Neuropsychic Development Research Articles

Comparative Study of Indicators of Mental Development of Primary School Children Living in Mountainous, Foothill and Coastal Areas

The presented article considers a comparative analysis of the results of the study of the influence of relief, climate and other factors on the mental development of primary school students in highland, foothill and coastal areas. Thus, a total of 164 primary school students from different regions aged 6-10 years were examined. The adaptation of primary school students is mainly influenced by indicators of mental development. From this point of view, the goal was to determine the formation of higher nervous activity, the period of transition to adolescence and normal individual mental development against the background of emerging neuroendocrine changes, conducting a study by testing primary school students living in areas with different relief (mountain, foothill and coastal), without causing emotional stress. The studies were conducted in Guba, Gusar, Khachmaz, Siyazan and Baku. As a result of the study, it was revealed that primary school students living in mountainous areas have a more stable nervous system. Thus, it was established that primary school children living in areas with different relief and climate have normal neuropsychic development. Baku school children had a higher level of individual anxiety than their peers. Primary school children living in mountainous, foothill and coastal areas have anxiety indicators within the normal range, indicating that they are more emotionally stable. At the same time, a stronger development of the sensory system and, as a result, a higher level of visual memory were recorded. It was established that primary school children living in highland areas have a high level of adaptation processes, the nervous system develops more stably and stress-resistant than their peers living in other areas.

Features of the perinatal and thoracic periods in children with autism spectrum disorders

Background. Autism spectrum disorders are a pathology that is becoming increasingly widespread throughout the world, regardless of geographic, climatic, socioeconomic or other regional characteristics. Due to the wide spread of this pathology, early detection of disease predictors is of great importance. Competent observation by a local pediatrician in the first year of life is of great importance in the first determination of disease symptoms / identification of risk groups. However, clear predictors indicating the presence of pathology have not been developed due to the lack of an accurate understanding of the etiology, pathogenesis of autism and the diversity of the clinical signs. It is believed that the gastrointestinal tract, microbiota, food intolerance play a certain role in the development and severity of ASD, but further research is needed in this area.Materials and methods. The study included 138 children with autism spectrum disorders aged 3–15 years (Me 6 [4; 7.5]) and their parents. There were 91 boys and 47 girls. A thorough analysis of the obstetric history, the course of the intranatal and neonatal periods, the nature of feeding, the neuropsychic development of children in the first year of life, and the social and everyday aspects of family life was carried out. Statistical analysis was performed using descriptive statistics methods.Results. The perinatal period of children with autism spectrum disorders does not differ significantly from the average data in the population. It was found that the assessment of emotional development is of great importance in monitoring children in the first year of life. Despite the fact that the examined patients did not have a clinically significant delay in neuropsychic development (more than 2 epicrisis periods), it is nevertheless noted that motor development was impaired less often than emotional, play and speech skills.Conclusions. Perinatal, social factors, the nature of feeding and past diseases do not affect the development of the disease. Among the assessment criteria in infancy, special attention should be paid to neuropsychic development, in particular emotional development and play activities.

Редкий случай гипотиреоза у ребенка

Hypothyroidism is a decrease or complete loss of thyroid function. In childhood, congenital hypothyroidism is the most common, which can be either permanent or transient. One of the reasons for the development of hypothyroidism in newborns may be the mother's intake of large doses of iodine during pregnancy and, as a consequence, the occurrence of the Wolf–Chaikoff phenomenon to prevent the synthesis of large amounts of thyroid hormones by the thyroid gland of the fetus and newborn. We present a clinical observation of a rare form of hypothyroidism with goiter in a child born to a mother who took narcotic drugs containing large doses of iodine. In the presented observation, hypothyroidism was transient in nature; a feature of the disease was a long-lasting enlargement of the thyroid gland. Taking into account that even a temporary decrease in the level of thyroid hormones can negatively affect the neuropsychic development of the child, the newborn patient was prescribed replacement therapy with levothyroxine sodium at a dose of 25 mcg/day. The patient's long-standing goiter served as the reason for prolonging replacement therapy until the age of 1 year and subsequent resumption of therapy twice until the volume of the thyroid gland normalized.

Cognitive, Emotional, and Behavioral Disorders in Children with Respiratory Allergic Diseases: Causes and Solutions

The publication is devoted to the review of accumulated data on the relationship of respiratory allergopathology with neuropsychiatric disorders in childhood. The immediacy of the problem is due to the mutual influence of allergic and neuropsychiatric conditions combined in a child on the course of these diseases. According to research, the connection of respiratory allergic diseases with disorders of neurodevelopment, in particular with attention deficit and hyperactivity disorder and autism spectrum disorders, is clearly manifested, and the first publications on the connection with speech and other mild cognitive impairments have appeared. At the same time, the formation of depression, suicidal behavior, and anxiety disorders in respiratory allergopathology is being actively studied. It is assumed that the close relationship between nervous and immune regulation provides a high correlation of allergic and neuropsychiatric pathological conditions, although cause-and-effect relationships have not yet been precisely established. In this regard, it becomes relevant to introduce into clinical practice monitoring of cognitive status, neuropsychic development and possible symptoms of anxiety, depression and suicidal thoughts in the treatment of children with respiratory allergic diseases. Timely detection of violations will make it possible to provide specialized interventions at an early stage in order to achieve a favorable treatment result in the long term.

Iron deficiency in pregnant women: effect on offspring neuropsychic development

Increasing evidence indicates that adversities in utero and early childhood can have long-lasting effects on physiological and mental health not only in childhood but also in adulthood. Micronutrient deficiency, and in particular iron deficiency, is one of the most significant factors. Based on literature data, to determine the effect of iron deficiency in pregnant women on the neuropsychological development of infants, as well as to determine a cohort of pregnant women who need iron supplements. The search was conducted in MEDLINE (from PubMed), EMBASE (from OVID), Cochrane Library and ClinicalTrials.gov from 2010 to December 2023 without language restrictions. Data were extracted. Primary outcomes included iron deficiency, serum ferritin less than 15 μg/L in pregnant women, perinatal outcomes, and development of children in infancy. The data of serum ferritin in umbilical cord blood in newborns were compared with the serum ferritin of mothers. Data on iron supplementation and its effect on perinatal outcomes were assessed. Daily oral iron supplementation during pregnancy in women without IDA or ID reduces the incidence of iron deficiency anemia at the woman’s due date, reduces the incidence of iron deficiency in fullterm neonates, and reduces the incidence of morbidity in low-birth-weight infants. Iron supplementation during pregnancy and the postpartum period is a strategy for timely replenishment of ID and prevention of IDA to reduce cerebral iron deficiency in the fetus and newborn. The absence of side effects and high bioavailability, enhanced by ascorbic acid, allow us to recommend SunActive®Fe Bonoferlat as a daily supplement for pregnant and lactating women, according to WHO recommendations.

Nijmegen syndrome in childhood: a clinical case

Nijmegen syndrome is a rare monogenic pathology with an autosomal recessive type of inheritance. The disease is manifested by congenital developmental anomalies and microcephaly, primary immunodeficiency, frequent recurrent viral and bacterial infections, retardation in physical and neuropsychic development. In the medical literature, 150 cases of the syndrome are described; pathology occurs more often among the Slavic population. Nijmegen syndrome belongs to a group of diseases with chromosomal instability. The pathogenetic feature of the syndrome is congenital immunodeficiency of the humoral (B-lymphocytes) and cellular (T-lymphocytes) components. According to statistics, 40 % of children with Nijmegen syndrome are diagnosed with malignant neoplasms. lymphoid tissue is more often affected (non-Hodgkin’s B and T-cell lymphomas, acute lymphoblastic leukemia), and the development of solid neoplasia is also possible. To diagnose Nijmegen syndrome, in addition to assessing the patient clinical status, it is necessary to conduct an extended immunological examination with the determination of immunoglobulins A, M, G and molecular genetic studies.The article presents a clinical case of diagnosis and treatment of Nijmegen syndrome in childhood.

Клинические случаи ранней офтальмологической диагностики септо-оптической дисплазии

Identification of a genetic variant of a hereditary disease of the visual organ is necessary not only to determine the features of clinical manifestations and course of the disease, but also to carry out preventive measures to prevent the birth of a sick child. Therefore, the identification of ophthalmopathology requires a mandatory assessment of the condition of the patient's body as a whole. The article presents two clinical cases of ophthalmological diagnosis of septo-optic dysplasia. It is a clinically heterogeneous condition representing a combination of hypoplasia of the optic nerves, pituitary hypoplasia and abnormal formation of structures along the midline of the brain. The diagnosis is established in the presence of two or more signs of the classical triad. Hypoplasia of the optic nerves leads to decreased vision, amblyopia. Violation of the hypothalamic-pituitary system requires hormone replacement therapy. The prognosis of mental development depends on central nervous system abnormalities, if any, mental retardation occurs. The first clinical case: a boy R., 11 months old, was directed by a neurologist due to the presence of a pendulum-like nystagmus, hypoplasia of the optic nerves of both eyes, uneven caliber and convoluted course of retinal vessels were also revealed upon examination. The lag in physical and neuropsychic development drew attention to itself. To clarify the diagnosis, the child was recommended to perform an MRI of the head, which revealed aplasia of the septum pellucidum. Septo-optic dysplasia was diagnosed on the basis of the revealed disorders. The second patient, a girl, 2 days old, was referred to an ophthalmologist by a neurologist, the absence of a septum pellucidum was revealed on the neurosonogram, hypoplasia of the optic nerves and tortuosity of the retinal vessels were found on examination of the fundus. Septo-optic dysplasia was diagnosed. Thanks to the early detection of this severe hereditary pathology, timely maintenance and replacement therapy by a neurologist and endocrinologist, and observation by a geneticist, it is possible not only to prevent complications of the disease itself, but also to prevent the re-birth of a sick child in the family. Keyword: septo-optic dysplasia; hypoplasia of the optic nerves; aplasia of the septum pellucidum

Identifying the Impact of Classes of the Kazakh National Sports Togyzkumalak Game on Increasing Educational and Cognitive Activity of Primary Class Students

The effectiveness of the impact of the Kazakh national sports Togyzkumalak game on increasing the educational and cognitive activity of primary school students in the educational and cognitive process is considered. Based on the analysis, it can be noted the need for further development and systematization of the use of knowledge from various fields in classes on the Togyzkumalak game, as well as in other academic subjects, such as mathematics, language, physical education and others. This involves creating themed challenges, stories, and other forms of playful interaction. This approach sees the path to the effective formation of the personality of a student with multifaceted needs and the development of their educational and cognitive abilities through individualization and activation of educational and cognitive activities. Classes on the Togyzkumalak game based on an interdisciplinary approach can contribute to the diversified development of students’ personality, which is confirmed by the results of the study. Regardless of the individual characteristics of the students, this approach creates a positive basis for their neuropsychic development.

Crouzon syndrome: features of clinical manifestations, management and outcomes in children

Syndromic craniosynostosis is a special group of hereditary pathologies. One of the syndromic craniosynostoses is Crouzon syndrome, an autosomal dominant pathology of the primary violation of the fusion of cranial sutures. It occurs with a frequency of 1:60,000 newborns. The disease leads to a number of secondary complications, such as exophthalmos, orthognathic problems, impaired vision, hearing, breathing, lag in neuropsychic development. The development of Crouzon syndrome is associated with a missense mutation in the fibroblast growth factor receptor-2 (FGFR2) gene. In modern medicine, a variant of Crouzon syndrome with black acanthosis is also known, the development of which is associated with a mutation in the FGFR3 gene. The similarity of clinical manifestations as with others syndromic craniosynostoses, also between 2 variants of Crouzon syndrome, leads to difficulties in differential diagnostic search. Knowledge and awareness of the full clinical presentation of this syndrome makes it possible to timely diagnose and treat, prevent possible severe complications and improve the quality of life of patients with Crouzon syndrome. This article describes 2 clinical cases with mutations in the FGFR2 and FGFR3 genes.

Modeling neurophysiological and psychomotor relevant criteria in children with motor dysfunction

Background. Cerebral palsy is the most common cause of childhood disability among diseases of the nervous system, the prevalence of which averages 2.5 cases per 1,000 children.Aim. To identify relevant indicators in relation to the prediction of delayed rates of neuropsychic development in children and the formation of cerebral palsy in children 5–8 years old using mathematical modeling.Materials and methods. The study included 100 patients aged 5–8 years: 79 patients with neurological disorders and deviations in psycho-speech development, 21 patients – comparison group. The examination of children in both groups included: analysis of the child’s life history, analysis of psychomotor development in the first year of life, analysis of morbidity in the first year of life, assessment of psychomotor development at the time of the study, electroneuromyography using stimulation and superficial electroneuromyography, as well as ultrasound examination of the lower leg muscles with assessment of the functional state and muscle density using fibroscan.For statistical processing of the obtained data, descriptive statistics were performed. Determination of the statistical significance of indicators was carried out using the Kolmogorov–Smirnov test for continuously distributed values and Fisher’s exact test for discrete values. One-hot coding was used to represent categorical features. The analysis of the obtained data was carried out using a Python program using the pandas, numpy, scikit-learn, and boruta libraries.Results and conclusion. For children with deviations in neuropsychic development, significant early diagnostic markers are parameters of psychomotor development and neurological status (age when the child began to hold his head, decreased strength of the flexors of the foot and hip, level of walking) and instrumental examination (ultrasound of muscles thighs, electroneuromyography) – changes in the density and parameters of electrical excitability of muscles, which can serve as an early diagnostic sign of the development of motor dysfunction and an indicator for the formation of a trajectory of rehabilitation therapy.

PATHOPHYSIOLOGICAL ASPECTS OF HABILITATION AND REHABILITATION OF CHILDREN FROM CHILDREN’S HOMES WITH NEURODEVELOPMENTAL DELAY OF PSYCHOSOCIAL GENESIS

Background. Psycho-emotional stress in institutionalized children leads to significant tension in regulatory systems. Justification for using a complex of habilitation and rehabilitation measures aimed at reducing the stress factor and cre-ating conditions for “catch-up” development is an urgent problem. The aim of the study. To create and to test the effectiveness of a complex of habilitation and rehabilitation measures aimed at reducing deprivation pressure and environmental stress. Material and methods. The study included 114 children from children’s homes of Donetsk and Makeevka and 44 chil-dren from families aged 3 to 7 years. The complex of habilitation and rehabilitation measures included optimization of the daily routine, conditioning exercises, music, toy and fairy tale therapy, sessions of individual play and play in small groups of 2–3 people in a separate playroom, phototherapy with bright solar spectrum lamps, enriched sensory envi-ronment, increased physical activity, differentiated drug support with L-carnitine, glycine, hopantenic acid, magnesium and pyridoxine complex. Neuropsychic development was studied using the Denver Screening Test and the Formalized Card for the Study of Psychoneurological Functions according to I.A. Skvortsov and N.A. Ermolenko. The functions of regulatory systems were assessed by the level of cortisol and melatonin in saliva, and brain-derived neurotrophic factor in blood serum. Conclusion. A comparison of the results of assessing the parameters of neuropsychic development confirmed the effec-tiveness of the proposed complex of habilitation and rehabilitation measures. Restoration of the function of regulatory systems was confirmed by normalization of the rhythms of cortisol and melatonin synthesis, as well as by a significant (3-fold) increase in the content of brain-derived neurotrophic factor in the blood serum in children of the main group.

Iron deficiency conditions prediction and prevention in children

The relevance of iron deficiency issues is due to the high frequency and tendency to steady growth, affecting the quality of life of the population. Pregnant, lactating women and young children are at high risk of developing iron deficiency conditions. Among pregnant women, a direct correlation was found between iron deficiency in the early stages of gestation and the pathological course of pregnancy and childbirth, lower indicators of physical, psychomotor development of children. Materials and methods. A prospective cohort study of 248 mother-child pairs was conducted. Pregnant, lactating women: the main group-women who received iron preparations during registration-106 persons, the comparison group-those who did not receive iron preparations-142. Inclusion criteria: absence of exacerbation of chronic pathology, allergic reactions, gastrointestinal pathology, infectious diseases. The women were examined at the end of the 3rd trimester and the postpartum period. Catamnestic observation was carried out for 248 children born to pregnant women. All children were observed with the informed consent of their parents. The duration of observation was up to a year. The children of the main group (106) and the comparison group (142) were singled out. Children of the main group on natural feeding (98) were divided into two subgroups. The first subgroup - 47 children whose mothers received iron preparations during lactation, the second subgroup - 51 children whose mothers did not receive iron subsidies. An assessment of the somatic status, a general clinical examination was carried out. Results and Discussion.Based on the data obtained using the statistical method of analysis, it was found that iron deficiency in the antenatal period significantly increased the frequency of premature birth, caused a deficiency of birth weight, heart disease, and led to a high frequency of viral infections in pregnant women. In newborns, from mothers who did not receive the iron preparation, a high frequency of latent iron deficiency (LID) and iron deficiency anemia (IDA) was noted. Newborns from the comparison group, according to the results of laboratory diagnostics, were treated with LID and IDA, however, lower indicators of physical development, NPR remained until 6 months. In the postnatal period, there was a direct correlation between the prophylactic intake of iron preparations by a nursing mother and the occurrence of latent iron deficiency and IDA in a child. Conclusion. The data obtained allow us to speak about the high effectiveness of preventive iron supplementation by a pregnant and lactating woman, to reduce the risk of pathological pregnancy and childbirth, affecting the indicators of physical and neuropsychic development (NPD) of a newborn and an infant. Even with the timely elimination of iron deficiency in a newborn, the delay in physical and NPR is noted up to 6 months. The analysis of the effect of iron deficiency in pregnant and nursing mothers on the course of the antenatal period, childbirth and the state of the child’s health dictates the need for prevention from the standpoint of a personalized approach.

Интеркогортный анализ родительских факторов риска развитию ребенка на первом году жизни

Children develop rapidly in the first year of life and this period should create a solid ground for their health in future. Diseases of the nervous system, mental and behavioral disorders occupy leading places among causes of childhood disability. Given that, the aim of this study was to search for parental risk factors endangering physical and neuropsychic development of infants. Infants living in Vologda region were selected as a research object. Our informational basis was represented by sample data of the prospective monitoring over children’s health (894 children from five different cohorts born in 1998, 2001, 2004, 2014 and 2020); statistical and sociological data on prevalence of risk factors in Russia and in the region. The information was provided by healthcare workers (obstetrician-gynecologist, neonatologist, and pediatrician) and children’s mothers. The applied methodology included inter- and intra-cohort sociological analysis; calculation of relative risk (RR) to assess a correlation between developmental delay and parental factors. Child development was assessed by a pediatrician using abnormal psychology and adaptation approaches. We analyzed Russian and foreign studies that focused on the same research subject. We calculated relative risks of various social-demographic, socioeconomic, biomedical and environmental factors for the development of children who participated in the cohort monitoring. This allowed us to identify those with prognostic value including young age of parents (RR = 1.40); a single-parent family (RR = 1.46), bad relationships between spouses (RR = 1.36); low purchasing ability of a family (RR = 1.59), poor living conditions (RR = 1.66); a future mother being exposed to chemicals and toxic substances (RR = 1.31), gas pollution (RR = 2.02), hand high temperatures (RR = 1.56) at her workplace one year prior to childbirth; a smoking mother (RR = 1.56); a father having a sexually transmitted disease (RR = 3.23); abnormal pregnancy. The identified risk factors for child development occur prior to childbirth and are manageable. Awareness about them makes it possible to neutralize their negative influence when a pregnancy is being planned. Our analysis of statistical and sociological data has revealed a descending trend for prevalence of practically all the analyzed risk factors. Still, some factors cause certain concern including high prevalence of smoking among women, future mothers included; prevalence of anemia in pregnant women; unresolved financial issues and poor living conditions of a considerable share of families who are expecting a child; effects produced on women by harmful working conditions. The results of this study can be used for developing programs aimed at protecting child’s health at any level, from an individual to the national one.

Inter-cohort analysis of parental risk factors for development of infants

Children develop rapidly in the first year of life and this period should create a solid ground for their health in future. Diseases of the nervous system, mental and behavioral disorders occupy leading places among causes of childhood disability. Given that, the aim of this study was to search for parental risk factors endangering physical and neuropsychic development of infants. Infants living in Vologda region were selected as a research object. Our informational basis was represented by sample data of the prospective monitoring over children’s health (894 children from five different cohorts born in 1998, 2001, 2004, 2014 and 2020); statistical and sociological data on prevalence of risk factors in Russia and in the region. The information was provided by healthcare workers (obstetrician-gynecologist, neonatologist, and pediatrician) and children’s mothers. The applied methodology included inter- and intra-cohort sociological analysis; calculation of relative risk (RR) to assess a correlation between developmental delay and parental factors. Child development was assessed by a pediatrician using abnormal psychology and adaptation approaches. We analyzed Russian and foreign studies that focused on the same research subject. We calculated relative risks of various social-demographic, socioeconomic, biomedical and environmental factors for the development of children who participated in the cohort monitoring. This allowed us to identify those with prognostic value including young age of parents (RR = 1.40); a single-parent family (RR = 1.46), bad relationships between spouses (RR = 1.36); low purchasing ability of a family (RR = 1.59), poor living conditions (RR = 1.66); a future mother being exposed to chemicals and toxic substances (RR = 1.31), gas pollution (RR = 2.02), hand high temperatures (RR = 1.56) at her workplace one year prior to childbirth; a smoking mother (RR = 1.56); a father having a sexually transmitted disease (RR = 3.23); abnormal pregnancy. The identified risk factors for child development occur prior to childbirth and are manageable. Awareness about them makes it possible to neutralize their negative influence when a pregnancy is being planned. Our analysis of statistical and sociological data has revealed a descending trend for prevalence of practically all the analyzed risk factors. Still, some factors cause certain concern including high prevalence of smoking among women, future mothers included; prevalence of anemia in pregnant women; unresolved financial issues and poor living conditions of a considerable share of families who are expecting a child; effects produced on women by harmful working conditions. The results of this study can be used for developing programs aimed at protecting child’s health at any level, from an individual to the national one.

НАРУШЕНИЯ НЕВРОЛОГИЧЕСКОГО РАЗВИТИЯ ДЕТЕЙ, РОЖДЕННЫХ НЕДОНОШЕННЫМИ

There has been a shift in the spectrum of diseases in preterm infants recorded recently: a significant improvement in survival rates has been achieved as well as a decrease in severe forms of cerebral palsy. However, many children born prematurely show manifestations of CNS developmental disorders, which include motor, cognitive and behavioral disorders. Premature birth leads to a slowdown and distortion of neuroontogenesis. The article deals with the morphophysiological prerequisites for neurological development disorders in children born prematurely. The bibliographical data and own studies of neurological disorders and deviations in neuropsychic development in 122 children aged 5 to 8 y/o born prematurely with Extremely low body weight (500 to 999 g, GA 25 to 30 weeks), VLBW (1000 to 1499 g, GA 28 to 33 weeks) and LBW (1500 to 2499 g, GA 31 to 36 weeks) were analyzed. The mechanisms and frequency of occurrence in prematurely born children of violations of general intellectual development, speech, schooling skills, attention deficit and hyperactivity disorder, autism, dyspraxia, tics, tension headache, anxiety and behavioral disorders are discussed. Under conditions of cerebral damage in the developing brain the neuroplasticity - a process of biological adaptation associated with the structure and functional reorganization of the CNS - acquires decisive importance. The developing brain has high neuroplasticity and significant reserve capabilities, which provide the ability of the elements of the nervous tissue for adaptive restructuring and compensatory (restorative) capabilities of the brain.

Конституциональные особенности состояния здоровья детей дошкольного возраста с рецидивирующей респираторной патологией

The purpose — to study the constitutional features of physical and neuropsychic development of 4–7 year old children of intro- and extravert types with chronic adenoiditis. Material and methods. The study included preschool children with a verified diagnosis of chronic adenoiditis. The control group consisted of conditionally healthy children without chronic diseases. All children were divided into introverts and extraverts. The features of somatometric and somatoscopic indicators of physical development, emotional, characterological and intellectual indicators of neuropsychic development and socialization were studied. Results. For introverted children with chronic adenoiditis, the disease onset occurred at the age of 3–4 years; obstructive sleep apnea syndrome in combination with snoring prevailed; the duration was about a year and a half; frequent acute purulent otitis media with a long monotonous course, the manifestation of excessive vagotonia and pronounced disorders of sound reproduction were observed. In extroverted children, chronic adenoiditis debuted at the age of 4–5 years, in the form of postnasal syndrome with night cough, excessive sympathicotonia and with earlier formation of exudative otitis and hearing loss; the duration of the disease was about six months. Introverts with chronic adenoiditis were three times more likely than healthy children of this type to have body mass deficiency and microsomia, lower indicators of social activity, abstract thinking, attention, fine motor skills and semantic memory. In extroverts with chronic adenoiditis, among the variants of physical development disorders, the frequency of excess body weight and macrosomia doubled, the level of impulsivity increased, discipline, large-motor giftedness, conceptual and visual-imaginative thinking decreased. Conclusion. Clinical and functional differences in the course of chronic adenoiditis in children of intro- and extravert types and the identified features of their physical and neuropsychic development can be the basis for creating differentiated programs for their medical and social support on an outpatient basis. The constitutional approach makes it possible to assess the psychophysiological features of individual qualities that make up the «ground» of the disease, both to make a reasonable choice of an effective combination of health disorders correction and prevention methods, and to ensure the fullest realization of a child’s physical and social potential.

Early diagnostics of motor disorders in children: an interdisciplinary approach

Assessment of motor development is an important part of the study of the neuropsychic development of children, which is carried out by a pediatrician during preventive examinations. To identify the causes of motor disorders, in addition to studying the anamnesis, it is necessary to conduct a physical examination of the child with the appointment of additional research methods. It is important to remember that developmental delay does not always indicate the presence of any disease but requires dynamic monitoring. However, if they progress, then these patients are more likely to be diagnosed with specific neuromuscular disorders. In this case, the pediatrician should pay attention to the neurological status of the child, assess visual acuity and hearing. At the same time, one should not forget that motor disorders are often combined with a general developmental delay (mental retardation) of the child. Fasciculation of the tongue, loss of motor skills, organomegaly, coarsening of facial features, increased levels of creatine phosphokinase (more than 3 times higher than normal), respiratory failure, in the presence of general weakness, a sharp deterioration in the child’s condition, accompanied by lethargy, vomiting, development of convulsive syndrome, disorders detected on MRI of the brain, are alarming symptoms that require urgent intervention by specialists (neurologist, genetics). Also, some hereditary (chromosomal and monogenic) diseases are often combined with the development of motor disorders. The best results are achieved if the early diagnosis of diseases accompanied by movement disorders is carried out using an interdisciplinary approach.

Maternal risk factors for a child’s health prior to and during pregnancy (results of long-term cohort monitoring in Vologda region)

The work presents the results of the 26-year monitoring with its focus on children’s health. Pre-school children living in the Vologda region were selected as a research object. The aim was to assess health risks for children caused by certain maternal factors and conditions. The study was accomplished as an intra-cohort analysis of data on 1454 children from five cohorts (born in 1998, 2001, 2004, 2014 and 2020) by calculating a relative risk rate. Negative effects produced by sociodemographic, socioeconomic and environmental conditions as well as maternal harmful occupational factors during pregnancy are significant health risk factors for a child. It is true not only for the neonatal period but also during pre-school years. Such health-related factors as stillbirths in case history, complications of a present pregnancy (up-to-date reproductive technologies being applied to achieve it, eclampsia, multiple pregnancy, dangerous fetus position, prematurity, postmaturity, anemia, edemas, protein in urine) and birth (rapid labor, use of vacuum extraction) do the most severe damage to a child’s health at birth and their influence persists as a child grows. Other significant risk factors that influence children’s health in their pre-school years include diseases of the genitourinary and endocrine systems diagnosed in a mother prior to pregnancy; a mother being single; low incomes; electromagnetic radiation at a place where a family lives; harmful working conditions at a mother’s workplace (gases in workplace air, work on a conveyor belt, radiation exposure). A mother’s young age is also a health risk factor for a fetus during the prenatal period but its influence reduces as a child grows. In contrast, if a mother is older than 40, this factor protects a child’s health during pregnancy but increases likelihood of retarded neuropsychic development by the school age (due to a mother’s low health potential). Overwhelming majority of health risk factors we detected in this study are quite manageable. Our results can be used in creating programs aimed at preserving health of a mother and a child at any level, from individual to national one.

Факторы риска здоровью ребенка со стороны матери до и во время беременности (итоги многолетнего когортного мониторинга в Вологодской области)

The work presents the results of the 26-year monitoring with its focus on children’s health. Pre-school children living in the Vologda region were selected as a research object. The aim was to assess health risks for children caused by certain maternal factors and conditions. The study was accomplished as an intra-cohort analysis of data on 1454 children from five cohorts (born in 1998, 2001, 2004, 2014 and 2020) by calculating a relative risk rate. Negative effects produced by sociodemographic, socioeconomic and environmental conditions as well as maternal harmful occupational factors during pregnancy are significant health risk factors for a child. It is true not only for the neonatal period but also during pre-school years. Such health-related factors as stillbirths in case history, complications of a present pregnancy (up-to-date reproductive technologies being applied to achieve it, eclampsia, multiple pregnancy, dangerous fetus position, prematurity, postmaturity, anemia, edemas, protein in urine) and birth (rapid labor, use of vacuum extraction) do the most severe damage to a child’s health at birth and their influence persists as a child grows. Other significant risk factors that influence children’s health in their pre-school years include diseases of the genitourinary and endocrine systems diagnosed in a mother prior to pregnancy; a mother being single; low incomes; electromagnetic radiation at a place where a family lives; harmful working conditions at a mother’s workplace (gases in workplace air, work on a conveyor belt, radiation exposure). A mother’s young age is also a health risk factor for a fetus during the prenatal period but its influence reduces as a child grows. In contrast, if a mother is older than 40, this factor protects a child’s health during pregnancy but increases likelihood of retarded neuropsychic development by the school age (due to a mother’s low health potential). Overwhelming majority of health risk factors we detected in this study are quite manageable. Our results can be used in creating programs aimed at preserving health of a mother and a child at any level, from individual to national one.

РАННЯЯ ДИАГНОСТИКА ПОСЛЕДСТВИЙ НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ У ДЕТЕЙ С ПЕРИНАТАЛЬНЫМ ГИПОКСИЧЕСКИМ ПОРАЖЕНИЕМ ГОЛОВНОГО МОЗГА

Exposure to hypoxia in the perinatal period leads to significant structural changes in the brain (B), which are reflected in the further neuropsychic development of the child. In this regard, the assessment of the state of brain structures and cerebral circulation in young children using high-tech diagnostic methods is of particular importance. Objective of the study: to analyze the indicators of magnetic resonance imaging (MRI) of B structures for early diagnosis of the consequences of cerebrovascular accident in children who underwent hypoxia in the perinatal period. Materials and methods of research: single-center prospective open non-randomized longitudinal observational uncontrolled study were included in 144 newborns, who were stationed in the intensive care unit and intensive therapy units (ICU) of the Regional Perinatal Center of the Krasnodar Regional Clinical Hospital for severe asphyxia and/or intrauterine hypoxia. Among those included in the study were 76 full-term babies (FTBs) (group 1) and 68 premature newborns (PNs) (group 2). The gestational age (GA) of PNs was 29–37 (32.7±2.6) weeks. The sex composition of the groups (boys/girls) did not differ statistically significantly: n=41/35 – 54%/46% in the 1st group versus n=38/30 – 56%/44% in the 2nd group (p=0.816). All children underwent MRI of the B on 2–10 day of life with the determination of the measurement of diffusion coefficient (DC) in the mode of diffusion-weighted images. Children were observed up to 3 years of age in the follow-up department of the Krasnodar Krai Regional Children's Clinical Hospital. Results: in the PNs group, 35 (51%) GA was 29–32 weeks, in 33 (49%) children – 33–37 weeks. The revealed consequences of hypoxic B damage in children were determined by morphological changes in the nervous tissue and were characterized by objective MRI indicators. Analysis of the data obtained made it possible to identify the ranges of B ADI values, reflecting the subsequent neurological outcome. Further formation of neurological deficits (infantile cerebral palsy, disorders of psychoverbal development, symptomatic epilepsy) was noted in PNs with relatively low DC values 0.69–1.30×10–3mm2/s and 0.64–1.07×10–3mm2/s – for white and gray matter of the large hemispheres of the B, respectively; in PNs with relatively low and relatively high DC values of the white matter of the large hemispheres of the B 1.05–1.24×10–3mm2/s and 1.88–2.00×10–3mm2/s, gray matter of the B cerebral hemispheres 0, 93–1.06×10–3mm2/s and 1.36–1.47×10–3mm2/s. The effect of hypoxia in the intrapartum period was manifested by low DC indices, reflecting manifestations of cerebral ischemia. A significant increase in DC indicators was observed in hypoxic brain damage in the antenatal period and characterized atrophic changes in the nervous tissue. Based on the results of the analysis of B DC indices, reflecting manifestations of cerebral ischemia, statistically significant (p<0.01) direct highly correlated relationships were revealed between the DC indices of the white matter of the cerebral hemispheres and the indices of the DC of the gray matter of the cerebral hemispheres (rxy=0.975), the indices of the DC of the midbrain (rxy=0.714) in FTBs, between the indicators of the DC of the white matter of the cerebral hemispheres and the indicators of the DC of the gray matter (rxy=0.923), the indicators of the DC of the midbrain (rxy=0.787) in the PBs, which indicates the global nature of the hypoxic damage to the B. Conclusions: early diagnosis of cerebrovascular accidents in children using MRI data makes it possible to predict the further neurological outcome of perinatal hypoxic brain injures, contributes to the timely implementation of therapeutic and rehabilitation measures based on an objective assessment of the identified disorders.