Accurate assessment of the disease severity and outcome prediction in children with neuroinfections is one of the most challenging problems in pediatric intensive care. Objective. To evaluate performance characteristics of several prognostic scales used in children with infections of the central nervous system (CNS). Patients and methods. We examined 100 children with a mean age of 3.5 years. Mean length of stay in the intensive care unit was 9.5 days; mean duration of ventilation was 6.0 days. The death rate was 11%. To evaluate patients’ condition, we used the following scales: PELOD2, PELOD, PRISM3, and pSOFA. Results. We found that 65% of patients had depressed consciousness; 22% of patients had high-grade fever. The stroke volume and ejection fraction were near the lower reference limit, while 20% of children had their ejection fraction ≤ 60%. Leukocytosis was observed in 51 children; 37 children had anemia. Hyponatremia was registered in 17% of cases. Severe hypocoagulation was observed in 7% of cases in patients with generalized meningococcal infection. We found that thrombocytopenia (117 × 109 cells/L) and SpO2/FiO2 ratio <200 mm Hg were the main predictors of death. The рSOFA scale demonstrated the highest accuracy among the scales studied (AUC = 0.717). Conclusion. The рSOFA scale is a highly sensitive and specific scale for the assessment of death risk in children with CNS infections, which allows us to recommend it for routine clinical practice. Key words: CNS infections, children, prognostic scales, PELOD, PELOD-2, рSOFA, SOFA

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Rotavirus infection (RVI) is one of the most common childhood diseases. The study of predictors of severe forms of this disease is of undoubted interest.Aim. Based on the study of the characteristics of the premorbid background, life history and clinical and laboratory parameters, determine predictors of severe forms of RVI.Patients and methods. In the departments of intestinal infections and resuscitation and intensive care of Pediatric Research and Clinical Center for Infectious Diseases in the period 2018 – 202. a retrospective study of 962 children aged 2 months to 2 years with rotavirus infection was carried out. he severity of the condition was assessed using the Clarke scale. To identify the most significant predictors of the development of severe forms of RVI, two groups of patients were compared: severe (> 16 points) and moderate (≤16 points) forms of RVI. Comparison of the frequency of occurrence of signs in the groups was performed using the Pearson χ2 test and Fisher’s exact method. The forecasting model was developed using discriminant analysis of the statistical package Statistica for Windows.Results. Severe forms of RVI were detected in 65 children. Among the patients with severe forms of RVI, there were no patients with completed preventive vaccination. Patients with severe forms of RVI were admitted to the hospital in the late stages of the disease and had a higher score on the CDS scale. Based on the research carried out, a model for predicting severe forms of RVI was developed. The features included in the model were: the day of illness at admission, the patient’s age, prehospital prescription of antibacterial drugs, the absence of completed vaccination against RVI, and the severity of dehydration. Assessment of the quality of the created model showed that the classification ability was 97.7%.Conclusion. Predictors of severe forms of RVI include admission to a hospital in the late stages of the disease with severe dehydration, early age, prehospital antibiotics and forced transfer to artificial feeding, and absence of completed prophylactic vaccination.

The article is devoted to the use of ultrasound diagnostics methods to assess the functional state of the cardiovascular system in critical conditions in children and the choice of optimal hemodynamic support. The need for careful detailed monitoring in patients in pediatric intensive care units has been demonstrated, the low sensitivity and specificity of the currently widely used clinical signs are reflected, which limits their use in the choice of treatment methods. As an alternative, it is proposed to use ultrasound diagnostics that assess cardiac output, allowing you to make an informed decision on medical measures taking into account the current clinical situation. The wide possibilities and numerous advantages of ultrasonic navigation in providing assistance to patients with a wide variety of life-threatening conditions are described. The main advantage is the possibility of obtaining information in real time, directly at the bedside. A clinical case of a target-oriented intensive therapy of left ventricular systolic dysfunction in a nine-year-old child against the background of a septic process using methods of ultrasonic assessment of hemodynamic status is presented. The use of ultrasound imaging methods made it possible to identify the cause of the deterioration of the condition and conduct a reasonable treatment correction, which ensured the fastest regression of hemodynamic disorders and contributed to a favorable outcome of the disease. The simplicity and accessibility of the Teicholz estimate of the ejection fraction was noted, which allows it to be used in routine practice to select the optimal hemodynamic support and assess the effectiveness of treatment over time.