EVALUATION OF DEVELOPMENTAL OUTCOMES WITH BAYLEY III TEST IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME.

Aim of our study was assessment of developmental outcome of neonates with respiratory distress syndrome, evaluation of the impact of RDS on child's health, growth and neurodevelopment at 2 years of age. Case control study included 138 children, from those, 74 preterm (gestational age 32-36 weeks), who were divided into 2 study groups: I groups - involved 38 preterm with RDS and II group - 36 preterm patients without RDS and other neonatal problems. Control group included 42 patients born term with uncomplicated history. To assess the impact of RDS without other co-factors, we excluded from the study children with congenital malformations, genetic and metabolic disorders; intracranial hemorrhage, neuromuscular diseases, severe hyperbilirubinemia, sepsis, congenital infections as well as family with drug or alcohol addiction, severe mental disorder, parents younger than 17 years of age at the time of the baby's birth. The study and control group were homogenous based on family social-economic status, parents education, mean parental age, mother health status, to minimize the bias. We assessed the health status, physical growth and development of children at mean age (corrected age) of 24+4 months. Physical growth was assessed based on the WHO Standard Deviation growth charts, health status based on detailed history and clinical examination, child development was assessed using Bayley Scales of Infant and toddler development III. We calculate composite scores for each sphere and compare mean composite scores of each group to each other. Statistical analyses were based on SPSS 17. The assessment of the health shows that children with RDS as well as prematurely born children without RDS have more respiratory infections during first years of life and more hospitalization than control group. The p-value is >0,5 comparing children with RDS and children with prematurity without RDS, but p < 0,05 if we compare the both group of premature with control group of term infants. Our study does not show that RDS affects significantly the prevalence of acute respiratory infections. The main causes of hospitalization in studied as well as in control group are respiratory tract infections and diarrhea. Growth assessment does not show significant difference in child's height and head circumference, while the percentage of children with underweight according corrected age was more evident in I and II group than in control (p=0,0401). The motor composite scores are lower in premature infants with RDS, but it does not show the significant difference (p=0.7755) compared to second group of premature infants without RDS, at the same time comparing both groups to controls show significant difference (P =0.0021). Mostly were affected fine motor abilities. Assessment of the cognitive scores does not show difference between study and control groups, while the language developmental scores in first and second group were significantly lower than in control (P < 0.0001), but there was no difference between I and groups. We found that premature children at 2 years of age despite RDS have lower scores comparing to term newborns in fine motor and language development. Prematurity increases risk for neurodevelopmental impairments that is important to identify and start early intervention to improve the outcomes. It is shown that neonatal complications (Jaundice, infections, asphyxia and etc.) affect development more than prematurity itself, it is very important to conduct big cohort studies on neonates with RDS to identify the risks associated with RDS and its severity.

ATTENTION DEFICIT HYPERACTIVITY DISORDER AND HAIR HEAVY METAL AND ESSENTIAL TRACE ELEMENT CONCENTRATIONS. IS THERE A LINK?

The aim of our study was to assess hair micro-elemental status in children with attention deficit hyperactivity disorder, determine micro-elemental misbalances and heavy metal concentrations and evaluate its impact on child behavior. Case-control study was conducted at Child Development Center of M. Iashvili Children's Central Hospital in 2015-2017years (Tbilisi, Georgia). We studied 70 children, mean age from 6 to 8 year. Target group involved 35 children with Attention Deficit Hyperactivity Disorder . Control group include 35 children of same age with normal behavior. Groups were homogenous based on different characteristics. To diagnose behavioral problems multi-profile group (pediatrician, neurologist, psychologist) assessment was used and final diagnostic was based on DSM V (Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association) and ICD-10 (International Clasiffication of Desease-10) criteria. Micro-elemental status was detected in the hair, with roentgen-fluorescence spectrometer method (Method MBИ 081/12-4502-000, Apparatus ELVAX-CIP, USA-UKRAIN). We study the content of 27 microelements (Zn, Fe, Cu, Mn, Co, Se, K, Cr, S , Cl, ,Ag ,V, Ni, Rb, Sr, Mo, Sr,, Pb, Hg, Br, Ti, Ba, As, Zr, Sb, Sn, Cd) in the hair in target and control groups. Computer program SPSS - 21 (Statistical Package for the Social Science - 21; Independent Samples T-Test,) was used for statistical analysis. The results of our study revealed deficiency of major elements (Fe, Mn, Co, Se), in target group and deficiency of zinc and cooper in both (control and target) groups,but the mean concentrations of manganese (sig 0,200; p>0,05), cooper(sig 0,813; p>0,05) and selenium(sig 0,320;p>0,05) does not show significant difference between control and target groups. Only in case of zinc (sig 0,000; p<0,05), iron (sig0,000;p<0,05) and cobalt (sig 0,000; p<0,05) deficiency we got significant values and meaningful associations between microelement's deficiency and ADHD.Our research didn't reveal any changes in other 17 elements (K, Cr, S, Cl, Ag, V, Ni, Rb, Sr, Mo, Sr, Ba, As, Zr, Sb, Sn, Cd) levels. We detected contamination with Pb (lead), Hg(mercury) and Ti (titanium) in both groups , but there were significant difference in Pb (sig 0,000; p<0,05) and Hg (sig 0,000; p<0,05) values between control and study groups, while difference of Ti (sig 0,177; p>0,05) level was not significant. Our study suggests that zinc, iron and cobalt deficiency as well as contamination with high lead and mercury are associated with attention deficit hyperactivity disorder.

HAIR HEAVY METAL AND ESSENTIAL TRACE ELEMENT CONCENTRATION IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

Our study aims evaluation of level of essential trace elements and heavy metals in the hair samples of children with autistic spectrum disorder (ASD) and identification of changes that are associated with autistic spectrum disorders. Case-control study was conducted at Child Development Center of Iashvili Children's Central Hospital (LD).We studied 60 children aged from 4 to 5 years old. The concentrations of 28 elements among (Ca,Zn, K, Fe, Cu, Se, Mn, Cr, S, Br, Cl, Co, Ag, V, Ni, Rb, Mo, Sr, Ti, Ba, Pb, As, Hg, Cd, Sb, Zr, Sn, Bi) them trace elements and toxic metals) were determined in scalp hair samples of children (n=30) with autistic spectrum disorder (ASD) and from control group of healthy children (n=30) with matched sex and age. Micro-elemental status was detected in the hair, with roentgen-fluorescence spectrometer method (Method MBИ 081/12-4502-000, Apparatus ALVAX- CIP, USA - UKRAIN) .To achieve the similarity of study and control groups, pre and postnatal as well as family and social history were assessed and similar groups were selected. Children with genetic problems, malnourished children, children from families with social problems were excluded from the study. The diagnosis of ASD were performed by pediatrician and psychologist (using M-CHAT and ADOS) according to DSM IV (Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric association) criteria. The study was statistically analyzed using computer program SPSS 19. Deficiencies of essential trace microelements revealed in both group, but there was significant difference between control and studied groups. The most deficient element was zinc (92% in target and 20% in control), then - manganese (55% and 8%) and selenium (38% and 4%). In case of cooper study revealed excess concentration of this element only in target group in 50% of cases. The contaminations to heavy metals were detected in case of lead (78% and 16), mercury (43% and 10%) and cadmium (38% and 8%). The study statistical results indicated, that deficient concentrations of trace elements such as zinc, manganese, molybdenum and selenium in hair significantly linked with ASD (Kramer's V was 0,740; 0,537; 0,333; 0,417 accordingly). In case of cooper we got excess levels of this element and this data was highly linked with autism spectrum disorder. We got high associations and significant values between of lead, mercury and cadmium concentrations and ASD. Study results indicate that there are significant differences of hair essential trace elements concentrations in children with autism spectrum disorder comparing with healthy children group. The result obtained also showed high contamination to heavy metals such as lead, mercury and cadmium in ASD children compared to healthy ones. So, our study demonstrated alteration in levels of toxic heavy metals and essential trace elements in children with autistic spectrum disorders as compared to healthy children. This suggests a possible pathophysiological role of heavy metals and trace elements in the genesis of symptoms of autism spectrum disorders.

PREVALENCE OF ATOPIC DERMATITIS SYMPTOMS IN CHILDREN WITH DEVELOPMENTAL AND BEHAVIORAL PROBLEMS.

A link between atopic dermatitis (AD,eczema) and emotional and behavioral dysfunction is more or less well recognized but concern still exists. Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. But psychosocial morbidity is less linked and studied in connection with other disease, especially AD. As mentioned before, AD is the most prevalent chronic disease in young children. The aim of the study was assessment of incidence of atopic dermatitis in children of 5-6 years with developmental and behavioral problems. The cross sectional study was conducted. Children with developmental and behavioral problems according to medical records and aged five to six years were recruited consecutively from a preventive care register in M. Iashvili Childrens Hospital Child Developmental Center in 2010-2014 years. Recruitment was done according developmental and behavioral assessment performed on the basis of team approach by pediatrician and psychologist. Parents evaluation of development status: developmental milestones (PEDS:DM) and Pictorial Checklist ( PIK -17) was used for assessment. 639 children with language delays, problems of externalization and internalization were enrolled in study. Children were examined by pediatricians based on the presence of at least three major and three minor criteria of Hanifin and Rajka's diagnostic criteria(H&R) and by semi structured, one-to-one interview with the parents. According our study: 1. Significant amount of children with developmental and behavioral problems and symptoms are developing AD(36%). 2. Children with language delay were more frequently developing AD symptoms than children with behavioral problems.3.There was not significant difference in children with language delay and behavioral problems in terms of impact on QL. In both cases everyday activities, sleep and recreational actives were affected and there more affected then in children with developmental and behavioral problems and symptoms with AD comparable to children without AD, especially sleep.4. Date represents that boys are more likely to develop AD than girls, this information is in correlation with known facts about dermatitis. Both boys and girls were similarly affected by QL problems in case of AD and developmental and behavioral problems and symptoms. Chronic diseases and development and behavior of children in further dilemma for researchers. Our study gives us further impulse for more deep insight in factors affecting children with delays and behavioral problems and prospective studies in group with developmental and behavioral problems and symptoms and AD.

INCIDENCE OF ALLERGIC RHINITIS AND RESPIRATORY INFECTIONS IN FIRST GRADE SCHOOL CHILDREN IN GEORGIA.

The aim of the study was assessment of incidence of allergic rhinitis and respiratory infections and evaluation of quality of life of first grade school age children with allergic rhinitis. The cross sectional study in randomly selected regions and schools was conducted using specially developed parent questionnaire and mini rhino conjunctivitis quality of life questionnaire (MiniRQLQ). On the first was used special questionnaire, and on the second phase MiniRQLQ was used in cases with allergic rhinitis. Total of 1530 parent of 6-8 years children were interviewed, 1499 first phase questionnaires and 174MiniRQLQ were analyzed by SPSS 19 program. From 1499 children 799 (53.3%) were girls and 700 (46.7%) - boys. The 810 (54%) live in urban, 524 (35%) in rural area and 165 (11%) in high mountains. The study revealed that 2.3% of children have respiratory infections 7-8 times per year, 19.9% 3-5 times, 53.4% 1-2 times and 24.2% became ill very rarely. There was statistically significant difference between the frequency of respiratory infection in rural and urban area (p<0,001).The frequency of chronic diseases reported by parents is 18.3% (n=274), from those 201 (73.3%) are allergic disorders (asthma, rhinitis, atopic dermatitis), that is 13.4% of total respondents. The incidence of allergic rhinitis was 11.6%, most frequent symptom was rhinorrhea 168 (11.2%), recurrent sneezing episodes during last year was seen in 153 (10.2%), nasal pruritus was reported in 137 (9.1%), nasal obstruction in 117 (7.8%). The eye symptoms were reported in 62 (4.2%). The symptoms of allergic rhinitis is significantly higher in urban population then in rural area (P<0.02), as well as in boys (P<0.05). The 109 (62.6%) of respondents answer that symptoms and mostly nasal obstruction affected their quality of life, especially on recreational activities and sleep. In 91 (52.9%) patients with already diagnosed allergic rhinitis treatment was prescribed according international guidelines. In group with symptoms but non-diagnosed allergic rhinitis frequently was used I generation antihistamines 52 (62.6%) and decongestants 57 (68.5%). Incidence of allergic rhinitis in first grade school population is high and it is comparable to indices of developed countries. Allergic rhinitis affects quality of life of children especially outdoor activities and sleep. ARI does not show an impact on severity of allergic rhinitis symptoms.

Infants' complementary feeding and factors influencing its timing.

The aim of our study was to detect factors that influence timing and adequacy of complementary feeding (CF) practices in Georgian families. The study was conducted at M. Iashvili Central Children's Hospital Child Developmental Center in 2013-2014 year. The data was collected from 389 mothers of infants' age ranging from six months to one year. Results of the study show that CF was started in time only in 30,2%, In 18,1% it was CF was introduced too early (<4 month), in 27,3 early (4-6 month) and in 11% - late. 13.4% of children haven't started CF at all. Most of mothers received information about CF and semi-solid and solid food used for CF from pediatricians and family-doctors. Timing of complementary feeding was related to maternal age, young mothers started CF too early, early or late. In urban areas early CF was significantly high (51.1%) than in rural (29.7%) areas (P<0,05). Proportionally employed mothers and students also started CF earlier (51.4%) than housewives (33%) (P<0.01). Mothers who had 2 and more child introduced CF timely compared to those who had the first child (P<0.01). Our research study showed that educated women started complementary feeding of their infants at appropriate ages as compared to those who were uneducated (P<0.001) among women who introduced CF in time most were educated (91%). The data from the study shows that many infants are beginning complementary feeding earlier than WHO recommends (6 month). Findings from our study revealed that maternal knowledge, age, education level was directly related with timing of CF. Promotion of strong community based education and support to ensure optimal infant and young child feeding is recommended.

Evaluation of nutritional knowledge of second grade school children and assessment of their dietary intake.

The aim of the study was assessment of the general nutrition knowledge and physical activity rate among the first grade school age children and evaluation of their diet and nutritional skills based on the parental interviews. Cross-sectional study was conducted in randomly selected schools of Tbilisi. In each school was selected one group of the second grade children and their parents by cluster selection method. A population of 290 children aged 6-8 years and their parents were interviewed. The statistical analysis was carried out by means of the SPPS 17. Questionnaires, except those with incomplete answers (n=30), were used for the analytical data. The study shows that in general, the level of knowledge related to rich sources of nutrients was poor. The most of the children can't identify the role of calcium (72,6%), proteins (68,1%) and iron (84,6 %). Children prefer to eat and select foods which they like (71,8%), such as sweets and cakes, hamburgers, chips and etc. The study showed that the most of the children (83,3%) have normal weight for age, underweight was revealed in 3,1% of children, more frequent was overweight (12,3%) and obesity (1,4%). There wasn't significant difference of overweight and underweight distribution in boys and girls. The assessment of child dietary intake show, that intake of fruits and vegetables, as well as milk and milk products is quite low, while intake of bread and pastry, and sweets and cakes are quite high. Daily consumption of sweets and snacks was significantly higher in girls (64.2%) than in boys (47.5%) (p<0.01). The study revealed that only 62 % of children eat the breakfast, in frequent cases children eat very fast (26,1%), 47,8 % of children need to remind to wash hands before eating, most children 60,4% view TV during the meal time or play computer games. The most of the children play the active games approximately 30-60 minutes, quite often children play active games only 20-30 minutes that is much less then WHO recommendations. The parent questionnaires reveal that most frequent problem that influenced child nutrition is lack of information about healthy feeding (55%), lack of time for preparation of food (33%), inability to control child's feeding (36%), financial deficit (4%). The dietary intake of children does not correspond to WHO recommendations. It is recommended on the one hand to conduct country wide assessment of dietary intake of children and adolescent and on the other hand to implement nutrition education programs.

The parameters of physical growth in 5-6 years old children in Tbilisi.

The aim of the study was to assess nutritional status and anthropometric parameters in children aged 5-6 and to identify possible factors influencing the growth pattern of Georgian children. The cross-sectional study was performed on a sample of 754 children boys and girls aged 5-6 attending preschool facilities and their main caregivers in the study sites. The study covered children population from 16 kindergartens of 2 regions (Gldani-Nadzaladevi, and Vake-Saburtalo) of Tbilisi, with different social-economical status. The following anthropometric parameters were studied--body weight, height, head and mid arm circumferences and body mass index (BMI). Physical parameters were assessed using WHO/NIH standardized growth charts (percentile and Z scores). Collected data was analyzed using the computer program EPI INFO. High weight and height (> 95 percentile/2 Z score) was found more frequently than low (< 5 percentile/-2 Z score) parameters. Most children's weight according to their stature was in normal 5-95 percentile range. At the same time in girls was often met low weigh for their stature then in boys. The imbalance between the weight and height is more evident than between weight and age or height and age. The results showed that the abnormal Z scores more or below +/-2 scores were in less percents of children then high and low weight and height by the age in percentiles. The results showed a prevalence of children having normal indices of BMI between 5 and 85 percentiles, approximately 13%of children have low weight (less than 5 percentile), approximately 18% have risk of overweight and 16% have obesity. A multivariate analysis of personal and nutritional variables with the standard nutritional indicators identified age, sex, bottle feeding, and type of solid foods as significant risk factors for stunted growth. Stunting increases with age and males have poorer growth pattern than females. The results of the study emphasize that in Tbilisi 5-6 years old child population more frequent is problem of overweight and obesity than underweight.

Non-viral wheezing in preschool children: the effect of inhaled fluticasone on symptoms and lung function.

Aims of this study were: to evaluate changes in lung function in wheezing children with detected MP and CP infection according to treatment; to measure the response to inhaled corticosteroids in children with significant wheezing who were selected as having a high risk of progressing into childhood asthma. 54 children were randomly assigned 2:1 into 2 groups-the main group (36 patients), in which inhaled corticosteroids were administered, and the control group (18 patients), without inhaled corticosteroids. Serum IgE levels were determined using the ELISA (reagents: IBL-Hamburg). Serologic studies were performed by the ELISA for IgM and IgG antibodies to MP and for IgG and IgA antibodies to CP (reagents: ImmunoLISA, Orgenics, Israel) on the Hiperion MRIII (USA). Pulmonary function testing was done with SpiroLab II (DEGO GmbH, Medizin-Elektronik, Germany). The patients of both groups were administered macrolides: azitromycin during five days. Patients of the first group received inhaled fluticasone propionate 125 mg twice daily. The parents were asked to record symptoms. Each symptom (wheezing, cough, and shortness of breath) were scored on a scale of 0 to 3--daily symptom score (DSS). Scores were calculated every 4 weeks for a total treatment period 16 weeks. The days within each period on which the DSS equalled zero were pointed as symptom free days (SFD). It had been shown an significant improvement in DSS, an increase in SFD and significant improvement of the lung functions following the treatment with inhaled fluticasone and macrolide in children with wheezing and documented MP or CP infection, compared to control group treated only with antibiotics. In conclusion, the use of ICS should be seriously considered in children with wheezing and the risk of persisting symptoms.

[Neopterine and ige during respiratory-syncytial virus infection in infants].

The number of studies confirms the correlation between IgE and neopterine levels. One of the forms of revelation of the immune answer of T-cells is the activation of T-cell system, that in its turn results in secretion of IL-2 and INF-gamma by Th-1 subtype cells. Activation of macrophages by INF-gamma the human organism. The target of our research was the evaluation of the role of the marker of macrophage activation -- neopterine in children with recurrent wheezing developed during onset of RSV infection and possible connection with IgE level. In the study 52 children of age from 1 to 12 months having RS-virus infection were included. Two groups were determined as controls -- group of healthy children and children with wheezing of non RSV etiology. Determination of neopterine was performed by enzyme immunoassay method (ELISA). During the RS-virus induced acute respiratory infection the rate of neopterine in the blood serum was significantly decreased in the group of patients with recurrent wheezing in comparison with the I group (first episode of wheezing). At the same time the significant difference between the group with wheezing of non -- RSV etiology and the control group was not observed. Decreasing of neopterin was significant in the II and III groups. IgE levels were elevated significantly in the second group of patients with recurrent wheezing. In this group negative correlation between neopterin and IgE was found.

Wobenzym in treatment of recurrent obstructive bronchitis in children.

A total of 27 patients with recurrent obstructive bronchitis (at least 3 episodes of obstructive bronchitis per year) of 5-15 years of age were studied. Serum IgE level (by ELISA method) and pulmonary function indices were determined together with the full clinical examination. The systemic enzyme preparation Wobenzym was administered with a dosage of 1 tablet for 6 kg weight. Wobenzym was administered for 3 months. Effectiveness of the treatment was assessed by special questionnaire, in which existence of the main symptoms were recorded. Analysis of the data, obtained after treatment, demonstrated decrease of the Daily Symptom Score and an increase of Symptom Free Days, as well as an improvement in spirometric indices (FVC, FEV, PEF). According to these data, it was concluded, that systemic enzyme preparation Wobenzym should be used as a supporting measure in combination treatment of recurrent obstructive bronchitis.

[INF-gamma during respiratory-syncytial induced obstructive respiratory syndrome in infection in children under one year of age].

Lately the connection of Asthma and RSV drew the sufficient attention. The recurrent wheezing developed during the RSV in children is particularly frequent in the families having history of atopy. The decreased expression of INFgamma may play the role in the pathogenesis of RSV infection. The target of our research was the study of the rate of INFgamma during various clinical courses of RSV-infection and definition of its role in the pathogenesis of ARVI. 52 children with RSV-associated wheezing have been studied, who had first (32) or recurrent episode (20) of bronchial obstruction and whose families had occurrence of atopy. 52 children with non RSV-associated wheezing (III group) and 10 healthy children up to 12 months of age (IV group) were considered as the control groups. Children from all four groups were from families with the history of atopy. INFgamma was measured by enzyme immunoassay (ELISA). Comparison of two groups of wheezing children with RSV infection showed significant reduction of INFgamma level in the group of children with recurrent wheezing vs. the group with first episode of wheezing. INFgamma levels were significantly higher in the two control groups. During the acute respiratory infection induced by RS-virus, which proceeds with the obstruction of respiratory tract (wheezing), reduction of INFgamma was noted and higher frequency of wheezing episodes is associated with more prominent alteration.