Introduction. Incomplete breast emptying is the main cause of lactostasis, which can contribute to the development of mastitis. The article discusses the issues of prevention and treatment of lactostasis in breastfeeding mothers in the district covered by childhealth care: how to arrange breastfeeding, expression of breast milk, regime issues from the baby’s first days, as well as present-day knowledge on breast milk microbiota dysbiosis and an option of probiotic therapy. Clinical cases are presented.

Clinical case 1. A breastfeeding mother found breast lumps on the one side 2 weeks after her labour. Lactostasis was diagnosed, it was caused by inappropriate breastfeeding technique. The breastfeeding mother was provided with the recommendations for proper performance of breastfeeding technique and prescribed the drug therapy: ibuprofen 400 mg once at fever ≥ 38.5 ºC and Lactobacillus fermentum CEST5716 – 1 capsule once daily. On the 3rd day, her health state significantly improved, the pain reduced, the temperature returned to normal, the breast lumps practically disappeared, on the 5th day the pain and breast lumps completely disappeared.

Clinical case 2. A breastfeeding mother, first labour, 2 months have passed since her labour, exclusively breastfeeding on demand, complaints of pain in the left breast, local hyperemia 3 x 3 cm occurred, no breast lumps, local pain elicited by palpation, fever of 37.2 ºC. The breastfeeding mother was diagnosed with lactostasis, she was provided with recommendations for the arrangement of breastfeeding and expression of breast milk; not proscribed with antibacterial therapy, but the therapy with Lactobacillus fermentum CEST5716, 1 capsule once daily for 1 month. A day later, her health state improved: the pain reduced, the hyperemia disappeared, her body temperature returned to normal. The patient was recommended non-drug measures for preventing lactostasis and continuous administration of Lactobacillus fermentum CEST5716 – 1 capsule daily for 1 month.

Clinical case 3. A breastfeeding mother detected daily lactostasis in her right breast 3 months after her labour. It might had been caused by chest contusion before the onset of the 1st episode of lactostasis. Medical examination revealed calcifications in her breast duct. Against the background of non-drug therapy, the patient adminstered Lactobacillus fermentum CEST5716 – 1 capsule daily, which resulted in a positive effect in a week’s time. The follow-up observation showed that lactostasis completely resolved without relapses in a 1.5-months’ time.

Сonclusion. The correct breastfeeding technique is key to the prevention of lactostasis and mastitis, and the use of probiotic therapy Lactobacillus fermentum CEST5716 is an effective and safe drug treatment.

Introduction. The use of in vitro fertilization methods plays an important role in overcoming the childlessness of families, but they must be combined with the success of nursing premature newborns to increase the effectiveness of assisted reproductive technologies. Children with very or extremely low body weight are at risk of increased rates of infant mortality and disability. The study of the state of health and the analysis of the psychomotor/neurological status of such children is extremely important due to the study of the possibilities of reducing the frequency of negative outcomes.

Aim. A study during the first 3 years of neurological/psychomotor development in premature infants diagnosed with extremely low/very low body weight, born as a result of in vitro fertilization and naturally.

Materials and methods. Studies of neurological/psychomotor development in premature infants have been carried out. The study included 189 infants diagnosed with prematurity at birth. The studies were carried out on the basis of the intensive care unit and the department of prematurity and neonatal pathology at the Republican Children’s Clinical Hospital (Ufa). Then, for 3 years, regular observation was carried out in the follow-up room in the same institution. Dynamic assessment of neurological and psychomotor status was performed using the Clinical Adaptive Test and Clinical linguistic and auditory milestone scales, as well as Gross Motor testing.

Results and discussion. It was found that the incidence of neurological morbidity related to developmental delay is significantly higher in children born as a result of in vitro fertilization than in those conceived naturally. Thus, the number of children lagging behind in speech development at the age of up to 1 year is 59.1/59.6 and 52.1/52.3% when diagnosed with very low and extremely low body weight.

Conclusion. The dynamics of the average coefficient of speech development in children conceived artificially did not reach (less than 75) normal values by the age of 3, and in the control group, the coefficient of speech development was normalized. There is no significant difference between very low and extremely low body weight children.

Feeding disorders in young and preschool-age children are a very important problem in modern pediatrics due to the high prevalence and negative consequences for the health and development of children due to chronic nutritional deficiency. Correction of feeding disorders in young children is a long-term process, during which it makes most sense to set short-term goals to reach a favourable outcome in the perspective.

In the initial phase, the primary goal is to identify warning signs (“red flags”) that pose a risk to children. The prevailing disorders that make feeding difficult are food selectivity, decreased appetite and fear of eating. Treatment should be complex and aimed, first of all, at the psychological side of the problem, with simultaneous correction of nutrition if necessary. The article presents a modern approach to the management of patients with the most common difficulties in feeding in outpatient pediatric practice. This approach provides for the exclusion of alarming signs of somatic and psychoneurological pathology, assessment of oral motor skills, the nutritional status of children and the identification of pathological types of feeding.

At present time, there are four main feeding styles: mindful (authoritative), supervising (authoritarian), indulging and uninvolved. Therapeutic tactics depend on the leading disorder of the eating behaviour. Recommendations for appetite correction depend on the underlying cause of its disorder. Providing the child with the necessary nutrients by prescribing “feeding insurance” through the inclusion of isocaloric food products containing native protein and micronutrients into the food ration, which enables the parents to reduce anxiety and avoid the use of forced feeding approaches.

Infant colic is an inconsolable cry of unknown cause in healthy babies. Observed in about 20% of infants, the most common reason for seeking medical attention at an early age. Colic is associated with maternal stress and the most significant risk factor for shaken baby syndrome, and can also cause premature breastfeeding termination. Informing and supporting parents with crying babies is increasingly important, and some guidelines recommend it as a cornerstone of intervention in families with a baby with colic. Because of the high quality randomized trials, none of the behavioral, dietary, pharmacological, or alternative interventions can be recommended as the only effective treatment. Unfortunately, many mothers around the world associate their child’s anxiety with “dietary mistakes” in their diets, leading to further dietary restrictions as a preventative measure. At the same time, according to the recommendations of the experts of the IV Rome Criteria, dietary restrictions for infant colic in breastfeeding mothers can be recommended only if there is a suspicion of suspicion of tolerance of cow’s milk protein. It is also possible for any type of feeding to prescribe fennel and chamomile preparations, in particular, in the form of aqueous infusions, and when breastfeeding it is desirable to use a bottle and excessively large volumes, which can reduce the amount of milk in a woman. It is desirable to exclude unreasonable dietary restrictions in breastfeeding mothers by excluding the so-called “gas-forming products” and ineffective therapy, in particular simethicone preparations.

Under current conditions of life with its intense rhythm, launch of new technologies, lack of time, both physical and mental workloads on a person increase. In these days, doctors more often report patients’ complaints of undue tiredness: they don’t feel rested even after a holiday and/or sleep. Today we tend to detect such manifestations not only in adults. Children also become less stress-resistant, more irritable due to an overabundance of information, and are prone to frequent infections. How can we help the growing generation cope with the increasing workloads? There’s no question, everyone knows about the need to use vitamins, but the right choice is not always possible. There are currently many single-component vitamin supplements and vitamin-mineral complexes. Some people prefer not to use industrially produced vitamins, but those contained in the natural products - fruits, vegetables, berries. But unfortunately, such a diet does not include the group of fat-soluble vitamins - A, D, E, K. In addition, far from everyone understands the importance of eating fatty acids. This article is devoted to the feasibility of additional intake of fat-soluble vitamins, polyunsaturated fatty acids (omega-3), their role in the body and deficiency symptoms. It has been established that the polyunsaturated fatty acid deficiency in the early period of life may trigger the development of cardiovascular disorders, problems associated with high cholesterol content, visual impairment, a drop of immunity, learning difficulties, and nervous system disorders in children in later years. Particular attention is paid to the omega-3 polyunsaturated fatty acid supplement combined with vitamins (A, E, D3), which enhance the positive effects. In addition, it does not cause negative emotions since it has a fruity taste.

Teething of temporary teeth in children is a natural and physiological process. However, in some cases, it can be accompanied by numerous unpleasant symptoms, such as fever, decreased appetite, anxiety in the child, sleep disturbance and indigestion. Knowledge of the physiology of teething, anatomical and physiological characteristics and factors affecting the process of teething of temporary teeth in children is important for the timely provision of assistance to such children. The article describes in detail the duration of teething, mechanisms, age and constitutional peculiarities during teething, the causes of pathological teething (dentitio difficiLis). The authors provided symptoms and differential diagnosis of delayed eruption of the teeth - the teething syndrome and presented methods and techniques for reducing pain intensity. The advantages and disadvantages of the main drugs that are used to treat the teething syndrome are also outlined: anti-infLammatory drugs (acetaminophen, ibuprofen), topical drugs (gels, ointments), homeopathic preparations. Particular attention is paid to the advantages of homeopathic combination preparations, which are highly effective, safe and provide a minimal pharmacological Load on the child’s body. CLinicaL cases of children aged 6.5 months and 8 months with teething symptoms and the use of a homeopathic combination preparation are presented. Positive changes were observed: heaLth improvement, anxiety reLief, fever reLief, appetite improvement. This case has demonstrated how non-drug measures, mother support and homeopathic preparations can effectiveLy heLp treat the baby’s teething syndrome without using non-steroidaL anti-infLammatory drugs and topicaL preparations.

The authors presented an overview of the existing data on inhalation therapy with antibacterial drugs in acute rhinosinusitis and exacerbation of chronic rhinosinusitis in children. The overview includes general information about the etiology and features of the course of acute rhinosinusitis. It also contains indications for systemic and topical antibiotic therapy in acute rhinosinusitis specified in the Russian clinical guidelines. The advantages of using a combination preparation of thiampheni-col and N-acetylcysteine by inhalation therapy for acute rhinosinusitis in children and adults are considered separately. A clinical case of a 15-year-old female patient with complaints of persistent rhinitis over the past 4-5 years is discussed. Historical information: a patient had a runny nose over the last 4-5 years: persistent, viscous nasal discharge with moderate nasal congestion. Nasal symptoms worsened with episodes of acute respiratory illness, and nasal discharge became mucopurulent. The child was preliminarily diagnosed with chronic rhinosinusitis (incomplete remission), moderate course. To reduce the severity of the symptoms of the disease, which were present at the time of examination, the following were recommended: daily one-to-two irrigation of the nasal cavity with slightly hypertonic (1.5-3%) solutions of sea water, followed by a toilet of the nasal cavity; in case of episodes of colds with the appearance of mucopurulent secretions, inhalation therapy in a pulsating mode of the inhaler with a solution of thiamphenicol and N-acetylcysteine at a dose of 500 mg once a day (in the first half of the day) for the next 10 days and further; the use of a nasal spray of mometasone furoate, 200 mcg per day during inhalation therapy for another 3 weeks. At the follow-up examination after 10 days of treatment, the patient reported a significant decrease in the severity of nasal symptoms, which coincided with an improvement in the rhinoscopic status. It can be concluded that the use of topical antibacterial drugs by inhalation therapy for acute rhinosinusitis, despite all its advantages, is not an equivalent substitute for systemic antibiotic therapy in the treatment of severe and especially complicated forms of the disease. The inhalation therapy is recommended in the presence of indications for systemic antibiotic therapy, since it is an auxiliary method of treatment, the action of which is aimed at enhancing the effect of systemic antibiotics.

Introduction. Clinical manifestations of rhinitis have a negative impact not only on the physical, social, and psychological health of children, but also on their parents, especially in families with a first child. Nasal congestion, nasal breathing difficulty cause problems with sleep and feeding.

Aim of the study. To estimate the occurrence of rhinitis in children under two years old in the outpatient practice of otorhinolar-yngologists, to consider features of the course and differential diagnostics of various rhinitis types, to evaluate the effectiveness of nasal irrigation-elimination therapy in the treatment of acute rhinitis symptoms.

Materials and Methods. Between September 2020 and July 2021, 220 patients between 0 to 18 years were managed: preschool-aged patients comprised 120 patients (54.5%), of whom 27 patients under two years old had symptoms of rhinitis, including those with symptoms lasting more than two weeks.

Results. Among the patients referred to us, infectious rhinitis was diagnosed in the majority of cases - in 18 patients (66,7%), which can be explained not only by the timing of the study but also by the highest prevalence of this pathology among the diseases of the nasal cavity. Allergic and non-allergic rhinitis occurred in only 4 (14.8%) and 5 (18.5%) persons, respectively. Symptomatic irrigation therapy with saline solutions is just as necessary for young children as it is for older children and adults. Some difficulties in nasal cavity care during rhinitis are the anatomical narrowness of the nasal passages and lack of blowing skills in young children. In these situations, preference should be given to gentle, non-traumatic, gentle aspiration with prior irrigation of the nasal cavity with an isotonic saline solution. When a nasal aspirator was used, there was a decrease in the duration of nasal discharge during the illness and a reduction in the duration of the disease.

Conclusion. Rhinitis in young children is a common but underestimated problem. Clinical manifestations are more often associated with typical symptoms: nasal congestion, discharge, nasal breathing difficulty, and sneezing. The use of irrigation-elimination intranasal therapy with the use of a nasal cavity aspirator can reduce the timing of clinical symptoms of rhinitis and reduce the overall duration of the disease.

Introduction. Cough is the most common manifestation of respiratory infections of the upper and lower respiratory tract and indicates impaired mucociliary clearance. The cause of cough must be determined to choose the management tactics for children with cough. The most commonly used mucoactive drugs liquefy sputum as a result of a direct action of the components on the tracheobronchial secretion and/or mucosa of the respiratory tract. Given the mucoactive effect of hypertonic salines, we conducted an open clinical study of the effectiveness of 3% hypertonic saline with hyaluronic acid in acute bronchitis in children.

Aim of the study. To evaluate the clinical effect of 3% hypertonic saline with hyaluronic acid in acute bronchitis in children.

Materials and methods. Clinical efficacy and safety of 3% hypertonic saline with hyaluronic acid in 50 patients aged 3 to 12 years old with acute bronchitis were evaluated in the dynamics on the 1st, 3rd, 7th days of treatment with the score assessment of symptoms (cough, stuffy nose, auscultation data) and an indication of adverse events (if any).

Results. Improvement of condition was noted in most patients by the 3rd day of therapy (mean score 1.88 ± 0.3), temperature normalized in all patients, manifestations of rhinitis decreased. By the 5th day of treatment, the intensity of cough did not exceed 1 point in all patients (0.7 ± 0.14 points). According to the patient’s diary data, by the 7th day of treatment 74% of the children had no cough. On the 7th day of treatment, some children had a rare residual cough (0.36 ± 0.06 points), minor rhinitis (0.16 ± 0.1 points). No rales were heard in the lungs in all patients, rigid breathing was heard in 11 patients (mean score 0.22 ± 0.05).

Conclusions. The conducted study demonstrated that 3% hypertonic saline with hyaluronic acid is an effective drug in the treatment of cough in acute bronchitis in children.

Introduction. At the same time, in the last decade, pediatricians have increased interest in the study of the therapeutic effect of bacteriophages in infectious diseases of rhinolaryngological organs.

Objective. The analysis of results of the use of inhalation bacteriophage therapy in children with acute tonsillitis, on an outpatient basis.

Materials and methods. Examined 212 children from 4 to 15 years old with acute tonsillitis. Conducted general clinical research, pharyngoscopy, bacteriological examination of a smear of tonsils. Bacteriophage therapy carried out using the Pyobacteriophage complex liquid (PCL).

Results. In the course of an objective clinical analysis, on the day of seeking outpatient care, patients noted asthenovegetative disorders in all patients (100%), in the form of general weakness (96.8%), loss of appetite (94.8%), and headache (92.5%). During the examination, cervical lymphadenopathy (98.6%), tonsil hyperemia and hyperplasia (98.1%), and exudates (48.1%) noted. It revealed that the main causative agents of acute tonsillitis in children were the bacteria Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae, with different relative proportions (from 24.2% to 59%). Inhalation bacteriophage therapy carried out from the first days of the disease. Against the background of therapy, it was noted - a decrease in swelling in the tonsils by 2-3 days with a decrease in general intoxication signs. On the 6th day from the beginning of bacteriophage therapy, asthenovegetative disorders stopped 2.2 times faster in relation to patients who did not receive bacteriophage therapy, against the background of a decrease in the manifestation of objective clinical signs of the disease.

Conclusion. The use of inhalation bacteriophage therapy as part of the conservative treatment of acute tonsillitis in children contributes 1.4 times to the fastest relief of the acute period and an improvement in the subjective assessment of well-being is 25% higher concerning the comparison group.

Invasive technologies in the complex treatment of tuberculosis in children and adolescents have a long history, which began in the pre-antibiotic period. This is the way of their improvement from independent use of artificial pneumothorax and pneumoperitoneum to the use of these techniques in the complex treatment of respiratory tuberculosis during the development of chemotherapy for the disease. New technology uses valvular bronchial blocking. That procedure creates hypoventilation and atelectasis in the affected region of the lung with preservation of drainage function of the blocked bronchus and destruction cavity, which allow reducing indications for surgical treatment as a method with a high level of injury rate. The approaches to surgical intervention in children and adolescents with respiratory tuberculosis have also changed. It is also part of the comprehensive treatment of the disease. Minimally invasive accesses under the control of video-assisted thoracoscopy are used, which significantly reduced the risk of surgery and increased the immediate efficiency of surgical treatment. New technologies combined with all types of surgeries are being widely developed: electro- and argon plasma coagulation and pleurodesis, vaporization of the tuberculous lesion, and encapsulated pleura by high-energy CO2 laser, new materials (polypropylene implants) are used. Further development of invasive technologies with multiple and extensively drug-resistant Mycobacterium tuberculosis, to children and adolescents compensates for the lack of efficiency of conservative chemotherapy and is an urgent problem at the present stage of pediatric phthisiology.

This article discusses the problem of cough in children as one of the symptoms of a complicated course of acute respiratory infection. The data on the peculiarities of the course of cough in children depending on the cause, the level of damage, and age are presented. Virulence of infectious agents, immune status, and the child’s constitution may influence the development of local inflammation covering the tonsils, adenoids, pharynx, larynx. The study of respiratory problems in children remains relevant due to the need to improve therapy tactics and rehabilitation after an infection. Acute upper respiratory tract infections affect about 23 million children annually, which is 52% of the total morbidity of children and adolescents aged 0-17 years. Various therapeutic options are discussed. Thus, central drugs have a direct antitussive effect and cause inhibition of the cough center: narcotic antitussive drugs, such as codeine-containing drugs; non-narcotic antitussive drugs (glaucine hydrochloride, butamirate citrate, etc.). Peripheral medications reduce the sensitivity of cough afferent receptors and act on the mucosa of the airways. There are drugs of combined action, as well as bronchodilators, mucoactive drugs, and chest cough sets. Particular attention is paid to the multicomponent drug, which has a complex anti-inflammatory, antitussive and antimicrobial action in cough. The results of various foreign and domestic studies on the efficacy and safety of this drug are given. The necessity of early treatment is emphasized to improve the quality of life of patients and to prevent the formation of chronic bronchial processes. It is concluded that for the treatment of children it is necessary to choose the best drugs. It should be drugs that have proven efficacy and safety, and most importantly - they should be registered for use in the Russian Federation.

The article notes features of the last epidemic season (2020-2021) in the form of extremely low activity of influenza viruses with SARS-CoV-2 remaining dominant in the etiological structure of acute respiratory viral infections. Presented own data indicating the heterogeneity of SARS-CoV-2 (Alpha, Delta, B.1.1.317, B.1.1.397, B.1.1.523) isolated from hospitalized patients was noted. An increase in the etiological role of bocavirus, alpha-coronavirus and metapneumovirus with a decrease in the frequency of parainfluenza viruses, adenoviruses, rhinoviruses and respiratory syncytial virus was established. An unusual shift of the period of maximum activity of respiratory syncytial virus to the 20th week was noted. Attention is paid to the need during the ongoing pandemic COVID-19 to fully immunize children as part of the National Immunization Calendar, also emphasized the role of mandatory annual vaccination against influenza. It is noted that the maximum protective effect of immunoprophylaxis of influenza acute and recurrent respiratory infections can be achieved with a combination of vaccination with bacterial lysates. The article presents a review of the literature and our data demonstrating the safety, good tolerability, and high clinical and immunological efficiency of polyvalent mechanical bacterial lysate for the prevention of acute and recurrent respiratory infections in children. It is shown that the use of polyvalent mechanical bacterial lysate during the prevaccination period makes it possible to substantially reduce the frequency of intercurrent infections, which reduces the number of temporary medical withdrawals and increases the coverage of vaccinations against influenza in organized groups to 85.1%. The role of trained immunity as one of the possible mechanisms providing nonspecific immunoprophylaxis during influenza vaccination and the use of bacterial lysates is discussed.

Respiratory diseases persistently lead in the structure of general morbidity in both children and adolescents. Acute respiratory infections are the most common among them. Interest of pediatricians to phytotherapy is not accidental and is due to the fact that it has a mild therapeutic effect, enhances the effectiveness of complex therapy, has few side effects. Of particular interest are herbal remedies containing ivy extract (Hedera helix), the active ingredients are mainly found in ivy leaves, they are biologically active substances: Triterpene saponins, glycosides, also contain carbohydrates, essential oils, steroids, phenolcarboxylic acids, coumarins, flavonoids, carotenoids, tocopherols (vitamin E), B and C vitamins, tannins, phytoncides. Ivy preparations are prescribed as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract due to their proven multidirectional effects: secretolytic, mucolytic, bronchospasmolytic. They also have anti-inflammatory, reparative, antioxidant effects.

This article presents a clinical example of an officinal ivy-based preparation used in the treatment of a 3.5 year old patient diagnosed with acute respiratory viral infection. Temperature increased to 38 °C, runny nose; on the second day of illness the temperature remained subfebrile and a dry cough appeared. Nasal vasoconstrictor drops and oral acetylcysteine were prescribed, but there was no relief. On the third day of the illness, against the background of subfebrile temperature, the cough persisted, single dry rales were heard in the lungs, wheezing appeared during physical exertion. Acetylcysteine was withdrawn and replaced by ivy-based drops (16 drops 3 times a day orally after meals in a small amount of water). After 2 days the cough was moist, the sputum was easily expectorated, the wheezing in the lungs was almost gone, there was no more wheezing and the temperature was normal. By the sixth day of treatment the cough was gone and the girl had almost recovered. Nevertheless, Gedelix was continued for another 4 days. Prospective results and detailed study of the effects of herbal preparations on the basis of ivy extracts served as the basis for their recommendation as a complex therapy of cough in children.

Introduction. Tonsillopharyngitis often accompanies the course of acute respiratory infections in children (up to 12-15%). The use of systemic antibacterial drugs for viral etiology of the disease has not been shown, therefore, the interest of researchers in the use of herbal products is increasing. In numerous clinical trials conducted around the world, the liquid extract of the roots of Pelargonium sidoides EPs® 7630 has been shown to be effective and safe in the treatment of acute respiratory infections, acute tonsillopharyngitis, rhinosinusitis, acute bronchitis in adults and children.

Objective of the study: assessment of the efficacy and safety of the drug EPs® 7630 (Umckalor) in acute tonsillopharyngitis of non-streptococcal etiology in children 2-6 years old on an outpatient basis.

Materials and methods. A prospective analysis of cases of treatment with Umckalor for acute tonsillopharyngitis of non-streptococcal etiology against the background of acute respiratory infection in children 2-6 years old (n = 23, group 1) was carried out.

The comparison group (2) consisted of children receiving standard therapy (n = 22). Systemic antibiotics and antiviral drugs were not used in all patients. The study was conducted over 6 months (2019-2020). The research results were processed using the Statistica 7.0 software (StatSoft, USA).

Results and discussion. Therapy with Umckalor in children with acute tonsillopharyngitis contributed to the elimination of the main clinical symptoms of the disease on the 4th day of treatment (efficiency was 69.9%, p < 0.05). The most persistent symptom was hyperemia of the tonsils and oropharynx. The period of convalescence occurred 2 days earlier than in the children of group 2 (p < 0.05). Umckalor was well tolerated, no side effects of the drug were identified.

Conclusions. The drug Umckalor can be recommended for monotherapy for 7 days in patients with acute non-streptococcal tonsillopharyngitis on an outpatient basis with mild and moderate disease.

The urgency of Epstein-Barr virus infection is explained by wide circulation of Epstein-Barr virus among children and adults, its tropism to immunocompetent cells with lifelong persistence after primary infection and polymorphism of clinical manifestations from subclinical forms, infectious mononucleosis to formation of oncological, autoimmune hematological diseases.

Persistence of Epstein - Barr virus Leads to suppression of cellular immunity, decreased production of interferons and nonspecific protection factors, which contributes to reactivation of persistent infection, most often without mononucleosis-like syndrome, and the appearance of atypical mononuclears in blood with the formation of lymphoproliferative, intoxication, astheno-vegetative syndrome, long-term subfebrile condition, which dictates the need for immunocorrective therapy. This article presents a clinical case describing and analyzing the course of a chronic Epstein-Barr virus infection in a preschool child (5 years 8 months) with a pre-morbid background. Episodes of reactivation of chronic persistent infection occurred under the mask of acute respiratory infection with lymphoproliferative syndrome, purulent tonsillitis, purulent adenoiditis. Therapy, including antibiotics, short-course antiviral agents, bacterial lysates, and physiotherapy, had a temporary and short-lived effect. meglumine acridonacetate. The described clinical case demonstrates the effectiveness of the inclusion of meglumine acridonacetate, which has antiviral, immunomodulatory and anti-inflammatory effects, in the complex treatment of Epstein-Barr virus infection, This allowed to obtain fairly rapid positive clinical dynamics of relieving intoxication and febrile and lymphoproliferative syndromes in the acute period, and subsequently - astheno-vegetative syndrome and achieve the transition of active chronic Epstein - Barr virus infection into a latent form.

In current conditions, traditional antiallergic therapy for atopic dermatitis does not always help to achieve timely remission, so the development of effective therapy methods is a very topical task. The promising direction of probiotics in combination with prebiot-ics, including the original mono-strain synbiotic Lactobacillus rhamnosus LGG® at optimal high concentration of 4 х 109 CFU and prebiotic fructooligosaccharides 800 mg is drawing attention. This article presents data in a clinical case format. This article presents its own data in a clinical case format. The clinical case 1 showed that administration of synbiotic in 1 sachet 1 time per day for 14 days in the composition therapeutic diet during the period of complex antiallergic therapy to a 5-month-old child with a moderate course of atopic dermatitis resulted in a pronounced positive dynamics and achievement of remission on the 10th day after the treatment start against normalization of stool. Prior to this, the child had received only antiallergic therapy, which led to improvement of the skin process, but full clinical remission could not be achieved. Clinical case 2 showed the effectiveness of synbiotic in the composition therapeutic diet during the period of comprehensive antiallergic therapy in a 10-month-old child with a mild course of atopic dermatitis. From day 2 of treatment there was a significant positive dynamics in the skin process. On day 12, remission was achieved: relief of acute inflammatory elements on the face and at the elbows on the background of increased lactobaciUus content from 104 to 106 CFU/g of feces and bifidobacteria from 107 to 109 CFU/g of feces. Clinical case 3 demonstrates the efficacy of synbiotic in 2 sachets once a day for 14 days in a 9-year-old child with atopic dermatitis of moderate severity with a continuously relapsing course. From the 4th day of the beginning of the complex therapy positive dynamics in the skin process was noted, on the 14^th day partial remission was achieved: erythematous elements on the back and extremities were eliminated, signs of hyperemia, infiltration and scratching disappeared against the background of stool normalization. Signs of dryness and slight lichenification persisted. Thus, these clinical examples demonstrate a high efficacy of synbiotic treatment in the complex antiallergic therapy of atopic dermatitis in children.

Weight, BMI and its changes with age are one of the key indicators in pediatrics. The values of these indicators are the main parameters for assessing nutritional status (NS) and defining nutritional disorders - obesity and protein-energy malnutrition. At the same time, body weight and its changes only conditionally reflect the mass of fat and the amount of fat-free mass (especially the compartment of skeletal muscles). In the healthy population (in which the relevant references had been obtained), the changes of BMI can significantly reflect the changes of body composition. In children with chronic diseases (and/or with metabolic disorders, and/ or in oncopediatrics) the sensitivity of BMI as an indicator of NS is significantly lower and variable. This is due to deviations from the “normal” body composition existing in these patients. As a result, a deficit of fat-free mass can be accompanied by an excess of fat mass. Sarcopenia, which has negative consequences for the child, can be masked by obesity. Therefore, this condition, sar-copenic obesity, represents a huge problem. On the one hand, due to the coexistence of two nutritional disorders in one patient. On the other hand, due to underestimation in pediatrics. The latter is the consequence of frequent understanding of the child’s body weight as an unconditional and independent indicator. This can have dramatic consequences for the development and growth of the child. Therefore, weight loss in an obese child does not yet mean positive dynamics.

Introduction. Acute gastroenteritis (AGE) is one of the leading causes of pediatric morbidity and mortality. The use of cytomuco-protectors that stabilize the intestinal barrier can increase the effectiveness of treatment.

The aim is to determine the gelatin tannate (GT) clinical efficacy, safety and antiviral activity in AGE in children admitted to the hospital.

Materials and methods. An open, prospective, randomized study included 52 children <7 years of age with AGE. The intervention group (n = 28) received GT, which was administered orally at 250 mg to children <3 years of age and 500 mg to children £ 3 years of age 4 times a day for 7 days. The severity of AGE (Vizikari scale: 10-14 points and CDC: 1-5 points) in parallel groups was significant. Standard treatment included rehydration and probiotic B. bifidum 1 (15 * 108 CFU / day in three divided doses). Antibiotic therapy (ABT) was received by 50% of children from each group. Fecal samples at screening and on the 7th day of treatment were examined in Real-time PCR with the determination of nucleic acids of rotaviruses A, noro-, adeno-, astro- and enteroviruses. The viral etiology of AGE was confirmed in 53.8%, salmonellosis - in 3.8% and campylobacteriosis - in 1.9% of patients.

Results. GT reduced the risk of diarrhea on day 5 by 32% [95% confidence interval 14-50%] OR 0.25 [0.11-0.25] and by 14% [4-24%] by day 7. In the GT group, on day 7 of treatment, all patients had normal stool consistency. GT reduced the time for stool normalization by 1.3 days [0.2-2.3]. A more significant effect was obtained in patients with risk factors for insufficient treatment efficacy and in patients with inflammatory AGE requiring ABT. In those who received GT, a decrease in the concentration of viruses in feces was found, in the control - no statistical differences. The recurrence of AGE symptoms during hospital treatment was recorded with a frequency of 3.6% and 16.7%, respectively (p = 0.111).

Conclusions. GT significantly reduced the risks of incomplete therapy effect by day 7 of treatment and the average positiveness of stool normalization. Trends in the antiviral action of GT and its positive effect on the incidence of nosocomial viruses.

Introduction. One of the urgent issues in the first stage of nursing premature infants is acute kidney injury. The incidence of neonatal acute kidney injury in developing countries is 3.9/1000 live births, with 34.5/1000 among neonatal intensive care patients.

The aim of the study was to establish echographic signs of acute kidney injury in deeply premature infants in the neonatal period.

Materials and methods. 24 children with clinical and laboratory signs of acute kidney injury “AKI+” and 76 children without signs of acute kidney injury “AKI-“. All the children included in the study were born with a body weight of less than 1500 g and a gestation period of less than 32 weeks and were in the neonatal intensive care unit. To clarify the nature of the detected changes, a scientific analysis of the results of pathoanatomic studies of 55 deceased preterm infants was carried out.

Results. In all children from the “AKI+” group, there was a pronounced diffuse-uneven increase in the echogenicity of the parenchyma, there was a depletion of the vascular pattern in the subcapsular zone and/or in the cortical layer of the parenchyma, in 25% of patients on the 5th-15th day of life, anechogenic formations without signs of blood flow, with a diameter of 1-3 mm in the cortical layer were noted. The changes had a bilateral nature of the lesion, with further observation they were gradually reduced and by 3 ± 2 months of life they were not determined during ultrasound of the kidneys.

Discussion. Acute kidney injury is an urgent problem of preterm infants born with very low and extremely low body weight. The article presents the results of ultrasound examination of the kidneys in comparison with clinical and laboratory indicators and the results of pathomorphological studies. As a result of the study, the most characteristic ultrasound signs of acute kidney injury were identified, which are an uneven diffuse increase in the echogenicity of the renal parenchyma, small anechoic avascular inclusions (cysts) of the parenchyma, depletion of renal blood flow.

Conclusions. Renal ultrasonography is an informative method, but echographic changes may be labile depending on the clinical course of the disease, and the absence of anechogenic masses in the parenchyma may be due to technical limitations of the ultrasonography method. It requires further monitoring and continued vigilance of the pediatrician and pediatric nephrologist.

Introduction. One of the urgent issues in the first stage of nursing premature infants is acute kidney injury. The incidence of neonatal acute kidney injury in developing countries is 3.9/1000 live births, with 34.5/1000 among neonatal intensive care patients.

The aim of the study was to establish echographic signs of acute kidney injury in deeply premature infants in the neonatal period.

Materials and methods. 24 children with clinical and laboratory signs of acute kidney injury “AKI+” and 76 children without signs of acute kidney injury “AKI-“. All the children included in the study were born with a body weight of less than 1500 g and a gestation period of less than 32 weeks and were in the neonatal intensive care unit. To clarify the nature of the detected changes, a scientific analysis of the results of pathoanatomic studies of 55 deceased preterm infants was carried out.

Results. In all children from the “AKI+” group, there was a pronounced diffuse-uneven increase in the echogenicity of the parenchyma, there was a depletion of the vascular pattern in the subcapsular zone and/or in the cortical layer of the parenchyma, in 25% of patients on the 5th-15th day of life, anechogenic formations without signs of blood flow, with a diameter of 1-3 mm in the cortical layer were noted. The changes had a bilateral nature of the lesion, with further observation they were gradually reduced and by 3 ± 2 months of life they were not determined during ultrasound of the kidneys.

Discussion. Acute kidney injury is an urgent problem of preterm infants born with very low and extremely low body weight. The article presents the results of ultrasound examination of the kidneys in comparison with clinical and laboratory indicators and the results of pathomorphological studies. As a result of the study, the most characteristic ultrasound signs of acute kidney injury were identified, which are an uneven diffuse increase in the echogenicity of the renal parenchyma, small anechoic avascular inclusions (cysts) of the parenchyma, depletion of renal blood flow.

Conclusions. Renal ultrasonography is an informative method, but echographic changes may be labile depending on the clinical course of the disease, and the absence of anechogenic masses in the parenchyma may be due to technical limitations of the ultrasonography method. It requires further monitoring and continued vigilance of the pediatrician and pediatric nephrologist.

The skin of children has its own anatomical and physiological characteristics, the epidermis is much thinner than in adults, the layers of the dermis and basement membrane are poorly developed and differentiated, the rate of transepidermal water loss is increased and the level of natural moisturizing factor (NMF) is reduced. Such a structure of the skin predisposes to a violation of its barrier function, contributes to the occurrence of skin diseases, provides an increased resorptive capacity of the skin and requires special attention when prescribing external therapy. The use of high-quality emollients is an important part of the basic treatment of chronic dermatoses and has its own characteristics in childhood. The use of emollients prevents the development of exacerbations and reduces the need for anti-inflammatory topical drugs. With the localization of the inflammatory process on the face, neck, genitals and large folds, it is necessary to give preference to short courses of topical glucocorticosteroids (THCS) with sufficient anti-inflammatory activity, rapid onset of action, minimal side effects. Given the high risk of side effects in children in these areas of the skin, strong fluorinated THCS, high-potency THCS, and the use of THCS under occlusive dressings are not recommended. The Russian experience of using 0.1% methylprednisolone aceponate in children of various age groups in the treatment of allergic dermatoses, including those with localization in sensitive areas, has shown good efficacy, tolerance and the absence of side effects. he article presents own clinical observations of the effectiveness of the use of combination therapy: an emollient agent - a special cream with physiological lipids omega 3-6-9 and cream methylprednisolone aceponate (with ceramides in the base) in the treatment of skin diseases in children with an emphasis on complex localizations, such as face, folds, genital area.

In recent decades, there has been a significant increase in allergy pathology among the pediatric population. One in five children at a pediatrician’s consultation has an allergic disease or has a history of allergy, or manifestations of an atopic constitution. Also, in recent years, the term «sensitive skin» has become increasingly common in the medical literature. It is an independent syndrome that manifests itself in two forms: objective, in which the syndrome clinic is observed in parallel with the skin disease, and subjective when the manifestations of the syndrome occur in healthy skin. The main manifestations of sensitive skin syndrome are burning, itching, and tingling sensations, as well as thickening and dryness of the skin in response to environmental factors. Often, sensitive skin is associated with the most common skin pathology of childhood - atopic dermatitis. This association obliges the use of combined external therapy in practice. Topical glucocorticosteroids in the form of monotherapy or combination with antibacterial and/or antifungal agents are designed to control the dynamics of inflammation and lead to the achievement and prolongation of remission. However, the combination of anti-inflammatory agents with reparative creams is more effective because it enhances the healing processes of the damaged skin.

The article describes clinical cases of skin treatment in children with a history of allergies, atopic dermatitis, and sensitive skin syndrome. The therapy used restorative agents of dermocosmetics in the example of reparative cream. Clinical examples showed high efficacy of the combination of topical anti-inflammatory agents and reparative cream. This combination led to a more rapid reduction of dryness and itching, the intensity of inflammation, contributed to the rapid recovery of damaged skin, increased adherence to treatment by patients and patient’s parents.

Due to the increase in the weight of allergic diseases in the general pathology of childhood, the diagnosis and treatment of allergic rhinitis in children and the management of these patients at the outpatient stage have not lost their relevance. The period of preschool and school age is characterized by a high frequency of acute respiratory diseases of the upper respiratory tract, especially acute rhinitis, rhinopharyngitis, rhinosinusitis. This daily poses to the district pediatrician the tasks of differential diagnosis of allergic rhinitis and acute rhinitis with a prolonged course. Allergic rhinitis most often does not require hospitalization and, with timely diagnosis, does not lead to serious consequences. It is known that children who are prone to allergies suffer from acute respiratory viral infections more often and more severely than their peers. An integrated approach to the diagnosis and treatment of such children with the participation of an allergist, an otorhinolaryngologist, under the constant supervision of a district pediatrician, the rational use of drug therapy can reduce the duration of the disease, improve the quality of life of the patient.

The article presents generalized principles of management of patients with allergic rhinitis from the point of view of domestic and international recommendations, describes in detail the rules of life for children with allergic rhinitis, emphasizes the role of the district pediatrician in teaching parents to ensure a hypoallergenic environment of the child. The authors present a clinical example of the effective use of a combined decognensant and an antihistamine for the treatment of acute respiratory viral infections in a child with allergic rhinitis.

Histamine is one of the key endogenous mediators involved in the regulation of essential physiological and pathological processes in the human body. Its effects are implemented through several types of specific cell surface histamine (H)-receptors. H1-receptors are the most studied ones. The main clinical effects of their stimulation are vasodilation, bronchoconstriction, pituitary gland stimulation of hormone production, increased mucus production by the nasal glands, etc. Histamine H1 receptor antagonists of two generations are pathogeneticaUy justified agents for the treatment of most allergic diseases in accordance with the current clinical guidelines. The second-generation antihistamines that are devoid of sedative effects and are clinically more effective than the first-generation drugs have been currently introduced into the allergic disease treatment practice. They are the main drugs for the treatment of allergic diseases, especially in acute symptoms of the disease. Dimetindene maleate is the drug of choice for the symptomatic treatment of skin lesions, especially in infants. The article presents the result of the analysis of 26 out-patient medical records of infants (aged from 4 to 12 months) with a verified diagnosis of “atopic dermatitis, limited form, in the exacerbation phase”. A mild course of the disease was observed in 17 children, and a moderately severe course in 9 children. The duration of treatment was 7 to 16 days. Against the background of therapy (group 1), the following results were obtained: on day 3 of treatment the SCORAD-TIS index decreased to 16.4 ± 1.6 and on day 7 to 9.1 ± 1.3 points in children with a moderate course, and to 6.7 ± 0.8 and 4.1 ± 0.9 points in children with a mild course, respectively. In the children from group 2, the decrease in SCORAD-TIS was less significant: 19.5 ± 1.5 points on day 3, 12.2 ± 1.1 points on day 7 in children with a moderate course, respectively. Similar values decreased to 9.0 ± 0.9 on day 3, and to 6.9 ± 1.2 points on day 7 in children with a mild course of atopic dermatitis. The conducted analysis demonstrates the high clinical efficacy, good tolerance and the absence of tachyphylaxis of dimetindene maleate, drops. No side effects including those associated with anticholinergic properties (dry mouth, agitation) were identified.

The article presents the modern views of clinicians and geneticists on one of the most severe genetic disorders of skeletal and connective tissues - osteogenesis imperfecta. The review provided the literature data that showed the incidence rates, genetic heterogeneity of osteogenesis imperfecta, as well as the role of some proteins involved in the construction of bone tissue, as well as a clinical classification of the main types of the disorder. The authors described a clinical case: a girl with typical clinical and radiological manifestations of the rarest of all types of osteogenesis imperfecta - type II (perinatal-lethal, congenital osteogenesis imperfecta, Vrolik’s syndrome). The child’s diagnosis was verified by a parallel DNA sequence analysis which showed a heterozygous mutation in exon 29 (c.1966G> A) of COL1A1 gene not previously described in the literature. It caused the substitution of glycine for serine at position 656. The role of antenatal diagnostics and the importance of medical genetic counselling of the family before planning the next pregnancy due to the existing risk of re-birth of a sick child is outlined. Due to the fact that majority of the patients with the most prognostically unfavourable type II osteogenesis imperfecta, as a rule, die in utero, the described case of observation of the girl with typical clinical and X-ray signs of the disorder for almost 3 months of postpartum period is extremely rare and highly indicative. The detection of the heterozygous mutation in exon 29 (c.1966G > A) of COL1A1 gene by a parallel DNA sequence analysis which was not previously described in the literature gives an additional significance to the described observation.

Acute otitis externa is a common disease in the pediatric population, characterized by diffuse inflammation of the external auditory canal. Typical symptoms of acute otitis externa include otology, itching, congestion, and a feeling of fullness in the sore ear. In the case of active inflammation, the process can go to the tympanic membrane, and acute otitis media will join the external one. Primary therapy for diffuse uncomplicated acute otitis externa should include a local antimicrobial drug, without systemic antibiotic therapy. Topical therapy with antibacterial drugs in combination with anesthetics is the most rational. A clinical case of a 12-year-old patient with acute diffuse otitis externa and otitis media with effusion; acute nasopharyngitis; and adenoiditis, which was established based on anamnesis and clinical data is presented. Complex therapy was prescribed, which included local antibiotic therapy with a complex topical drug for the treatment of imperforated otitis externa and imperforated otitis media. At reexamination 5 days later, the patient demonstrated positive dynamics, pain in the left ear was eliminated. In cases of uncomplicated diffuse otitis externa, as well as in cases of its combination with otitis media with effusion, topical antibiotic therapy is a major priority. It should be borne in mind that the topical medication is more effective with the cleansing of the external auditory canal from inflammatory secretion. If it is used correctly, it would provide positive dynamics without systemic antibiotic prescription. It preserves the microbiome and mobilizes the body’s defenses. The application of complex topical antibiotic drugs can be widely recommended in pediatric practice.

Introduction. Potter’s sequence is a very rare and severe syndromic complex that includes congenital kidney defects leading to oligohydramnios, lung hypoplasia and structural skeletal disorders. Clinical case presentation: observation of a boy born from the 5th pregnancy to the mother at 37 weeks. Antenatally, the fetus was found to have bilateral renal and urinary bladder agenesis, malformations of the limbs, but the parents refused to terminate the pregnancy. After birth, the child was diagnosed with Potter’s syndrome with severe hypoplasia of the lungs, which required mechanical ventilation. In 2 hours after birth, the child developed a tension pneumothorax, which was arrested by performing drainage of the pleural cavity. During the day, the patient received complex treatment in the intensive care unit, despite which, by the 2nd day of life, the death of the child occurred. Currently, there are no guidelines for the treatment of Potter syndrome with proven positive long-term outcomes.

Discussion. Children with Potter syndrome do not have the same set of symptoms, but they develop a chain of events leading to a common ultimate result - decreased amount of amniotic fluid. Abnormalities leading to oligohydramnios may include severe hypoplasia, dysplasia, polycystic, obstructive uropathy or renal agenesis. In most cases, the disease occurs sporadically, but there are also forms with transmission of the disorder through successive generations: autosomal dominant or recessive inheritance of polycystic disease, hereditary renal dysplasia caused by mutations in RET, UPK3A genes and other chromosomal abnormalities.

Conclusion. Potter syndrome is a set of severe syndromes manifested by abnormalities in the development of kidneys, oligohydramnios, leading to lung hypoplasia, skeletal disorders and other congenital anomalies. The severity of congenital defects included in the set depends on the time periods when oligohydramnios occurred. Despite the availability of experimental therapies, the disease is now considered to be fatal.

Infant colic is one of the most common functional disorders of the gastrointestinal tract in children of the first year of life, worsening the condition of both the child himself and the psychological climate in the family. Infant intestinal colic is a multifactorial symptom complex that requires differential diagnosis between norm and pathology. Until now, there is no clear understanding of the criteria for the need for dietary and drug correction of this condition. The article presents an analysis of the modern literature on the problem of intestinal colic in infants The pathogenesis of functional intestinal colic is determined by a combination of reasons, including the immaturity of the central nervous system, hypothalamic-pituitary system, regulation of the intestinal innervation and the enzymatic system, a certain dependence on psychosocial factors has also been identified, the intestinal microflora has a great influence. H. Kianifar et al. (2014) in the findings of a study noted that a multiprobiotic (seven strains of probiotics and fructooligosaccharides) significantly improved colic symptoms, in particular a reduction in crying time, (82.6%) compared with placebo (35.7%) on day 7 of intake (p < 0.005). On day 30, treatment success was 87% and 46% in the synbiotics and placebo groups, respectively (p < 0.01). The results of a domestic study by I.N. Zakharova et al. (2016) multiprobiotic, which showed that after the use of a multistrain probiotic, intestinal colic remained in 3 (10%) children of the main group and in all children in the placebo group. After taking the probiotic, 80% of children showed normalization of stool, and in the placebo group, stool disorders (loose, watery stools or no stool with the need to empty after an enema) were recorded in 87% of children. Cases from clinical practice with experience of using a multistrain probiotic for colic are shown.

Introduction. The work is devoted to the study of vitamin D status in adolescent girls and the selection of adequate doses for its correction.

Study objective. To study the dynamics of calcidiol concentration in the blood serum against vitamin D3 intake and evaluate the effectiveness of correcting doses of vitamin in adolescent girls from Moscow.

Study design. A double-blind, placebo-controlled, prospective, randomized clinical study.

Materials and methods. The study involved adolescent girls aged from 11 to 17 years (n = 218) from I-II health groups, with determined serum level of 25(OH)D. Participants were randomly assigned to the main and control groups. The adolescent girls in the study group received vitamin D3 tablets, and the control group received a placebo. Study duration was 6 months. The dose of vitamin D3 was dependent on baseline serum caLcidioL levels and ranged from 800 IU to 2000 IU. Vitamin D status was redetermined in the girls who completed the treatment (n = 192).

Results. Initially, 96.4% of girls had a low vitamin D status, while vitamin D insufficiency was observed in 26.6%, deficiency in 57.8%, deep deficiency in 12%. The median level of 25(OH)D in the main group before taking the vitamin was 16.25 ng/ml, after taking - 24.1            ng/ml, in the control group - 17.9 and 11.4 ng/ml, respectively (p < 0.001). In the main group, an increase in the content of the metabolite was observed in 94.9% of the subjects, the initially identified pronounced deficit was completely absent.

Conclusions. A differentiated approach to prescribing different doses of cholecalciferon, depending on the baseline level of 25(OH)D, BMI and age, is an effective method for replenishing vitamin D deficiency in adolescents. The high probability of normalization of vitamin D status in certain age groups, mainly with the appointment of low corrective doses of cholecalciferol justifies the possibility of their use for 6 months or more in adolescents during puberty period.

Introduction. The study of schoolchildren’s nutrition features in different regions of the Russian Federation is one of the important tasks to health promotion of children by developing regional practices for optimization the nutrition of schoolchildren.

Objective. To study schoolchildren’s nutrition features in industrial cities of the Siberian federal district (Siberian FD).

Materials and methods. Specialized questionnaire was developed in order to study the nutrition organization of schoolchildren in various regions of the Russian Federation. 323 parents (legal representatives) of children aged 7-18 years living in the biggest industrial cities of south-eastern Siberia (the cities of Angarsk and Irkutsk) took part in the survey, based on the questionnaire. The obtained data was compared to the result of studies conducted in the Central federal district (Central FD), that included 162 observations. The frequency method was used to analyze the food consumption.

Results. The study established that consumption of milk, meat, cereals, potatoes, nuts, vegetables and fruits by children in the Siberian federal district was, all in all, significantly higher than in the Central federal district and in the Russian Federation in general. The nutrition of schoolchildren in the SFD is defined by a higher consumption of confectionery products, including chocolate, and such products as mayonnaise and margarine. It is noted that 75% of children in Angarsk and about 60% of children in Irkutsk regularly include chips and crackers in their diet and about 60% of children regularly consume fast food. At the same time, children living in Angarsk consume more food products with a high content of carbohydrates (cereals, potatoes, as well as added sugar in cookies, chocolates, sweet carbonated drinks), salt (in salted and dried fish), mayonnaise, and significantly less fermented dairy products and fresh fish compared to children in Irkutsk. Frozen products are more commonly consumed in the city of Angarsk than in Irkutsk. Physical development of children and its correlation with the variety of their diet was also assessed in the study. The assessment showed that children living in Angarsk have a significantly higher prevalence of obesity, which is a reflection of the irrational food diversity in their diets.

Conclusions. The obtained data reflect the need of the introduction of educational programs on healthy nutrition among schoolchildren and their parents, taking into account the regional specifics of nutrition.

Introduction. Hyperinsulinemic hypoglycemia in children is most commonly due to congenital hyperinsulinism. When hyperinsu-linemia is accompanied by fasting hypoglycemia and postprandial hyperglycemia, rare syndromes of severe insulin resistance, which include Rabson - Mendenhall syndrome, should be suspected. This article provides an analytical review of current data on this rare genetic pathology and presents a clinical case of a previously undescribed combination of Rabson-Mendenhall syndrome with mutations in the insulin receptor gene INSR in the compound heterozygous state with multiple congenital anomalies of other organs.

Clinical case. Patient N, 5.5 months old boy, with suspected congenital hyperinsulinism due to episodes of frequent severe hypoglycemia from the first day of life. At the age of 5 months, an episode of hypoglycemia up to 2.2 mmol/L was registered at an appointment with a pediatric endocrinologist. An examination was ordered, which found that against a background decrease in blood glucose to 1.9 mmol/L, C-Peptide level >5000 ng/mL, insulin level >300 lU/mL, cortisol - 971 nmol/L, TSH -3.88 mlU/L, free T4 - 10.53 pmol/L (10-23.2).

The importance of early diagnosis of severe insulin resistance to prevent developmental disorders in children is emphasized. The issue of organizing multiple effective monitoring of a patient’s glycemia required special attention in this clinical case. Due to the features of metabolism in young children, we abandoned flash glucose monitoring systems and used a modern glucose meter with an integration program with a mobile application and the ability to generate reports for subsequent analysis as a reliable means of glycemic control.

Summary. Based on the results of the genetic study in association with the clinical phenotype, age of debut, the patient was clinically diagnosed with Rabson-Mendenhall syndrome.

Discussion. The paradoxical nature of glycemic fluctuations (severe fasting hypoglycemia and postprandial diabetic hyperglycemia) is quite typical for syndromes of severe insulin resistance and should draw the attention of an informed primary care physician.

Conclusion. Careful attention to the symptoms of hypoglycemia, especially with a debut in the neonatal period, recurrent episodes, and the severity of the decrease in blood glycemia. If normal or elevated levels of insulin and C-peptide are detected against the background of hypoglycemia, the first thing to think about is congenital hyperinsulinism.

The incidence of antibiotic-associated diarrhea, according to various authors, ranges from 5 to 39% and depends on the patient’s age and other contributing factors. Antibiotic-associated diarrhea can be caused by any antibiotic, regardless of dosage form or route of administration. In the pediatric population, the prevalence of antibiotic-associated diarrhea ranges from 6 to 70%. An urgent problem is the development of this disease against the background of a course of H. pylori eradication therapy, which significantly complicates tolerance and adherence to therapy. This article presents current data on the pathogenesis and risk factors of antibiotic-associated diarrhea in children. The clinical picture ranges from idiopathic enteritis to antibiotic-associated diarrhea caused by Cl. difficile - pseudomembranous colitis.

The main principle of antibiotic-associated diarrhea treatment is cancellation of the antibacterial medicine that caused the diarrhea, or reducing its dose (if the course of the disease allows it). In complex treatment sorbents are used, correction of water-electrolyte balance is carried out. The use of probiotics seems quite logical for the treatment and prevention of antibiotic-associated diarrhea in terms of the pathogenesis of this condition. To correct dysbiosis, drugs are used to maintain and restore the quantitative and qualitative composition of the intestinal microbiota.

Taking into account modern recommendations the main groups of drugs (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented. The mechanism of action of probiotics and mechanisms of their effect on intestinal microflora are considered. The basic requirements for bacterial strains that are part of the probiotic drugs are presented.

The results of various randomized clinical trials and meta-analyses confirming the necessity of including probiotic complexes in antibiotic-associated diarrhea treatment regimens are presented from an evidence-based medicine perspective. The clinical effects of strains of Lactobacillusspp., Bifidobacterium spp.,Streptococcusspp. and Lactococcusspp. on the digestive tract microbiota are considered. The role of a synbiotic containing 9 probiotic strains of 4.5 * 10⁹ CFU in one capsule and the prebiotic component fructooligosac-charides in the prevention of antibiotic-associated diarrhea in children is discussed separately. The results of microbiological studies confirmed the presence of microorganisms of genera Bifidobacterium, Lactobacillus, Streptococcus in the product, and the content of bacteria in one dose of the product was not less than 2 x 10¹⁰ CFU.

Familial hypercholesterolemia is characterized by a significant increase in serum low-density lipoprotein cholesterol concentration, which even in the absence of other risk factors leads to the development of atherosclerotic vascular lesions beginning in childhood. With significant prevalence in the population, familial hypercholesterolemia is rarely diagnosed in time due to the Long absence of clinical manifestations. Today the urgent task is to develop and implement programs of primary detection of familial hypercholesterolemia in children and adolescents. Early detection of patients with familial hypercholesterolemia and timely initiation of adequate lipid-lowering therapy will curb the rate of atherosclerosis progression, which will significantly reduce disability and mortality from cardiovascular diseases in older age groups. There are four types of screening: cascade, targeted, opportunistic and universal. Cascade screening is currently considered the most effective and cost-effective way to identify new patients with familial hypercholesterolemia among relatives of an index patient, the patient with the established diagnosis. Targeted screening is based on searching for individuals with familial hypercholesterolemia among groups of patients with the early development of atherosclerotic vascular lesions, for example, in cardiology or neurology hospitals. Opportunistic screening is a non-systematic, sporadic determination of cholesterol levels in patients seeking medical care for any reason. It is most applicable in primary care health care settings. Universal screening is a mass screening of certain age groups and is a highly effective way of early diagnosis, especially in combination with reverse cascade screening of parents, siblings, and other relatives of the index patient. Implementation of programs of early childhood detection of familial hypercholesterolemia, setting up systems of adequate routing of patients, timely prescription of effective lipid-lowering therapy will contribute to health preservation and prolongation of working age, development, and preservation of labor potential of the country.

The respiratory diseases are consistently ranked first in the morbidity pattern among children and adolescents in the Russian Federation. Registry data show that 10-12% of children with pulmonary hypertension have PH-associated chronic lung pathology. Pulmonary hypertension as a life-threatening complication of such chronic lung diseases as hypersensitive pneumonitis, bronchiectasis, bronchial asthma, etc. aggravates the severity of their clinical course and has a great impact on the outcome of the disease. The article summarizes modern data on pulmonary hypertension in children of various ages associated with chronic bronchopulmonary pathology. The issues of classification, pathogenetic mechanisms, criteria and modern methods of diagnosis and treatment, as well as prognosis are considered. The authors come to the conclusion that despite the in-depth study of the pathogenetic aspects of the development of pulmonary hypertension in chronic bronchopulmonary pathology in children, which has recently made it possible to shed light on the understanding of many of its aspects, it should be admitted that the problem as a whole is far from being resolved. Early detection and treatment of pulmonary hemodynamic pathology is extremely important to prevent the formation of cor pulmonale. Pulmonary hypertension, which complicates the chronic lung diseases, is still incurable and is associated with high mortality. Now, young patients with pulmonary hypertension are still often examined and treated using guidelines for adult patients. However, differences in etiology, clinical presentations and diagnostic capabilities require a special approach to studying this problem in children, which raises the question of the need to develop separate clinical guidelines for pediatric practice.