International Journal of Scientific Pediatrics

THE ROLE OF PERINATAL AND POSTNATAL FACTORS IN THE FORMATION OF THE GUT MICROBIOME AND HEALTH STATUS OF INFANTS DURING THE FIRST YEARS OF LIFE

Shoira Agzamova — 2026-02-23

Introduction. The first year of life represents a critical “window of development” characterized by high microbiome plasticity and increased sensitivity to various early-life factors. During this period, the foundations of immune tolerance, intestinal barrier function, and regulation of inflammatory responses are established. Numerous studies have demonstrated the significant influence of the gut microbiota on the health status and development of infants in the first year of life. The aim of the study. To analyze international experience in assessing the role of perinatal and postnatal factors in the formation of the gut microbiome and health status of infants during the first year of life. Materials and Methods. A total of 36 publications were analyzed, including systematic reviews, cohort studies, prospective randomized controlled trials (RCTs), and original research articles focusing on the role of perinatal and postnatal factors in shaping the gut microbiome and its association with infant health outcomes. Results and Discussion. The formation of the gut microbiome begins at birth and represents a stepwise dynamic process. The mode of delivery has a significant impact on the initial composition of the intestinal microbiota. Vaginally delivered infants are predominantly colonized by microorganisms of the genera Bifidobacterium, Lactobacillus, and Bacteroides, whereas infants born by cesarean section demonstrate reduced microbial diversity and delayed intestinal colonization. The maternal microbiome status, nutritional characteristics, and the presence of somatic diseases significantly influence primary intestinal colonization in newborns. The maternal microbiota has been identified as one of the main sources of microorganisms transmitted to the infant during the perinatal period. Thе microbiome is determined not only by its taxonomic composition but also by its metabolic activity, particularly the ability of microorganisms to synthesize biologically active metabolites such as short-chain fatty acids (SCFAs) — acetate, propionate, and butyrate. Up to 10% of the daily energy requirements in infants may be covered by microbial metabolites, primarily SCFAs. Delayed formation of an “age-appropriate” microbiome is associated with slower weight gain, reduced body length increment, and impaired proportional physical development. This phenomenon is especially pronounced during the first 6–12 months of life, when the microbiota undergoes active maturation. Conclusion. The gut microbiome represents a crucial link connecting early-life factors with physical and psychomotor development during the first year of life. Disruptions in microbiome formation during this period may be associated with impaired physical development, increased susceptibility to infectious diseases, and the development of functional gastrointestinal disorders, highlighting the importance of early prevention and correction of dysbiosis conditions.

ANESTHESIOLOGICAL DETERMINANTS OF PERIOPERATIVE OUTCOMES IN CHILDREN WITH INTESTINAL OBSTRUCTION

Sherzod Toshboev — 2026-01-19

Intestinal obstruction in infants and young children is associated with high perioperative morbidity and mortality. Besides surgical factors, anesthesiological management and perioperative intensive care may significantly influence outcomes. Objective.This study aimed to identify perioperative predictors of adverse outcomes in children with intestinal obstruction and to evaluate anesthesiological management strategies. Methods. A retrospective observational study was conducted at the Andijan Regional Multidisciplinary Medical Center. Medical records of 99 children aged 0-3 years who underwent emergency surgery for intestinal obstruction were analyzed. Demographic, clinical, anesthetic, and perioperative variables were evaluated. Binary logistic regression and receiver operating characteristic (ROC) analysis were applied to identify independent predictors of adverse outcomes. Results. Adverse outcomes (severe complications and/or death) occurred in 34.3% of patients. Operation duration was identified as an independent predictor of adverse outcome (OR 1.064 per minute; 95% CI 1.023-1.107; p=0.002). Delayed hospital admission (>24 h) showed a borderline association with adverse outcome (p=0.057). The regression model demonstrated acceptable discrimination (AUC=0.722). Late hospital admission (>24 hours) was marginally associated with adverse outcomes (p=0.057). The regression model had satisfactory discriminant ability, with an area under the ROC curve (AUC) of 0.722. According to the results of the analysis, the duration of surgery was identified as an independent and reliable predictor of adverse clinical outcomes (OR=1.078; 95% CI: 1.028-1.131; p=0.002). This indicates that each additional minute of surgery increases the probability of developing an adverse clinical outcome by an average of 7-8%. This suggests that metabolic disorders associated with prolonged surgical time and increased surgical stress negatively affect clinical outcomes. Also, late hospital presentation (>24 hours) was noted as a significant factor significantly increasing the risk of adverse clinical outcomes (OR=9.20; 95% CI: 1.62-52.38; p=0.012). This result can be explained by the late diagnosis of the disease, increased risk of intestinal ischemia and infectious-septic complications. The type of anesthesia, in particular multimodal anesthesia, did not reach independent statistical significance within the multivariate model (p=0.301). Conclusion. Perioperative factors, particularly operation duration, play a critical role in determining outcomes in pediatric intestinal obstruction. Early hospital admission and optimization of anesthesiological management may contribute to improved clinical results.

IMPROVEMENT OF TREATMENT TACTICS FOR SEVERE DEGREES OF PECTUS EXCAVATUM IN PRESCHOOL-AGED CHILDREN

Mirzakarimov Bahromjon — 2026-01-19

The pathogenesis of pectus excavatum involves not only osteochondral structures but also the soft tissue components of the anterior chest wall, including the sternodiaphragmatic ligament, which plays an important role. The aim of this study was to improve the treatment strategy for severe forms of pectus excavatum (PE) in preschool-aged children. Clinical material: the treatment outcomes of 30 children aged 1 to 6 years diagnosed with grade III–IV pectus excavatum were analyzed. Methods: the degree of deformity was determined using multislice computed tomography (MSCT). In all patients, the morphological and functional status of the sternodiaphragmatic ligament (SDL) was additionally assessed by ultrasonography (US). Based on these findings, an individualized treatment strategy was selected. In patients with grade III–IV deformities and the presence of contracture and fibrotic changes of the SDL, ligament release was performed followed by correction using the vacuum bell technique. Results: In preschool-aged children with severe pectus excavatum, assessment of the sternodiaphragmatic ligament using ultrasonography is of great importance for selecting the appropriate treatment strategy. In patients with a morphologically preserved ligament, vacuum bell therapy was effective, whereas in cases with fibrotic changes and contracture, the use of vacuum bell correction combined with ligament release provided significantly better clinical and anatomical outcomes. Statistical analysis of the obtained results demonstrated a significant association between anterior chest wall deformation and mechanical stresses and the severity of the deformity. According to MSCT and computational biomechanical modeling, both the compression depth and the maximum von Mises stress values increased in a statistically significant manner with increasing deformity severity (p < 0.01). Compared with patients with grade II deformity, those with grade III–IV deformities showed significantly higher compression depth values at the central anatomical points (P3–P5) (p < 0.01), while the differences at the peripheral points (P1–P2) were less pronounced (p < 0.05). This indicates that mechanical loading is predominantly concentrated in the central regions of the anterior chest wall. Conclusion: In the treatment of severe pectus excavatum in preschool-aged children, an individualized approach based on ultrasonographic evaluation of the sternodiaphragmatic ligament demonstrates high clinical efficacy, reduces the extent of invasive surgical interventions, and expands the possibilities for early correction.

CARDIOPROTECTION IN ANESTHESIOLOGICAL SUPPORT FOR PEDIATRIC OPEN HEART SURGERY: CLINICAL CAPABILITIES OF SEVOFLURANE

Farmon Toxirov — 2026-01-20

Experimental studies have shown that volatile anesthetics can induce pharmacological preconditioning and reduce the degree of myocardial damage, however, clinical data in pediatric practice remain limited and contradictory. Objective. Compare the cardioprotective effects of sevofluron and total intravenous propofol anesthesia in children who underwent open-heart surgery using artificial blood circulation. Methods. A prospective one-centered study included 106 children aged 6 months to 5 years with congenital heart defects who underwent open-heart surgery with cardioplegic cardiac arrest. Patients were divided into two groups: sevofluran (n=53) and propofol (n=53). The primary endpoint was the maximum level of cardiospecific troponin T in the postoperative period. Secondary endpoints included the frequency of arrhythmias, indicators of hemodynamic stability, echocardiography data, the need for inotropic support, the duration of mechanical ventilation and stay in the intensive care unit. Results. In all observations, an increase in the level of cardiospecific troponin T after surgery was noted, however, its values were significantly lower in the sevofluran group at all stages of observation. After 3 hours, the level of cTnT was 1.2±0.3 ng/ml in the sevoflurane group and 1.9±0.4 ng/ml in the propofol group (p<0.05), after 8 hours-1.7±0.4 and 2.6±0.5 ng/ml respectively (p<0.01), after 12 hours-1.5±0.3 and 2.3±0.5 ng/ml (p<0.05), after 24 hours-1.1±0.2 and 1.8±0.3 ng/ml (p<0.05). Arrhythmias were registered in 11.3% of patients in the sevoflurane group and in 26.4% of patients in the propofol group (p<0.05). The need for inotropic support was lower when using sevoflurane (15.1% versus 32.1%, p<0.05). The time of artificial lung ventilation (9.2±3.1 versus 13.6±4.4 hours, p<0.01) and the duration of stay in the ICU (36±10 versus 52±14 hours, p<0.05) were significantly shorter in the sevoflurane group. Echo-indicators indicated a faster restoration of myocardial systolic and diastolic function in patients receiving sevoflurane. Conclusion. The use of sevoflurane in open-heart surgeries in children is associated with more pronounced cardioprotection compared to propofol, which is manifested by a lower degree of myocardial damage, more stable hemodynamics, and faster functional recovery of the heart in the early postoperative period.

ASSESSMENT OF THE RESULTS OF PREVENTIVE INTERVENTION TO CHANGE LIFESTYLE IN OVERWEIGHT AND OBESE CHILDREN

Gulhayo Mamatkhujayeva — 2026-01-30

Obesity is associated with serious health problems in children and is a major and early risk factor for morbidity and mortality in adults. The direct health effects of obesity include hyperlipidemia, hypertension, and glucose tolerance. Purpose of the study: assessment of leptin and adiponectin levels before and after lifestyle changes in children with obesity and overweight and determining their role as biomarkers. Material and methods: One hundred and four overweight and obese children (51 boys and 53 girls) were included in this study and constituted the main group. Fifty-four children with normal body weight without endocrine, cardiovascular, gastrointestinal, or liver diseases constituted the study's control group. Of the first 104 children, 48 returned for re-examination after a year of lifestyle changes. Anthropometric indicators were assessed in these children at the initial stage, as well as after one year. Lifestyle intervention is included in the educational program, which includes changes in nutrition and physical activity. Children and their parents are advised to switch to a normal calorie diet based on a balanced distribution of carbohydrates (55%), proteins (15%), and lipids (total 30%, saturated fats less than 10%). When changing the form of physical activity, it is recommended to perform aerobic exercises three to five times a week for no less than 45-60 minutes. Results: Clinical and biochemical characteristics were determined in children with obesity and excess body weight (group A, n=104) at the initial stage compared to the control group (group B, n=54), at the initial stage (group C, n=48) and after 1 year of intervention (group D, n=48). After 1 year of preventive intervention, 48 children were re-examined. Children with unchanged body weight and those who lost weight were compared. Children with obesity and excess weight did not have statistical differences in many parameters, including insulin levels, HOMA-IR, and adiponectin levels, compared to children who lost weight and had normal weight, which once again indicates the positive effect of lifestyle changes on children. However, the level of leptin was still higher in children with obesity and excess body weight than in children with normal weight, which allows us to assume that, despite the "normalization" of metabolic status, leptin did not change in accordance with these positive changes. Conclusions: our study confirms the positive effect of simple dietary recommendations and physical activity on metabolic and clinical parameters in children with obesity and excess body weight. The level of leptin was significantly increased in children who did not lose weight, but in children who actually lost weight, there were no significant changes compared to the baseline level, which allows us to assume that leptin is not directly related to the change in body weight. Adiponectin is the best and simplest marker for assessing the positive results of prevention and treatment of obesity and excess weight in children, monitoring metabolic changes, and their detection.

IMMUNOHEMATOLOGICAL MARKERS OF INFLAMMATION IN FULL-TERM NEWBORNS WITH CONGENITAL PNEUMONIA

Gullola Turabidinova — 2026-01-31

Relevance. Congenital pneumonia (СP) remains one of the most severe forms of perinatal infection, exerting a significant impact on neonatal morbidity and mortality. According to the World Health Organization (WHO), over 7 million children in early infancy suffer annually from the consequences of intrauterine infection, with more than 600,000 cases resulting in death during the neonatal and infant periods. The purpose . To assess the diagnostic value of leukocyte profile parameters in umbilical cord blood of newborns with intrauterine pneumonia. Materials and Methods. A prospective study was conducted involving 81 full-term newborns (gestational age 37–42 weeks), including 61 infants diagnosed with СP (main group) and 20 healthy newborns (control group). Umbilical cord blood samples were collected within the first hours of life to determine absolute leukocyte and lymphocyte counts. Statistical analysis included calculation of mean values, standard deviations, correlation coefficients (r), and significance levels (p). Results. Significant alterations in leukocyte profiles were observed in newborns with СP. The mean leukocyte count was 14.77 ± 0.512 × 10⁹/L, markedly higher than in the control group (9.87 ± 1.317 × 10⁹/L). A similar trend was noted for lymphocytes: 6.02 ± 0.719 × 10⁹/L versus 1.56 ± 0.361 × 10⁹/L. A moderate positive correlation was found between leukocyte and lymphocyte counts (r = 0.59; p < 0.05), indicating synchronized activation of the innate immune response. Peak levels were recorded on the third day of life. Conclusion. The leukocyte profile of umbilical cord blood serves as a valuable marker of inflammatory activity in СP and can be utilized for early immunological monitoring in newborns.

IMPROVING THE RESULTS OF DIAGNOSIS AND TREATMENT OF CRYPTORCHIDISM IN CHILDREN

Adxam Gafurov — 2026-02-04

Cryptorchidism is one of the most common congenital anomalies of the male reproductive system and is characterized by the failure of testicular descent into the scrotum. This condition leads to impaired microcirculation, vascularization, and thermoregulation of the testicular tissue, resulting in degenerative changes, suppression of spermatogenesis, and an increased risk of infertility. According to the literature, the incidence of cryptorchidism ranges from 1.6% to 9% in full-term newborns and reaches up to 30% in preterm infants. Delayed medical consultation, late diagnosis, and inappropriate treatment strategies significantly worsen therapeutic outcomes. Aim of the study: To improve the outcomes of cryptorchidism treatment in children through early diagnosis and a comprehensive therapeutic approach. Materials and methods: From 2020 to 2025, 253 patients aged from 8 months to 17 years with various forms of cryptorchidism were examined and treated at the In the urology department of the Andijan Regional Children's Multidisciplinary Medical Center. Diagnostic methods included Doppler ultrasonography, multislice computed tomography (MSCT), magnetic resonance imaging (MRI), and diagnostic laparoscopy when indicated. All patients underwent clinical and laboratory investigations; in cases of non-palpable gonads, serum sex hormone levels were additionally assessed. Results and conclusion: The results demonstrate that early detection of cryptorchidism and a differentiated surgical approach contribute to the preservation of gonadal function and reduction of postoperative complications. Timely application of minimally invasive endoscopic techniques significantly decreases the incidence of testicular atrophy, retraction, and the risk of infertility.

PREGNANCY OUTCOMES IN THE FIRST TRIMESTER COMPLICATED BY RETROCHORIAL HEMATOMA

Gulyamovna Rasul-Zade Yulduz — 2026-02-18

Introduction. Retrochorial hematoma (RCH) in early gestation in women can predict adverse maternal, fetal, and neonatal outcomes. The relationship between the presence of RCH, its location, size, and perinatal complications was studied. Increased RCH size is associated with an increased risk of pregnancy complications such as vaginal bleeding in the first trimester, early fetal loss, fetal growth restriction, placental abruption, and preterm labor. The aim of this study was to investigate the association between first-trimester retrochorial hematoma and gestational and perinatal complications. Patients and methods. Information on 177 patients whose pregnancies in the first trimester (<14 weeks) were complicated by retrochorial hematoma was obtained from an analysis of archival material at Tashkent Regional Clinical and Practical Center No. 6, conducted between January 2023 and December 2025. A control group (35 healthy pregnant women) was recruited from the outpatient clinic of this institution. The presence of fetal cardiac activity at the time of diagnosis of retrochorial hematoma was a prerequisite for inclusion in the study. Depending on the hematoma size, pregnant women with RCH were divided into three groups: with small hematomas (RCH-I group, n = 57), with medium hematomas (RCH-II group (n = 101) and with large hematomas (RCH-III group, n = 19). The control group consisted of 35 pregnant women without RCH and vaginal bleeding. Statistical processing of the data was performed within the framework of a retrospective study using Statistica software (version 25.0). Results. Retrochorial hematoma is associated with an increased frequency of bleeding in the first trimester, regardless of its size, as well as with a lower gestational age of the fetus at delivery. At the same time, an increase in the size of a retrochorial hematoma increases the risk of placental abruption, preterm labor, SIDS and fetal loss. Conclusions. Thus, the association of early gestation retrochorial hematoma with The association of retrochorial hematoma with maternal, fetal, and neonatal complications is widely discussed and requires further research aimed at identifying common pathogenetic mechanisms of retrochorial hematoma and adverse pregnancy outcomes, particularly fetal growth restriction syndrome.

DEPRESSION IN PARKINSON'S DISEASE: THE DETERMINING ROLE OF DISEASE STAGE AND MOTOR DEFICIT

Gullola Isroilova — 2026-02-18

Introduction. Depression is a frequent non-motor manifestation of Parkinson's disease (PD), significantly affecting patients' quality of life and prognosis. The aim of the study the prevalence of depression using the HADS scale and its associations with clinical and demographic parameters in PD patients. Materials and Methods. A total of 153 PD patients were examined. The assessment tools included Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) for motor evaluation and the Hospital Anxiety and Depression Scale (HADS) for depression screening. Patients were categorized based on HADS scores into groups: no depression (0-7), subclinical depression (8-10), and clinical depression (≥11). Results and Discussion. Subclinical depression was identified in 68.6% (n=105) of patients, while clinical depression was found in 9.9% (n=15). Age and gender did not differ significantly between the groups (p>0.05). Strong positive correlations were established between the depression score and the Hoehn & Yahr stage (p=0.00043) as well as the UPDRS-III score (p=0.002). In the multivariate regression model, the PD stage was a borderline significant predictor of clinical depression (p=0.065). Conclusions. Depression in PD is predominantly subclinical and is strongly associated with the severity of motor deficit and disease stage. This justifies the rationale for implementing stage-oriented screening for depression in this patient population.

POLYMORPHISM OF THE FTO GENE (RS9939609) AS A RISK FACTOR FOR EARLY KIDNEY DAMAGE IN CHILDREN WITH OBESITY

Lilya Garifulina — 2026-02-27

Introduction. The problem of obesity in children continues to attract the attention of pediatricians worldwide. The development of a comorbid pathology, namely kidney damage, is of particular importance. In the pathogenesis of kidney disorders in obesity, both metabolic disorders and genetically determined predisposition lie. Studying these facts will allow us to identify a high-risk group among children with obesity for early preventive and treatment measures. The aim of the study is to study the relationship between kidney functional disorders and FTO gene polymorphism in children with obesity. Material and methods. 211 children with alimentary exogenous-constitutional obesity were examined, and from the examined sample of patients, groups were formed according to the types of fat tissue distribution: a group of children with abdominal fat tissue distribution type; a group of children with a uniform fat tissue distribution type. The control group consisted of 104 children of the same age and sex with normal body weight. We investigated the features of anthropometric data, biochemical and molecular genetic studies, including determining the excretion of albumin with urine, cystatin levels, calculating glomerular filtration rate, and determining the polymorphism of the FTO gene. Results and Discussion. Our studies showed that in children with abdominal obesity, the frequency of the AA genotype was higher (28.4%) compared to the group of children with moderate obesity (16%) with a statistically significant advantage (2=4.529, p=0.034). This allowed us to classify the AA genotype as predisposing to the development of abdominal obesity. Both in children with abdominal obesity and in children with moderate obesity, the highest level of urine albumin (77.03±6.52 mg/l and 54.11±5.17 mg/l) was noted in carriers of the A/A genotype, and the lowest in children with carriers of the T/T genotype (38.83±5.03 mg/l and 21.39±3.14 mg/l; p<0.001). In children with a uniform type of obesity, carriers of the mutant A/A genotype showed a decrease in blood cystatin levels and an increase in glomerular filtration rate, which indicated hyperfiltration, which is the beginning of pathological changes in the kidneys in obesity. In children with abdominal obesity and carriage of the A/A genotype, unlike children with moderate obesity, an increase in the level of cystatin and a decrease in the glomerular filtration rate were observed, which is a manifestation of obesity glomerulopathy. Conclusion. Studies have shown that the polymorphism of the FTO gene in children with obesity is associated with functional kidney damage. Carriers of the A/A genotype with abdominal obesity are more susceptible to metabolic disorders, namely metabolic kidney damage, which is expressed in a significant increase in the level of microalbuminuria, a pathology of the level of cystatin, and a decrease in glomerular filtration rate.