Внебольничная пневмония, ассоциированная с герпетической инфекцией у детей

USMF “Nicolae Testemiţanu”, Departamentul PediatrieBackground: Respiratory system diseases have high levels incidence in children (up to 70%), pneumonia being the most acute clinical form amongst all of them, having also a high incidence (20 – 40 %) and the presence of comorbidities is associated with herpes infection. Community-acquired pneumonia is an actual problem and the main reason for infant-mortaliry worldwide (WHO 2010). Association of acute respiratory dizeases with herpes infection markedly increases the mortality risk, especially amongst children of young age. Aim: Evaluation of clinical and immunological peculiarities in children under 5 years of age with acute pneumonia associated with pesistent herpes infection. Objectives: 1. Estimation of the anamnestic, clinical and laboratory data in acute respiratory infections associated with herpes infection. 2. Cellular and humoral immunity study. 3. Examination of anti-herpes and anti-cytomegalovirus antibodies in serum and urine, and virus DNA identifi cation in patients with suggestive history for Herpes simplex or Cytomegalovirus infection. Materials and methods: The study group included 47 children under 5 years of age with community-acquired pneumonia, associated with Herpes infection. Diagnosis of Herpes infection was confi rmed by PCR and IFM. Results: Immunological disorders were observed in 2/3 of cases (decreased levels of CD4, CD8, CD20 and serum IgA and IgG levels). The presence of HSV and/or CMV in parents was confi rmed by PCR in 79% of cases, by ELISA method - 11%. Viruses coinfections (ARD, HSV, CMV) determines immunological disorder and severity of clinical manifestations. Conclusions: Prenatal and postnatal risk factors in association with history of herpes infections determine acute manifestations of the commutity-acquired pneumonia. In 2/3 of cases IgG levels are three fold higher than the normal once, that indicates the presence of persistent herpes infection. Cellular and humoral immunological disorders contribute to a more sever and complex evolution of pneumonia in patients if associated with latent and persistent herpes infection.Актуальность: Внебольничная пневмония является актуальной проблемой и главной причиной детской смертности в мире (ВОЗ, 2010). Ассоциация острых респираторных заболеваний с герпетической инфекцией (ГИ) создает огромный риск смертности, особенно среди детей младшего возраста. Цель работы: Исследование клинико-иммунологических особенностей острых респираторных инфекций у детей в возрасте до 5 лет, протекающих в виде острых пневмоний, ассоциированных с устойчивой герпетической инфекцией (ГИ). Задачи: 1. Оценка анамнестических, клинических и параклинических данных при острых респираторных инфекциях, ассоциированных с ГИ. 2. Изучение клеточного и гуморального иммунитета. 3. Серологическое исследование на присутствие анти-герпетических антител 1-го, 2-го типа, антицитомегаловирусных антител в сыворотке крови и моче обследуемых детей, а также определение ДНК в сыворотке крови и моче у пациентов с положительным семейным анамнезом в отношение вируса герпеса и/или цитомегаловирвируса. Материалы и методы: В исследование были включены 48 детей в возрасте до 5 лет с острой внебольничной пневмонией, ассоциированной с герпетической инфекцией и положительным семейнымй анамнезом (наличие герпеса-инфекций). Диагноз герпетической инфекции был подтвержден методом ПЦР (Полимеразная Циклическая Реакция) и ИФР (Иммунофлюоресцентная Реакция). Результаты и дискуссии: Иммунный дисбаланс присутствовал в 2/3 случаев (уменьшение уровня CD8, CD4, CD20 и плазменных иммуноглобулинов IgA и IgG). Присутствие герпетической инфекции (HSV 1, 2 типа) и/ или цитомегаловиротической инфекции (CMV) у родителей было подтверждено методом ПЦР в 79% случаев и ИФР в 11% случаев. Семейный анамнез подтверждает высокую заболеваемость HSV в исследовании (94%), а у 16% обследованных присутством CMV. У 14% детей из группы исследования была диагностирована гирпетическая инфекция. ДНК-CMV была выявлена в плазме у 25,9% детей, а ДНК-HSV 1-го, 2-го, 6-го типов – в 27,6% случаев. Выводы: 1. Пренатальные и постнатальные факторы риска совместно с положительным герпетическим семейным анамнезом определяют тяжелое течение внебольничной пневмонии у детей до 5 лет. 2. У 2/3 детей уровень IgG был увеличен в 3 раза по сравнению с нормой, что подтверждает присутствие устойчивой герпетической инфекции. 3. Ассоциация респираторной инфекции с HSV 1-го, 2-го типа и CMV регистрировалось у 1/3 детей. 4. Выявились иммунологические нарушения, как клеточного, так и гуморального иммунитета, что объясняет тяжесть течения и сложность терапии латентной, устойчивой инфекции с дыхательной системы, такой как пневмония

Пищевая аллергия у детей

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaA food allergy often affects children in the first months of life and leads to the development of chronic diseases: urticaria, atopic dermatitis, bronchial asthma. A cohort study that included 80 children with food allergies demonstrated the role of both genetic factors and abnormal nutrition of the child (starting with the period of fetal development), as well as measures to prevent the development of allergic diseases and their exacerbation.Пищевая аллергия очень часто поражает детское население с первых месяцев жизни и приводит к развитию хронической патологии: крапивница, атопический дерматит, бронхиальная астма. В работе, при наблюдении 80 детей с пищевой аллергией показана роль, как генетических факторов, так и нерациональное питание ребенка (начиная с периода внутриутробного развития), а также указаны профилактические мероприятия по предотвращению, как развития аллергических заболеваний, так и их обострения

The diagnosis and surgical treatment in biliary lithiasis associated with hepatitis satellite

USMF „N.Testemițanu”, Chişinau, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Alegerea momentului operator şi volumul de intervenție chirurgicală, rămîn probleme de discuție în litiaza biliară, în prezența unui teren hepatic alterat. Scopul. Analiza experienței tratamentului pacienților cu litiază biliară asociată cu hepatită satelit. Material şi metode. Din 256 pacienți tratați în 1995-2010 pentru sindrom icteric în litiaza biliară, hepatita satelit s-a constatat la 74 (28,2%). Suferințe hepatice au relatat 59 pacienți: ciroză hepatică – 5(8,5%), hepatită cronică postvirală – 31(52,5%), hepatită cronică persistentă idiopatică – 23(40%). În 15 cazuri reacția colestatică a fost cauzată de componenta infecțioasă severă. Aprecierea severității hepatitei s-a bazat pe aspecte clinice, biochimice şi investigații paraclinice. Rezultate. Am remarcat evoluări bruşte a fermenților de citoliză cu involuție durabilă postdecompresie biliară. Hipoproteinemia s-a instalat precoce şi a necesitat corecție pre- şi postoperatorie. Procesele de lipoperoxidare cu formare de radicali liberi sunt exprimate: DAM marcată cu 28%, SOD – cu 12,5%. Hipocoagularea precoce necesită o medicație terapeutică apreciată. Din aceste considerente au fost utilizate intervenții chirurgicale în două etape. PSTE în I etapă a fost efectuată în 51 cazuri. La pacienții cu componentă infecțioasă severă s-a efectuat drenarea externă a căii biliare. Asocierea medicației de corecție a dismetabolismului hepatic a permis în timp rezolvarea chirurgicală definitivă. Morbiditatea (6,9%) şi mortalitatea (2,7%) sunt în concordanță cu gravitatea şi durata suferinței hepatice, durata icterului şi apariția mai precoce a insuficienței hepatice – factor de risc fundamental. Concluzie: Folosirea criteriilor de apreciere a severității maladiei şi utilizarea tehnicilor chirurgicale moderne cresc acuratețea diagnosticului şi rezultatele tratamentului chirurgical. Decompresia biliară preoperatorie reprezintă metoda de elecție în rezolvarea sindromului icteric la aceşti pacienți.Introduction.To time the operative intervention and to select the operation procedure is a problem for discussion in biliary stones associated with hepatitic disturbances.Purpose. Analysis of treatment experience of patients with biliary stones associated with hepatitis satellite. Material and methods. Of 256 patients treated in 1995-2010 for jaundice syndrome in biliary lithiasis, hepatitis satellite was found in 74 (28.9%). History of liver disease reported 59 patients: liver cirrhosis - 5 (8.5%), chronic hepatitis viral etiology- 31 (52.5%), chronic persistent hepatitis, idiopathic etiology - 23 (40%). In 15 cases cholestatic liver reaction occurred neagravat field, caused by severe infectious component. Assessing the severity of hepatitis was based on clinical aspects, biochemical and laboratory investigations. Results. I noticed evolving more pronounced cytolysis of fermented with involution sustainable post biliary tract decompression . The decrease of the protein level was installed earlier and required pre-and postoperative correction. Lipidic peroxidation processes with formation of free radicals are expressed: DAM marked 28%, SOD - by 12.5%. A medication regimen requires early hypocoagulation appreciated. For these reasons surgery was used in two stages. Primary biliary decompression path through PSTE was made in 51 cases. In patients with severe infectious component was originally made to track external biliary drainage. Combination drug correction of the liver disturbances, surgery allows for definitive resolution. Morbidity (6.75%) and mortality (2.7%) are consistent with the severity and duration of liver disease, during early development of jaundice and liver failure - key risk factor. Conclusion: Using criteria for assessing the severity of disease and use of modern surgical techniques increase the accuracy of diagnosis and results of surgical treatment. Preoperative biliary decompression by means is method of choice in resolving jaundice

Синдром хронической сердечной недостаточности вторичной Тетраде Фалло: клинические и диагностические аспекты на основе одного случая

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe authors present a clinical case of a 17 year old boy, which in his clinical and paraclinical data highlighted the following diagnostic: Congenital heart failure; Tetralogy of Fallot; AV Block gr. III; Mitral valve insufficiency gr. IV; Tricuspid valve insufficiency gr. IV; Heart failure NYHA functional class gr. III-IV. The case focuses on complications that may occur in late cardio surgeries and the development of AV block gr. III disorders. If complications arose during the evolution of the disease, there would have been performed multiple pacemaker reimplantations. The article insists on the way how cardiovascular complications start as much as on the importance of prompt medical supervision to ensure the patient’s quality of life.В данной статье описан клинический случай ребёнка в возрасте 17 лет, у которого по клинико-инструментальным данным был установлен клинический диагноз – врожденный порок сердца, Tетрада Фалло, aтриовентрикулярная блокада III-ей степени. Имплантация исскуственного кардиостимулятора ритма сердца (1998, 2002, 2007). Недостаточность митрального клапана IV-ой степени. Недостаточность трикуспидального клапана IV-ой степени. НК IV NYHA

Факторы риска и особенности клинического течения и диагностики инфекций мочевыводящих путей у детей первого года жизни

USMF „Nicolae Testemiţanu“, Departamentul PediatrieBackground. Urinary tract infection (UTI) is one of the most common bacterial infections in children; the diagnosis is difficult particularly in young children and infants, because in this age group the clinical presentation of urine infection is often with non-specific clinical signs. UTI among other infant diseases have a special place because of the increased risk for sequels and renal scarring. Aim: To estimate risk factors for urinary tract infections in children and to evaluate clinical and diagnosis features of these in infants. Material and methods. The retrospective study included 44 children under 1 year of age diagnosed with UTI, who were hospitalized to the Nephrology Department of the Institute of Maternal and Child Healthcare in the period December 2007 to 2010. The studied children were 25 females and 19 males. The following methods were used for the examination of patients and experimental data processing: clinical – history, onset and clinical symptoms; laboratory – urinalysis and examination of the urine by Necipurenko method; instrumental – renal ultrasound and scintigraphy; statistical processing of results. Results. This paper highlights the contributory factors for the development of ITU in children under 1 year of age. Of a great importance is the mother’s health, especially during the antenatal period when certain risk factors may affect the child: heredity, chronic pyelonephritis (50%), gestosis (95,2%), nephropathies (45,3%), risk of abortion (36,3%). In the postnatal period risk factors include background conditions (52,3%), infectious inflammatory processes (40,9%), acute respiratory viral infections (22,7%). Conclusions: Becomes obvious the need to estimate the contribution of risk factors in the development of UTI in infants in order to attribute the child to a “risk group” and also to bring real improvements to early diagnosis, treatment outcomes and prevention of this disease.Введение. Инфекция мочевыводящих путей (ИМП) является одной из самых распространенных бактериальных инфекций у детей. Диагностика этих сотсояний часто затруднена, особенно у маленьких детей и младенцев, так как в этой возрастной группе клинические проявления часто характеризуются неспецифическими признаками. Среди других заболеваний детского возраста ИМП занимают особое место в связи с повышенным риском развития рубцовых осложнений. Цель: оценить факторы риска развития инфекции мочевыводящих путей у детей на первом году жизни, а также оценить особенности клинического течения и диагноза у детей грудного возраста. Материалы и методы. Ретроспективное исследование включило 44 ребенка (25 девочек и 19 мальчиков) в возрасте до 1 года с диагнозом ИМП, которые были госпитализированы в отделение нефрологии Института Матери и Ребенка в период с декабря 2007 по 2010 год. Следующие методы были использованы для обследования пациентов и обработки экспериментальных данных: клинические – анамнез, развитие заболевания и клинические проявления; лабораторные методы – анализ мочи и исследование мочи по методу Нечипуренко; инструментальные методы – УЗИ почек и сцинтиграфия; статистическая обработка результатов. Результаты. Данное исследование раскрывает факторы, способствующие развитию ИМП у детей грудного возраста. Большое значение имеет здоровье матери, особенно в дородовой период, когда определенные факторы риска могут негативно влиять на развитие плода: наследственность, хронический пиелонефрит (50%), гестоз (95,2%), нефропатии (45,3%), риск преждевременных родов (36,3%). В послеродовом периоде факторы риска включают преморбидные состояния (52,3%), инфекционные воспалительные процессы (40,9%), острые респираторные вирусные инфекции (22,7%). Выводы: Становится очевидной необходимость оценки вклада факторов риска в развитии инфекции мочевыводящих путей у детей раннего возраста с целью выявления групп высокого риска, а также улучшения ранней диагностики, результатов лечения и профилактики данных заболеваний

Thrombembolic complications in the biliary lithiasis surgery in aged patients, the preventive measures

USMF „N.Testemițanu”, Chişinau, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Boala trombembolică este complicația severă ce poate interveni în chirurgie, necesitînd permanent perfecționarea diagnosticului şi tratamentului. Scopul. Analiza tratamentului pacienților vîrstici cu litiază biliară , evidențierea factorilor de risc şi exercitatea metodelor de profilacsie în boala tromboembolică (BTE) .Material şi metode. Din 1314 pacienți tratați chirurgical în 2005 - 2010 pentru litiază biliară, pacienții cu vârsta de peste 60 ani au fost în 562 cazuri (42,8%). Operați pentru colecistită cronică - 419, pentru colecistită acută - 143 bolnavi. Colecistectomii clasice - 436 , laporoscopice - 126 cazuri. Durata intervenției chirurgicale de la 45 min – 2 ore 30 min. Evaluați factorii de risc ai BTE. S-au determinat: indicele protrombinic, fibrionogenul, TTPA (timpul trombinei parțial active), TAR (timpul activ de recalcificare), proba cu etanol, timpul de sângerare şi coagulare, s-a efectuat examinarea ecografică periferică Doppler în caz de afecțiuni vasculare.Rezultate. S-a constatat nivelul înalt de risc la toți pacienții cu vârsta de peste 60 ani. . Necătând profilaxiei s-au constatat următoarele complicații trombembolice: embolia arterelor pulmonare de calibru mare – 1 caz, embolia arterelor pulmonare de calibru mediu şi mic – 3 cazuri, tromboza venelor profunde – 2 cazuri, tromboflebită a venelor profunde – 2 cazuri, tromboflebită a venelor superficiale – 3 cazuri, sindrom dolor in molet cu marcarea timpului de coagulare – 26 cazuri. Complicațiile au survenit în lotul de pacienți operați în urgență, la indicații vitale, atât clasic cât şi laparoscopic. Profilaxia s-a efectuat cu heparină şi cu fraxiparină 2850ME - 3-4 zile. În cazul emboliei ramurilor masive a a. pulmonare a survenit subit un deces, celelalte au fost rezolvate prin tratament cu anticoagulante şi externare la a 15 - 23 zi, cu evaluare dinamică timp de trei luni.Introduction. Thrombembolic disease is a severe complications in surgery and need permanent improuvment of diagnosis and treatment.. Purpose. Analysis of risk factors and the prevention measures in thrombembolic complications (TEC) in treatment experience of aged patients with biliary stones .Material and methods: Of 1314 patients treated in 2005 - 2010 for biliary lithiasis, the aged patients were in 562 cases (42,8%). The cronic cholecystitis was in 419 cases, the acute cholecystitis was in 143 cases. The classic cholecystectomy was been done in 436 cases, the laparoscopic cholecistectomy - in 126 cases. The operations time was from 45 min to 2 hour 30 min. The analysis of risk factors of thrombembolic complications was been done. The laboratory investigations included : blood prothrombin, blood coagulation, the test with ethanol, hemoconcentration, Doplerography.Results. It was noticed the high risk of TEC in all aged patients. But in post operation period we determined some complications: the pulmonary large artery thrombembolism -1case, the little bronchus of pulmonary artery thrombembolism –3 cases, the thrombosis of deep veins-2 cases, the thrombophlebitis of deep veins-2 cases, the thrombophlebitis of varicose veins-3 cases, the arching pain syndrome with the increasing of coagulation time in 26 cases. These complications had appeared in group with urgent surgical treatment and was in classic and laparoscopic cholecystectomy. We notice that these patients were administrated heparin, fragmin and fraxiparin for 3-4 days. One case of pulmonary embolism had a fatal outcomes.The treatment of thrombembolic complications was anticoagulant therapy. The patients were discharged from the hospital on the 15 – 23 days of the treatment. We follow-up of this patients for 3 months

Прогностические показатели развития ювенильного идиопатического артрита

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaJuvenile idiopathic arthritis (JIA) is a highly disabling disease that leads to functional and physical compromise by osteo-articulars lesions and premature mortality in systemic diseases, impacting medical, social and economic well-being. To determine the prognosis of development indices JIA, discriminant function (F) was used and clinical examination was performed which included studying the patient’s age at disease onset, disease duration, number of joints and laboratory tests included studying the radiological stage after Steinbrocker. The discriminant function was performed in a group of 51 patients diagnosed with JIA. Factors that influenced the favorable evolution of JIA were high patient age at the onset of disease, low disease duration, a low number of joints and radiological stages I-II after Steinbrocker. The presence of these factors allowed us to predict 72.4% of cases with a favorable outcome. On the other hand, young age at onset, long disease duration, a high number of joints and radiological stages III-IV after Steinbrocker were unfavorable prognostic factors. The presence of these indices allowed the estimation of adverse developments in 77.3% of cases.Ювенильный идиопатический артрит (ЮИА) является хроническим заболеванием, которое приводит к функциональной и физической недостаточности, костно-суставным повреждениям преждевременной смертности (при системном варианте), имеет медицинское, социальное и экономическое значение. Для определения прогнозирующих факторов развития ЮИА была использована математическая дискриминантная функция (F) с проведением клинического обследования, которое включало изучение возраста пациента в начале заболевания, длительность заболевания, количество болезненных суставов, а лабораторные исследования включали изучение радиологических стадий по Штейнброкеру. Дискриминантная функция была определена у 51 пациентов с ЮИА. Таким образом, факторы, влияющие на благоприятную эволюцию ЮИА, были: возраст старше 10 лет в начале заболевания, короткая длительность заболевания, малое число болезненных суставов и радиологические стадии I-II по Штейнброкеру. Наличие этих факторов позволило в 72,4% случаев прогнозировать благоприятный исход ЮИА. С другой стороны, малый возраст пациента в начале заболевания, большая длительность заболевания, большое количество болезненных суставов и радиологические стадии III-IV по Штейнброкеру были неблагоприятными прогностическими факторами. Присутствие этих показателей позволило прогнозировать неблагоприятный исход в 77,3% случаев

Neurotrophic factors (BDNF) and disorders of residual psychological development of the child

Department of Pediatrics, Clinic of Child’s neurology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of MoldovaObjective: highlight the relationship between mixed specific psycho-developmental disorders in children and BDNF. Materials and methods: We assessed BDNF serum levels via immunoenzymatic method in 48 children (study group) presenting residual mixed specific psycho-developmental disorders (aged between 2 and 5 years old) and 25 healthy children (control group). Results: Patients from study group presented: language retardation, emotional, cognitive and behavioral disorders. An overall analysis showed that BDNF serum levels were significantly lower in children from study group in comparison to controls (p<.05). Significantly low levels of serum BDNF were noted in children with severe cognitive disorders frequently associated with language disorders. Moreover, neuroimaging data revealed abnormalities of nerve tissue maturation. There is statistical evidence that psychological disorders are negatively correlated with serum BDNF levels. Thus, BDNF represents an important marker of child’s psychological development. Conclusions: Our data confirm the role of BDNF on the child’s psychological development (it contributes to nerve fibers maturation language, behavior and emotional centers). We suggest that low levels of BDNF influence the synaptic plasticity and the interaction between neural and glial cells, thereby playing a decisive role in the complex child’s behavior including language acquisition, cognition, affect etc. BDNF studies could have an important implication in the comprehension of psycho-developmental disorders, as well as in the treatment of neurodevelopmental disorders

Влияние цитомегаловирусной инфекции на новорожденных с врожденным пороком Пьер-Робин

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe authors present a clinical case of a newborn child aged 2 months in which the basis of clinical and genetic screening established diagnosis of Pierre-Robin syndrome. The article shows clinical prognosis of disease date.В работе авторами представлен клинический случай ребенка 2 месяцев, у которого на основании клинических и генетических данных был выставлен диагноз синдрома Пьера-Робина. В статье излагаются некоторые особенности клинической и генетической диагностики, эволюции и прогноза заболевания

Наблюдение детей с низкой массой тела при рождении в практической деятельности семейного врача

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThis study focused on the monitoring and promoting the health of LBW – infants during their first year of life. The value and stumbling blocks for integrated management of LBW – babies were assessed based on the development and one – year outcomes of two groups of LBW – infants managed at one of polyclinic from Chişinău (full – term babies with intrauterine grow retardation and premature babies). The two groups were compared based on parent – related factors, the characteristics of the babies and the health promotion services provided by the polyclinic. the availability of various integrated health care services ensuring global management proved beneficial.Был сделан анализ 60 амбулаторных карточек детей, рожденных с низкой массой (недоношенных, доношенных, но с ЗВР (задержка внутриутробного развития) в течение 1 года жизни. У обеих групп детей были выявлены факторы риска в перинатальном и постнатальном периодах. Была сделана оценка качества наблюдения этих детей в условиях поликлиники