The history of the creation of the first in the country institute of advanced training of paediatricians is intriguing by the intertwining of state tasks and personal destinies of various people: royal persons, architects, doctors. The article describes the prerequisites and tasks that were set during the arrangement, construction and the first years of operating of the Yelenin Institute. The article provides the stories of the first doctors - paediatricians of the Yelenin Institute, the main doctors of the first children’s hospitals in St. Petersburg.

 

Presently, there is solid evidence that breast-feeding is ideal for the nutrition, harmonious physical and psychosocial development of the infants. This postulate is confirmed not only by modern scientific data, but also by the entire history of humanity from ancient times. However, history also shows that at all times there were various factors besides medical ones that prevent the appropriate and widespread breastfeeding of infants. These factors were both religious and social, and even political; they changed from one era to another and from one nation to another, and unfortunately, take place in modern society. They often had a character of prejudice and reflected on the health state of both infants and their mothers. This article presents a historical overview of the factors preventing breastfeeding, which can help the paediatrician understand the current causes of the insufficient prevalence of natural feeding.

 

The article deals with the features of skin structure and functions in infants and the causes of diaper dermatitis. It determined the priority of preventive measures and the choice of optimal agents for topical application that meet international standards. The requirements for topical agents used in infants for prevention of DD are described in detail, according to the international opinion of the experts group.

 

The article presents the main variants of functional gastrointestinal disorders in young infants - posseting, evacuation disorder, intestinal infantile colic, clinical features, modern view on the causes and methods for correction of these conditions (step-bystep methods to alleviate the pain syndrome). It also describes the manipulation methods that help with these conditions (inserting a flatus tube, cleansing enema in infants), as well as the basic principles for counselling and education of parents.

 

According to the literature, hypogalactia is the most common cause of early termination of breast-feeding. The article describes the risk factors for the development of hypogalactia in the first days after birth, such as cesarean section, motherchild separation, and the low frequency of newborn feeding in the first day of life. In addition, the use of formulas without medical indications, especially in the first days after birth, when the success lactation is being established, is the most common cause of termination of breastfeeding due to hypogalactia. Medical indications for supplementary feeding, as well as ways of feeding with a formula that would not suppress the mother’s own lactation, are discussed in detail in the article on the basis of the guidelines of the American Academy of Breastfeeding Medicine. Particular attention is paid to the main factors of the establishment of natural lactation: early application to the breast during the first hour of life, prolonged skin-toskin contact  between  mother  and  child, frequent feeding upon request of the child, recommended by the World Health Organization (WHO).

 

In order to assess the growth and development of schoolchildren living in a metropolis, 809 boys aged 12 to 15 years were examined in St. Petersburg. Characteristics of indicators of physical development are given according to the norms of «WHO Growth Reference 2007»; the level of puberty - with the help of a phenotypic evaluation according to the method of M.V. Maksimova. The high prevalence of overweight (13.3%) and obesity (12.5%) among schoolchildren was revealed. It is noted that the initiation of the boys’ puberty occurs at the earlier time compared with the data given in the literature.

 

Acute laryngotracheitis (croup) is an acute condition that most commonly affects children of the first 6 years. Croup is caused by viral infection of the upper airway, predominantly by parainfluenza virus. Croup is characterized by the signs of subglottic stenosis, which determines croup severity. Corticosteroids are the mainstay of croup treatment due to a strong anti-inflammatory effect. Typically, duration of corticosteroid treatment in croup does not exce ed several days. Even short-course systemic corticosteroids are associated with a number of adverse effects: nausea, vomiting, behavioral changes and sleep disturbance, etc. According to Russian clinical guidelines for croup management inhaled corticosteroid budesonide is the first line therapy. Budesonide efficacy in croup has been proved in numerous clinical trials. Based on similar effectiveness of inhaled and systemic corticosteroids in croup patients, budesonide is the preferred treatment option, because it helps to minimize the risk of adverse effects.

In this study it has been studied the functional status of the middle ear, depending on the pathology of the tonsils of the pharynx. There has been discovered the dependence of the auditory tube dysfunction, the presence of the nosological form of the disease and age of the children. The highest risk of severe obstruction of the auditory tube exudate with persistent tympanic cavity is installed in infants with associated hypertrophy of the tonsils of the pharynx.

 

This article provides an overview of the current clinical guidelines and consensus papers on the role of bacterial infection, indications and algorithm for antibiotic therapy in the treatment of the most common acute upper respiratory tract infections in children: acute rhinosinusitis, acute otitis media and acute tonsillitis.

Acute respiratory diseases, which include a whole list of diseases caused by different types of viruses, account for the lion’s share of diseases in paediatric practice. The complications of these diseases are especially dangerous. If the treatment is chosen and prescribed in a proper and timely manner, it prevents serious and sometimes irreparable consequences. It is the paediatrician, who first diagnoses the disease and determines the optimal treatment tactics. In his interview, Vasily Mikhailovich Delyagin, MD, Professor of the Department of Polyclinic and Emergency Paediatrics of Pirogov Russian Research Medical University of the Ministry of Health of Russia (Moscow), Head of the Department of Clinical Physiology, Professor of the Department of Paediatrics and Health Organization of Dmitri Rogachev National Research Center, told us about the practical skills and guidelines for the treatment of complicated ARVI, especially for the treatment of otitis.

The article considered the characteristics of the course of rhinosinusitis in children, discussed the treatment regimens of this pathology according to the clinical guidelines, and placed emphasis on the topical intranasal combination therapy.

 

The article presents an overview of the role of vitamin D in prevention of acute otitis media in children. It provides brief pathogenetic justification of the action of vitamin D on the human immune system. The reasons for the urgency of the use of vitamin D supplements in prevention of acute otitis media in children are analysed. Topical issues to further study the problem in paediatric practice are presented.

Acetaminophen (AAP) is one of the most common and widely used antipyretic drugs, but its overdose is the leading cause of fulminant hepatic insufficiency in the world. Mechanisms of liver damage at the use of toxic doses of AAP are caused by the transformation of the isoform of cytochrome P450 (CYP2E1, CYP2A6) into a reactive metabolite, N-acetyl-parabenzoquinonimine (NAPQI), which plays a major role in hepatotoxicity. Another mechanism of hepatotoxicity includes the formation of peroxynitrite – a toxic free radical produced in the mitochondria, which causes oxidative damage. In addition to liver damage in case of acetaminophen poisoning, nephrotoxic effect can occur. Potential mechanisms of nephrotoxicity in overdose of AAP are presented, caused by cytochrome P450, as well as prostaglandin synthetase and enzyme N-deacetylase are described. In the clinical case described by us, the development of fulminant hepatic insufficiency against the background of acetaminophen administration led to the development of a coma along with the kidney damage, however, a stable positive dynamics, was achieved during treatment. In the catamnesis 2.5 years later, there were no signs of fibrosis or cirrhosis of the liver.

Every paediatrician faces the problem of how to diagnose and treat constipation in children in the daily practice. According to the sociological survey of parents and doctors, on average every third child has a delay in evacuating stool. According to the 2016 Rome VI criteria, the diagnosis of functional constipation in children from 0 to 4 years of age is based on diagnostic signs that differ for children older than 4 years old. This article considers the mechanisms of constipation development in children of different age groups, and discusses the influence of microbiota on the development of motor and neurosensory intestinal disorders. The use of probiotics in constipation therapy is still controversial. The article presents recent studies of the efficacy of different probiotic strains in the treatment of constipation in children. So far, only Lactobacillus reuteri (DSM 17938) has a proven effect for the treatment of constipation in using monostam probiotics.

According to the frequency of contact with a doctor, abdominal pain in children is second only to respiratory diseases. Since the pain syndrome is a nonspecific manifestation of various pathologies, the doctor faces a serious diagnostic task, which is especially difficult in pediatric practice. One of the frequent causes of abdominal pain in children is a disruption of the function of the digestive tract, in particular, the dysfunction of the billiard tract. The article considers etiopathogenetic mechanisms of development of functional disorders of the biliary tract in children, classification in the light of the Rome IV consensus, modern low-invasive methods for diagnosing dysfunctions of the biliary tract. The ultrasound of the hepatobiliary zone was assessed. Questions are given for self-control.

The authors raise the question of the problems of diagnosis of developmental disorders in young children. The article provides a review of domestic and foreign methods of diagnostics of psychomotor development. The «Algorithm for diagnosing the child’s psychomotor development» is proposed, based on a step-by-step approach to assessing the dynamics of the child’s neuropsychological development.

Stress is one of the main reasons for the exponential growth of most chronic non-infectious diseases. The stress response is a genetically determined nonspecific adaptive mechanism. However, if it is an overly intense and prolonged, it becomes a risk factor for the pathogenesis of cardiovascular and oncological diseases, immunodeficiencies, digestive tract diseases and other pathological conditions. Studies have shown that magnesium deficiency, which develops against the background of stress, repeatedly intensifies its negative manifestations. Magnesium preparations make up the basis of therapeutic and rehabilitation activities in children experiencing stress. Timely correction of magnesium deficiency can increase the resistance against the action of stressors, neutralize or mitigate their damaging effect, and also prevent the development of stress-induced pathology.

The comparative analysis of content of cytokine and significant local antimicrobial factors (IL-6, IL-8, IL-17, INF-γ, TNF-α, IL-10, CRP, lysozyme, lactoferrin) in the coprofiltrates and serum of patients with acute and chronic reactive arthritis (ReA) made it possible to determine the markers predicting the course and outcomes of arthritis. It is established that the method of predicting ReA involving the analysis of the parameters characterizing coprofiltrates of children is the more accurate and effective method.

 

Atopic dermatitis (AtD) is a chronic inflammatory skin disease with complex etiopathogenesis, which begins in childhood. Purpose of the study: To evaluate the clinical efficacy and safety of Skin-cap cream as a topical background therapy in children with diabetes. Materials and methods: The study included 77 children aged 1 to 11 years with moderately severe AtD with a widespread lesion of the skin (33,5%), skin itching, inflammatory skin reaction and exacerbations occurring 3 to 4 times a year. During the study, two arms of children were formed: the treatment arm - 39 children with an average course of the disease (SCORAD index = 33,9 ± 2,2 points), who received the background therapy with the prescription of Skin-cap cream. Comparison arm: 38 children (SCORAD index = 34,2 ± 2,1 points), who received Afloderm cream as a background therapy. Results: Patients of the treatment arm showed a significant dynamics of relief of AtD symptoms as compared with the comparison arm. the differences in the duration of dermal manifestations were as follows: in the treatment arm, the time of reducing hyperaemia was 4,4 ± 1,2 days, in the comparison arm, hyperaemia was reduced at 5,7 ± 1,5 days (p< 0.05), the mean duration of alleviation of the skin itching was 3,0 ± 0,9 days and 5,8 ± 1,4 days (p< 0,05) at 6,8 and 7,3 days in the treatment arm and the comparison arm, respectively. Conclusions: The conducted study confirmed the high efficacy of the use of Skin-cap cream as a topical agent for background therapy of AtD, as compared to topical glucocorticosteroids.

The article presents data on the anatomical and physiological features of the newborns skin. It also considers the issues of pathogenesis of the diaper dermatitis. The main measures aimed at the prevention and treatment of diaper dermatitis in newborns are provided. The articles highlights the role of dexpanthenol-containing drugs in the external therapy of skin diseases in young children.

 

Objective: To determine the clinical and functional characteristics of kidney damage in diabetes mellitus (DM) type I in children to establish the criteria for the prediction and early diagnosis of diabetic nephropathy (DN). Patients and methods. A total of 125 patients 4–18 years with type 1 diabetes. Kidney function was assessed by determining serum cystatin C and calculation of glomerular filtration rate (GFR) using the formula Hawke. Results and discussion: the majority of patients with type 1 diabetes with the NAM, the median age was observed for 2.5 years more than in the comparison group (p <0.01). The high risk of developing MD in children with early-onset disease (51.7% of cases – up to 5 years of life) and the duration of diabetes for over 10 years. Nam 100% combined with other disease complications: neuropathy, retinopathy. In patients with DN revealed lower values of birth weight: 3,100 (2800–3400) c. against 3280 (3100–3600) c. In assessing the physical development of children, more than half have a disharmonious physical development. Assessment of blood pressure levels revealed its increase in most of the patients with DN. The majority of patients with DN (72.4%) marked signs of dyslipidemia, which is significantly higher than in the comparison group (29.2%, p <0.005). Conclusions: The risk factors for the formation of NAM in children are older than 15 years, disease duration of more than 10 years, presence of neuropathy, retinopathy, cataract, and combinations of these complications, low growth, hypertension, lipid spectrum of the blood plasma.

The article considers the role of histamine in the pathogenesis of allergic diseases and other pathological conditions. The mechanisms that contribute to the development of skin itching are considered separately. The article also shows the role and function of H1-histamine receptor blockers in the treatment of allergic diseases and pseudo allergic reactions. The mechanism of action, indications, contraindications and side effects of the antihistamine therapy are presented. The article also discusses the difference in first and second-generation antihistamines and shows the possible advantages of the first-generation drugs in paediatric practice. The article presents data on the use of dimethindene maleate (Fenistil) in children’s practice, including the use for the relief of skin itching of various genesis.

The issues of diagnosis and management of allergic rhinitis (AR) in pediatric patients are considered on the basis of the current Russian clinical guidelines. The article presents the paediatrician tasks on the collection of anamnesis, the assessment of clinical symptoms, the setting of a preliminary diagnosis, the development of a diagnosis and therapy plan taking into account the modern medical care quality criteria. It also discloses the general principles of AR treatment, approaches to emergency symptomatic therapy using a combined intranasal drug Vibrocil (dimethindene + phenylephrine). The paper provides recommendations for the management of patients with allergic rhinitis in the district covered by child health care.

Relevance. The bicuspid aortic valve (BAV) can be combined with genetic developmental syndromes, but the pediatric aspects of the problem have not been adequately studied. Goal. Determine the frequency of BAV from the data of the ultrasound examination rooms (ultrasound) and characterize the clinical and echocardiographic aspects of the bicuspid aortic valve. Material and methods. 19 patients with BAV (17 children and 2 adults) were examined. To evaluate the possible long-term consequences of BAV, 45 adults were examined: men 25 (mean age 61.72 ± 1.42 years), women 20 (mean age 64.9 ± 1.46 years). Results. The frequency of BAV according to the ultrasound examination rooms is 1 case per 20 000-23 500 studies. BAV was combined with genetic syndromes of connective tissue dysplasia (hypermobility syndromes of joints, Marfan, FreemanSheldon, etc.), registered in twins. The average value of the eccentricity index of the BAV leaflets was 3.5, the standard deviation was 1.1, the standard error was 0.274. In adult patients with BAV, calcification of the valves was observed, which was not detected in the control group (p = 0.006). Conclusion. BAV can be both an accidental finding, and be combined with another pathology. BAV is more often found in people with hereditary developmental syndromes. The presence of BAV requires the exclusion of genetic developmental syndromes. Despite the comparative rarity of BAV in the general population, a remote prognosis may be serious, which requires the pediatrician to organize interdisciplinary interaction. 

Purpose of the study: to determine the clinical significance of Zn deficiency based on the 14-year prospective study of children with different levels of zinc at birth. Patients and methods. Pregnant women and their newborns (n = 316) were screened for serum Zn levels. A total of 146 motherchild pairs were followed-up during the year, of which 102 children were followed-up for up to 14 years. Results. The study showed that the prevalence of zinc deficiency in the women followed-up was as follows: 77% in pregnant women, 80% in newborns. 94% of children with Zn deficiency at birth demonstrated zinc deficiency even at school age. There is a correlation between the serum Zn level in children and their mothers both during the newborn period and at school age (r = 0.38), with p <0.05. the period of newborns, and at school age (r = 0.38), with p <0.05. The 1-year-children with zinc deficiency, in comparison with infants with sufficient zinc levels are more often diagnosed with rickets 86,2% and 45,1%, anemia 37,9% and 17,7%, dystrophy 27,5% and 13,8 %, as well as atopic dermatitis 65.5% and 29.4%, allergic reactions 24.1% and 15.7%, at school age they were diagnosed with a pathology of the musculoskeletal system (79% and 52%, respectively), gastrointestinal tract (61% and 41%), nervous systems (54% and 30%) and skin (66% and 45%) with p <0.05. The decrease in resistance of the body was identified 2 times more often in zinc-deficient children. The conclusion. Zinc is important at all stages of a person’s life, therefore the analysis of zinc availability should be carried out not only in pregnant and nursing mothers, children of early age, but also among risk groups for the deficiency of this microelement.

The article presents the results of using Normobact L Synbiotic for the treatment of acute intestinal infections (AII) in children. The study included 60 children aged between 6 months and 6 years with a clinical diagnosis of AII, acute gastroenteritis of viral etiology. The average age of patients enrolled was 2.6 years, with 46.7% (28/60) girls. The treatment of AII was carried out in accordance with the clinical guidelines for the management of acute intestinal infections and included pathogenetic and symptomatic therapy. In addition, the study groupa recieved the biologically active additive (BAA) Normobact L (manufacturer Akrikhin, Russia) containing a probiotic strain Lactodacillus rhamnosus GG. According to the ESPGHAN guidelines, this strain has the largest evidence base of efficacy in the treatment of AII [8]. Synbiotic Normobact L was used at a dose of 1 sachet once daily for 7 days. In the comparison group, the patients received Bifidumbacterin in the amount 15 doses divided into 3 daily intakes for 7 days in addition to pathogenetic and symptomatic therapy. The obtained data analysis showed that diarrheal syndrome ceased earlier in the group of children who received Normobact L. The stool became normal 1.19 days sooner than in the group of children receiving Bifidumbacterin. In general, the period of normalization of stools in Group 1 (Normobact L) was significantly less than in Group 2 (Bifidumbacterin): 3.24 ± 0.4 days and 4.43 ± 0.2 days, respectively. It was also found that the period of normalization of temperature in Group 1 (Normobact L) was significantly less than in Group 2 (Bifidumbacterin): 53.00 ± 1.98 and 78.3 ± 2.44 h respectively. The body temperature in 100% of patients in the group of children receiving Normobact L became normal on Day 5, in the group of children receiving Bifidumbacterin on Day 7.

Infectious diseases accompanied by a rise in temperature is the most common reason for seeking medical help in childhood. A study of the frequency of antipyretic drugs showed that more than 95% of children with a temperature of 38.0 ° C or higher receive an antipyretic at least once. In this regard, the optimal approach to monitoring the body temperature in a febrile child remains an urgent issue in medicine.

 

Analysis of the literature data on the surgical treatment of feet deformities in children with cerebral palsy allowed determining of the first key pathogenesis aspects and management of surgical treatment. The main types of changes occurring in the feet under the influence of spastic disorders and the optimal methods of progressive deformities of feet surgical treatment were studied. The treatment management preference depends on intrapatient habits, age, the pattern of rescue, deformation gravity and mobility, level of the gross motor function (GMFCS). Various «soft tissue surgery» forms are effective provided sufficient deformation mobility for younger children group patients. The bone-cutting feet surgical measures are justified provided rigid deformations in more older children. A differentiated neurogenic feet deformities surgical treatment approach provides obtaining both early and long-term satisfactory treatment results.

The objective need to address interconnected challenges of medical and social nature is increasing in today’s Russian society as part of the child- and family-centred care in rural areas.

 

The article presents updated data on the composition, formation and role of the intestinal microbiota. It shows the relationship between changes in the intestinal microbiota and the formation of various forms of pathology. Data on the effectiveness of the prophylactic and therapeutic effect of probiotic strains, most often used in paediatric practice, are provided.