The article discusses the unique property of autonomous variability in breast milk composition under the influence of external factors, including endogenous (hormonal) and exogenous (dietary, environmental) factors. The authors presented the analysis of study findings, how the method of delivery and antibiotic prophylaxis affect the bacterial composition of milk and discuss whether there is a difference between two factors. The results of EUROMAPGROUP and HUMAP studies and an approximate estimation of antibiotics volume (in tons) used in food animal production are presented, which demonstrates one of the global problems of our time antibiotic resistance. A modern method for preventing lactational mastitis using the probiotic Lactobacillus fermentum CECT5716, which was recently launched to the Russian pharmaceutical market, is proposed to prevent the child from receiving subtherapeutic antibiotic doses with mother’s milk. The main studies on the breast milk probiotics and the prevention of mastitis and lactostasis in breastfeeding women are presented.

Micronutrients (vitamins, minerals, micronutrients) are essential for the normal functioning of the body. The problem of vitamin deficiency leads to the risk of alimentary-dependent diseases. The reasons of inadequate provision with vitamins and minerals are given: unbalanced irrational nutrition, the quality of the products themselves, the nutritional value of which is significantly reduced with the use of modern production technologies. It is noted that the biological availability, i.e. the degree of absorption of vitamins from different products, varies widely from 5 to 80% of their total content in the product. In order to concretize the diverse physiological role of micronutrients as an important component of various enzyme systems and metabolic catalysts, the authors summarize the literature reflecting the importance of vitamins of group B, ascorbic acid, retinol, vitamin D and their functional correlations, as well as the need for a balanced and harmonious approach to their dosing. The problem of negative influence of deficiency of microelements on the structural and functional condition of various organs and systems, on morbidity, linear growth, development of various skills and psycho-emotional sphere of the child is covered. Attention is paid to the danger of micronutrient deficiency, which often remains unrecognized for a long time, because its clinical manifestations are not specific and can be observed in various diseases. However, the excess of individual micronutrients also disrupts the physiological and biochemical processes in the body. The vitamin requirements of healthy infants correspond to the amount of vitamins consumed daily with the mother’s milk: From 4-6 months of age, the provision of vitamins to the child is significantly affected by the introduction of complementary foods, for children from 1.5 to 3 years of age, the daily dose of vitamins and minerals in the VMC should not exceed 50% of the daily physiological needs, and for children over 3 years of age should not exceed 100% of the daily physiological needs for vitamins A, D and micronutrients (selenium, zinc, iodine, copper, iron), and 200% for water-soluble vitamins. An example of balanced and complete composition of vitamin complexes Multi-Tabs is given.

In order to prevent the development of chronic diseases, including cardiovascular diseases, overweight and obesity, diabetes mellitus, cancer and allergic pathology, it is necessary to adhere to a balanced diet from an early age, with the inclusion of functional ingredients, including dietary fiber, vitamins and vitamin-like compounds, minerals, polyunsaturated fatty acids, prebiotics and probiotics. Combined enrichment of dairy products with prebiotics and probiotics helps to combine their positive and effective impacts. There has been an improvement in the survival of probiotic microorganisms in the gastrointestinal tract (GIT). It has been shown that the addition of prebiotics and probiotics to the diet helps to change the composition of the intestinal microbiota towards a more balanced structure, thereby increasing the barrier function of the intestine and the formation of optimal immune interactions. The general effects of prebiotics and probiotics include maintaining homeostasis and integrity of the intestinal mucosa, providing colonization potential for pathogens, production of short-chain fatty acids and vitamins, metabolism of bile acids, regulation of transit through the gastrointestinal tract, and increased regeneration of enterocytes. The combination of bifidobacteria or lactobacteria with fructo-oligosaccharides in symbiotic products is most commonly used in human nutrition. In our study, patients aged 8 to 18 months, reconvalescents of acute respiratory disease for which antibacterial therapy was prescribed, included in their diet for 3 months drinking yoghurts enriched with Bifidobacterium Lactis BB12 and inulin. Inclusion of yoghurt in the diet of children contributed to the normalization of intestinal microbiota composition after antibacterial therapy, as well as strengthening immunity by stimulating the synthesis of protective factors secretory immunoglobulin A and lysozyme.

The article is devoted to the study of the intensity, prevalence of dental caries and oral hygiene indices among younger schoolchildren, against the background of a complex of preventive measures and dental education, which was carried out on an individual and group level in the conditions of a school dental office, and health lessons in classes. The dental study involved 106 primary schoolchildren, including 54 boys (51%) and 52 girls (49%) aged 7–8 years, who were examined on the basis of the dental office of the school №176 of Nizhny Novgorod. The children were divided into 2 groups: 1 – prevention group and 2 – control group. In 1 group of children every three months during the year we carried out professional oral hygiene, then treatment of all teeth with a deep fluoridation and training in the standard method of brushing teeth on models in a dental office. In addition, for children of group 1, we organized health lessons with training in the standard method of brushing teeth in the classroom, the use of additional hygiene products for the oral cavity in children of this age and the demonstration of a cartoon about dental caries. In the control group a set of preventive measures was also carried out in the form of professional oral hygiene and application of all teeth with the drug Gluftored, training in the standard method of brushing teeth on models every three months during the year, but dental education in the form of health lessons in the classroom was not. According to the clinical examination of 7–8 year’s children, it was revealed that during regular preventive measures and dental education among younger schoolchildren, the development of caries for permanent teeth is not observed, oral hygiene is improved, and dental health is rising.

Justification of the study. The normalization of vitamin D levels in both children and adults is the goal of numerous studies around the world, and the setting of a number of objectives related to this vector of preventive medicine, dictates the need for a more detailed study of regional features of the status of calcidiol and the identification of both risk factors and risk groups. Aim of the study: to analyze the impact of risk factors on the provision of vitamin D to adolescents in the Moscow region. Methods: 360 children over 11 years of age (average age was 14.74 ± 1.92 years) who attended a children’s polyclinic for preventive check-ups or are under observation in a day-care centre. After the examination, all schoolchildren were determined to have serum content of calcidiol – active metabolite of vitamin D. Results: the analysis revealed low vitamin D levels in children, with a median of 16.1 ng/ml. Normal vitamin D levels were found in only 6.7% of cases. The following risk factors for vitamin D deficiency were identified in Moscow schoolchildren: time of year (p < 0.001), inclusion of such foods as fish (p = 0.021) and liver (p = 0.036), gastrointestinal pathology (p < 0.001), endocrine system pathology (p < 0.001), musculoskeletal system pathology (p = 0.045): course of chronic inflammatory process (p = 0.01) in the body. The correlation between acute respiratory diseases and calcidiol supply was analyzed: at low frequency of acute respiratory infections during the year, the median level of vitamin D was 17.1 ng/ml (Q¹-Q³: 12.6-22.1 ng/ml), at an average frequency – 11.4 ng/ml (Q¹-Q³: 8.45-16.05 ng/ml), at high frequency – decreased to 7.94 ng/ml (Q¹-Q³: 5.89-9.06 ng/ml). Conclusion: Vitamin D deficiency prophylaxis should be provided to children all year round, without a break for the summer months. If a child has a risk factor for vitamin D deficiency, the metabolite correction should be controlled by the calcidiol serum content.

The article presents data on the etiology, modern methods for diagnosis and treatment of respiratory system diseases and examines in detail cough as the main symptom. Particular attention is paid to hypertussivity, which is defined as a cough that occurs in the absence of obvious reasons. In addition, the emphasize was put on the role of anatomical and physiological features in the development and characteristics of cough, especially in young children. The authors draw attention to the complex mechanism of the cough, which development involves many body systems such as nervous, immune, endocrine and respiratory. The article describes the main treatment methods, drugs prescribed to the patients with cough, which are divided into «antitussive» drugs used as cough suppressants and «protussive» drugs used in situations, in which mobilization of secretions is desired, combined drugs. The role of new combined drugs, in particular, Rengalin, which affects the central and peripheral links of the cough reflex, was noted.

The article presents an overview of modern approaches to diagnosis and treatment of acute otitis media in children. On the basis of the existing clinical recommendations the indications for systemic antibacterial therapy and tympanocentesis are listed, the algorithm of antibacterial therapy accepted in Russia is described. The role of various drugs in the form of ear drops for local treatment of acute otitis media in children is considered separately. One clinical case is presented, illustrating the capabilities of local anesthetics in the treatment of acute otitis media.

The inflammatory process in the bronchial mucosa of various origins (infectious, allergic, irritative, etc.) cause changes in the sputum production and its rheological properties, slowing of mucociliary clearance. Mucoactive therapy is one of the important components of the management of bronchopulmonary diseases. The article provides a detailed review of the modern literature, as well as the authors’ own experience regarding the cough therapy methods, including techniques used in the bronchial obstructive syndrome. The use of combination drugs, which simultaneously affect various pathogenetic mechanisms of inflammation and cough, including those in the respiratory diseases with bronchial obstructive syndrome, becomes a promising direction of mucoactive therapy. Due to relative safety and clinical efficacy, the modern combination therapy, including a fixed-dose combination of salbutamol, bromhexine, guaifenesin (Ascoril, Ascoril expectorant), is increasingly becoming the drug of informed choice in mild bronchial obstruction in childhood in pediatric practice.

The article describes state-of-the-art knowledge regarding etiology, epidemiology, clinical features and diagnostic criteria for respiratory infections caused by Mycoplasma pneumoniae (M. pneumoniae). It presents the characteristics of the main forms of lesions in mycoplasma infections of the respiratory tract – pharyngitis, bronchitis and pneumonia. Particular attention is paid to the differential diagnosis of community-acquired pneumonia of pneumococcal and mycoplasma etiology. The issues of rational choice of initial etiotropic therapy for the treatment of respiratory mycoplasmosis in children are discussed.

The presented review is devoted to topical issues of managing patients with cough, includes literature data on epidemiology, clinical classification, analysis of the causes, and the necessary diagnostic methods and lines of cough pharmacotherapy in children. The article focuses on the differential diagnosis of various pathological conditions and diseases, where cough is the leading clinical sign. The author provides information on treatment and characteristics of drugs recommended for symptomatic therapy of cough and indicates principles for rational antitussive and mucoactive pharmacotherapy.

Currently, the pathology of the nasal cavity and paranasal sinuses is an urgent public health problem. Rhinosinusitis is one of the leading causes of patients seeking medical attention. In addition to traditional anti-inflammatory, antibacterial, decongestant and antihistamine therapy, agents with mucolytic properties are widely used. The basis of rhinosinusitis is a process of violation of mucociliary clearance. Sinonasal secretions in rhinosinusitis are more viscous,elastic, and adhesive than normal nasal mucus. A change in the composition of the nasal secretion leads to stagnation of the contents in the sinuses, promotes bacterial colonization. The appointment of mucolytics regulates secretion and normalizes the viscosity of the secretion. The article provides an example of the clinical use of Sinupret®.

The article discusses the possibilities of local antibiotic therapy for acute respiratory infections in children. Despite the fact that most acute respiratory infections are caused by viruses, unreasonably high (up to 70% and higher in different countries) prescription of antibacterial drugs by primary care physicians has been observed. At the same time, it is highly likely that bacterial superinfection may develop in young children, in children with a prolonged course of acute respiratory infection, as well as in children with chronic ENT pathology, which requires the prescription of antibacterial therapy both to treat and, possibly, to prevent bacterial superinfection. In this case, the drug of choice should be antibiotics for topical (inhalation) use, such as Fluimucil®-antibiotic IT, which act directly at the infection site with the achievement of a quick therapeutic effect, without side effects that are associated with systemic antibiotics.

The article describes the features of the structure and functioning of the nasal mucosa in newborns and young children. The remarkable thing is that the nasal cavity and paranasal sinuses serve as a particular air conditioner that provides almost 100% hydration, heating, filtering and catchment of foreign particles. The development of pathology and functional disorders in the newborns and young children have serious consequences, such as respiratory distress or discomfort, sleep cycle disorder, an increased risk of obstructive sleep apnea and difficulties with feeding. The authors analysed the role and efficacy of nasal irrigation taking into account the solution concentration and the type of irrigation device, and reported the effect of elimination-irrigation therapy on mucociliary clearance and trophic epithelium of the nasal mucosa. It has been proved that the standard treatment (antibiotics, mucolytics and local nasal decongestants) for acute rhinosinusitis in children is more effective, if the treatment protocol includes irrigation of the nasal cavity with isotonic solution, and not without adverse events, in contrast to decongestants, which use increases the risk for tachyphylaxis. The authors determined the role of irrigation and elimination therapy in the prevention of pathology of the nasal cavity and paranasal sinuses and in the complex therapy for acute and exacerbation of chronic rhinosinusitis in newborns and young children. The most common mistakes in caring for the nasal cavity in newborns and young children are highlighted. The article identifies the main indications for the use of Otrivin Baby aspirator and drops, and clarifies the main positions for using Otrivin Baby aspirator. It also describes the advantages of using Otrivin Baby device, which includes an aspirator and sterile isotonic solution drops for safe and effective care for the nasal cavity in newborns and young children with rhinitis.

The article presents the clinical evidence of safety and efficacy of mucolytics and expectorants in the treatment of both productive and non-productive coughs in respiratory infections in childhood in all stages of the infectious-inflammatory process. The authors set a goal to study the efficacy and safety of mucolytics and expectorants in children with respiratory infection in the pediatric practice. Materials and methods. A total of 96 children undergoing inpatient treatment for various variants of acute respiratory infection were examined. The average age of the patients was 7.6 ± 0.9 years old (from 3 to 14 years old). All patients were divided into 3 groups. Primary outcomes. Using the investigational drugs in children with various forms of acute respiratory infection made it possible to quickly reduce the intensity and frequency of cough by Day 3-5 from the onset of the disease and therapy, and transform cough into productive wet cough. The study showed rapid positive dynamics in cases, when acetylcysteine was prescribed from the first days of the disease, with a consistent cough therapy using herbal products. Both investigational drugs showed no adverse drug effects during the study. The results of the analysis brings us to the conclusion that a multimodal approach to cough treatment provides a comprehensive effect, which potentiates the treatment effect and allows us to recommend them in everyday pediatric practice as effective symptomatic agents to treat inflammatory diseases of the respiratory tract. This method helps to prevent polypharmacy, minimizing the drug load on the child.

Functional disorders of the gastrointestinal tract (GIT) are a common problem in children. The Roman IV criteria adopted in 2016, devoted to the problem of constipation and biliary tract dysfunction in children are developed in accordance with age and are idendoitified by the letter code. This article presents data on the correspondence of the Roman IV criteria and ICD-10 in the combined problem of constipation and biliary tract dysfunction in children. The development of upper gastrointestinal tract pathology caused by increased intracavitary pressure associated with impaired colon motility (chronic constipation) is natural during a prolonged course of chronic constipation. The study based on a specially designed questionnaire in Russia showed that an average of 54% of children in different age groups suffer from chronic constipation, that is, almost every second child. Studies showed that the frequency of biliary tract dysfunction in children with chronic constipation accounts for 42.3 to 100% cases. The survey that we conducted among pediatricians showed that a quarter of doctors found it difficult to establish diagnosis, and 41% of pediatricians struggled with prescribing therapy for persistent constipation in children, especially constipation combined with motor-tonic dysfunction of the colon in children with biliary tract dysfunction. A total of 201 children aged 6 to 15 years (96 boys and 114 girls) were enrolled in the study. In addition to pain syndrome, cellular energy exchange disorder in the form of decreased level of intracellular antioxidant catalase enzyme and plasma antioxidant activity (PAO) was identified against the background of chronic constipation and biliary tract dysfunction in this group of children, which is evidence of decompensation of antioxidant protection in the acute stage of biliary tract dysfunctional disorders in children. The identified changes make a strong case for prescribing a drug with hepatoprotective, choleretic and antioxidant effects. The use of herbal extract of fresh artichoke leaves (Chophytol®, Mayoly Spindle, France) showed the relief of pain syndrome by Day 14 of treatment in 92% of patients (75% in the comparison group), nausea in 74% of children, constipation in 88% (50% of patients in the comparison group). It is important to detect an elevated α-tocopherol level and significantly reduced catalase level, which indicates the need to choose a drug with selective antioxidant activity, which does not change the α-tocopherol level. The introduction of the herbal extract of fresh artichoke leaves (Chophytol®) in the complex therapy of the studied patients accelerated the relief of the clinical symptoms of functional biliary tract disorders and reduced the frequency of constipation in children by 4 times as compared with the control group without significant effect on the α-tocopherol level.

Patients on a gluten-free diet are at risk of developing polyhypoavitaminosis and deficiency states, which requires the supplementation of their diet to prevent nutrient deficiencies. The aim of the study: to analyze the dynamics of anthropometric and laboratory parameters, components of the quality of life in children with coeliac disease on the background of a month-long course of administration of hypercaloric mixture for enteric nutrition. Materials and methods: 45 children with coeliac disease aged 2-10 years (mean age 6.3 ± 0.3 years) on a strict gluten-free diet for more than one year. All patients received additional enteric nutrition with a hypercaloric mixture in the volume of 200 ml/day (300 kcal/day) for 1 month as a supplement to the main food ration. Two groups of patients receiving the supplement in 2012-2013 and 2017-2018 were identified. Physical development was assessed under the WHO AnthroPlus programme. The quality of life indicators were assessed using the PedQL 4.0 questionnaire. Results: the total frequency of protein-сalorie deficiency (PCD) before the course of nutritional supplementation was 13 (28.9%) cases, while acute PCD was diagnosed in 6 (13.3%) and chronic PCD in 7 (15.6%) patients. Against the background of the course of nutritious supplementation in children with coeliac disease, there was a significant reduction in weight, height and BMI in both groups. Patients in 2012-2013 initially had a greater gap in weight and height compared to children in 2017-2018. There was an improvement in the sum of the quality of life indicators by 6.3% for children in the first group and by 4.3% for children in the second group against the background of nutritional supplementation. Conclusions: Enrichment of children’s diets with a hypercaloric blend of dietary fiber helps to accelerate the pace of physical development, reduce the number of children with diabetes mellitus, improve hemogram rates and most components of quality of life.

The article presents data on the prevalence of infant colic, etiological factors, diagnostic criteria, differential diagnosis and therapy with justification of approaches to the choice of formula in children on artificial feeding. When choosing a formula, it is necessary to take into account the compositional features aimed at overcoming the functional immaturity of the gastrointestinal tract, enteric nervous system, and the ongoing formation of the intestinal microbiome – the presence of a partially hydrolyzed protein, a reduced lactose content, the presence of prebiotics (fructooligosaccharides) and probiotics. The formula Similac Comfort is fully compliant. This formula additionally contains oligosaccharide of the breast milk 2 fucosillactose (2’-FL), 0.2 g / l – identical to that found in breast milk, which has proven positive effects in the form of an immunomodulating effect, anti-infectious effect, is involved in the regulation of growth and maturation of intestinal epithelial cells, in the development of the nervous system.

Due to high prevalence in the pediatric population, chronic recurrent course and difficulties in choosing the local therapy, atopic dermatitis is an urgent problem for pediatricians, dermatologists and allergists. The review presents data on the prevalence and features of the clinical manifestations of atopic dermatitis in various age periods. The authors consider structural, functional and immunological features of the skin barrier are considered in detail under normal and under pathological conditions. They emphasize the problems of quality of life, compliance and steroidophobia of patients with atopic dermatitis. Particular attention is paid to the concept of sensitive skin, the definition of this concept and the localization of sensitive skin area on the surface of the body. The article describes approaches to the method of choosing external therapy according to the European guidelines for the treatment of atopic dermatitis in 2018. It presents a modern practical algorithm for prescribing local anti-inflammatory drugs (topical glucocorticosteroids, topical calcineurin inhibitors) taking into account the severity of the clinical manifestations of the disease and the areas of application (sensitive skin areas/other parts of the body). The authors provide evidence of the efficacy and safety of topical calcineurin inhibitors, in particular pimecrolimus, in the treatment of patients with mild to moderate severity of atopic dermatitis, especially in sensitive skin areas.

Human skin is the largest yet complex organ that performs many functions. The skin barrier is crucial for survival, preventing moisture loss and the entry of infectious or toxic substances. Skin is also a complex habitat for a diverse population of microbiota. During childbirth and subsequent exposure to the postnatal environment, the skin is colonized by many microbes, many of which are commensal or symbiotic. The useful functions of the resident microbiota include inhibition of pathogenic species through various mechanisms that are actively studied. Modern research is increasingly focused on the role of human microbiomes, including skin microbioms, in the development of a range of pathological diseases, including dermatological, allergic and infectious diseases. Due to the growing spread of the 16S rRNA bacteria gene sequencing method, more and more information on the microbial composition of various body systems, including the skin, is becoming available every year. The review presents current data on the composition of a healthy skin microbiome and its changes over the course of human’s life, and demonstrates some mechanisms of its effect on the health of the skin and the body as a whole. Special attention is paid to the concept of ecological niches of skin, their peculiarities and unique microbial composition. The role of microbiomal abnormalities in the development of a number of chronic inflammatory skin diseases, including atopic dermatitis, psoriasis and acne, was also analyzed.

This article presents an overview of current views on the problem of allergic rhinitis in children. Modern data on the epidemiology of allergic rhinitis and basic comorbid conditions are covered. The issue of patient routing with suspicion of allergic rhinitis and the main directions in the treatment of this disease is briefly discussed. On the basis of the data of the latest consensus papers, the role of various medication therapy for allergic rhinitis has been evaluated: first and second generation antihistamines, intranasal glucocorticosteroids, leukotriene receptor antagonists, and mast cell membrane stabilizers. Possibilities of symptomatic nasal obstruction therapy in case of allergic rhinitis with the help of nasal vasoconstrictor drugs (decongestants) have been assessed in more detail. The basics of pharmacokinetics and pharmacodynamics of decongestants are presented, as well as the data of a clinical study demonstrating the efficacy and safety of the combined preparation of phenylephrine and dimethindene maleate in the symptomatic treatment of allergic rhinitis in children. On the basis of the presented material it is concluded that timely diagnosis and further management of patients with allergic rhinitis in accordance with the principles reflected in modern clinical guidelines, in most cases, allow to effectively control the course of the disease, maintaining the quality of life of patients at a high level.

The follow-up group of «frequently ill children» is formed on the basis of criteria formulated by domestic pediatricians A.A. Baranov and V.Yu. Al’bitskiy, due to the high relevance of medical, social and economic problems caused by the increased morbidity in this category of patients especially with acute respiratory infections, with likely development of severe complications or the manifestation of chronic respiratory diseases. In general, the state of the immune system in frequently ill children is characterized by decreased local immunity and increased stress of systemic immunity, and the features of the functional immunity activity in this category of patients determine the various possibilities to affect immunity during the prevention and treatment of acute respiratory infections. This article discusses the features of the functional activity of the immune system in frequently ill children, as well as the possibilities of drug management of its disorders and the benefits of using inosine pranobex to prevent and treat respiratory infections in this category of patients. According to the international classification of drugs maintained by the World Health Organization, the drug belongs to the groups of immunomodulators (L) and antimicrobial antiviral drugs (J) for systemic use. It is proved that inosine pranobex effectively increases cellular and humoral immunity, and reduces non-specifically the viral replication capacity. During clinical trials, the drug proved to be a highly effective and safe component of the complex treatment of acute respiratory infections in frequently ill children. The use of inosine pranobex reduces the duration and intensity of symptoms of infectious respiratory tract diseases. The drug can be recommended for children with concomitant chronic respiratory tract diseases.

Due to the prevalence of allergic rhinitis (AR) among the population of Russia, especially in pediatric practice, it is important today to give coverage to its clinical manifestations, principles of diagnosis, management of the patients and the possibilities to prevent exacerbations and increasing severity of illness. The authors provide the reasons behind why the intermittent AR has a persistent course. The article presents the diagnostic methods recommended in the ARIA documents. The authors note the important role of tight junctions in the nasal mucosa structure in protecting a person from aeroallergens and substantiate the rationality of prescribing systemic antihistamines to treat viral and a number of other types of infection. They also provide characteristics of minimal persistent inflammation and the distinctive features of local AR. According to the authors, the rationale for the use of complex treatment is the impossibility to completely cure AR. The article lists the activities and drugs included in the therapy regimen that is defined in the ARIA documents. However, the choice of a drug prescribed to the patient should be personified. The authors substantiate the prescription of systemic antihistamines in the development of acute respiratory viral infections caused by rhinovirus and give preference to Fenistil® due to the possibility of its use at an early age from 1 month in the form of syrup and drops as the most convenient dosage forms. The benefits of Fenistil® include: the speed of onset of a drug effect and its duration, high antihistamine activity and, as a result, pronounced itch relief, as well as the absence of a cardiotoxic effect, mild sedative effect, the ability of precise dosing and reduced production of nasal secretions. A clinical case with the rationale for the systemic use of this drug is presented. It is concluded that clinical data on the high efficacy and safety of Fenistil® entitle us to believe that its use is expedient, especially in pediatric practice.

Literary data on peculiarities of immune system, anti-infectious immunity, including local protection of respiratory tract (lymphaticepithelial pharyngeal system), in children of early and preschool age, causing their higher incidence of acute respiratory infections (ARI) are given in the article. This age period is characterized by «physiological» humoral immune deficiency, reduced activation of the complement system, insufficient synthesis of cytokines, including interferons, T-cell immunosuppression, impaired intercellular cooperation, poor functional activity of natural killers and phagocytes. Despite the large range of means and methods of prophylaxis of infectious and inflammatory diseases of viral and bacterial etiology, it is necessary to search for new approaches taking into account the peculiarities of immune status in young children. The article presents the possibilities of controlling the system of congenital and adaptive immunity with medications, in particular, by using the bacterial lysate Broncho-munal®. The immunoregulatory role of bacterial lysates is presented in detail. The pathogenetic substantiation of the use of bacterial lysate Broncho-munal® for the prevention of acute respiratory infections in children, including children with recurrent respiratory infections is given.

The purpose of the study: to evaluate the protective properties of a multi-strain probiotic in the development of gastrointestinal disorders with impaired microbiota during antibiotic therapy (ABT) for 1 to 3 years old children with acute respiratory infection (ARI). Objectives of research: to evaluate the incidence of development and severity of gastrointestinal disorders, as well as changes in the dynamics of intestinal microbiota using 16S rRNA gene sequencing in 1 to 3 years old children with ARI and receiving ABT, depending on the addition of a multi-strain probiotic to the treatment regimen. Materials and methods: the study involved 148 children from 1 to 7 years old both girls and boys (54 children were 1 to 3 y.o. and 65 were 3 to 7 y.o.), hospitalized within first 3 days of URTI symptoms (acute upper respiratory tract infection – URTI) and 29 healthy children from outpatient department as a healthy control. Present article covers data and outcomes of younger age group – 54 children 1 to 3 years old, hospitalized within first 3 days of illness and 10 healthy children of the same age range. The main group included 27 children who received ABT + multi-strain probiotic Bac-Set® Baby for the entire period of ABT and extra 14 days after its discontinuation; the comparison group included 27 children who received only ABT. The frequency of bowel movements was assessed, feces were evaluated accordingly to Bristol scale upon admission to the hospital, befor e discharge from the hospital (in 7 ± 2 days), and in 21 ± 2 days from the beginning of ABT. Results. The frequency of bowel movements after 7 ± 2 days and 21 ± 2 days from the start of therapy was significantly higher in the comparison group than in the main group (81.5% and 26% versus 7.4% and 7.4%, respectively). The stool rate accordingly to Bristol scale in the comparison group changed up to moderate diarrhea, which was not registered in the main group. In both groups, an increase in alpha-diversity of microbiota was observed within 2-week period after discontinuation of antibiotic therapy. During the study, adverse reactions of multi-strain probiotic were not found. Conclusions. The results allow to suggest that the use of Bac-Set® Baby multistrain probiotic helps to maintain the stability of the microbiome during antibiotic therapy and in the recovery period after it. The use of Bac-Set® Baby with antibacterial therapy has a protective effect on gastrointestinal upsets incidence rate and reduces the negative impact on microbiome.

Purpose. Evaluate the effect of metabolic control of gestational diabetes mellitus (GDM) on the perinatal period course and anthropometric parameters of newborns.

Materials and methods. 300 newborns were divided into 4 groups depending on the metabolic control of the mother. Group 1: fasting glycemia <5.1 mmol/L, 1 hour after meals <7.0 mmol/L (n = 50); Group 2: <5.3 mmol/L and <7.8 mmol/L (n = 90); Group 3: > 5.3 mmol/L and> 7.8 mmol/L (n = 46), respectively; Group 4: control (n = 114). The analysis of the perinatal period course was carried out, the anthropometric parameters were estimated according to the tables INTERGROWTH-21st.

Results. Differences in the frequency of obstetric injuries, which risk is associated with «above average» body weight of the newborn (p = 0.04), were found between the GDM group and the control group (38.7 and 12.3%, respectively, p = 0.0000005). The risk of having a baby with «above average» body weight (Group 1/Group 4, OR = 1.9, p = 0.1; Gr. 2/Gr. 4, OR = 2.6, and Gr. 3/Gr. 4, OR = 3.7, p <0.05), the ratio of weight/length (Gr. 1/Gr. 4, OR = 0.9, p = 0.9; Gr. 2/Gr. 4, OR = 3.6, and Gr. 3/Gr. 4, OR = 4.9, p <0.05) and head circumference (G.1/Gr. 4, OR = 1.1, p = 0.6; Gr. 2/Gr. 4, OR = 2.5, and Gr. 3/Gr. 4, OR = 2.9, p <0.05) was higher in Groups 2 and 3 than in Group 4. In the early neonatal period with GDM, hypoglycemia was more common than in the control Group 4. The lowest risk was in Group 1 (Gr. 1/Gr. 4, OR = 4.8; Gr. 2/Gr. 4, OR = 6.7; Gr. 3/Gr. 4, OR = 7.9, р < 0,05).

Conclusions. Group 1 showed the lowest frequency and risk of adverse effects, which meets the control criteria of the Russian consensus.

The article considers the present-day idea of the etiopathogenesis of atopic dermatitis in children, which forms, from the pediatrician’s point of view, basis for decision making on effective modern therapeutic and preventive measures. Due attention is given to the description of highly effective topical glucocorticosteroids, which allows to gain control over the disease within a short time. Among all the topical corticosteroids of methylprednisolone aceponate 0.1%, local glucocorticosteroid can be used in children aged 4 months and older and has an optimal therapeutic index, safe, which is proved in the randomized trials. The article states the principles of management of sick children with atopic dermatitis, taking into account a wide range of comorbid conditions and diseases.

The review is devoted to the analysis of data on the effects of Lactobacillus reuteri DSM 17938, confirmed in clinical trials. Thanks to their antimicrobial activity, L. reuteri is able to inhibit colonization by pathogenic microorganisms and restore the composition of compensatory intestinal microbiota. Another study showed a positive protective effect of intestinal microbiota when administered L. reuteri simultaneously with antibiotics. In addition, L. reuteri supports the immune system of the human body. For example, some strains of L. reuteri may reduce the production of pro-inflammatory cytokines while stimulating the development and proliferation of regulatory T-lymphocytes. Adding L. reuteri to the diet may be attractive in terms of preventing the development of inflammatory bowel disease. The results of a recent meta-analysis confirmed the efficacy of L. reuteri in the treatment of infantile colic. Further research is aimed at finding evidence of the efficacy of L. reuteri use in children who are artificially fed, with infant colic and in children born by caesarean section.

Rationale. Currently, the literature describes about 374 cases of Marshall syndrome. According to some authors, the prevalence of Marshall syndrome is 2.3 per 10,000 children, in general, the epidemiology of PFAPA syndrome in the pediatric population is unknown.

Purpose. The aim of our study is to justify surgical treatment in children with Marshall syndrome. Objectives. The objectives of this study are to give a comparative assessment of the effectiveness of tonsillectomy and adenotonzyllectomy for this syndrome and to evaluate the quality of life indicators before and after surgical treatment.

Materials and methods. The study included 26 patients with Marshall syndrome, of which 18 patients underwent adenotonzyllectomy and 8 patients underwent bilateral tonsillectomy. A clinical case of a typical manifestation of Marshall syndrome is also described, and follow-up results of the effectiveness of surgical treatment for Marshall syndrome are presented. In the course of the work, an adapted questionnaire was developed to assess the quality of life of parents of children with Marshall syndrome.

Results. The result of our work is the fact that in relation to the relief of PFAPA-syndrome, children of preschool and primary school age have more effective adenotonsillectomy (88.2%), while tonsillectomy was effective only in 55.6% of patients.

Conclusion. A multidisciplinary approach is required to address the diagnosis and treatment of Marshall syndrome.