[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[The methodology of therapeutic hypothermia in children born in a state of asphyxia].

This guideline provides the diagnostic and treatment algorithm for newborns with gestational age over 35 weeks and weighing more than 1800g who has severe asphyxia in birth with the threat of severe or medium-severe hypoxic-ischemic encephalopathy.

[Nosocomial respiratory syncytial virus bronchiolitis in preterm infants: characteristics of the course, treatment and prevention in clinical practice].

OBJECTIVE: To study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions. PATIENTS AND METHODS: We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF/PCR in neonatal Moscow hospitals in 2011-2013. RESULTS: RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling, segmental infiltration and bronchial obstruction (atelectasis, hypoventilation). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital, CONCLUSIONS: The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxis of RSV infection in children at risk.

[Experience of extracorporeal membrane oxygenation in critical care of respiratory failure in newborn with congenital diaphragmatic hernia in perinatal center].

The article deals with an experience of veno-arterial extracorporeal membrane oxygenation use in preterm infants with congenital diaphragmatic hernia during postoperative period in the perinatal center.

[Detection of the markers of herpes simplex virus and cytomegalovirus in newborns and infants].

A total of 111 children suspected for herpesvirus infection were examined. In blood and urine samples the infectious activity of herpes simplex virus (HSV) and cytomegalovirus (CMV) was detected by the rapid culture method (RCM) and the presence of virus DNA--by the polymerase chain reaction (PCR). HSV and/or CMV were detected by two laboratory methods in 57 examined children (51%). Of these, in 18 children (16.2%) both HSV and CMV were detected. The coincidence of the results of the detection of HSV and CMV by these two methods was observed in 72.4% and 75.2% of cases respectively. The comparative analysis of the detection of anti-CMV IgG and IgM was made with the use of commercial test systems produced bythe following manufacturers: "Vector-Best" and "Bioservice" (Russia), "HUMAN" and "Boehringer" (Germany). The effective detection of both anti-CMV (IgG and IgM) was ensured by the test systems "Boehringer". The test system "Vector-Best" for anti-CMV IgG proved to be not inferior as regards sensitivity and specificity. The German test systems demonstrated the highest specificity in the detection of low-avid antibodies. The data obtained in this study indicate that the detection rate of HSV and CMV markers in newborns and infants suspected for herpesvirus infection was, on the average, 20 - 40%. Reliable diagnostics in newborns and infants is possible only in the presence of the combination of at least 2 serological tests (the determination of antivirus IgM and IgG avidity) and 2 methods for the detection of direct herpesvirus markers (PCR and RCM).

[Quantitative laboratory methods for the diagnosis of cytomegalovirus infection in premature infants].

31 prematures with signs of the cytomegalovirus infection (CMV) were examined. The blood and urine samples were tested for direct viral markers, i.e. for infectious CMV by the rapid culture method (RCM) and for viral DNA by quantitative PCR. Besides, the parameters of the specific immune response were studied in the babies. CMV was detected by RCM and/or PCR in 25 of the 31 examined babies during their 1st life week. The highest content of CMV within the investigated samples, i.e. 100 antigen-containing cells per 2.5 x 10(5) culture cells and above 2000 copies/ml of viral DNA was detected in 8 (32%) children. The quantity of viral DNA did not exceed 1000 copies/ml and one to three of stained cells was detected by PCR in 13 (42%) children. A study of anti-CMV in sera revealed high-titer of AT IgG in all 30 children. High avidity of anti-CMV-IgG was demonstrated to correlate with a low viral load and a low CMV infection activity in the newborns. According to the results, at least 3 laboratory diagnosis tools should be used in the diagnosis, they are PCR, RCM and determination of the anti-CMV avidity.

[Polymerase chain reaction in the diagnosis of viral infections in the newborn]. / Ispol'zovanie metoda polimeraznoi tsepnoi reaktsii v diagnostike virusnykh infektsii u novorozhdennykh detei.

Two hundred and ten newborns from among a high risk group were examined for intrauterine infections by polymerase chain reaction (PCR) with the aim of assessing the clinical information density of the method in the diagnostic sphere. The patients were examined for the presence of DNA/RNA viruses and bacteria. Genetic samples of various causative agents were detected in 49% of the newborns. No correlation was established between the clinical pattern and the presence of DNA of certain microorganisms. The most severe condition of newborns was noted in cases when a DNA causative agent was found in several different biological samples. The highest mortality (in per cent) was registered in the group of newborns with detected DNA of Herpesviridae viruses. The PCR clinical value was affirmed for establishing a disease etiology in newborns.

[An expert system to support diagnostic decision making by a neonatologist]. / Ekspertnaia sistema podderzhki priniatiia diagnosticheskikh reshenii vrachom-neonatologom.

An "NATEX" expert system has been designed, which is intended to support a neonatologist's diagnostic decision making at the first stage of neonatal nursing. While designing the expert system, the authors used the shell "REPROCODE" wherein medical knowledge is presented as hierarchical semantic threshold network with shared attribute space. The designed system is realized on the basis of an IBM PC XT/AT, its operation requires only the processor 80286 and the operating system MS DOS 3.0 or higher. The "NATEX" expert system is employed to diagnose major syndromes of neonatal diseases. The knowledge base of the "NATEX" system has an account of 33 syndromes of neonatal diseases and, with various forms of severities borne in mind, the total number of diagnosed conditions in a baby is 63. In terms of content, it covers all major syndromes assessing the vital systems of the neonatal body and their occurring processes. The total number of symptoms which are necessary and sufficient for making a diagnostic decision as realization of either syndromes is 700.