On November 14, 2018, on the eve of the World Prematurity Day, the Scientific and Practical Conference «New Technologies of Preterm Infant Care» was held in the Moscow Regional Perinatal Center in Balashikha. The conference was organized by the Ministry of Health of the Moscow region, the Association of paediatricians of the Moscow region, the Department of Neonatology of the Moscow Regional Research and Clinical Institute («MONIKI») and Moscow Regional Perinatal Center in Balashikha. 

In October 2018, a symposium for neonatologists and pediatricians «Child of the first year. Problems and Solutions» was held in the framework of the 17th Russian Congress «Innovative Technologies in Pediatrics and Pediatric Surgery». The problem of breastfeeding of newborns and its importance for the proper and harmonious development of the child was raised along with such relevant topics as the dynamics of the psychomotor development of prematurely born children, practical significance of findings of neurosonography, comprehensive assistance to children with disabilities. Report on the topic «How to overcome hypogalactia? Clinical case study, prevention and successful management of hypogalactia» was presented by Zhdanova Svetlana Igorevna, Cand. of Sci. (Med.), a neonatologist, the Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Assistant of Chair of Hospital Pediatrics with a Course of Outpatient Pediatrics in Kazan State Medical University of the Ministry of Health of Russia.

Adequate nutrition is a key component of the health and optimal growth of a newborn child. The article presents recommendations on support of breastfeeding in healthy newborns, as well as clinical experience in terms of organization of breastfeeding, maintenance of lactation in the mother in case of birth of sick and prematurely born child, indications for breast milk expression. Experience and effectiveness assessment of clinical and individual breast pumps is described. The issues of differentiated consultation on feeding premature infants with various pathologies and optimal conditions of breast milk expression are considered.

This article is a continuation of a series of articles on the role of nurses in the care of children during their first year of life. The article presents the authors’ vision on the creation of a team system (doctor – nurse) of outpatient care and counseling of parents on the causes of diaper dermatitis, methods of prevention and treatment of this pathology, depending on the stage of the process. The algorithm of appointment and choice of external means in treatment of diaper dermatitis is presented, their possibilities and efficiency depending on forms of release a cream or an ointment are defined.

Non-communicable diseases result in more than 63% of all deaths according to the data announced at the meeting on the prevention of non-communicable diseases held by the UN General Assembly in 2011. Such diseases are caused by genetic and socioecological factors, the level of health care system, individual lifestyle (diet, physical activity). Due to morphofunctional characteristics of organs and systems, children are most at risk from exposure to toxic substances contained in food. The article describes exactly what effect the most harmful and common toxicants of food have on the child’s body and provides food safety and nutrition strategies developed at the state level.

The article highlights the role and place of elimination and irrigation therapy in the treatment and prevention of acute respiratory infections in children. Increasing emphasis is being placed on the effectiveness of the combined elimination drug containing trace nutrients and benzalkonium chloride antiseptic (Renorin).

One of the topical problems of modern medicine is the impact of microbiota on human health. The correlation between microbiome disorders and the development of diseases of the gastrointestinal tract, skin, respiratory system, obesity, autism and even depression has been established. Specialists pay most attention to the formation and maintenance of microbiota balance in children from birth, which is necessary for the preservation of their health in the future. Microbiota is studied by scientists from all over the world, which makes it possible to establish safe and effective strains of probiotic bacteria and on their basis to create a new generation of multiprobiotics. Creation of modern probiotics, their rational use and efficiency were discussed at the international symposium «Microbiotic disorders as an interdisciplinary problem of global level», held in the framework of the XVII Russian Congress «Innovative technologies in pediatrics and pediatric surgery» in October 2018. Dr. Ashton Harper (UK) and Professor Irina Zakharova shared their experience of effective dysbiosis correction with the help of modern English multiprobiotic Bak-Set.

The authors discuss the features of the treatment of acute respiratory infections (ARI) in the modern era, emphasizing the lack of its efficacy due to the constantly emerging drug resistance in viruses and bacteria. The article substantiates and proposes a modern approach to the prevention and treatment of ARI, using preparations of natural origin. It also analyses the international and domestic experience in using the bioregulatory approach to the treatment of ARI in practical medicine. The legal basis for using the homoeopathy method in Russia is discussed. The authors share their own clinical experience, analyse a clinical case, provide the detailed history of life and illness of a child, and propose a consistent protocol for patient treatment alongside with an explanation of the chosen approach.

ARVI and influenza are one of the topical problems of pediatrics, which is due to the high level of morbidity in the child population, a significant incidence of severe and complicated forms of disease, especially in young children. In the structure of infectious pathology in children, this group of diseases still retains its leading position, accounting for up to 70% of all registered cases. Almost every child annually and more than once endures ARVI or flu episodes. This group of infections causes significant economic damage both to the household budget and the national budget as a whole. In order to improve the provision of medical care for children, improve the qualifications of pediatricians and share experience of the Department of Pediatrics named after Academician G.N. Speranskiy RMACPE (Head of Department Dr. of Sci. (Med), Professor I.N. Zakharova), a scientific and practical seminar «Influenza and acute respiratory infections 2018/2019: challenges and solutions» was held. Within the framework of the event, supported by «Valenta Pharm», specialists considered a number of topical issues, including vaccine prophylaxis and treatment of ARVI and influenza, taking into account modern epidemiological, microbiological and virological data. The seminar participants paid special attention to the validity of antiviral therapy in children, in particular, such drug as Ingavirin®.

The article presents a review of materials on the role of nasal cavity irrigation and elimination therapy (IET) in rhinological pathology in children. On the basis of separate clinical studies the clinical experience of using modern ready-made drugs for IET in paediatric practice was studied. The conclusions about the high level of effectiveness and safety of this method of treatment of inflammatory rhinological pathology in children were made.

Acute respiratory infections (ARI, commen cold) are the most common infection diseases in children. They account for up 75% of all cases of respiratory diseases. In most cases, ARI are selfterminating diseases that require only symptomatic treatment. The most common symptom of ARI is cough. In outpatient practice justified the use of herbal medicine. As an antisussive well eastablished syrup Gedelix. The effectivnesses of the medicine, the possibility of accuracy dosing, pleasant taste facilitate it use in children.

The article describes the differences and advantages of membrane nebulizers as compared to ultrasonic and compressor nebulizers. It covers the areas of nebulizers use in pediatric pulmonology. It presents data on the new Glenmark mesh nebulizer model – NEBZMART in the Russian market that differs from other nebulizers by high cost effectiveness, efficiency and safety, which was evidenced by both the results of technical tests and practical experience.

The article deals with the problem of acute cough treatment against the background of a cold. The efficiency and side effects of official medicine and modern phytotherapy are discussed. The data of the Cochrane reviews, meta-analyses, international and Russian researches proving expediency and efficiency of coughing symptoms treatment by means of natural origin are given.

The article presents data on the prevalence of upper respiratory tract infections in paediatric practice. The following complications may pose health risks: sinusitis, acute suppurative otitis media and chronic tonsillitis. The authors provide statistical data on the prevalence of these complications, a multivariate analysis of the clinical symptoms of the diseases, the main symptoms of which are temperature reaction, leucocytosis, regenerative left shift, increased ESR. Special attention is paid to the choice of antipyretic agents that affect not only the fever, but also the inflammatory reaction of the upper respiratory tract mucosa, which may quickly ease the symptoms of the disease.

The article presents modern information about epidemiology, etiology, pathogenesis, clinical picture, classification by severity, diagnostics and differential diagnostics, treatment and prognosis of viral and relapsing croup in children. Etiological factors, differential diagnostic features and prognosis of croup recidivism in children are considered. The basic diagnostic criteria of alternative diseases with a stridor are given. Croup therapy is characterized on the basis of the Federal Clinical Recommendations and international consensus documents using the principles of evidence-based medicine.

Onset of fever and pain syndrome in children is one of the most frequent reasons parents take their children to a paediatrician. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve such symptoms. The mechanism of action of NSAIDs is to inhibit the activity of the enzyme called cyclooxygenase (COX). Paracetamol, one of the drugs that inhibit COX, exerts its pharmacodynamic effect in the central nervous system, thereby providing antipyretic and analgesic effects, but it is ineffective in stopping inflammation. Such common conditions in children as fever and pain syndrome of mild to medium intensity are among the indications for use of Efferalgan containing paracetamol as an active ingredient. Solution and rectal suppositories are the most commonly used dosage forms of Efferalgan in children, as these dosage forms can be used, when the child reaches 1 and 3 months of age, respectively. The correct dose of paracetamol for a child depends on their weight. It should be remembered that the relief of a fever or pain syndrome is a symptomatic treatment. Therefore, if they appear, you should visit a doctor to identify carefully the possible cause and select the appropriate therapy.

Acute tonsillopharyngitis (ATP) is a common infectious disease in paediatric practice. Throat pain, as the main symptom of acute tonsillopharyngitis, is the most common cause of seeking outpatient care. ATP is a polyethyological disease and requires a clarification of the etiological factor. Viral tonsillitis is the most common in children’s practice. Among bacterial pathogens, the beta hemolytic streptococcus group A (BHSA Streptococcus pyogenes) is of particular importance. This pathogen is associated with 5 to 15% of cases of acute tonsillopharyngitis in adults and 20- 30% in children [5]. Suspicion of BHSA in ATP requires the mandatory prescription of systemic antibiotic therapy. Currently, there are no reliable criteria for differential diagnosis of viral and bacterial ATP. As a result, the choice of ATP treatment tactics is an important task. On the one hand, this pathology is most often associated with unnecessary and unjustified prescription of systemic antibiotic therapy, and on the other hand, the rejection of antibiotics can contribute to the development of serious complications. Given the high frequency of viral ATP, an important area of pediatric practice is the use of local antiseptic and anti-inflammatory drugs. Topical drugs can be used both as monotherapy and, if necessary, in combination therapy of ATP. Timely etiological diagnostics and rational therapy of ATP are an important part of the effectiveness of ATP treatment in children and prevention of antibiotic resistance of microorganisms.

Acute respiratory infections are the most common pathology in childhood, representing not only a medical but also a socio-economic problem. Numerous studies on the use of anti-inflammatory therapy in ARI have shown high efficacy and safety profile of fenspiride. The combination of anti-inflammatory, antiallergic, and antispasmodic properties ensures the success of fenspiride in the treatment of acute respiratory diseases in children. Fenspiride reduces symptoms of ARI, accelerates recovery, reduces the need for additional prescription of other drugs.

Making sure that the child is absorbing properly the main nutrients such as proteins, fats, carbohydrates, and vitamins, macro- and micronutrients is a key influencer when it comes to the harmonious growth and development. In infants, triglycerides digestion starts in the stomach, where three lipases – human milk, gastric and lingual lipases – split triglycerides. The participation of breast milk lipase stimulated by bile salts in the duodenum in splitting fats is an important feature of digestion in breastfed babies. The absorption of fatty acids differs depending on the length of the carbon chain and the location of the fatty acid in the glycerol molecule. Short-chain and medium-chain fatty acids, as well as glycerine, choline are hydrophilic compounds, which are absorbed without pancreatic lipase and bile acids, directly into the blood, bypassing the lymphatic system. The specific configuration of human milk triglycerides improves the absorption of fatty acids. In situations where lipids digestion or absorption appears impaired, one may talk of steatorrhea. If young children have type I steatorrhea (the presence of neutral fat in stool), it is first required to exclude absolute exocrine pancreatic insufficiency: cystic fibrosis, Shwachman-Diamond syndrome, Pearson syndrome, isolated lipase deficiency (Sheldon – Ray syndrome), etc. Type II steatorrhea (excretion of fatty acids in stool) is not a specific symptom of certain diseases, but is often observed in the small intestine pathology.

Urine testing has not only helped physicians to diagnose various diseases since ancient times, but has also stimulated the emergence of such areas of medicine as urology, nephrology, endocrinology. The method itself has evolved over the centuries from purely visual (uroscopy) to modern, physico-chemical, biochemical and microscopic examination of urine. Despite the emergence in recent years of new accurate and more advanced methods for the study of biological fluids, clinical analysis of urine remains one of the most frequently performed studies in the practice of a doctor, including a paediatrician. This relatively simple and quick analysis is a screening method for the diagnosis of diseases of the urinary system, as well as many other organs and systems. The article describes the current aspects of this laboratory study, which is still one of the most important in the arsenal of a pediatrician.

With antibiotic resistance increasing and new microbial resistance factors forming, the problem of creating new methods to treat and prevent the urinary tract infections becomes topical. The latest studies showed that urothelium contains a large number of immune factors providing its protection against the adverse effects of various uropathogens in vivo. There are very promising molecules – antimicrobial peptides (AMPs) – in terms of further therapeutic use among the components of inborn immunity. AMPs are the evolutionarily oldest molecules of innate immunity. The article discusses current data on the presence of various classes of AMPs in the urinary system, demonstrates data on their effectiveness as therapeutic agents against UTI, and describes further prospects for their use in the GP practice.

The article is devoted to the problem of sebaceous gland diseases in infants. The activity of sebaceous glands and associated inflammatory diseases are determined by the age of the child and related hormonal rearrangements in the body. The role of fungal and bacterial flora in pathogenesis of diseases is described in detail in the article. Clinical varieties of such dermatoses, as cradle caps, seborrheic dermatitis, neonatal and infant acne and other diseases are described. Special attention is paid to the role of therapeutic cosmetics in the treatment of these conditions, which affects all links of pathogenesis of sebaceous gland diseases and is safe for babies.

Allergic diseases without a doubt have become one of the biggest problems of pediatrics in recent decades. One of the evidence of this is the maximum occupancy of halls at the IV All-Russian Congress of the Association of Pediatric Allergists and Immunologists of Russia. The symposium «Antihistamines in children’s allergology» was among the most popular.

This article describes the mechanism of action of topical decongestants from the perspective of their efficient and safe use in paediatric otorhinolaryngology. It also presents the structure of the most common nosologies in the outpatient unit of otorhinolaryngological practice.

Today, the composition of the gut microbiota has been studied in sufficient detail. Increasing number of studies show that the respiratory tract, both the upper and lower respiratory tract, have their own microbiota. The article presents the main today’s data about the species diversity of microorganisms in the respiratory and gastrointestinal tracts, describes the role of a healthy microbiota in providing local and general immunity. The authors specify the role of probiotic strains of microorganisms and their effect on various parts of the immune response and present the data of studies on the effect of probiotic products on the immunological resistance of humans, especially the respiratory tract with high viral load. Restoration of a healthy microbiota in the human tract using probiotic products administered through the gastrointestinal tract can reduce the risk and severity of manifestation of the respiratory infections.

In the context of the wide range of products recommended for antiviral therapy, there is still a need for continuous evaluation of their effectiveness and safety in pediatrics. The work describes the experience of non-interventional study of the domestic drug umifenovir in the modern clinical practice. The authors studied 216 case histories of children hospitalized with acute respiratory viral infections at early stages of the disease. Against the background of the drug administration a significant reduction in the duration of all symptoms of the infectious process and the need to prescribe antibiotic therapy to patients, a reduction in the chances of complicated flu and acute respiratory viral infections, as well as a favorable safety spectrum and a high level of compliance during treatment.

Thanks to the innovations in the information technology field, computer acoustic diagnosis is beginning to be used in the clinical practice. Computer bronchophonography is one of the promising domestic innovations in the field of methods of measuring the functional state of the respiratory system. This method can be used at any stage of medical care to identify bronchial obstruction, monitor the effectiveness of treatment and preventive measures in patients with bronchopulmonary diseases, which is especially important in early and preschool years. However, further research is required in this current field, both from research and practical perspectives. In the article, the authors present their own experience in using and interpreting the results of bronchophonography in children.

Cough is one of the most common reasons why parents bring their children to the pediatrician. The article presents the results of a study of the clinical efficacy of treatment of dry cough using Sinecod syrup. A total of 60 children aged 3–15 years with the upper respiratory tract infections and complaints of dry (non-productive) cough were enrolled in the study. In Group 1 (the main group), the children received Sinecod syrup in addition to the standard therapy, in Group 2 (the comparison group) children received Stoptussin-Phyto syrup. The effectiveness of treatment was evaluated based on the clinical examination findings. On Day 8–11 after the first examination, Group 2 showed a decrease in the severity of day and night cough according to VAS by more than 4 points compared with Group 2. Significant regression of the severity of day and night cough in the studied groups was only observed in patients from Group 1. Sleep disorders of the patients normalized.

Nutrition is of great importance in maintaining normal growth and development of the child, ensuring the ability to learn and resistance to adverse environmental factors. Due to the higher need for nutrients, limited nutrient reserves, and particular characteristics of metabolic processes, children are more prone to the development of various nutritional disorders, in particular, protein and energy deficiency. The nutritional factor becomes of great importance on the background of the accompanying acute and chronic diseases in children. The studies convincingly demonstrated that malnutrition leads to a prolongation of hospital stay, increased frequency of complications and increased risk of adverse outcomes. Therefore, timely diagnosis of nutritional disorders is an essential factor in maintaining health and improving the children’s quality of life. The article presents the current classification of malnutritiion, illustrates the main stages of the anthropometric examination, identifies approaches to the differential diagnosis of protein-energy deficiency causes, and discusses the possibilities of nutritional support using specialized mixtures.

In the review article the basic problems of children’s health of young age are considered deficiency of vitamins and minerals at breastfeeding, complexity of skin care, allergies, acute respiratory viral infections. Attention is paid to hypovitaminosis and nipple cracks in mothers during lactation, as well as to the necessity of vitamin-mineral complexes subsidizing and mammary gland skin care during this period. Proper care for a child of early age is a guarantee of his health and harmonious development. Paediatricians should promote maternal literacy in modern methods of child care, disease prevention and treatment.

Acute respiratory viral infections (ARVI) occupy an important place in infectious pathology of children’s age. One of the frequent and severe manifestations of ARVI, accompanied by respiratory disorders, is stenosing laryngotracheitis (croup syndrome). Primary stenosing laryngotracheitis develops, as a rule, in children of the second-third year of life, rarely-older than 5 years. In 30–50% of patients, croup syndrome recur, often accompanied by signs of bronchial obstruction. The reasons for the formation of the relapses studied enough: discusses the role of concomitant allergic diseases, immune dysfunction, autonomic reactivity, etc. At the same time, the importance of such background conditions as the infection with Mycobacterium tuberculosis, the presence of local forms of tuberculosis (TB) in children in the development of croup syndrome and its recurrence in the literature is not reflected. In the course of our study, it was found that children with primary and recurrent croup are often infected with Mycobacterium tuberculosis at the age of 5 years, which allows them to be classified as at risk of tuberculosis infection; recurrent croup is significantly more often implemented in the early period of primary infection with Mycobacterium tuberculosis and the development of local forms of TB. Chemoprophylaxis and TB therapy can reduce the risk of developing recurrent croup syndrome in 82% of patients. Thus, one of the possible factors in the etiopathogenesis of the syndrome of croup can be a TB infection.

The article is devoted to the study of the level of dental knowledge and hygiene skills in adolescents studying at the school №176 in Nizhny Novgorod with use of individually designed questionnaire. The questionnaire included twenty-one questions: about individual hygiene of oral cavity, the choice of subjects and means of hygiene of oral cavity, the frequency of hygienic care for oral cavity at home, the presence of inflammatory diseases of oral cavity and dentition anomalies at the time of the survey, sources of hygiene knowledge and skills of students about psycho-emotional relation of children to the procedures for the hygienic care of oral hygiene and periodic visits to the dentist. Based on the survey of 14 year’s adolescents, it can be concluded that the level of knowledge of children’s choice of subjects and means for oral hygiene and the need for regular dental education for the prevention and early detection of risk factors for the development of periodontal diseases in schoolchildren.

Coughing in acute respiratory infections, regardless of the level of infection: upper or lower respiratory tract is a frequent clinical symptom in childhood. The analysis of the modern literature and the data of the authors’ own researches testify to the fact that the prescription of mucoactive therapy in a complex of therapeutic measures (etiotropic, basic therapy, bronchopulmonary drainage, etc.).) should be differentiated and determined not only by the nature and severity of coughs, separated sputum, but also by individual characteristics of the patient, the severity and course of bronchopulmonary pathology, the age of the child, the presence of adverse environmental factors (in particular, passive smoking), the level of compliance with the patient. The use of combined medications simultaneously influencing various pathogenetic mechanisms of inflammation and coughing becomes a promising direction of mucoactive therapy. One of them is Eucabal® syrup containing liquid extracts of thyme and plantain. Due to the synergy of its components, Eucabal® syrup has an expectorant and anti-inflammatory effect, which is important in the initial period of acute respiratory viral infections (tracheitis, bronchitis tracheobronchitis), especially in dry, painful cough with hard-to-remove sputum. In case of acute respiratory viral infections accompanied by a wet cough with a viscous, difficult to separate sputum, mucolytic agents are shown first of all. One of the modern widely used drugs of this group is acetylcysteine (ESPA-NAC®) in a convenient dosage form.

The multiple increase in the number of «conceived in vitro» newborns is accompanied by an increase in the number of questions arising around this method of infertility treatment Evaluating the potential health realities of this category of children, it is necessary to consider the course of pregnancy caused by ART as a fundamental factor directly affecting the well-being of the future child. Patients who became pregnant as a result of the use of ART are a special group that differs not only from pregnant women with normal reproductive function, but also from pregnant women with long-term infertility in their history. Children’s health is criteria for assessing the well-being of society, the basis of its sustainable development and national security. Some members of the medical community suggest banning ART because of the «environmental degradation of reproduction, which leads to an almost doubling of infant mortality and congenital anomalies». Negative emotions are often caused today not even by assisted reproduction methods themselves, but by preimplantation diagnosis to select embryos based on specific characteristics, which is sometimes medically necessary. The skeletal system of newborn children is characterized by a number of features: the presence of large amounts of cartilage, the reticular structure of the bones, the rich vascular network in the areas of the bone neck and a significant thickness of the periosteum. In the first months and years of life, along with the development of the skeleton, there is a multiple rearrangement of the structure of bone tissue, reflecting its phylogenesis. Intensive growth with simultaneous remodeling creates a very special position for bone tissue, in which it is particularly sensitive to adverse effects of the environment, namely, disorders of nutrition, motor behavior of the child, muscle tone, etc. In premature infants, intense processes of phosphorus-calcium metabolism regulation are performed against the background of gestational immaturity of organs and general pathological reactions (hypoxia, acidosis), developing in the postnatal period. The study of health and bone metabolism in infants born through IVF remains an under-studied area of pediatrics and is of scientific interest for practical health care.

The article presents the results of vitamin D tests in children with cystic fibrosis and in healthy children living in the South of Russia. The study showed the high prevalence of vitamin D deficiency and inadequate levels in patients with cystic fibrosis (86.7%). 25(OH) D level characterizing the vitamin D status decreases progressively in patients and healthy children. With regard to the above mentioned, it is significantly lower in patients with cystic fibrosis than in healthy children in all age periods. The correlation between the serum calcidiol level and the age of patients with cystic fibrosis was r = -0.44 (p = 0.015). Intake of prophylactic (500--1000 IU/day) and therapeutic (1500--3000 IU/day) doses of cholecalciferol results in a less significant increase in calcidiol levels in patients with cystic fibrosis compared with healthy children. A significantly lower 25(OH)D level was detected in patients with cystic fibrosis infected with Staph. aureus. The 25(OH)D levels are significantly lower in children with cystic fibrosis and hypocholesterolemia, than in patients with normal cholesterol levels. Risk factors for the development of severe hypovitaminosis D in children with cystic fibrosis are age, physical developmental delay, exocrine pancreatic insufficiency, presence of chronic Staph. Aureus bronchopulmonary infection. Given the conducted study, the dosage of cholecalciferol in patients with cystic fibrosis should be at least 2 times higher than that in healthy children.

Growth is one of the most important indicators of child health. This article focuses on hypopituitarism, an endocrine disease with isolated growth hormone deficiency (somatotropic hormone) or multiple deficiency of the pituitary tropic hormones. The authors describe the etiology, genetic mechanisms of the disease development and provide the classification. The clinical picture and its variants, the diagnostic search are described in detail, and the criteria of referral to the endocrinologist are given. A separate chapter is devoted to the detailed discussion of stimulation samples, criteria for samples selection and scheduling. The authors also raise an issue of retesting. The scheme of treatment of hypopituitarism in accordance with domestic and foreign standards is provided. A list of necessary examinations in the framework of observation of a child with hypopituitarism is given.

This article addresses the problem of recurrent otitis media (ROM) in children. The study was aimed to increase the clinical efficacy of prophylactic treatment of ROM in children. The study showed that the children diagnosed with ROM had significantly lower serum 25(OH) vitamin D levels as compared to the healthy children. The follow-up observation and treatment of children with ROM allowed for the conclusion that all children at risk of ROM required the systemic examination of serum 25(OH) vitamin D and further therapeutic and prophylactic management.