА у детей является респираторным последствием БЛД, коморбидным заболеванием с отдельным фенотипом. Оказание медицинской помощи детям, страдающим БА и БЛД, должно предусматривать учет и оценку эпидемиологии, факторов риска развития, клинико-лабораторных особенностей с реализацией этапного клинического и аллергологического обследования и выработкой программы индивидуализированного ведения пациентов

In children with bronchial asthma: Causal, complicated, unspecified, reverse

The review, based on modern literature data and the results of many years of research conducted by the authors, highlights the problem of comorbidity (multimorbidity) in children with bronchial asthma (BA). There is a grouping of concomitant diseases in children with asthma depending on the type of comorbidity (causal, complicated, unspecified, reverse). Based on epidemiological data, observational and cohort studies, systematic reviews and meta-analyses, information on the frequency of BA in children with various comorbid diseases and comorbid diseases in children with BA was summarized. Scientific, theoretical and practical significance of comorbidity in BA, diagnostic and treatment programs in pediatric patients suffering from BA and comorbid diseases are substantiated. © 2021, Pediatria Ltd.. All rights reserved

The structure of interstitial lung diseases in children of the first two years of life

For the first time in Russia, the article provides data on interstitial lung diseases structure in children of the first two years of life, based on a series of observations of 68 patients with these rare diseases, as a part of multi-center ambispective study. Interstitial lung diseases in observed children included: Wilson-Mikity syndrome (23,4%), neuroendocrine hyperplasia of infancy (22%), bronchiolitis obliterans with organizing pneumonia (7,4%), primary pulmonary hypoplasia (1,5%), secondary pulmonary hypoplasia with Jeune syndrome (10,3%), secondary pulmonary hypoplasia with Edwards syndrome (2,9%), secondary pulmonary hypoplasia with other associated pathology (omphalocele - 1,5%, non-immune fetal hydrops - 1,5%), subpleural cysts in patients with Down syndrome (5,9%), congenital deficiency of surfactant protein B (1,5%), brain-lung- thyroid syndrome (2,9%), congenital alveolar-capillary dysplasia (1,5%), interstitial lung diseases with systemic diseases (Langerhans cell histiocytosis - 16,2%, Niemann-Pick disease - 1,5%). The article summarizes clinical features, the results of image diagnosis and disease outcomes. © 2015, Pediatria Ltd. All rights reserved

The structure of interstitial lung diseases in children of the first two years of life

For the first time in Russia, the article provides data on interstitial lung diseases structure in children of the first two years of life, based on a series of observations of 68 patients with these rare diseases, as a part of multi-center ambispective study. Interstitial lung diseases in observed children included: Wilson-Mikity syndrome (23,4%), neuroendocrine hyperplasia of infancy (22%), bronchiolitis obliterans with organizing pneumonia (7,4%), primary pulmonary hypoplasia (1,5%), secondary pulmonary hypoplasia with Jeune syndrome (10,3%), secondary pulmonary hypoplasia with Edwards syndrome (2,9%), secondary pulmonary hypoplasia with other associated pathology (omphalocele - 1,5%, non-immune fetal hydrops - 1,5%), subpleural cysts in patients with Down syndrome (5,9%), congenital deficiency of surfactant protein B (1,5%), brain-lung- thyroid syndrome (2,9%), congenital alveolar-capillary dysplasia (1,5%), interstitial lung diseases with systemic diseases (Langerhans cell histiocytosis - 16,2%, Niemann-Pick disease - 1,5%). The article summarizes clinical features, the results of image diagnosis and disease outcomes. © 2015, Pediatria Ltd. All rights reserved