Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. Due to objective reasons, the indicators of perinatal and early neonatal deaths of children in the Russian Federation have been steadily declining over the past decades. Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. However, it is necessary to take into account the risks of operative delivery for both mother and baby. The planned caesarean section does not allow to fully activate the adaptive mechanisms of the baby, which disrupts the cytokine cascade and leads to various immunological disorders, one of which is allergy. The last meta-analysis of 13 trials showed a high risk of developing bronchial asthma in children born by cesarean section. Autoimmune diseases, oncological processes and systemic diseases is clearly in evidence in this group. This article discusses the risks for children born by planned cesarean section in the short and long term and the possibility of prevention according to modern trials.

Unfortunately, not every mammary gland functions in full when fulfils its main function, which is milk production for infant feeding. Most often, the technical errors during breastfeeding the baby cause nipple cracks, maceration and women stop breastfeeding. Engorgement is one of the most common problems faced during natural breastfeeding. The article highlights the issues of the physiology of lactation, discusses the problems arising during lactation, the risk factors for the development of hypogalactia, and describes the rules for using breast pumps to maintain lactation.

Breast milk is the «gold standard» for infant feeding. Its unique properties are due to the balanced macroand micro-nutrient composition and the presence of a whole range of functional components that have a multifaceted impact on the postnatal development of the baby’s organs and tissues. The carbohydrate fraction is currently of great interest to the researchers. Particular attention is paid to the human milk oligosaccharides (HMO), which are the third largest component in human milk after fat component and lactose in concentration. The main HMOs are fucosylated molecules – 2’-fucosyllactose (2’-FL) and 3’-fucosyllactose (3’-FL), lacto-N-fucopentaose (LNFP I, II, III), as well as some neutral and acidic oligosaccharides. The numerous laboratory and clinical studies showed that HMOs are the key nutrients that contribute to the formation of the intestinal microbiota of the infant, provide an anti-infectious and immunological effect, and participate in the postnatal formation of brain structures. If breastfeeding is not possible, the milk formula is likely to be the sole source of oligosaccharides for infants. The introduction of breast milk oligosaccharides into the baby food composition is an important stage in adaptation of such foods and making those more like the “gold standard” of feeding in composition.

Due to the growth of non-infectious morbidity of the world’s child and adult population, the concept of nutritional programming connecting cardiovascular and certain endocrine diseases with the fetoplacental complex disorders in the antenatal period has been developed over the past 25 years. An increase in the prevalence of obesity and gestational diabetes in pregnant women lays the groundwork for an increase in the prevalence of glucose metabolism disorders and the risk of endocrine pathology in children. Both low weight and overweight at birth evidence the unfavourable course of the intrauterine period. The review discusses the factors contributing to the fetal organs and systems growth retardation, hypovitaminosis D, insulin resistance and possible mechanisms for their development. The authors present the analysis of the data available in the modern literature on the mechanism of the obesity and GDM programming effect on the diseases in new-borns and children.

The article proposes a variant of functional responsibilities distribution between the patronage nurse and the doctor regarding counselling on the baby skin care and correction of the most frequent and typical disruptions of its continuity. It presents the main structural characteristics of the skin in young children. Theoretical justification of the differentiated approach to the choice of skin care products are provided.

The article presents modern data on the main molecular and genetic determinants of shaping the taste preferences. The authors present the structure and mechanism of the functioning of sweet taste receptors, umami taste, acidic and bitter tastes, as well as other molecules and cellular structures influencing the perception of flavors – the gust protein, toll-like receptors. They described the role of structures ensuring perception of taste outside the oral cavity – the cells of the hypothalamus. The article underlines the importance of the genetic polymorphism of these structures and the importance of interaction of genetic factors and environmental factors in shaping the taste preferences and eating behavior of the infant. Particular attention is given to the practical significance of the presented data in the context of introduction of supplemental foods for infants.

Global trigger tool algorithm was described by this article. Global triggers are the special tools to increase inpatients’ safety, which is based on identifying of unwanted events’ high-risk indicators in medical documents. Global trigger tool was initially developed for adult patients and only recent several years there have been … efforts to create special pediatric algorithm. At the moment Global Assessment of Pediatric Patient Safety (GAPPS) is it. There are triggers of that algorithm in the article. Moreover, development process was described and foreign studies with GAPPS were demonstrated here. That tool while have not been implemented into Russian pediatrics. It is more effective approach to identify unwanted events by triggers compared to spontaneous messages in order to increase inpatients’ safety.

This review provides information on the composition and functions of the intestinal microbiota, its role in the immune development. At present, prophylactic and therapeutic uses of probiotics are widely common for a variety of pathological conditions, however they have proven efficacy only in certain diseases. This review provides information on the efficacy of the use of probiotic microorganism L. rhamnosus GG in the paediatric practice as one of the most studied and tested strains. It summarized the currently available evidence on the efficacy of its use for the treatment of acute diarrhea, the prevention of antibiotic-associated diarrhoea and nosocomial infections, defined the role of L. rhamnosus GG in the prevention of respiratory tract infections and gastrointestinal infections in children, considered its therapeutic and preventive use in allergic diseases and other nosological forms. Special attention was paid to the effect of L. rhamnosus GG on the immune system functioning. The results of this strain test as adjuvant vaccines are also encouraging. The review describes the molecular mechanisms of action of L. rhamnosus GG, which provide immunomodulating effect of this strain. In addition, it presents data on the clinical efficacy of Normobact L synbiotic comprising a combination of LGG (4 x 109) and fructooligosaccharides (800 mg), which is approved for use in children in Russia.

In this article, the authors discussed the issues in the management of acute respiratory infections (ARI) in the coming season. Modern therapy was considered from the perspective of its expediency and effectiveness. The authors substantiated and proposed a new approach to the treatment and prevention of complications of ARI. They also reviewed the international and domestic experience in using preparations of natural origin in practical medicine. The authors shared their own clinical experience in preparing the ARI prevention and treatment programs.

The authors reviewed the results of domestic studies of the therapeutic efficacy and preventive capabilities of the irrigationelimination therapy product line based on the seawater Aqualor. The article describes rationality and expediency of using these products in children and adults with various ENT pathologies. Particular attention is given to the possibility of using hypertonic saline solutions as an alternative to topical decongestants, especially in childhood.

The authors presented an analytical review of domestic and foreign literature on the clinical efficacy and safety of release-active drug in the treatment and prevention of acute respiratory infections in children.

Upper respiratory tract infections are the most common diseases in childhood. Most of them have viral etiology and resolve on their own. However, there is a category of children with a complicated course of viral infection or with a bacterial infection, who require prescription of the systemic antibiotic therapy. The article discusses the main manifestations of upper respiratory tract infections, indications for antimicrobial treatment of a particular nosology, a group of antibacterial drugs, their effective doses and the duration of therapy.

The article discusses topical issues of symptomatic management of acute respiratory viral infections at an early age, the need for antipyretics and the rationality of using combination drugs with due regard to the catarrhal syndrome.

The article presents data on the clinical features of ARVI in children: description of the febrile syndrome as one of the leading symptoms in these infections, the use of Panadol as the drug of choice during the anti-pyretic therapy in children.

Acute tonsillopharyngitis (ATP) is the most common community-acquired infection, especially in children. Sore throat is the main manifestation of ATP. This is the most common reason for seeking outpatient medical care or self-medication. The widespread, unreasonable use of antibiotics for the therapy of sore throat, as the main component in the treatment of ATP without taking into account the presence of group A beta-hemolytic streptococcus, leads to an increase in the number of frequently ill children and dysbiosis of the mucous membranes. Topical therapy of sore throat is the most effective and safe approach to the management of ATP.

The article presents the results of the study of clinical efficacy of treatment of acute rhinosinusitis in 80 children aged 3–15 years using Sialor® as an adjunct to comprehensive treatment. The children of group 1 (active treatment group) received Sialor® in addition to the standard treatment without use of decongestants. group 2 (comparison group) received decongestants in addition to the standard treatment without use of Sialor®. The efficacy of treatment was assessed according to clinical examination findings. The study showed that the inclusion of Sialor® (silver proteinate) in the combined treatment improves the clinical efficacy of treatment of acute rhinosinusitis. On Day 4 after the first examination, group I showed a decrease in nasal congestion that was evaluated using Visual Analogue Scale (VAS) by more than 4 points as compared with group 2. On Day 4 of treatment, presentations of rhinorrhea in the active treatment group of children decreased by more than 2 points on VAS scale compared with the control group. The children who received Sialor also demonstrated an improvement in the quality of sleep. The results showed that the inclusion of Sialor (silver proteinate) in the treatment regimen of ARS allows to achieve a more rapid relief of symptoms of intoxication, nasal congestion, rhinorrhea, restoration of smell, improvement in the quality of sleep of patients by Day 4 from the start of treatment.

The article considers the variety of factors that favor the occurrence of cough and describes its types in detail. Particular attention is paid to the prevalence of dry cough; an optimal variant of pharmacotherapy with the choice of a modern centrally active antitussive drug is suggested.

Despite the fact that acute respiratory infections have viral etiology, the frequency of antibiotic prescriptions accounts for more than 70% in outpatient practice. However, the preventive administration of systemic antibiotics does not reduce the duration of the disease and the incidence of bacterial complications. In addition, the irrational use of antibiotic therapy can lead to the development of antibiotic resistance of infectious disease pathogens. The global problem of antibiotic resistance is seen as a serious threat to public health, and therefore the systemic antibiotic restriction policy is crucial, which helps to reduce the formation of antibiotic-resistant strains of infectious agents. The possibility of using local antibacterial drugs enables optimization of antibiotic therapy and reduces the risk of the development of antibiotic resistance. The article discusses the issues of use of thiamphenicol glycinate acetylcysteinate in various diseases in children.

Immediacy of the problem of combination therapy of respiratory diseases in paediatric practice is caused by their multifactorial pathogenesis in children and the need to achieve a high clinical effect in the use of drugs at relatively low doses and with minimum risks of serious adverse effects and drug interactions. The fixed-dose combination of salbutamol, bromhexine and guaifenesin produced in the form of tablets and syrup fully meets these requirements, which makes it possible to use it in children and adults with acute, chronic infectious (ARVI, bacterial pneumonia, respiratory tuberculosis, etc.) and non-infectious (bronchial asthma, pulmonary cystic fibrosis, primary ciliary dyskinesia, etc.) diseases.

The article presents an extensive clinical experience about the treatment and prevention of influenza by oseltamivir for children and adults including high-risk group patients through different countries around the world over the past 17 years. The article reveals the causes of resistance to oseltamivir with a relative evolution proportion. The new domestic drug Nomides (oseltamivir), which manufactured by Pharmasintez JSC (Russia) in accordance with the Good Manufacturing Practice (GMP), has been represented in the article by unique dosage forms 30 and 45 mg on the Russian market for childrens older than one years old.

The incidence of acute respiratory infections (ARI) of the upper respiratory tract in children of the first 3 years of life can reach 3796.29: 1,000. Pre-school children from organized groups register up to 6–10 episodes of ARI annually, and 7–12 in primary school children. The frequency of bacterial complications (otitis, sinusitis, tracheobronchitis, pneumonia) in different age groups and socioeconomic conditions is 10–60%, which requires the appointment of antibiotics. In the case of a severe course of complications, with previously prescribed drugs of the 1st line, an unfavorable premorbid background the treatment with cefixime is preferable.

The article gives a modern definition of constipation and working classification used in Pediatrics; frequency of defecation and qualitative characteristics of stool depending on age and type of feeding are presented. Particular attention is paid to the reasons for the development of functional constipation in young children, diagnostic criteria in accordance with the Rome consensus IV revision (2016) and tactics of management of children with constipation. Part of the information is devoted to the use of osmotic laxatives. The main mechanism of action of polyethylene glycol and its advantages in stopping constipation in infants older than 6 months are shown. age’s.

The prevalence of allergic diseases and asthma are increasing worldwide. Scientists say up to 30–40% of the adult population have various forms of allergy (gastrointestinal, skin, respiratory, isolated or combined) in recent years. There is no tendency for the number of children with this pathology to reduce despite a deeper understanding of the pathogenesis of atopic diseases and the achievements of pharmacology. Experts in various health areas (paediatricians, allergists, dermatologists, immunologists, gastroenterologists) actively discuss the role of the intestinal microbiota in the mechanisms of the development of food allergies. The article discusses the pathogenesis of food allergies and atopic dermatitis in children, discusses the possibility of using probiotics in complex therapy, taking into account the results of global clinical studies.

A balanced gastrointestinal microbiome is crucial for the development of the immune system. The use of antibiotic therapy in infants often leads to intestinal dysbiosis. This article presents a convincing argument that the use of antibiotics in infants and young children affects their health in the future. The purpose of antibiotic therapy in childhood should be well thought out, because its negative effect on the gastrointestinal tract the ability to cause diarrhoea, has been proven, and, in addition, antibiotics have long-term effects: overweight, irritable bowel syndrome (IBS), allergic diseases. Conclusion: clinicians should weigh the need and consequences of using antibiotics in infancy and early childhood.

The preservation of the human urinary tract integrity in interaction with microorganisms depends on the balance of many components: the viability of nonspecific protective factors of the urinary tract mucosa, the virulence factors of microorganisms, the intensity of the innate immune response of the urinary tract tissue to the presence of microorganisms, the mutual impact of the microand macro-organism upon each other that is directed towards creation of a normal microbiome, and not inflammation. Most of these factors are genetically determined both by microorganisms and humans. The article presents modern data of Russian and foreign literature devoted to the description of factors supporting the homeostasis of the urinary tract in interacting with microorganisms. The authors emphasise a key role of these data in the practice of clinicians, including paediatricians and paediatric nephrologists, family doctors.

The article deals with the clinical aspects of inflammatory manifestations of dermatoses at an early age. It presents the results of the use of a non-steroidal anti-inflammatory drug based on activated pyrithione zinc

Atopic dermatitis is a disease of early childhood and the first manifestation of an atopic march. Therapy of patients with atopic dermatitis does not affect the cause of the desease and has mainly a pathogenetic or symptomatic character, which proves urgent need to prevent disease in early childhood, beginning the perinatal period. The article considers in detail the risk factors for the disease development in modern society. Particular attention is given to the use of emollients in the primary prevention of atopic dermatitis.

The article presents the issues of epidemiology, pathogenesis and treatment of allergic rhinitis. It describes the various types of nonallergic rhinitis, the relationship of allergic rhinitis and rhinosinusitis polyposa, eosinophilic nonallergic rhinitis, and rhinitis medicamentosa. The leading role of topical glucocorticosteroids in the therapy of rhinitis including non-allergic is considered in detail.

This article discusses issues of clinical diagnosis and course of bronchial asthma in children. We discuss assessment of asthma severity and, accordingly, the extent of the step-by-step therapy according to updated recommendations (GINA 2018). Particular attention is paid to the possibility of improving the control of asthma with the help of the M-cholinolytic drug of long-acting tiotropium bromide, presented as a special inhalation form of tiotropium Respimat and registered in the Russian Federation for treatment of asthma in children of moderate and severe course from 6 years of age. Application tiotropium Respimat in children with insufficient control of asthma allows to improve lung function and asthma control.

The article presents actual data on the composition and functions of the intestinal microbiota, and examines the mechanisms of the microbiota effect on the macroorganism’s health state. The necessity and possibility of correction of microbiota are shown by the analysis of the composition and evaluation of the functions of the intestinal microbiota, and the mechanisms of the symbiotic relationship «microflora macroorganism» and the causes leading to the development of intestinal dysbiosis. The main groups of preparations (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented by taking into account the modern guidelines.

The article presents an analysis of causes of recurrent respiratory infections in children. The special attention is drawn to the need for improvement of the epidemiological, anamnestic, social and other data to clarify the causes and provoking factors for increased respiratory morbidity. It has been shown that allergic diseases, immunodeficiency states, persistent herpetic infections, functional gastrointestinal disorders, etc. are often hidden.under the mask of “frequently ill children”. This determines the importance of a detailed assessment of clinical manifestations of each episode of the disease and the correct interpretation of examination results for the timely diagnosis specification. It was proposed to move from targeting the “frequently ill children” group to nosological verification, which have a high level of respiratory morbidity. It has been proved that early arriving at a diagnosis makes it possible to timely prescribe etiopathogenetic therapy, which significantly increases the effectiveness of treatment. The article presents an analysis of clinical studies of the effectiveness and safety of OM-85 immunomodulator of bacterial origin in children with recurrent respiratory diseases.

The incidence of acute intestinal infections in Russia is ranked 3rd 4th among all infectious diseases, and rotavirus is the most frequent etiologic factor in children under 5 years old. Almost 40% of children under the age of two have three episodes of rotavirus infection, the same group undergo the most severe course of the disease. Rotavirus gastroenteritis causes 197,000 annual deaths, 23 children die due to this infection every hour. The high resistance of rotavirus in the environment, the ease of transmission and the large number of asymptomatic carriers predetermine the need for timely vaccination. There are 2 licensed oral live attenuated rotavirus vaccines on the international market, one of which is RotaTeq pentavalent vaccine.

Gastroschisis is a complex anterior abdominal wall defect requiring urgent surgical repair. Oneor two-stage surgery to return the intestines to the abdominal cavity may result in developing acute renal failure. Preservation of the Arantsiev duct lumen provokes serious changes in the portal vein system. The state of the microcirculatory bloodstream in the intestinal wall clearly correlates with the clinical data indicating the restoration of the passage through the gastrointestinal tract.

The article presents the experience of application of preparation containing vitamin in complex rectal suppositories (riboflavin, cocarboxylase, lipoic acid) in infants and young children .

The article presents an overview of laparoscopic appendectomy experience in 3,766 children with complicated appendicitis in the clinic of the Department of Paediatric Surgery of the Russian State Medical Academy of Continuous Vocational Education (Moscow). The authors showed the high efficiency of laparoscopic techniques in the operative treatment. The features of tactics in destructive appendicitis and peritonitis are highlighted.

Objective of the study: Assess the health and quality of life in children with recurrent respiratory pathology and justify the effectiveness of comprehensive rehabilitation program to improve health involving additional nutritional support.

Materials and methods: 101 children aged 5–9 years with recurrent respiratory pathology received a non-comparative clinical examination and rehabilitation. The first group included 75 children with disorders of nutritional status that were identified upon results of physical examination, anthropometric measurements, including body composition analysis (bioimpedance measurement), biochemical parameters and actual nutrition evaluation. The observed children of the main group received «PediaSure with fiber» functional product as part of the complex rehabilitation therapy to replenish the diet with the basic nutrients, vitamins and trace elements. The second group of 26 children comparable in age and gender, but not having disorders of nutritional status was allocated in order to assess the impact of the nutritional deficiency on the severity of recurrent respiratory disease. Those children received only general health therapy and usual sanatorium traditional food. The effectiveness of the therapy was assessed on the basis of the positive dynamics of the nutritional status and the quality of life study using the questionnaire Pediatric Quality of Life Questionnaire (Generic Core Scales). The study was conducted in Duslyk children’s sanatorium in Ufa.

Results: The comprehensive health improvement program and additional nutritional support in children with recurrent respiratory pathology showed a significant improvement in anthropometric data, a 2.5-fold decrease in the average number (from 7.12 to 2.9, p <0.05), and 1.8 -fold decrease in the average duration (from 11.88 to 6.76 days, p <0.05) of episodes of recurrent respiratory infections, and also allowed to achieve significant improvement in all parameters of the children’s quality of life.

Conclusion: The comprehensive health improvement program and additional nutritional support in children with recurrent respiratory pathology contribute to improving the quality of life, increasing adaptive capacity, reducing the frequency and duration of acute respiratory infections.

The article presents a modern view of the fat acid profile of breast milk (BM) and modern artificial formulas. Milk fat of BM is the main source of energy for baby. Triglycerides, which are represented by fat globules of milk form the basis of the fat component of BM. BM is also characterized by the optimal content and ratio of fatty acids. It contains essential polyunsaturated fatty acids (PUFA), such as linoleic and α-linolenic acids with derivatives. PUFAs are included in the milk composition, providing both short-term and long-term effects on infant development. The article presents the results of studies showing the role of fish oil supplements in the diet of pregnant and lactating women, which led to a significant increase of docosahexaenoic acid content in the milk. It is proved that PUFAs are involved in the formation of the brain, neuroretina in infants, participate in immunological processes. Palmitic acid is the most common saturated fat in the BM. If palmitic acid, located in Sn-1 and Sn-3 position, is included in the infant feeding, it affects the formation of insoluble calcium soaps and the formation of a stiffer stool. These properties of β-palmitate are taken into account when developing new approaches to creating formlulas for feeding children, bringing their fat composition closer to the composition of GM. The unique patented DigestX® component, which is part of Kabrita® Gold’s goat milk mixes, is designed to bring the fat component of the blends closer to the unique structure of BM fat. It is shown that mixtures with a high content of β-palmitate provide various metabolic functions, and affect the formation of the infant immunity, the composition of its intestinal microbiota. The formulas with β-palmitate play an important role in forming the bone matrix of the child.

Homozygous familial hypercholesterolemia is a rare genetic disease featuring extremely high of low-density lipoprotein blood level, cutaneous and tendon xanthomas and accelerated atherosclerosis with often manifestions in the first 2 decades of life, resulting to premature death due to atherosclerosis-related diseases. Modern combined lipid-lowering therapy is able to increase life duration considerably for these patients.

Currently, testosterone drugs are used to treat hypogonadotropic hypogonadism, which allow men to get a good height and reach a stage of sexual development corresponding to their age. In this case, the testicular volume remains of pre-pubertal size, and the spermatogenic epithelium fails to reach its mature stage under such conditions. The study was aimed at initiating puberty in a 17-year-old male with hypogonadotropic hypogonadism using gonadotropic hormone drugs. The patient received foliotropinalpha injections in combination with chorionic gonadotropin for 9 months. The treatment efficacy was evaluated after 3, 6, 9 months of therapy by measuring the testicle volume (using Prader orchidometer and ultrasound) and the sex hormones and inhibin B serum levels. During the treatment period, the testicle volume increased from 1.5 to 8 ml based on clinical measurements, and from 1.38 and 1.14 to 5.8 and 5.87 ml (right and left, respectively) based on ultrasound imaging. The level of testosterone reached normal values, inhibin B also increased. The use of recombinant FSH for nine months in the combination therapy of idiopathic hypogonadotropic hypogonadism in a 17-year-old male contributed to the initiation of a true puberty.

Myocardial infarction and acute coronary syndrome in children is referred to as a rare congenital anomaly up to the present date. However, despite the rarity of this syndrome, practicing pediatricians, cardiologists should be cautious about the disease in order to avoid the fatal consequences of untimely diagnosis. The article describes the main causes, pathogenesis, clinical picture, treatment tactics and disease prognosis – according to the literature of Russian and foreign authors, and presents a clinical discussion of the case of early detection of the Bland-White-Garland syndrome during the planned outpatient examination of the child.