Innovative technologies in the reanimation and intensive therapy permitted to improve the survival of premature infants, including those with extremely low birth weight infants. There are considered various issues of practical medical care for very-low-birth weight infants in the first three years of life. The special attention is given to patients with bronchopulmonary dysplasia (BPD). There is briefly presented the own authors’ experience of the observation for premature infants in conditions of a multidisciplinary team care approach. There were described such important aspects of the mentioned category of patients as neurodietology/nutritional rehabilitation, compliance with aseptic environmental conditions, the correction of visual and hearing impairment, treatment of neurological deficit, especially neuropharmacology, treatment of paroxysmal disorders and epilepsy.
Study Objective: to analyse the dynamics in morbidity of the classic and New forms of bronchopulmonary dysplasia (BPD) in children hospitalised to the National Medical Research Centre of Children Health during previous 8 years. Study Design: retrospective analysis of medical records. Materials and Methods. In 2012–2019, we analysed 369 cases of children with the new BPD and 231 cases of children with the classic disease. Study Results. The article contains the information on the 8-year observation demonstrating prevalence of the new BPD and describes disease characteristics and course in premature infants. The retrospective analysis of 2012–2019 data shows that the number of paediatric patients with the new BPD is gradually increasing. Whereas in 2012 the classic BPD prevailed (156 (68.4%) out of 228 children with confirmed diagnosis), later the new form accounted for more BPD cases (p < 0.05). According to information available, an equal ratio (50% for the classic form and 50% for the new form) is demonstrated in 2013, the period when the Russian Federation started using the live birth and dead birth criteria proposed by the World Health Organisation (WHO). Conclusion. Improved neonatal intensive care methods and transition of the Russian Federation to the WHO live birth and dead birth criteria in 2012 were pre-conditions for BPD pathomorphism. The of rate of the classic form in the Russian Federation has been decreasing year after year. It is essential to identify the long-term complications from the new BPD, especially functional capabilities of the respiratory tract in older patients with the history of disease. Study of the features and long-term complications from this new form is a burning issue of paediatric pulmonology and requires careful attention. Keywords: bronchopulmonary dysplasia, new form, classic form, premature infants.
The aim is to identify parents’ (legal representatives’) satisfaction with the quality of medical care provided to their disabled children to improve this type of service further. Materials and methods. A sociological survey was conducted of 506 legal representatives of minors (aged from birth to 17 years) with the status of a disabled child. The study design is single-center, non-randomized, uncontrolled. Results. An analysis of the living conditions of a disabled child in the family, the parents’ assessment of his health status, the problems arising in the registration of disability, in the provision of medical and rehabilitation assistance, and issues of medical and social support made it possible to determine the position of this part of the child population in current legal and medical and social conditions. The main problems were the collection of a large number of documents when registering a disability, a long wait for the day of examination, the remoteness of the medical and social examination bureau, the lack of specialist doctors, problems with obtaining subsidized drugs, the lack of consideration of the individual needs of the child when conducting unique rehabilitation programs, the need to apply at the same time to various organizations and departments, violation of rights in the provision of medical services to a disabled child. Conclusion. The obtained information is very significant for further improving the provision of medical and social assistance to disabled children and children with disabilities. The main task today is to develop mechanisms for implementing the declared rights and freedoms of persons with disabilities, the obligations assumed by the State concerning them.
ВВЕДЕНИЕБронхолегочная дисплазия (БЛД) -полиэтиологич-ное хроническое заболевание морфологически незрелых легких, развивающееся у новорожденных, главным обра-зом глубоко недоношенных детей, получающих кисло-родотерапию и находящихся на искусственной вентиля-ции легких (ИВЛ). Клиническая картина характеризуется преимущественным поражением бронхиол и паренхимы легких, развитием эмфиземы, фиброза и/или нарушени-ем репликации альвеол, кислородозависимостью в воз-расте 28 сут жизни и старше, бронхообструктивным синдромом и другими симптомами дыхательной недоста-точности. Для болезни специфичны рентгенологические изменения и регресс клинических проявлений по мере роста ребенка [1][2][3]. Определение БЛД, как и представ-ления о факторах, способствующих развитию заболе-вания, его частоте, классификации, сведения о патоге-незе и превентивных мерах подробно изложены в ряде отечественных и зарубежных монографий и закреплены рекомендациями Российского респираторного общества и Союза педиатров России [1][2][3]. Это позволило достичь единообразия в используемой терминологии и сделать эти представления практически общепринятыми.В настоящем обзоре проанализирована современ-ная литература, касающаяся факторов риска формиро-вания БЛД, течения и исхода заболевания. ТЕЧЕНИЕ БРОНХОЛЕГОЧНОЙ ДИСПЛАЗИИРазвитие БЛД описывается с разных позиций. В част-ности, анализируются особенности клинических прояв-лений болезни, обусловливающих тяжесть повреждения бронхолегочной системы, в том числе в зависимости от возраста, массы тела при рождении, проводимой тера-пии. Кроме того, учитываются результаты функциональ-ных тестов, рентгенологических изменений, эпизодов обострений и их частота.Типичными для детей с БЛД считают синдромы утечки воздуха (пневмоторакс, пневмомедиастинум, интерстициальная эмфизема), приступы апноэ с бра-дикардией, приобретенные инфекционные процессы в легких (пневмонии, бронхиты как обострение заболе-вания) в сочетании с дефицитными состояниями недо-
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