[Efficacy of complex system of dietary provision of children in critical states. Part 2. Developing a system of choice of a method and implementation of artificial nutrition of children in critical status].

To increase efficacy of treatment of children in intensive care departments a system of dietary provision of children in critical status has been developed. A way of determining the time to start enteral nutrition for such children was determined. Study of the effectiveness of mixed (parenteral-enteral) feeding, showed its high efficiency as compared with exclusively enteral nutrition, thus recommend this method for children with resuscitation and intensive therapy.

[Efficacy of complex system of dietary provision of children in critical states. Part 1. System of early diagnostics of nutritional status' disturbaneces and evaluation of functional state of gastro-intestional tract organs].

The increase efficacy of treatment of children in intensive care departments a system of dietary provision of children in critical status was developed. A way of determining the time to start entheral nutrition of such children was determined.

[Actual feeding of children in intensive care units].

The paper deals with the actual feeding status of infants in intensive care units (ICU). A total of 275 children aged 1 month to 15 years, treated in the ICU of a Tushino children's city hospital, Moscow, for brain injury, pyoinflammatory abdominal diseases, and severe pneumonia in 2000-2006, were examined to study the dietary provision of children in the ICU with essential nutrients and calories depending on age and feeding mode over time in the early post-aggression period. Mixed (parenteral and enteral) feeding was found to provide dietary intake with significantly large quantities of essential nutrients and calories than enteral feeding alone. At the same time, the changes between the enteral feeding and mixed feeding groups in such indices as the quantity of ingested protein, fat, and calories were significant (p < 0.05).

[The nutritional status of children in intensive care units].

The paper deals with the nutritional status of infants in intensive care units (ICU). It shows nutritional trends in 269 children aged 1 month to 15 years, treated in the ICU of a Tushino children's city hospital, Moscow, for brain injury, abdominal surgical diseases, and severe pneumonia. The paper evaluates the physical development of children in the ICU, shows the trends in weight-height, somatometric, laboratory parameters, and balance study data. The values of protein losses and nitrogen balance in children in the postaggression period and their relationship to age and feeding mode (enteral, parenteral-enteral) are shown.

[Nutritive provision of children during intensive therapy in the early post-aggressive period].

The purpose of the study conducted at the intensive care units (ICI) of a Tushino children's city hospital (CCH), Moscow, in 2000-2005, was to enhance the efficiency of treatment in children with brain injuries, severe pneumonias, or appendicitis-induced peritonitis in the early postaggression period, by optimizing their feeding. Examination of 224 patients aged 1 month to 15 years, treated at the ICI of the Tushino CCH for brain injuries, severe pneumonias, or appendicitis-induced peritonitis in 2000-2005, indicated that mixed (parenteral and enteral) feeding was more effective in children in the early postaggression period than enteral feeding. Consideration of the size of protein losses and the amount of dietary protein and energy and estimation of nitrogen balance revealed that, by increasing the amount of dietary protein and energy, lowering protein losses, and thus producing positive changes in nitrogen balance, higher blood glucose decrease rates, and in a number of anthropometric and somatometric indices, mixed (parenteral and enteral) feeding is an effective method of nutritive provision in children at an intensive care unit.

[Procedure for determining the initiation of tube feeding in children in an intensive care unit].

A procedure is proposed to determine the timing of tube feeding in children treated in an intensive care unit, which records the hypertonia of the pyloric sphincter and consists in the determination the time of gastric administration of distilled water before its evacuation into the duodenal lumen (water evacuation test) visualized in the real-time mode through abdominal ultrasonography. The proposed procedure was successfully applied to 42 children aged 3 months to 14 years who had severe brain injury, appendicular peritonitis, polytrauma, and polysegmental pneumonias. This determining procedure makes it possible to exclude radiation exposure in patients treated in intensive care units and to improve the outcomes of treatment, by prescribing the artificial feeding, that is adequate to the patients' status, in the periods optimal for each specific clinical case.

[Experience with a selenium-containing biological active supplement used in children with pneumonias in an intensive care unit].

The efficacy of the biologically active additive (BAA) "Spirulin-Sochi-Selen" was evaluated in 45 children aged 3 to 15 years who had acute pneumonia treated in the intensive care unit for infected patients of the Tushino children's city hospital, Moscow. The levels of selenium were determined by the Alfthan microfluorimetric technique (1984). The time course of clinical, laboratory, functional, and X-ray changes was determined. A control group comprised 20 children taking no selenium-containing foods or biologically active additives. The findings suggest that the BAA "Spirulin-Sochi-Selen" is effective as part of therapy for acute pneumonia in children treated in an intensive care unit. There were no signs of selenium deficiency in any case despite the baseline reduction in the average serum levels in both groups.

[Inhalation and peroral mucolytic therapy in mucoviscidosis in children]. / Ingaliatsionnaia i peroral'naia mukoliticheskaia terapiia pri mukovistsidoze u detei.

The paper summarizes the results of clinical studies of 98 children with mucoviscidosis whose age was 7 to 18 years. There is research evidence for possibility and expediency of using new classes of mucolytic agents in the therapy of mucoviscidosis in children. Analysis of the rheological properties of sputum showed the advantage of inhalation route of mucolytics over their oral administration. There is evidence for the advantage of mucosolvan over carbocysteine and unithiol via all routes of administration, the optimal methods of administration and differentiated indications have been developed.

[Use ciprofloxacin in children with mucoviscidosis]. / Opyt primeneniia tsiprofloksatsina u detei, bol'nykh mukovistsidozom.

Ciprofloxacin was used in treatment of 13 children aged 6 to 18 years with mucoviscidosis and exacerbation of the bronchopulmonary process. The dose of the drug was 20 to 30 mg/kg a day when administered orally or 15 mg/kg a day when administered at first intravenously and then orally. The treatment course averaged 14 days. The indications to the drug use were: severe processes of mucoviscidosis and chronic colonization of the bronchial mucosa and lung tissues with Pseudomonas aeruginosa (mucoid or nonmucoid form) sensitive to ciprofloxacin and resistant to other antibiotics. The trials showed that ciprofloxacin was highly efficient: the state of the patients improved and the inflammation index of the total blood count normalized. However, eradication of P. aeruginosa from the respiratory tracts was not observed. The drug allergy in 1 patient and a transient increase in the level of transaminases in 5 patients as the adverse reactions were recorded.