Breastfeeding support is an important  task of paediatric care. The high awareness of the female population  about the importance of breastfeeding contributes to the  formation  of lactation  dominant  among  women  in the  future. The level  of information  in support and recovery of breastfeeding (relaktation) in a motivated  female audience  has been studied. The readiness  of women to use the additional  feeding system, which simulates  breastfeeding, to increase lactation  and relation has been analysed. The study was conducted  on the basis of the questionnaire results of 100 female students of the medical university, 56 paediatricians of the advanced training course, as well as 56 maternity women on 2–5 days after childbirth. Previously, students at a high scientific and practical level were informed about the disadvantages of artificial nutrition and the benefits  of breastfeeding, including from the perspective  of modern  scientific  research  into the  components of breast  milk as living tissue. The doctors’ questionnaire was preceded  by a practical lesson and a lecture  on breastfeeding support and possible ways of relation. The participation of all the respondents in the study was exclusively voluntary. In the student  and medical environment, the prevalence  of awareness in the formation of a high commitment  to breastfeeding has been revealed. In contrast, in a group of maternity women with a high level of lactation  dominant, a single notification of relacement and the application  of an additional Medela SNS feeding system did not achieve the desired indicators of motivation for breast feeding.

Introduction:  in addition  to genetic  predisposition,  a significant  exogenous  factor in the  formation  of Undifferentiated connective tissue dysplasia (UDCTD) is the deficiency of osteotropic micronutrients such as vitamins (D, A, C, E, K); macroelements (calcium, phosphorus, magnesium), trace elements (copper, manganese, zinc, boron, selenium, silicon), so essential for the connective tissue matrix and, above all, for bone tissue. A small number of studies of osteotropic micronutrients and the state  of bone tissue in adolescents with UDCTD served as the basis for this comprehensive study.

Materials: a randomized  study of 130 adolescents aged 10–16  years in the 1–2  health  groups. The first group (primary) was 90 subjects with detected UDCTD. The second group (comparative) was 40 people  with no signs of dysplasia.

Methods: included the definition of: vitamin D – 25(ON)D: trace elements; calcium ductation: spinal column densitometry at L_II–L_IV level; physical development and psycho-emotional stress levels.

Availability disorders of 25(OH)D, low calcium consumption, magnesium  deficiency, and shifts in micronutrient content  correlated with densitometric data showing a 75% decrease  BMD in Group 1 adolescents, while in Group 2 only 27.5%.

The results  of a comprehensive study showed  that  osteotropic micronutrient deficiency is a serious  exogenous  trigger  for the development and progression  of UDCTD with osteopenia/osteoporosis formation. Osteopenia/osteoporosis, low physical development, disorders in the psycho-emotional sphere  indicate the seriousness of the prognosis of UDCTD in adolescents.

Skin care in children has been a problem exercising the minds of both parents and doctors from the moment of birth. Why are they so interested in knowing about the infant skin and care for it? Consideration must be given to the anatomical and physiological features of the newborn skin structure and differences from the adult skin structure. Its weight accounts for 10–13% of the newborn body weight as compared to 3% of the adult body weight. Anatomical maturity only partially correlates with functional maturity, these differences concern both barrier function and thermoregulation. The epidermis in newborns and infants is much thinner, looser, the layers are underdeveloped. The epidermal basement membrane connecting the epidermis and the dermis is made up of four poorly differentiated sublayers, the cells are of small size, the number of desmosomes  at the cell-cell  junctions is also much lower, which results in the unstable connection between the epidermis and the dermis. These distinctive features explain the difference in the newborn skin care, the choice of care products, the prevention of various pathological conditions, and even the subtleties of treatment. The variety of skin care products for newborns, the difference in composition and different dosage forms can cause confusion in young parents, and improper use of such products and various disturbing factors can lead to impairment of the normal state and function of the skin. And as a consequence of this, various pathological conditions may develop that already require active and even long-term treatment. The purpose of this article is to give the reader a brief picture of the anatomical and functional features of the skin structure, any changes developing in the postnatal period, and the need for the use of skin care products. It provides the skincare rules, compliance with which will not lead to the opposite effect.

Currently, there is a wide introduction of inhaled  glucocorticosteroids (InGCS) into otorhinolaryngological practice, which is explained by their local impact and low bioavailability, as well as proven high therapeutic effectiveness in various forms of rhinosinusitis (RS), adenoiditis and allergic rhinitis (AR). The feasibility of using InGCS enshrined in international consensus documents. Thus, this group of drugs is recommended  for use in acute postviral and bacterial  MS, chronic MS, polypous chronic rhinosinusitis, and in the postoperative period when intervening in the nasal cavity and in the paranasal sinuses.

Recently, due to the deterioration of the environmental situation in the world and in connection with the improvement of the diagnosis of sensitization, the number of patients suffering from AR has increased. InGCS are included in the complex of treatment of moderate and severe course of intermittent and persistent AR.

The effectiveness of InGCS in non-allergic eosinophilic rhinitis has been proved. In the complex therapy of adenoids and chronic adenoiditis, InGCS is also used with a high degree of efficiency, which allows such patients to avoid invasive treatment methods, including adenotomy.

Particularly severe course of RS and adenoids is observed in patients with allergies. In this situation, the feasibility of using InGCS has been proven.

One of the most effective and safe drugs in this group is fluticasone propionate (FP) - Flixonase, especially if the patient is sensitized to inhaled allergens. The advantages and possible side effects of FP are described.

The authors cite the results of their own research, which used FP in the complex treatment of children with nasal breathing difficulties caused by adenoids and various forms of AR. As a result of 3 months of treatment and follow-up, 95.2% of patients recovered nasal breathing and no need for surgical removal of adenoids.

The authors consider the feasibility and effectiveness of using inhaled glucocorticosteroids in the treatment of major diseases of the ENT organs, such as various forms of rhinosinusitis (RS), allergic and non-allergic rhinitis, and adenoiditis. It is emphasized that this group of drugs has an evidence base and is included in the main concession documents on otorhinolaryngology. Their advantages, pharmacotherapy and possible side effects are noted. The advantages of the drug fluticasone propionate (Flixonase), the relevance and advantages of its use are highlighted. The paper presents the authors own observations in the treatment of patients with nasal polypous chronic RS with this drug.

Acute respiratory infections (ORI) are one of the most common causes of primary medical care in Pediatrics. The clinical picture of ORI is almost always accompanied by a combination of symptoms such as nasal discharge, nasal congestion, sore throat and cough, combined with muscle pain, weakness, fatigue, headache, and decreased appetite. Depending on the pathogen of the disease, there is a predominance of one of the symptoms and, therefore, the clinical picture of ORI can be very diverse and is determined by the anatomical localization of the main manifestations of infection. Cough is the most common symptom of acute respiratory diseases in children and is a protective reflex aimed at clearing the Airways in conditions of insufficient mucociliary clearance. By evaluating certain characteristics of a cough, pediatricians can determine the location and often the nature of the disease that causes it. By nature, it can be productive and unproductive (depending on the presence of sputum), by duration acute, subacute and chronic. The main causes of coughing in children are inflammation of the upper and lower respiratory tract, bronchial asthma, and foreign bodies in the bronchi. and timely diagnosis of the disease. Treatment of asthma, bronchiolitis, whooping cough, pneumonia, aspiration of foreign bodies. the Effectiveness of cough therapy depends on the timely and correct determination of the cause that causes it. Therapy should be aimed at thinning sputum, reducing the viscosity and increasing the productivity of the cough. As an antitussive agent, the use of ivy leaf syrup Gedelix is justified. The safety of the drug and the possibility of accurate dosing justify its use in Pediatrics.

Tonsillopharyngitis is a common disease among pediatric patients. Visits associated with sore throat account for 6 to 8% of all visits to pediatricians and general practitioners. Tonsillopharyngitis can have both infectious and non-infectious etiologies. In pediatric practice, most cases of upper respiratory tract infections are of viral origin, especially in children of early and preschool age. In most cases, uncomplicated course and non-infectious etiology of the disease do not require the administration of antibacterial drugs. The bacterial nature of the disease can be distinguished from the viral one using the data of culture analysis and rapid test for group A β-hemolytic streptococcus (GABHS) or Streptococcus pyogenes. The etiotropic therapy of streptococcal tonsillopharyngitis is antibiotic therapy. In GABHS, antibiotic therapy shortens the duration and reduces the severity of symptoms, reduces the Likelihood of purulent complications, post-streptococcal diseases and prevents the generalization of streptococcal infection. The use of modern antiseptic herbal medicines may be an additional and alternative line of therapy. The authors presented a literature review of the clinical trials results of a modern herbal medicine and provided the results of their own case of the combined treatment of a 10-year-old child with a diagnosis: acute moderate tonsillopharyngitis, bilateral cervical lymphadenitis; acute rhinitis; chronic adenoiditis, exacerbation; degree 2 adenoids. Antibacterial therapy included amoxicillin: oral: 100 mg/kg/day in 2 divided doses for 10 days, combined with an anti-inflammatory and antiseptic herbal medicine due to the complicated course of the disease in the form of concomitant regional lymphadenitis. The course of therapy resulted in clear positive changes: overall well-being improved as early as on the second day of treatment, sore throat and submandibular region ceased to cause pain by 5th day of treatment, the temperature became normal by 5th day of the disease. This clinical observation shows the possibility to introduce an anti-inflammatory herbal medicine to the complex treatment of acute tonsillopharyngitis in children, including cases of complicated course of the disease.

According to official statistics,  acute  respiratory  infections  (ARI) always rank highest  among  the  infectious  diseases,  especially among  children. In Russia, the  annual  rate  of ARI is at least  70–80,000 diseases  per 100,000  children’s population  (3.3 times higher than in adults) without downward trend. Reduction and relief of symptoms is one of the main objectives  in the treatment of acute  respiratory infections  in children. Fever, runny nose, sore throat, and cough are the most common symptoms that  affect the health  condition  of children. Cough is one of the top five reasons  for patients to seek medical treatment, as it is a common symptom in both outpatient and hospital practice. In particular, the majority of acute and chronic bronchopulmonary diseases  are almost always accompanied  by cough, and patients with chronic cough of unclear  etiology account  for 10 to 38% of patients in the  practice  of a pulmonologist. Many articles  give much attention to cough and its causes, describe  treatment methods. The rational choice and use of antitussive  therapy in pediatrics involve the knowledge of at least two main factors: the causes of cough and the features  of the mechanism  of cough reflex in children, as well as the mechanisms  of action of antitussive  drugs used. The necessity to treat  cough as such i.e. to prescribe  the so-called  antitussive  therapy arises when a child has unproductive, dry, persistent  cough. The article discusses the potential causes and mechanisms  of the production of cough in children, in particular dry cough, and considers  using central  and peripheral  antitussive  drugs in paediatric  practice. Special attention is given to the efficacy and safety of the antitussive  drug butamirate citrate.

Severe bronchial asthma in children remains a serious problem, which is due to the high risk of mortality, side effects of therapy with high doses of glucocorticosteroids, significant consumption of health resources. The article presents modern data on the pathogenetic mechanisms of bronchial asthma, in particular, on the participation of interleukin-5 (IL-5) in the development of eosinophilic inflammation. Research data demonstrate the safety and effectiveness of anti-IL-5 therapy as a supplement to standard treatment for severe eosinophilic BA and its poor control, including in children. Mepolizumab is the most widely researched anti-IL-5-monoclonal drug. It statistically significantly reduces the level of eosinophilia in the organs, target tissues, reduces the frequency of exacerbations and hospitalizations, significantly reduces the need for maintenance therapy with glucocorticosteroids. The high profile of efficacy and safety of mepolizumab obtained as a result of randomized controlled clinical trials makes it a drug of choice in the treatment of children aged 6 and older with severe eosinophilic BA. However, further post-marketing biomarker studies are required to evaluate the response to anti-IL-5 drugs treatment, to determine the optimal duration and long-term effects of treatment, the risk of relapse in case of withdrawal in children with BA, especially those under 12 years of age.

Nasal congestion in children has many causes. In each case, the doctor has to find factors that cause chronic or intermittent nasal congestion. As a rule, the causes of impaired nasal airflow differ between different age groups. Mild nasal congestion from the first days of life, which can be defined as “stertorous breathing," may be a normal variant in healthy children or a manifestation of stridor congenitus. Eating habits of infants often lead to regurgitation, which can contribute to the irritation of nasopharyngeal mucosa with stomach contents and provoke an inflammatory response that leads to prolonged nasal breathing problems. This problem is solved by the joint efforts of a paediatrician and an ENT doctor. Acute inflammation of the paranasal sinuses - sinusitis, ethmoiditis, frontal sinusitis, sphenoiditis - most often develops as a complication after acute respiratory viral infections, especially when children attend a kindergarten, which promotes close contact and exchange of infectious agents between children. Hypertrophy of the lymphoid tissue of the pharyngeal ring (adenoiditis, hypertrophy of the tonsils) is a natural reaction to the invasion of the upper respiratory tract by pathogenic microbes, which leads to impaired nasal breathing. Allergic rhinitis is a common cause of nasal breathing problems in children. The combination of lymphoid tissue hypertrophy, sinusitis and allergic pathology creates a complicated cause-and-effect complex with constant nasal breathing problems. The above-mentioned circumstances necessitate a multidisciplinary approach to the problem, which will make it possible to formulate the correct diagnosis and determine the effective therapeutic approach. Saline nasal irrigation is one of the leading measures to prevent nasal breathing disorders and treat rhinitis, adenoiditis, sinusitis of various etiologies. In newborns and young children, the use of nasal aspirators is a convenient and useful method to clean the nasal cavity from secretion after nasal irrigation. The article explains how to use the aspirator and demonstrates the need for irrigation procedures. The use of these methods will effectively prevent nasal breathing problems.

Acute respiratory viral infection is characterized by oral pharynx involvement resulting in edema and hyperemia of the mucous membranes, rhinitis and cough, which develops due to inflammatory processes in the upper airways, where cough receptors are found. The main mechanisms of viral infection removal is mucociliary clearance, which is ensured by the adequate functioning of the ciliated epithelium found in mucous membranes. The cyclic beatings of the cilia of epithelium constantly drive a flow of mucus out of the airways in the proximal direction. Coughing is an additional reflex technique to clear the airways. Much attention is paid to secretomotor and secretolytic therapy in the treatment of cough. Many medicinal herbs have such properties, which are widely used in the treatment of cough in children: plantain leaf, coltsfoot leaf, thermopsis herb, ipecacuanha root, marshmallow root, licorice root, anise fruit, thyme (thyme) herb extract, ivy leaf extract. Bronchipret Syrup is one of the well-known combined officinal herbal medicines, which contains liquid extracts of ivy leaves and thyme grass. Ivy enhances the production of surfactant, increases the number of |32-adrenergic receptors on the surface of the alveolar cells found throughout the bronchial tree, to which active substance extracted from ivy (а-hederin) having bronchospasmolytic and expectorant effects is attached. The thymol in thyme has anti-inflammatory and antibacterial properties, and in general, the components of ivy and thyme have a synergistic effect -reinforcing each other’s action. A considerable number of clinical studies showed high efficacy and safety of Bronchipret, which makes it possible to recommend it as the drug of choice, if the symptomatic cough therapy is required in children with acute respiratory viral infections. The article describes the main causes and forms of cough in children. It gives an estimate of efficacy and safety of the herb secretolytic medicine Bronchipret in the treatment of cough in acute respiratory viral infections. A clinical example shows the efficacy of the use of Bronchipret in the treatment of prolonged cough in a child with acute respiratory viral infection.

The article  presents  the  results  of Russian authors’ research  aimed at studying the  clinical efficacy of topical  drugs containing silver in treating  acute  serous adenoiditis  and sinusitis in children. The authors  noted  the efficacy and safety of the drug (silver proteinate and polyvinyl-N-pyrrolidone) in the complex treatment of inflammatory diseases  of the nose and paranasal sinuses in children. Clinical observation  was carried out – comparison  of two groups of 30 patients aged from 5 to 14 years, average  age 6 years 3 months, the groups included: 17 boys (56.7%) and 13 girls (43.3%), all children had adenoid  vegetations of the 1st-2nd degree. To assess the clinical efficacy of the drug, a control group of children with similar pathology was recruited, comparable  in age and sex (14 boys and 16 girls). The main group received the drug Sialor and irrigation therapy. The control group received local antibacterial drugs and decongestants according to age. At the beginning of treatment normal values of mucociliary transport  were not observed  in any patient  (0%) of the main and control groups. Disorder of the 1st degree  mucociliary transport  function was determined in 6 children (20%) of the main group and 7 children (23.3%) of the control group, 2nd degree  – in 21 children (70%) of the main group and 19 children (63.3%) of the control group, 3rd degree – in 3 (10%) patients of the main group and 4 children (13.4%) of the control group. In 7 days from the beginning of treatment normal values of MCT were observed in 28 patients (93.3%) of the main group and 9 patients (30%) of the control group, the disorder of MCT function of the 1st degree  had 3 patients (9%) of the main and control groups, the 2nd degree  was not in the main group and was revealed  in 18 patients (60%) of the control group, no disorder of MCT function of the 3rd degree  was revealed  (neither in the main nor control groups).

The average  time of MCT was: before treatment – 49 minutes  (main group) and 47 minutes  (control group), the 3rd day of treatment – 28 minutes (main group) and 36 minutes (control group). On the 7th day of the drug intake – 14 minutes (main group) and 21 minutes  (control group).

Thus, normalization  of MCT time was noted only in patients of the main group. On the 7th day of treatment with Sialor in the main group of children under examination,  nasal mucosa edema, nasal excretion  and adenoid  tissue size decreased, mucociliary transport parameters normalized, nasal breathing improved.

Sialor has a pronounced  anti-inflammatory and anti-edema effect, is well tolerated by patients and can be recommended for inclusion in standard  treatment protocols of patients with diseases  of the nasal cavity, paranasal sinuses.

Introduction. Gastrointestinal dysfunctions remain one of the most frequent problems in young children (0 to 2 years). Among the main causes are immaturity of the enzymatic system, morphology and function of the gastrointestinal tract, regulatory mechanisms of the nervous system, immune response. The composition of intestinal microflora in children in the first years of life is unstable and can easily change under the influence of unfavorable factors: feeding disorders, infectious pathogens, congenital defects, incomplete immunity. Modern scientific literature and clinical guidelines most accurately reflect the results of studies on the positive role of probiotics, for example, in the prevention and treatment of antibiotic-associated diarrhoea and acute diarrhoea of various genesis. The research base is so large that in 2012 the World Gastroenterology Organization developed an international practical guide to the use of probiotics in clinical practice, recommending the use of probiotics that meet certain criteria.

The review is devoted to evaluating the effectiveness and safety of treatment with probiotics containing Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 in children aged 0 to 2 years. Data from meta-analyses of the Cochrane library, PubMed, EMBASE, CENTRAL, and Russian open clinical randomized, placebo-controlled studies on the use of probiotics containing Bifidobacterium lactis, BB-12, and Streptococcus thermophilus TH-4 in pediatric practice are presented. Study objective. A comparative description of the most popular commercial drugs used for the treatment and prevention of functional disorders of the gastrointestinal tract in children aged 0 to 2 years, containing at least one of these strains, is presented.

Results. Evidence of the significance of probiotic therapy for various disorders of the gastrointestinal tract in children aged 0 to 2 years with complex drugs containing a combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 strains in children aged 0 to 2 years is presented. There is no reliable evidence of the effectiveness of multi-strain drug combinations in this age group.

Conclusion. The combination of Bifidobacterium lactis, BB-12 and Streptococcus thermophilus TH-4 is an effective and safe combination for the treatment of gastrointestinal disorders in children aged 0 to 2 years.

In the structure of infectious diseases in children, acute intestinal infections are only inferior to respiratory infections. The World Health Organization considers the effectiveness of only two therapeutic interventions to be absolutely proven: oral or parenteral rehydration and diet therapy. The main indicator that assesses the severity of a child’s condition and determines the tactics to be followed is the degree of dehydration. The World Health Organization recommends calculating the percentage of child weight loss during the disease: up to 3% is a mild degree, more than 9% is a severe degree of dehydration. From a practical point of view, a more convenient method is the Clinical Dehydration Scale - assessment of the child’s appearance, skin and mucous membranes: 0 points - no dehydration, 1 to 4 points - mild dehydration, 5 to 8 points - medium and severe dehydration. The key to the treatment of patients with acute gastroenteritis, regardless of the etiology of the disease, is oral rehydration, which should be prescribed as early as possible. In the complex of therapeutic measures for acute intestinal infections diet therapy takes an important place, as infectious diseases lead to significant violations of the nutritional status of a sick child. Organization of proper nutrition in children with acute intestinal infections is important not only in the acute period of the disease to correct nutritional disorders, but also to prevent functional disorders of the gastrointestinal tract, which often develop in the postinfectious period. The authors cite data from a systematic review (19 studies) showing the frequency of registration of postinfectious functional dyspepsia and irritable bowel syndrome, and give the results of assessment of tolerability and effectiveness of industrial food products in acute intestinal infections in children.

Pyoderma - a pustular skin disease caused by pyogenic bacteria, - golden staphylococcus and pyogenic streptococcus [1], belongs to the group of diseases of interdisciplinary character, because it is found in the practice of therapists, infectious disease specialists, pediatricians, surgeons, and others. [2]. Pyodermas are one of the most widespread dermatoses in Russia and abroad, accounting for 17 to 43% of the total structure of skin pathology [3]. Changes in macroorganism reactivity, pathogenicity of microorganisms and unfavorable influence of environment determine pathogenetic mechanisms of pyodermas development. In this article, each of the listed factors for the development of the skin infection process, clinical forms and complications are considered in detail. Pyodermas caused by S. aureus are the most frequently encountered in the practice of a pediatrician. To date, the clinical picture of staphylodermia in children is very diverse and includes both localized and widespread forms, and may be characterized by a generalized flow threatening the life of the patient. The most dangerous forms of pyodermas in pediatric practice are Ritter’s exfoliating dermatitis and Staphylococcal scalded skin syndrome. This article describes the general principles of diagnosis and treatment of pyodermas. Emphasis is placed on the description of antibacterial therapy under conditions of continuous growth of antibiotic resistance. Taking into account the high prevalence of the disease among children, the age features and variants of the course of pustular diseases in this group of patients are analyzed in detail.

In recent decades, there has been an increase in the prevalence of allergic diseases around the world. In industrialized countries, the prevalence of allergic rhinitis reaches up to 40%. Symptoms of allergic rhinitis can have a negative impact on patients’ quality of life, disturb sleep, and contribute to poor school performance. In allergic rhinitis, characteristic changes of the nasal mucous membrane epithelium are noted: metaplasia of goblet cells; exfoliation of the epithelium; decrease in number of cells with mobile cilia; loss of cilia by epithelial cells; infiltration of mucous membrane by inflammatory cells; thickening of basal membrane. Symptoms of allergic rhinitis include rhinorrhoea, obstructed nasal breathing, itching and sneezing. Modern classifications of allergic rhinitis take into account the etiology, duration and severity of symptoms and pathophysiological changes. Allergic rhinitis often debut in children under 6, which is often preceded by sensitization. The algorithm of management of patients with allergic rhinitis has four main methods that are necessary simultaneously: training of patients, including children and their parents, elimination of allergens, pharmacotherapy, immunotherapy. Elimination measures are very important for patients with allergic rhinitis, but it is not always possible to completely eliminate contact with the causal allergen. The choice of drug therapy depends on the form and clinical severity of the disease, the age of the patient (age restriction of the drug), the availability of the drug in pharmacies and its price, as well as the acceptability and satisfaction of the patient with the specific treatment method. Intranasal antihistamines have been shown to be highly effective in reducing symptoms such as sneezing, rhinorrhoea, itching, and to a lesser extent - nasal congestion. Intranasal antihistamines also have faster onset than oral antihistamines. Nasal congestion is most effectively facilitated by decongestants.

The article highlights  the present-day knowledge  on the role of leukotrienes in the pathogenesis of allergic diseases  of respiratory tract such as bronchial asthma in children. It presents  the mechanisms  of action that determine the points of application  and recommended indications  for use of Montelukast, a leukotriene  receptor  antagonist. The clinical trials showed  its efficacy and safety in children  of 2 years and over. Montelukast  is used  to prevent  daytime  and night-time  symptoms  of bronchial  asthma, bronchospasm caused by physical exertion  and cold air, treat bronchial asthma  in patients with hypersensitivity to acetylsalicylic acid, known as aspirin asthma, improve the daytime and night-time  symptoms  of seasonal  and/or  year-round  allergic rhinitis in children. Montelukast  is effective in bronchial asthma  caused by viral, specifically rhinovirus, infections, and in bronchial asthma combined  with allergic  rhinitis. It can be successfully  used  as monotherapy  in mild bronchial  asthma.  If situation  requires  to strengthen the baseline  therapy in moderate  and severe bronchial asthma, the alternative to increasing the dose of inhaled glucocorticosteroids would be addition of Montelukast to the complex therapy. The drug is well tolerated, side effects are quite rare. It must be admitted  that  today anti-leukotriene agents  have filled a specific market niche in the treatment of bronchial asthma and allergic rhinitis in children, have showed their clinical efficacy, especially in certain phenotypes of the disease, which proves that they would become widely used in the near future.

Bronchial asthma is the most common among chronic bronchopulmonary diseases with heterogeneity in symptom profiles. Despite the delivery of baseline anti-inflammatory iGCS therapy, including the subsequent staged addition of other controlling treatment methods, symptoms of the disease persist in 40% of patients. Lack of asthma control results in high morbidity, mortality and treatment costs, which justifies the search for new therapeutic options to improve control and reduce the risk of future exacerbations. Tiotropium, a long-acting anticholinergic bronchodilator, can be a good alternative in the therapeutic treatment of poorly controlled asthma in both adults and children. Several clinical studies showed the efficacy and safety of Tiotropium Respimat Soft Mist Inhaler at a dose of 5 mg in various asthma treatment options in children at 6 years old and over, who do not achieve asthma control with iGCS monotherapy at medium/high doses or with iGCS/LABA combination at medium/high doses. All asthma studies in children were conducted using Respimat Soft Mist Inhalers that generate an aerosol with a larger number of small particles, which ensures effective drug distribution and deposition in the lungs. The aerosol cloud velocity at the nozzle outlet of the inhaler is just 0.8 m/s, and the time period over which the aerosol is released is extended to 1.5 s. Moving slowly, aerosol particles more often avoid colliding with the posterior pharyngeal wall and tongue, which reduces the drug deposition in the oral cavity, significantly increasing the amount of active substance delivered to the air ways. 55% of the dose of tiotropium bromide is released in the form of particles with an optimal aerodynamic diameter, which guarantees a high level of lung deposition - 52% of the ex-valve dose.

Relevance. The article is devoted to a topical problem - treatment and prevention of atopic dermatitis in children, which occurs most often in the practice of pediatricians and dermatologists, taking leading positions among the diseases of childhood. The prevalence of atopic dermatitis among children’s population is about 20%. To treat atopic dermatitis, along with diet and drug therapy, the possibility of using probiotics is being discussed. Literary analysis and practical experience show the significant role of probiotics in the prevention and treatment of atopic dermatitis patients. Due to the unfavourable environmental situation, changing nutrition patterns and increasing percentage of children on complementary feeding, there is a steady increase in allergic diseases in children worldwide. Aim. The aim of the study was to justify the efficacy and safety of probiotics for the recovery of intestinal microbiocenosis in integrated therapy and prevention of atopic dermatitis in children.

Materials and methods. As materials of the study the review of the literature sources and clinical cases of complex treatment of atopic dermatitis with addition of probiotics Linex baby® to the basic therapy are presented. Clinical manifestations of the disease were assessed. Addition of probiotic Linex baby® contributed to a marked decrease in the typical clinical manifestations of the disease, the intensity of itching, and the resolution of rashes in a shorter period of time compared to patients in whom no probiotics were used.

Conclusions. Thus, the addition of probiotic Linex baby® to the basic therapy of atopic dermatitis contributed to a shortening of the period of exacerbation of the disease and marked improvement of the clinical picture of the disease, which confirms the prospects and feasibility of probiotic drugs in the treatment of this disease.

Objective: to study the effectiveness of compressor nebulizers in the treatment of respiratory tract respiratory infections in children of different age groups.

Material and methods: the main group consisted of 57 children - the average age was 9,7 ± 4,3 years, who were treated with nebulizer therapy using the compressor nebulizer during treatment, 32 children were included in the control group - the average age was 10,8 ± 4,7 years who have not been administered inhalation therapy. Along with conventional therapy, children of the main group underwent inhalation therapy using the compressor nebulizer in two modes, depending on the clinical symptoms of the patient: for bronchitis, the course was 5-6 days, for pneumonia - up to 8-9 days. Using the compressor nebulizer, physiological saline, ipratropium bromide, berodual, pulmicort, lasolvan were injected in a constant flow mode, and in cases of diagnosed rhinosinusitis, a pulsed aerosol delivery regime was used.

Results: when analyzing the clinical picture, it was revealed that in all patients the process took a torpid course with prolonged unproductive cough, viscous sputum and persistently retained auscultatory data with insignificant changes in the general blood test. Analysis of the obtained data on the use of various treatment regimens for nosological forms of diseases in the examined children showed that in the patients of the main group the clinical symptoms of a combination of pulmonary diseases and rhino-sinusitis were stopped when applying the pulsating delivery regimen in terms of 6,1 ± 0,7 days (p<0.05), in cases of isolated variants of bronchitis and pneumonia, the use of a constant flow regime reduced the hospitalization of children to 82 ± 7,4% of the standard indicators of bed days.

Conclusion: our own studies on the effectiveness of inhalation therapy in children revealed a wide range of clinical effects using the compressor nebulizer, regardless of the age of the patient: the clinical symptoms of a combination of pulmonary diseases and rhinosinusitis were stopped by using a pulsating delivery regimen in a shorter time compared to the control group without inhalation therapy, which reduced the hospitalization of children in the hospital.

Relevance: immunotropic effects of cholecalciferol are caused by vitamin-D-induced synthesis of antimicrobial peptides (AMP), in particular р-defensins. There are very few studies in pediatric clinical practice confirming the effect of vitamin D availability on AMP synthesis.

Aim: analysis of the correlation between vitamin D availability and AMP production and assessment of the effect of cholecalciferol medication intake on defensin synthesis in young children.

Materials and methods: 108 healthy children aged 1 month to 3 years were examined, of which 34 (31.5%) were adequately provided with vitamin D (calcidiol level over 30 ng/ml), 40 (37.0%) with insufficiency (20 to 30 ng/ml), 27 (25.0%) with vitamin D deficiency (10 to 20 ng/ml) and 7 (6.5%) with severe deficit (less than 10 ng/ml). In the presence of hypovitaminose of vitamin D the monthly course of cholecalciferol in doses of 2000-4000 lU/day was prescribed for correction, and in normal provision -prophylactic administration of 1000 IU/day. The indices of 25(ON)D, β1- and β2-defensins were determined three times.

Results. On natural feeding, the rates of β1-defensin are 2.3 times (p<0.05) and β2-defensin 7.5 times (p<0.001) higher than those of children on artificial feeding.

Against the background of the correction course, the level of β1-dephensin increased from 3.3 [2.24-5.85] pg/ml to 3.7 [2.25-6.32] pg/ml (p = 0.05), and β2-dephensin from 240.7 [86.77-686.64] pg/ml to 514.2 [468.19-1104.98] pg/ml (р<0.001). The treatment doses of cholecalciferol contributed to a more significant increase of β1- and β2-defensin; a direct correlation relationship (r = 0.34, p<0.05) was found between the daily dose of vitamin D and the increase of β2-defensin.

Reception of the prophylactic dose of cholecalcipherol of 1000 lU/day during 6 months was accompanied by further increase of AMP production - the level of β1-defensin increased 2.4 times (р<0,001), and the level of β2-defensin - 2.5 times (р<0,001) in comparison with the initial values.

Conclusions. Administration of cholecalcipherol preparations in children of early age is accompanied by an increase in the level of в-defensins - the most important factors of congenital immunity.

Breastfeeding is one of the main components of the health and optimal growth of a newborn child. The article presents recommendations on breastfeeding support in case of lactostasis and mastitis, as well as the role of neonatologist and pediatrician in prevention and preservation of breastfeeding when mother faces problems, lactation support in case of lactational mastitis development in mother. Prolonged lactostasis may be the cause of mastitis - breast inflammation, which is characterized by painfulness, swelling and redness of the breast. If the symptoms persist for 12-24 hours, in conditions of impaired milk evacuation the growth of microorganisms occurs, which leads to infectious lactation mastitis, which may be complicated by an abscess. The main risk factors of mastitis development, various methods of diagnostics, lactostasis and lactation mastitis prophylaxis are considered, and the special role of breastfeeding advice to the mother is emphasized. Data on modern and prospective method of lactostasis and mastitis prophylaxis - application of the product Lactanza based on Lactobacillus fermentum CECT5716 are presented. The use of probiotic bacteria was proposed as a method of modulating the immune system of a developing child to reduce the risk of immune aberrations and improve the immune protection of his or her body. According to the published data, there was a 51% reduction of mastitis frequency in the group that received probiotic Lactobacillus fermentum CECT5716. Therefore, it is advisable for women who start breastfeeding with increased risk factors for lactostasis and mastitis to recommend taking Lactobacillus fermentum CECT5716 probiotic immediately after childbirth during the first month of breastfeeding. The drug is also indicated for treatment of lactostasis in breastfeeding women to prevent mastitis from developing and after antibiotic therapy of mastitis to restore breast microbiome and lower the risk of relapse.

Unwanted drug reactions of the gastrointestinal tract (GIT), often with the development of antibiotic-associated diarrhoea (AAD), are the most frequent adverse effects of antibacterial therapy in outpatient practice. This review presents the most current data on antibiotic-associated intestinal lesions. It provides up-to-date information on the epidemiology and etiology of microbial factors of AAD and pseudomembranous colitis.

The authors cite clinical forms of AAD, which range from idiopathic with a picture of enteritis to pathogen-specific AAD (antibiotic-associated colitis). A comprehensive approach to AAD verification and patient management tactics makes it possible to significantly reduce the number and severity of possible complications. AAD, including C. difficile-associated diarrhoea/colitis, should be suspected in any patient with diarrhoea who has received antibiotics in the previous 2 months. In addition to clinical signs, laboratory tests confirming clostridial infection should be evaluated. The article presents the algorithm of the comprehensive approach to the treatment of antibiotic-associated diarrhea (AAD), which along with the use of metronidazole and vancomycin places a high priority on the probiotics, which not only prevents relapse, but also protects from this pathology.

The article presents general characteristics of probiotic preparations, mechanisms of action of probiotics: antagonistic influence on pathogenic and opportunistic bacteria of microbiota, strengthening of mucous barrier of gastrointestinal tract, and also influence on modulation of immune response, as a result of which the chain of mechanisms of immunological protection starts. On the basis of publications of domestic and foreign researchers, the possibilities of using various probiotic strains of bacteria, and in particular, the prospects of using Lactobacillus reuteri, have been considered.

Osteoporosis is one of the significant problems of pediatrics, due to numerous factors and the high prevalence of this pathology, the characteristics of the onset of diseases in childhood, as well as the need for early changes in bone mineral density to prevent fractures. Of particular interest are new technologies for assessing the main indicators of phosphorus-calcium metabolism and metabolism in bone tissue and their lack of information in routine clinical practice.

The purpose of this publication is to present generalized data on clinical and laboratory parameters and early detection of osteoporosis in children and adolescents.

Osteoporosis is a systemic metabolic disease of the skeleton, characterized by a decrease in bone mass, microstructural remodeling of bone tissue, increased fragility and fragility. Depending on the pathogenetic mechanism, two types of diseases are distinguished: primary (without concomitant pathology or medications that adversely affect bone metabolism) and secondary (endocrine, nutritional, iatrogenic, etc.). The main diseases should be considered a violation of the balance between bone resorption and osteosynthesis, when it can occur for a long time latently and often manifests itself accidentally during an X-ray examination in connection with another somatic pathology.

The clinical manifestations of osteoporosis in children are conditionally divided into 2 groups - extra-bone (tissue calcium deficiency) and bone (decreased mineralization and impaired bone architectonics).

The review presents diagnostic criteria for osteoporosis based on osteodensitometry (determination of bone mineral density), analysis of markers of bone metabolism (exposure to osteoclasts and osteoblasts), assessment of mineral metabolism (calcium and phosphorus in the blood, urinary excretion), and additional research methods (provision with vitamin D, hormonal status, molecular genetic studies, x-ray imaging, etc.).

Special attention is paid to the importance of the anamnesis based on special questionnaires, according to which calcium deficiency can be identified and risk groups for violation of bone mineralization can be identified.

The publications indicate the main laboratory and instrumental markers of osteoporosis in children with a change in the Z-criterion of more than 2 SD (according to osteodensitometry), the level of biochemical parameters of bone resorption and formation (c-terminal-telopeptide, hydroxyproline, osteocalcin, acid alkaline phosphatase), etc.), increased excretion of calcium in urine.

Professional and scientific activity of the doctor of medicine Alexander Andreevich Russow, the founder of department of children’s diseases  at Imperial clinical institute  of the Grand duchess Elena Pavlovna is presented in article.