Arterial ischemic stroke in children: The use of thrombolytic therapy

In recent years, the number of diagnosed cases of arterial ischemic stroke (AIS) in children has increased significantly. Intravenous and endovascular thrombolytic therapy of AIS is the most effective treatment for adults. Currently, the literature provides descriptions of a series of clinical observations in children with AIS, that received therapy with thrombolysis. This type of therapy is recommended to be performed on the basis of pediatric stroke primary centers. Since 2018, on the basis of the Center for Cerebrovascular Pathology Treatment, Morozov Children’s City Clinical Hospital, 34 children with AIS aged 3,5-14 years received intravenous thrombolytic therapy. The article describes the clinical observations of 4 patients with AIS who underwent treatment with thrombolysis. © 2020, Pediatria Ltd. All rights reserved

СОЗДАНИЕ И УНИКАЛЬНЫЙ ОПЫТ РАБОТЫ ЦЕНТРА ПО ЛЕЧЕНИЮ ДЕТЕЙ И ПОДРОСТКОВ С ЦЕРЕБРОВАСКУЛЯРНЫМИ ЗАБОЛЕВАНИЯМИ НА БАЗЕ МНОГОПРОФИЛЬНОГО ПЕДИАТРИЧЕСКОГО СТАЦИОНАРА КАК ЕДИНСТВЕННОГО В РОССИЙСКОЙ ФЕДЕРАЦИИ ПЕРВИЧНОГО ЦЕНТРА ДЕТСКОГО ИНСУЛЬТА

Stroke is in the top ten causes of children death, ahead of brain tumors. Х-ray diagnostics development has significantly improved the detectability of pediatric stroke. The average incidence of cerebrovascular diseases in children was 13 per 100,000 children annually. The main feature of children's stroke is its multifactorial character, which complicates diagnostic process and requires involvement of doctors of different specialties to determine the leading etiological factors and choose optimal therapy and management tactics. The Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents was established on the basis of Morozov Children City Clinical Hospital by Moscow Healthcare Department, Order No. 169, dated February 27, 2014. The main task was to create a pediatric stroke center on the basis of multidisciplinary Morozov Children City Clinical Hospital, which met the main international requirements of the primary center for pediatric stroke. It was done to improve early diagnostic process, refine the algorithm for maintaining patient data in acute periods, develop preventive measures, maintain city pediatric stroke register, introduce family consultations, coordinate medical care for children with cerebrovascular pathology at various levels in Moscow, and improve medical care quality for children with cerebrovascular pathology and their families. Since April 2014 more than 800 children have undergone inpatient treatment and more than 420 have been treated in outpatient departments of Morozov Children City Clinical Hospital.У детей инсульт находится в первой десятке причин смерти, опережая опухоли головного мозга. С развитием лучевой диагностики значительно улучшилась выявляемость детского инсульта. Средняя частота возникновения цереброваскулярных заболеваний у детей составила 13 на 100 тыс. детей в год. Основной особенностью детского инсульта является его мультифакториальность, что усложняет диагностику и требует привлечения врачей разных специальностей для определения ведущих этиологических факторов и выбора оптимальной терапии и тактики ведения. Приказом Департамента здравоохранения г. Москвы от 27.02.2014 № 169 на базе ГБУЗ «Морозовская детская городская клиническая больница ДЗМ» (МДГКБ) был создан Центр по лечению детей и подростков с цереброваскулярными заболеваниями. Основной задачей было создание на базе многопрофильного стационара ГБУЗ «Морозовская ДГБК ДЗМ» центра детского инсульта, отвечающего основным международным требованиям первичного центра детского инсульта, для улучшения ранней диагностики, отработки алгоритма ведения данных пациентов в острейшем и остром периодах, разработки профилактических мероприятий, ведения городского регистра детского инсульта, внедрения опыта семейного консультирования, координации медицинской помощи детям с цереброваскулярными заболеваниями на различных уровнях оказания медицинской помощи детям и подросткам в г. Москве, улучшения качества медицинской помощи детям и членам их семей с цереброваскулярными заболеваниями. Стационарное лечение на базе отделений МДГКБ за время существования центра с апреля 2014 г. прошли более 800 детей, наблюдались амбулаторно - более 420

Оценка качества стационарной помощи детям в регионах Российской Федерации

Background: The quality of pediatric healthcare is a cornerstone for good maternal and infant health. Aims: To evaluate the quality of healthcare in secondary and tertiary regional pediatric hospitals in the Russian Federation.Methods: Healthcare quality assessment was performed in 21 pediatric hospitals (tertiary, n=5; secondary, n=16) of four regions. The WHO recommendations were used. Results: In all regions, similar traits of inpatient pediatric healthcare determining a poor quality were observed. These included low preparedness for emergent care at admission departments; a high rate of unjustified hospitalization due to lack of clear indications for inpatient care; a widespread polypharmacy and unnecessary painful procedures and treatment; inadequate unjustified antimicrobial and parenteral therapy. Conclusions: The revealed identity of problems in different regions of the country allows to consider a common strategy to overcome them, which, obviously, should primarily involve education of medical personnel, restructuring of hospital beds to increase day care beds, increasing the clinical expert work in hospitals.Обоснование. Качество оказания медицинской помощи детям является основой для реализации различных программ по сохранению здоровья матери и ребенка. Цель исследования: оценка качества помощи детям в стационарах второго и третьего уровня в различных регионах Российской Федерации.Методы. В статье обсуждаются результаты аудита стационарной помощи детям в четырех регионах Российской Федерации. Оценка качества стационарной помощи детям с помощью инструментария Всемирной организации здравоохранения была проведена в 21 больнице (из них 5 — третьего уровня, 16 — второго уровня). Результаты. Во всех участвовавших в проверке больницах регионов выявлены похожие, зачастую определяющие низкое качество особенности стационарной педиатрической помощи детям: низкая готовность к оказанию неотложной помощи в приемных отделениях, зачастую безосновательные госпитализации вследствие отсутствия четких критериев для пребывания детей в круглосуточном стационаре, крайне высокий уровень полипрагмазии и необоснованного болезненного лечения, избыточное и неадекватное применение антибактериальных препаратов и инфузионной терапии. Заключение. Идентичность проблем в различных регионах страны позволяет продумать общую стратегию их преодоления, которая, очевидно, должна, прежде всего, подразумевать образование медицинского персонала, реструктуризацию коечного фонда с увеличением коек дневных стационаров, усиление клинико-экспертной работы в больницах

Multisystem inflammatory syndrome in children associated with new coronavirus infection (Covid-19): Clinical and morphological comparisons

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with new coronavirus infection (COVID-19), with signs of Kawasaki disease (KD) and toxic shock syndrome, well-defined diagnostic criteria, is the most severe manifestation of COVID-19 in pediatric patients. MIS-C is analogous to the cytokine storm in children with COVID-19. The article presents a clinical observation of a child with MIS-C with a lethal outcome. Clinical and anamnestic data, the results of laboratory and instrumental research allowed to diagnose MIS-C in a 2-year-old girl with full KD form. Autopsy results, detailed microscopic examination, which revealed systemic vasculitis of small and medium-sized vessels, inflammatory infiltrates in different organs, are presented, clinical and morphological comparisons are made. © 2020, Pediatria Ltd.. All rights reserved

Clinical, laboratory-instrumental characteristics, course and therapy of pediatric multisystem inflammatory syndrome associated with covid-19

The most severe manifestation of the new coronavirus infection COVID-19 in children is the multisystem inflammatory syndrome in children (MIS-C). A systematic review of foreign publications as of July 25, 2020 contains an analysis of the disease course in 662 children with this syndrome and is used for comparison with the data obtained. Objective of the research: to characterize clinical manifestation, results of laboratory and instrumental studies, therapy, outcomes and consequences of the COVID-19-associated MIS-C, based on the observation of patients hospitalized to Morozov Children's City Clinical Hospital and Children’s clinical hospital of infectious diseases № 6 from May 1 to September 15, 2020. Materials and methods: the pilot study included 32 children aged 9 months – 15 years with COVID-19-associated MIS-C, verified based on WHO criteria (2020), including symptoms of Kawasaki disease (KD), arterial hypotension/shock, laboratory and instrumental signs of heart damage, signs of coagulopathy, gastrointestinal symptoms, increased inflammation markers, COVID-19 markers. Results: the median age of patients was 6 years, boys predominated among the patients (66%), all patients had antibodies to SARS-CoV-2 (31 children of the IgG class); MIS-C manifested itself as a combination of KD symptom complex (75% of patients) with arterial hypotension/shock (28%), neurological (50%), respiratory (41%), gastrointestinal (59%) symptoms; macrophage activation syndrome (MAS) was verified in 16% of patients. Therapy included intravenous immunoglobulin (75%), systemic glucocorticosteroids (88%), anticoagulants (91%), vasoactive/vasopressor support (31%). In 38% of cases treatment was performed in intensive care unit; one child died. According to echocardiography, 16% of patients had coronariitis, ectasia, and coronary arteries aneurysms. Conclusion: COVID-19-associated MIS-C is characterized by a severe course, cross-features with KD, shock syndrome with KD, MAS which requires intensive therapy and can cause acquired pathology of the cardiovascular system in children. © 2020, Pediatria Ltd. All rights reserved

Congenital deficiency of surfactant protein c: Literature review and first clinical observations in the russian federation

Surfactant is a complex mixture of phospholipids, neutral lipids and specific surfactant-associated proteins. Genetic diseases associated with gene mutations of surfactant proteins are rare, and treatment options for these children are currently limited. The article presents modern information on congenital deficiency of surfactant protein C, its genetics, pathogenesis, histological patterns, clinical and radiological manifestations in children and adults, outcomes and therapy. It also provides clinical observations of first three pediatric patients in the Russian Federation with this disease, including a rare manifestation in the form of primary pulmonary alveolar proteinosis. © 2018, Pediatria Ltd. All rights reserved