ARTIFICIAL VENTILATION OF THE LUNGS IN THE NEONATAL PERIOD: LONG-TERM OUTCOMES.

It is observed a correlation between the administration of artificial ventilation in the neonatal period and the subsequent formation of bronchopulmonary pathology. Aim - to study the frequency and the features of the course of broncho-pulmonary pathology in young children who were on artificial ventilation of the lungs in the neonatal period. The directions of the selection of medical histories were conducted, which was carried out by artificial ventilation of the lungs for pulmonary causes. The article presents the literature data and own experience of authors, which proves that there is a correlation between the conducted artificial ventilation of the lungs in the neonatal period and the subsequent formation of bronchopulmonary pathology. The results of a retrospective analysis of 475 children who received respiratory therapy are shown. It is a positive correlation is observed between the duration of artificial ventilation and the incidence of bronchitis (p<0.005) and pneumonia (p<0.005). There is a close correlation between the early introduction of artificial feeding and the development of allergies. We found a positive correlation between the presence of allergic pathology and hereditary predisposition to the development of atopy, gestational age and the development of bronchopulmonary dysplasia. In 27% of children who stayed on artificial ventilation during the neonatal period, there was a recurrent broncho-obstructive syndrome in early childhood. Premature children who have undergone acute pulmonary disorder and hereditary hereditary burdens should be considered as a high-risk group for developing bronchial asthma. Repeated episodes of broncho-obstructive syndrome in young children, who during the neonatal period were on artificial ventilation of the lungs, were most often due to bronchial asthma, which was characterized by a severe course.

ANALYSIS OF CAUSATIVE FACTORS OF RECURRENT BRONCHIAL OBSTRUCTION SYNDROME IN YOUNG CHILDREN.

Nowadays, newborns that required prolonged respiratory maintenance for different reasons are more often surviving. Increase in the number of complications is observed on the background of positive clinical effects of certain component of intensive therapy. Search for the factors, which provoke appearance of recurrent bronchial obstruction syndrome, is an important component and basis of prophylaxis. The aim of our research was to conduct analysis of factors that provoke the development of recurrent bronchial obstruction syndrome. To build mathematical model of bronchial obstruction development in young children with respiratory disorders in neonatal period, the method of logistic regression was used. The results of conducted analysis enabled to detect that the presence of respiratory therapy significantly determines the risk of appearance of recurrent bronchial obstruction syndrome and suggest mathematical model of individual calculation of risk factors in this pathology. Data of conduction of mathematical analysis can be used for elaboration of a complex of rehabilitation measures concerning the development of recurrent bronchial obstruction syndrome in children, who suffered respiratory disorders in neonatal period. The highest risk of recurrent bronchial obstruction syndrome development in children born before 29 gestational week with simultaneous combination of prolonged (over 700 hours) total period of respiratory therapy. Elaborated method of individual calculation of the risk of recurrent bronchial obstruction syndrome development in young children, who experienced respiratory disorders in neonatal period, has practical significance and can be applied in everyday clinical practice.

PECULIARITIES OF DIAGNOSING ALLERGY TO COW'S MILK PROTEIN IN CHILDREN UNDER ONE YEAR OF AGE.

Cow's milk protein allergy is an urgent problem in young children. Early diagnostics and formation of therapeutic tactics are the basic priorities in allergy treatment among young children. Oral provocation tests, which can be performed only in medical establishments, are a golden standard for diagnosing food allergy. Active search continues for optimal scheme of diagnosing cow's milk protein allergy in children in the first year of life. The aim of our research was to create the algorithm of diagnosing cow's milk protein allergy in children younger than one year of age, which will optimize obtaining reliable data on a patient's condition and decrease a load of laboratory examinations on young children using elimination and provocation food test. To complete the set goal, a record of allergological anamnesis, examination, assessment of physical condition and determination of specific IgE to cow's milk proteins were conducted to diagnose cow's milk protein allergy. Then, based on the obtained results, elimination and provocation food test was performed in two phases - elimination phase and provocation phase. Diagnostic in vitro is needed to choose the level of medical establishment for conduction of oral provocation tests: in case a specific IgE index is over 0.7 kU/L, testing is performed in an intensive care unit, if IgE is less than 0.7 kU/L - in a specialized inpatient department. Three clinical cases involving different methods have been presented for diagnosing cow's milk protein allergy - elimination and provocation test, oral provocation test and administration of individual diet based on the obtained results. A complex diagnostic approach, in particular, study of anamnesis, record of nutrition diary, elimination diet, enables to optimize diagnostics of food allergy, and diagnostic addition of a product - to assess tolerance clinically during extension of diet. An elaborated method of diagnosing cow's milk protein allergy in children younger than one year of age can be recommended for wide use in a clinical practice.

HYPERSENSITIVITY REACTIONS TO FOOD ADDITIVES IN PEDIATRIC PRACTICE: TWO CLINICAL CASES.

The article presents analysis of causes of occurence and own diagnostic search for hypersensitivity to food additives in children. Food additives are substances of natural and artificial origin, purposefully added to food products for certain technological effects (color, resistance to spoiling, maintenance of the structure and appearance). It has been shown in the article that most frequently "harmful" food additives are present in meat, dairy and confectionery products, beverages, sauces, canned products, spices. The most threatening as to the development of allergic reactions in children (dermatitis, urticaria) are the following additives: E 102 - tartrazine, E 103 - alkaline, E 104 - yellow quinoline, E 105 - transparent yellow, E 110 - yellow "sunset", E 111 - orange alpha-naphthol, E 122 - carmoazine, E 123 - amaranth, E 124 - ponso 4R, E 126 - ponso 6R. Regarding the preservatives, the most commonly spread triggers of allergic reactions are benzoates (E 210-219) and sulfites (E 220-229), which can cause urticaria, dermatitis, bronchial asthma exacerbations, and anaphylaxis. Taking two clinical cases as the example, the observation of the development of severe allergic reactions associated with the harmful effects of certain nutritional additives (E 102 - tartrazine and E 110 - yellow "sunset") could be conducted. It is necessary to instruct patients to read and correctly interpret the information on the packaging of the products. Brightly colored foods, products with intense smell and long shelf life are often the source of "harmful" food additives. The longer is the list of the ingredients of the product on the packaging, the higher is the likelihood that it contains doubtful ingredients.

[OPTIMIZATION OF ALLERGEN-SPECIFIC IMMUNOTHERAPY IN CHILDREN WITH BRONCHIAL ASTHMA: SELECTION FEATURES, PATIENT MONITORING AND EFFICACY].

The aim of the study was to optimize the method of selecting patients with bronchial asthma for the use of allergen-specific immunotherapy with allergens of house dust mites and to evaluate its effectiveness. The research was carried out based on the Municipal Non-Commercial Enterprise «City Children's Clinical Hospital¼ in Lviv. The study included 120 school-age children (aged 6-17) with bronchial asthma and sensitization to house dust mites. 60 patients were the main group of patients who received ASIT along with the basic treatment (30 sublingual sprays, 30 subcutaneous ASIT). The other 60 patients were in the comparison group and received only basic therapy for bronchial asthma. The presence of sensitization to house dust mites was proved based on skin prick testing. Optimization of patient selection consisted of molecular allergy diagnostics using the Immuno CAP method with the determination of sIgE to components of allergens of house dust mites rDer p1, rDer p2, rDer p10 to accurately assess patient sensitization for further use of ASIT. To assess the effectiveness of ASIT, asthma control test (ACT) indicators were analyzed, patients' quality of life was assessed, spirometric indicators were evaluated (FEV1 and PEF), and IFNγ and IL13 levels were assessed in patients with ASIT. After one year of treatment, the average asthma control test among patients receiving sublingual ASIT increased the most - by 26.32% (p <0.01). Also in this group of patients, there was the largest increase in PEF - by 9.82% (p <0.01). Regarding the increase in FEV 1, it was the highest in the group of patients receiving subcutaneous ASIT - by 9.85% (p <0.01). The quality of life of patients in the assessment of symptoms increased the most in patients who received sublingual ASIT by 28.7%. Based on our results, we can draw the following conclusions: The application of molecular allergy diagnostics using the definition of sIgE to the components of allergens of house dust mites rDer p1, rDer p2, rDer p10 allows optimizing the selection of patients for allergen-specific immunotherapy. Treatment of bronchial asthma with the involvement of ASIT during the first year allows obtaining higher efficiency indicators, which are manifested by a significant improvement in asthma control test, external respiration function and quality of life. Monitoring of immunological parameters showed a significant increase in IFNγ, which can be regarded as the activation of the process of switching the immune response from Th-2 to Th-1 indirect, and thus illustrates the positive effect of ASIT.

[An analysis of the information value of certain factors in the prognosis of the severe form of bronchial asthma in adolescents]. / Analiz informatsiinoï tsinnosti deiakykh faktoriv u prohnozuvanni tiazhkoï formy bronkhial'noï astmy u pidlitkiv.

A total of 150 children of pubertal age, who had bronchial asthma were examined. An in-depth analysis of those factors promoting the development of a grave form of the condition in the examined children permitted the selection of five of them, that have statistically significant effects on formation of this pathology: sex, concurrent skin afflictions, early onset of the illness. Improper treatment, abuse of antibiotics. With the aid of the logistic regression technique there has been developed a mathematical model that permits the prognostication of severity of bronchial asthma course at pubertal age to be carried out on an individual basis.