RU2571290C1 - Method for predicting frequent arvi morbidity in young children with cerebral palsy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: to predict frequent ARVI morbidity in young children with spastic forms of cerebral palsy antioxidant activity of urine is determined in child of second year of life by chemiluminiscence method by value of tangent of angle of curve inclination to time axis and is index value is lower than 21.0 mV/sec, frequent ARVI morbidity till 3-year old age is predicted. Invention makes it possible to determine group of risk of forming frequent ARVI morbidity among said group of children in due time and prescribe them necessary prophylactic procedures.

EFFECT: reduced probability of realisation of risk of frequent ARVI morbidity will increase children's rehabilitation potential.

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Description

The invention relates to medicine, namely to pediatrics, and can be used to predict the frequent incidence of acute respiratory viral infections in young children with spastic forms of cerebral palsy (cerebral palsy).

The relevance of the development of the method is determined by the fact that cerebral palsy, despite years of study, remains the main cause of children's disability [ET Lilin, I.N. Ivanitskaya Modern views on the etiology of cerebral palsy // Russian Pediatric Journal. - 2002. - No. 3. - S. 35-40]. Cerebral palsy is one of the most serious consequences of perinatal CNS lesions [Classification of perinatal CNS lesions in the neonatal period and their consequences in the first year of life, 2007]. The most common are spastic forms of cerebral palsy, which account for up to 80-85% [S. Nemkova Cerebral palsy: diagnosis and correction of cognitive impairment. - M.: Union of Pediatricians of Russia, 2012. - 60 p.]. It is known that in addition to neurological disorders in children with cerebral palsy, somatic health also suffers, and the body's resistance decreases. In the first year of life, the group of often sick includes children who have suffered 4 or more episodes of acute respiratory viral infections, aged 1 to 3 years - 6 or more episodes of acute respiratory viral infections per year [Modern approaches to the treatment and rehabilitation of frequently ill children / Baleeva L.S., Balyasinskaya G.L., Blistinova Z.A. et al. // Medical Technology. - M., 2006. - 46 p.]. It was found that a third of young children with cerebral palsy (34.2%) belong to the group of often sick [Somatic pathology and individual biochemical parameters of young children with spastic forms of cerebral palsy / Gordeeva N.V., Vorobyova EA, Filkina O.M. and others // Bulletin of the Ivanovo Medical Academy. - 2014. - No. 1]. Most often ill children with cerebral palsy have a history of complicated ARVI.

Frequent incidence of acute respiratory viral infections significantly limits the rehabilitation potential of children with cerebral palsy. Development of a method for predicting the frequent incidence of acute respiratory viral infections in young children with cerebral palsy will allow timely identification of children at risk and prescribe preventive measures. Prevention of the risk of frequent acute respiratory viral infections in young children with cerebral palsy will increase their rehabilitation potential.

A known method for predicting frequent morbidity in children of the first year of life by determining in cord blood the relative content of lymphocytes and neutrophils with receptors for sheep erythrocytes (E-ROL and E-RON) and the C3 complement component (EAC-ROL and EAC-RON) by the method of rosette formation [ A.S. No. 1777081 Russia. A method for predicting frequent morbidity in children of the 1st year of life / Kopilova EB, Sotnikova N.Yu., Shilyaev P.P. // Discoveries. Inventions - 1992. - No. 43. - S. 121.]. For forecasting, the authors propose intervals for these indicators, and if individual values fall into at least one interval, frequent incidence is predicted in the first year of life. However, this method allows to predict the frequent incidence of acute respiratory viral infections in children only the first year of life. In addition, when performing the method of rosette formation, non-standardized reagents are used: sheep erythrocytes, rabbit antiserum and bovine erythrocytes.

A known method for predicting the incidence of respiratory infections in young children is that in a child attending a preschool, on the 10th day after the start of the visit, a color sedimentary reaction according to Kimbarovsky is carried out in a urine sample, and on the 5th day cardiointervalography is performed, according to the results of which calculate the fashion value and with a value of the first indicator above 52.4 cu, and the second below 0.45 s. the child is predicted to have a frequent incidence of SARS during the first year of attendance at a preschool Denia [Patent №2018832 Russia. A method for predicting the incidence of respiratory infections in young children / Puzyrev OI, Ageev AK // Inventions. - 1994. - No. 16. - S.120.].

The disadvantages of the method

1. The narrow application of the method only for children attending a kindergarten.

2. The need for two studies at different time periods.

3. Uninformativeness of conducting only a urine sample without performing cardiointervalography.

4. The relationship between predicting frequent acute morbidity and adaptation to a kindergarten.

5. The forecast accuracy of 85.7%.

A known method for predicting frequent morbidity in young children with minimal cerebral dysfunction is that in children older than 1 year, the content of CD72 + lymphocytes is determined in peripheral venous blood and, with an increase of more than 20.31%, frequent acute respiratory diseases of up to 3 years are predicted age [Patent No. 2142639 Russia. A method for predicting frequent morbidity in young children with minimal brain dysfunction / Filkina OM, Kocherova O.Yu., Shanina TG et al. // Inventions. - 1999. - No. 34; 4.2. - S. 319.] The accuracy of the method is 78.5%.

The disadvantages of the method

1. The narrow application of the method only for children with minimal cerebral dysfunction, is not used in children with other consequences of perinatal lesions of the central nervous system.

2. The sensitivity and specificity of the method are not indicated.

3. Large time costs (1 hour 40 minutes).

4. The intake of a large volume of blood - 1 ml.

5. The invasiveness of the method.

The closest technical solution to the claimed method is a method for predicting the frequent incidence of acute respiratory viral infections in young children with perinatal CNS lesions by determining the relative content of CD16 + lymphocytes in a peripheral venous blood of a child older than 1 year old and with its value equal to 10.1% and more, predict frequent incidence in children under 3 years of age [Patent No. 2338196 Russia. A method for predicting frequent morbidity in young children with perinatal lesions of the central nervous system / Sotnikova N.Yu., Filkina OM, Matveeva EA et al. // Inventions. Useful models. - 2008. - No. 31. - S.785.].

The disadvantages of the method

1. The method allows to predict the frequent incidence of acute respiratory viral infections only in children with hypoxic-ischemic damage to the central nervous system.

2. Venous blood sampling, a child’s negative attitude to the procedure, and highly qualified medical personnel are required.

3. The need for expensive equipment (flow cytometer).

4. Large time costs (1 hour 10 minutes).

5. The accuracy of the forecast is 80%.

These disadvantages are proposed to eliminate in the present method.

The technical solution of the proposed method is to simplify and improve the accuracy of predicting the frequent incidence of acute respiratory viral infections in young children with spastic forms of cerebral palsy up to 92.3%. The technical solution is carried out by determining the method of chemiluminescence of the antioxidant activity of the urine of a child of the second year of life by the value of the tangent of the slope of the curve to the time axis (tgα). With an indicator value of less than 21.0 mV / s, frequent incidence of acute respiratory viral infections in children under three years of age is predicted.

The novelty of the method:

It is proposed for the first time to predict the frequent incidence of acute respiratory viral infections in young children (from 1 to 3 years old) with spastic cerebral palsy by the antioxidant activity of urine (by the values of the slope of the curve to the time axis (tgα)).

Urine chemiluminescence indices were used for early detection of urological pathology in children [Akhmadel RI Early detection of children with urological pathology by the method of registration of urine chemiluminescence: abstract. dis. Cand. honey. sciences. - Ufa, 1991. - 20 p.]. A decrease in the antioxidant activity of urine is described in non-specific lung diseases [Farhutdinov U.R. Diagnostic value of urine chemiluminescence in patients with non-specific lung diseases // Therapeutic Archive. - 2005. - No. 12. - S. 67-70], with chronic pyelonephritis in remission on the background of congenital malformations of the organs of the urinary system [Priezheva E.Yu., Lebedko OA, Kozlov V.K. Chemiluminescence of blood serum and urine in children with chronic pyelonephritis in remission on the background of congenital malformations of the urinary system // Pediatrician Handbook. - 2010. - No. 5].

We revealed a compensatory increase in the antioxidant activity of urine in young children with spastic forms of cerebral palsy [Features of somatic pathology, physical development, individual functional and biochemical parameters of young children with spastic forms of cerebral palsy / Gordeeva N.V., Vorobyeva EA, Filkina O.M. et al. // Bulletin of new medical technologies. Electronic journal. - 2013. - No. 1. - http://medtsu.tula.ru/VNMT/Bulletin/E2013-1/00.html]. However, in children at risk for the frequent incidence of acute respiratory viral infections, a significant decrease in the antioxidant activity of urine was established, which is a prognostically unfavorable factor.

A decrease in antioxidant activity leads to the accumulation of toxic products of free radical (peroxide) lipid oxidation and the development of oxidative stress, which is possibly one of the pathogenetic mechanisms of the development of frequent acute respiratory viral infections. A decrease in antioxidant activity leads to an increase in the permeability of cell membranes for viruses, which contributes to the frequent incidence of SARS.

Distinctive features of the method: the prognostic parameter of the values of the antioxidant activity of urine is established, determined by chemiluminescence by the value of the tangent of the slope of the curve to the time axis in children with spastic forms of cerebral palsy. If the value of the indicator is less than 21.0 mV / s, frequent incidence is predicted up to 3 years of age.

The method is carried out standardly as follows:

1. In children of the second year of life with an established diagnosis of a spastic form of cerebral palsy, a morning dose of urine is collected. The duration of storage of urine until the time of the study should not exceed 3 hours.

2. 0.4 ml of urine, 0.2 ml of buffer, 0.2 ml of iron sulfate are added to the measuring cell, then it is placed in the cuvette block of the BHL-07 chemiluminometer (Russia). After that, 0.2 ml of a solution of H ₂ O ₂ is quickly added and the cuvette is transferred to the measuring position. Chemiluminescence (CL) is recorded within 40 seconds.

3. At the end of the set time, the measurement is interrupted and the necessary parameters of the chemiluminescent signal are calculated. The program goes to the processing window, on which the experience map appears. The antioxidant potential of the test sample correlates with the tangent of the slope of the curve to the time axis (tgα), expressed in mV / s.

The essence of the proposed method is illustrated by the following examples.

Example 1

Baby A. was born from a second pregnancy, second birth, within 30 weeks. Pregnancy in the mother proceeded with a threat of interruption, prenatal discharge of amniotic fluid, a long anhydrous period (30 hours). Body weight at birth - 1300 g, body length - 41 cm, Apgar score of 6-7 points. Until the 20th day of life, he was in the children's intensive care unit, the first 14 days on mechanical ventilation. Then transferred to the department of nursing premature babies. Diagnosis: hypoxic-ischemic lesion of the central nervous system of moderate severity, motor impairment syndrome. Type 1 respiratory distress syndrome, severe. In the first year of life, she had ARVI twice, complicated by acute obstructive bronchitis (at 7 months) and larynx stenosis (at 10 months). He was regularly observed by a pediatrician, neurologist. At 1 year old, she was diagnosed with cerebral palsy, spastic diplegia (G80.1). The study of the antioxidant activity of urine was carried out at 1 year 2 months in the absence of signs of infectious and inflammatory pathology, tgα was 16.5 mV / sec. Frequent incidence of SARS was predicted. During subsequent observation in the second year of life, he had ARVI 7 times, including those complicated by stenosis of the larynx (1 year 3 months) and acute obstructive bronchitis (1 year 7 months). In the third year of life, he had ARVI 6 times, including complicated by acute obstructive bronchitis (2 years 3 months). Thus, the prognosis of the frequent incidence of a child with a spastic form of cerebral palsy by the proposed method was confirmed.

Example 2

Baby B. was born from the third pregnancy, the second birth in the period of 27 weeks. Maternal pregnancy proceeded against gestosis, with the threat of interruption, prenatal discharge of amniotic fluid, and a long anhydrous period (5 days). Body weight at birth - 920 g, body length - 36 cm, Apgar score of 5-7 points. The first 7 days of life was in the children's intensive care unit, then transferred to the nursing department of premature babies. Diagnosis: perinatal damage to the central nervous system of hypoxic-ischemic genesis, severe degree, cerebral ischemia of the 2nd to 3rd degree, periventricular leukomalacia, intraventricular hemorrhage of the 2nd degree, depression syndrome. In the first year of life, ARVI was twice sick (at 8 months, 11 months). He was regularly observed by a pediatrician, neurologist. At 1 year old, she was diagnosed with cerebral palsy, spastic cerebral palsy (double hemiplegia) (G80.0). The study of the antioxidant activity of urine was carried out at 1 year 3 months in the absence of signs of infectious and inflammatory pathology, tgα was 20.9 mV / s. Frequent incidence of SARS was predicted. During subsequent observation in the second year of life, he suffered ARVI 6 times, including acute tracheobronchitis. In the third year of life, he had ARVI 6 times. Thus, the prognosis of frequent incidence of the proposed method was confirmed.

Example 3

Baby V. was born from the second pregnancy, the first birth at the age of 31 weeks. Pregnancy proceeded against the background of anemia, gestosis, and the threat of interruption. Body weight at birth - 1530 g, body length - 41 cm, Apgar score of 6-7 points. The first 4 days of life was in the children's intensive care unit, then transferred to the nursing department of premature babies. Diagnosis: perinatal CNS damage of hypoxic-ischemic genesis, moderate severity, cerebral ischemia of 2 degrees, periventricular leukomalacia, intraventricular hemorrhage of 1 degree, syndrome of motor disorders. In the first year of life, I had ARVI 1 time (10 months). He was regularly observed by a pediatrician, neurologist. At 1 year old, she was diagnosed with cerebral palsy, spastic diplegia (G80.1). The study of the antioxidant activity of urine was carried out at 1 year 1 month in the absence of signs of infectious and inflammatory pathology, tgα was 21.0 mV / s. Frequent incidence was not predicted. In the second year of life he suffered ARVI 3 times. In the third year of life, he had ARVI 4 times. Thus, the forecast for the proposed method was confirmed.

The advantages of the method

1. The inventive method does not require a lot of time and is carried out in 5 minutes

2. The proposed method has a high accuracy of 92.3%.

3. This method is non-invasive.

4. A small volume of urine (0.4 ml) is examined.

5. The cheapness of the method.

6. Does not require highly qualified personnel (can be performed by paramedical personnel).

7. The method is a screening, ie allows you to examine a large number of children.

8. It allows you to timely identify the risk group for the formation of a frequent incidence of acute respiratory viral infections among young children with spastic forms of cerebral palsy and to prescribe the necessary preventive measures for them, to reduce the likelihood of realizing the risk of frequent acute respiratory viral infections and to increase their rehabilitation potential.

In this way, 91 young children with spastic forms of cerebral palsy were examined.

The results of the study are presented in table 1.

Table 1 The number of examined 91 Truly Positive Results 23 True negative results 61 Falsely positive results four Falsely negative results 3 Method accuracy 92.3% Method sensitivity 88.5% The specificity of the method 93.8%

Claims (1)

A method for predicting the frequent incidence of acute respiratory viral infections in young children with the consequences of perinatal CNS damage, including the study of the biological fluid of a second-year-old child, characterized in that the antioxidant activity of urine is determined by chemiluminescence by the value of the tangent of the slope of the curve to the time axis and when the indicator value is less than 21, 0 mV / s predict frequent incidence up to 3 years of age in children with spastic forms of cerebral palsy.