Introduction. Premature newborns suffer from osteopenia, which scientists attribute to vitamin D deficiency. Its deficiency leads to impaired development, the success of which depends on the first years of life. Given the increase in the number of premature babies born after in vitro fertilization, the question arises regarding the risk of them developing vitamin D deficiency.

Aim to establish risk factors and develop prognostic tables for vitamin D deficiency in premature infants of the first three years of life born by in vitro fertilization and naturally.

Materials and methods. We studied premature newborns (n = 189), which we divided into two groups, born by in vitro fertilization and naturally (comparison group). In each group, two subgroups of infants were identified. In the main in vitro fertilization group, the 1st subgroup included newborns weighing 1,000–1,500 g (n = 52), and the 2nd – weighing less than 1,000 g (n = 49). The comparison group included infants born naturally with a body weight of 1,000–1,500 g (n = 46) and those with a body weight of less than 1,000 g (n = 42).

Results. Vitamin D deficiency was established in 67.7 ± 4.8% premature babies during the first year of life. In the second year of life, with intake of vitamin D 1000 IU/day, the level of calcidiol stabilized to normal value. The most sensitive group concerning vitamin D insufficiency is the group of babies with breast-milk substitutes. Factors associated with in vitro fertilization had not shown statistically significant influence on the vitamin D insufficiency in premature babies.

Conclusion. We have proposed beneficial predictive tables for an individual risk evaluation of possible bone metabolic conditions in premature babies.

Introduction. The variability of the dentition terms is caused by numerous factors: the age and health of the parents, the parity, etc. Children may experience discomfort, which may be relieved by various pharmacological and non-pharmacological methods. Aim. To study the effect of factors on the temporary teeth eruption in children, the severity of discomfort symptoms and the therapeutic efficacy of a homeopathic medicine during the period of dentition.

Materials and methods. The study included patients aged 4 months to 2 years. All children were divided into two groups. Group I included 97 apparently healthy children, Group II included 318 children with verified somatic pathology, who had residual effects of the perinatal hypoxic nervous system injury.

Results and discussion. The analyses of correlation relationship between the dentition terms and medical and biological factors during pregnancy and childbirth in children showed the pronounced relationships: in group I – between the 53rd tooth eruption timing and the age of the mother, the mother’s disease during pregnancy, the threat of miscarriage (r = 0.98, p < 0.05); in group II – a high correlation coefficient between the 65th tooth eruption timing and acute infections suffered by the mother during pregnancy (r = 0.76; p < 0.05). Symptoms associated with teething were observed in 61% of children in group I and 72% (p < 0.05) in group II. Given the low awareness of parents about the homeopathic medicine (8.5%), we gave a talk and suggested using a homeopathic medicine during the next tooth eruption in a child.

Conclusions. The temporary teeth eruption timetable is influenced by the course of the antenatal period, the mother’s age and the residual effects of the perinatal hypoxic nervous system injury. The homeopathic medicine is indicated to relieve symptoms of discomfort during the dentition period in the first year of life.

Introduction. Cough is one of the most common symptoms faced by a pediatrician in clinical practice. The most common cause of acute cough in children is a viral infection. A growing amount of scientific data indicates that phytotherapy is an effective and safe form of auxiliary treatment of acute and chronic inflammatory diseases of the respiratory tract, accompanied by cough and sputum formation (tracheitis, tracheobronchitis, bronchitis).

Aim. To evaluate the effectiveness of the use of herbal medicinal product (extract combination of thyme herb and Hedera helix leaves) in acute bronchitis, including in children with bronchitis of atypical etiology.

Materials and methods. A comparative prospective follow-up of 60 outpatient patients aged 3–12 years with a diagnosis of Acute bronchitis was carried out. The patients were divided into groups: group 1 (n = 28) – receiving the phytopreparation, of which 8 children with mycoplasma bronchitis – a combination of herbal medicinal product + clarithromycin; group 2 (n = 32) – receiving ambroxol, of which 10 patients with mycoplasma bronchitis – a combination of ambroxol + clarithromycin. Patients were included in the study for 2–3 days of the disease, control points of examinations – 6–7 days and 10–12 days. The time period of the study is 2019–2021.

Results. Against the background of taking the drug herbal medicinal product, there was a faster decrease in cough episodes (from 85 to 10% of patients), the transfer of dry cough to wet, as well as normalization of daily activities (95%), compared with ambroxol. The maximum effect was achieved by the 10th day of observation. In atypical bronchitis, results were obtained confirming the effectiveness and safety of using the drug herbal medicinal product with an antibiotic.

Conclusions. The results obtained indicate the expediency of using the drug herbal medicinal product in acute bronchitis, including in combination with an antibiotic for bronchitis of atypical etiology.

The problem of community-acquired pneumonia in children remains relevant at the present time. Complicated forms, which include pleural empyema, abscess, necrotizing pneumonia, bronchopleural fistulas and acute respiratory distress syndrome do not decrease, despite modern antibacterial therapy and the availability of vaccination against pneumococcus. The main pathogens associated with lung destruction in children are S. pneumoniae and S. aureus, often MRSA. The role of other pathogens in necrotizing pneumonia is much less frequently reported: Streptococcus pyogenes, Haemophilus influenzae, Pseudomonas aeruginosa, Fusobacterium nucleatum, Legionella pneumophila, Klebsiella pneumoniae, anaerobes. However not only pathogenic factors of the pathogen are important for necrotizing pneumonia development. Often, a viral prodrome, often associated with the influenza A (H1N1) virus, precedes complicated pneumonia. During the epidemic of COVID-19, endothelial damage with a high degree of probability was a predisposing factor for the development of a secondary bacterial infection with lung tissue necrosis. Significant destruction and liquefaction of the lung tissue may develop despite adequate antibiotic therapy. Great importance in the development of necrosis is attached to the activation of hemostasis and thrombus formation in the vessels of the lungs. Timely diagnosis often is difficult due to the predominance of general symptoms over local ones, especially in young children. Chest x-ray is the standard for diagnosing. However, the diagnostic capabilities of this method in necrotizing pneumonia are limited. To assess a number of parameters of the state of the pleural cavity and lung tissue, ultrasound is preferred. It is necessary to analyze the current features of the course of necrotizing pneumonia in children and develop clinical guidelines for the management of patients in the acute period and rehabilitation.

Acute otitis media (AOM), one of the most common infectious and inflammatory diseases in infants, toddlers and young children, is defined as an infectious inflammation of the middle ear, usually bacterial, often with earache, fever, and possibly otorrhea. Almost all children suffer from otitis media, 80–90% – at preschool age. The frequency of acute otitis media in children in a megapolis is more than 4 000 cases per 100 000 population, however, given the large proportion of asymptomatic variants against the background of acute respiratory infections, insufficient equipment of pediatricians with otoscopes, registration of acute otitis media almost exclusively by ENT doctors, the frequency of acute otitis media may be significantly higher. The clinical picture may be nonspecific. Ear pain and otoscopy are decisive for the diagnosis. The severity of inflammation correlates well with the scale of visual assessment of pain according to the child’s facial expressions. The aims of treatment are to relieve pain using topical or systemic analgesics, decide together with an ENT specialist on the need for antibiotic therapy, avoid not indicated antibiotic therapy, prevent complications (tympanic membrane perforation, acute mastoiditis, meningitis). With unexpressed otitis media, it is advisable to use symptomatic therapy and drops. A complex of compounds (lidocaine, phenazone) provides a quick therapeutic effect. Topical anaesthetics block the transmission of the pain signal from the receptor to the central nervous system through the inhibition of voltage-gated sodium channels. The symptomatic treatment (analgesics, antipyretics, topical therapy) results in improvement in 60% of patients within the next 24 hours, and in 80% within the next 3 days.

For prophylaxis of otitis, it is necessary to prevent acute respiratory infections, do vaccination against influenza and pneumococcal infections, avoid exposure to tobacco smoke, and keep babies breastfeeding.

In the practice of a pediatrician, among all detected infectious diseases, acute respiratory infections (ARI) continue to lead. The causes of respiratory infections can be varied. Great importance is attached to the normal microflora, as one of the main regulatory factors that can ensure the adaptation of children to different living conditions, and is responsible for maintaining homeostasis and maturation of the immune system. It has now been established that a healthy oral microbiome is the key to somatic health, and one of the important components of anti-infective protection. Therefore, one of the promising areas for the prevention of respiratory infections is the use of oral probiotics. The article provides an overview of findings from the studies on the efficacy and safety of the probiotic strain Streptococcus salivarius K12 showing inhibitory activities against the main respiratory pathogens – Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. S. salivarius K12 produces the bacteriocin-like inhibitory substance BLIS K12 (Bacteriocin-Like Inhibitory Substance), which plays an important role in maintaining the natural flora of the upper respiratory tract. It has been proven that the use of S. salivarius K12 results in a reduction of the level of pathogen colonization of the oropharyngeal mucosa, a rapid decline of the clinical symptoms of acute and chronic diseases of the ENT organs, and the prevention of acute respiratory diseases. The reason for this is that the intake of S. salivarius K12 increases the amount of interferon γ in saliva, stimulating the adaptive immunity against many viral infections. S. salivarius K12 is included in the clinical guideline on acute tonsillopharyngitis for the prevention of relapses, as well as the recovery of the normal biota of the oropharyngeal mucosa after disease.

Introduction. Adenoid hypertrophy (pharyngeal tonsil hypertrophy) is considered as one of the most common diseases of the ENT organs.

Aim. To study the polymorphism of the IL-10 gene (interleukin 10) and infections caused by human herpesvirus 6 (HHV6), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in children with AH.

Materials and methods. The study included 106 children with adenoid hypertrophy and 38 healthy children aged 2 to 11 years. All children with adenoid hypertrophy were divided into three subgroups depending on the size of the pharyngeal tonsil. Viruses were determined by real-time quantitative polymerase chain reaction (PCR).

Results. In patients with AH, HHV6 was detected more often than in CMV and EBV. Among the three subgroups of children with HGM, HHV6 and EBV infections prevailed in children with the maximum degree of pharyngeal tonsil hypertrophy. The frequency of the GG genotype was higher in the control group of children. Significantly higher frequencies of the G allele and GG and GA genotypes for IL-10 rs1800896 were found in the subgroup of children with the smallest size of the pharyngeal tonsil compared to other subgroups.

Discussions. The frequencies of HHV-6 and CMV in the control group are significantly different. HHV-6 was the most frequently detected virus in patients with HGM compared with CMV and EBV. The frequency of the GG genotype was in the control group of children. A significantly higher frequency of the G allele and GG genotypes was found in the first subgroup of children compared to the second and exclusive subgroups. We found a lower frequency of the G allele and GG and GA genotypes in a significant subgroup of children compared to the second subgroup. Previous studies show a significant increase in the frequency of the A allele and the AA and IL-10 genotypes (rs1800896-1082G/A) in patients resistant to HHV-6 and CMV infections compared to those infected.

Conclusions. The presence of HHV-6 and CMV infections contributes to the development of pharyngeal tonsil hypertrophy, and HHV-6 and EBV may contribute to the size of the pharyngeal tonsil.

Introduction. Cough is one of the most frequent complaint when contacting a pediatrician. One of the mechanisms of cough development is the formation of viscous difficult-to-separate sputum. Therefore, determining the tactics of using expectorants and choosing the most effective and safe drug is an important part of the pediatrician’s work.

Аim. Тo study the tactics of expectorant medicines use in pediatric practice.

Materials and methods. The study included 84 patients with acute respiratory viral infections accompanied by cough, including 36 (42.85%) girls and 48 (57.15%) boys. The age of the children ranged from 4 to 7 years and averaged 5.57 ± 0.88 years. The drug of herbal syrups based on ivy extract in the form of syrup was prescribed to children in a dosage of 2.5 ml 4 times a day for 7 days. The effectiveness of the drug was evaluated on a scale of improvement/worsening of cough symptoms. In addition, the frequency of coughing, the ease of sputum discharge and the well-being of patients according to VAS were evaluated. The safety of the drug was assessed by identifying signs of the development of adverse events. Statistical processing of the obtained data was carried out using the SPSS 12.0 program.

Results and discussion. After 7 days of the medicine using, a significant decrease in the frequency and severity of cough was recorded, as well as relief of sputum discharge in most children. 84.52% of children had no cough after the first week of therapy. In this regard, their well-being has significantly improved. No adverse events were detected during the use of the drug. Very few herbal medicinal products are manufactured for young children, whereas it is herbal therapy that is the most suitable for use at this age. The study of the effects of herbal medicinal products containing ivy leaf extracts approved for use in children from birth showed promising results.

Conclusions. The use of the drug of herbal syrups based on ivy extract in preschool children contributes to a significant reduction in the frequency of cough, relief of sputum discharge and improvement of patients’ well-being. The drug is safe – there were no adverse events during its use.

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Introduction. Acute bronchiolitis (АB) is a common  infection  in children  under  the  age of 2 years. In modern  clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.

Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive  care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison  with therapy without  the inclusion of this drug.

Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy  of 3% HSCS with HS AB was conducted  in comparison  with historical control.

Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the  age younger than  3 months  (40.7%). The presence of risk factors for severe  course  of acute  respiratory  failure had an impact  on the average  bed-day and on the need  for respiratory  support  (p = 0.04), in addition  to which patients often  received drug therapy. There were no statistically significant differences  in the terms of hospitalization, the duration  of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there  was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma  by the 2nd day of the disease.

Conclusion. AB in ICU patients most  often  has RSV etiology, developing in the  presence of risk factors  for severe  course. The influence  of modern  guidelines for the treatment of AB in the ICU remains  controversial. The addition  of 3% HSCS with HS can improve the flow of AB.

Introduction. According to current clinical guidelines for the effective treatment of type 1 diabetes mellitus (DM1) in children and adolescents, regular self-monitoring of blood glucose using a glucose meter is an integral part of all training and long-term follow-up programs.

Aim. To evaluate the clinical and metabolic efficiency of the method of self-monitoring of glycemia with a home glucometer in patients with diabetes DM1.

Materials and methods. The study included 107 patients with DM1 using the method of self-monitoring of glycemia using a home glucometer. Based on the received reports was evaluated the average level of glycemia, glycemia above the target range, time in range, glycemia below the target range, frequency of hypoglycemia, the frequency of daily measurements, as well as glycated hemoglobin (Hb_A1c). Statistical analysis was carried out using the program IBM SPSS Statistics 23.0.

Results. During the work, children and adolescents with DM1 showed a decrease in Hb_A1c from 8.5% [7.2; 9.7] to 8.0% [6.9; 9.0] (p < 0.005). There was a decrease in TAR and TBR by 5 and 0.4%, respectively (p = 0.002, p < 0.001), which causes an increase in TIR from 44.4% [33; 56] to 49.8% [32; 75] (p = 0.003). During the study, patients were divided into groups according to the frequency of daily measurements, which revealed a decrease in Hb_A1c from 8.2% [7.2; 9.4] to 7.8% [6.9; 8.8] (p < 0.001) in the group with a frequency of daily measurements 6 per a day and more compared with the group where the frequency of measurements was less than 6 per a day.

Findings. Conscious self-monitoring, combined with quality physician support, ensures the achievement of diabetes targets and a decrease in glycemic variability when using the self-monitoring method with a home glucometer. Using specialized software to work with a home glucometer helps to reduce the time to achieve compensation for type 1 diabetes in children and adolescents.

Breast milk is the gold standard for infant feeding. In case of its lack or insufficiency, this brings up the question about an affordable and adequate alternative. Adapted cow’s milk formulas are most commonly used, but the incidence of cow’s milk protein allergy in young children is increasing worldwide. Given the early onset of gastrointestinal disorders in infants, minimal digestive dysfunctions are often interpreted by doctors as sensitization to cow’s milk proteins or functional gastrointestinal disorders. However, there are conditions associated not with cow’s milk protein allergy, but intolerance. These conditions are difficult to diagnose, as the mechanism of development of cow’s milk protein allergy has not been sufficiently studied and is often not associated with an IgE-mediated immunological response. Food intolerance is associated with the enzymatic immaturity of the gastrointestinal tract and insufficient activity of intestinal microbiota. This article highlights the issues of cow’s milk protein allergy and food intolerance. In case of food sensitization and even minimal clinical manifestations of cow’s milk protein allergy, the choice of formula should always be made in favour of deep-hydrolyzed milk protein formulas. Goat protein formulas cannot be used in cases of cow’s milk protein allergy due to cross-sensitization effects. The aim of the article was to analyze a differentiated approach to the choice of infant nutrition in the absence of breastfeeding.

Introduction. Malnutrition in children manifests itself in the form of general metabolic disorders and leads to impaired cellular differentiation of tissues. The state of nutritional status is an important success factor in the treatment of any disease, therefore, the development of methodological approaches to optimize the nutritional status of children with protein-energy malnutrition is an urgent task.

Aim. To study the efficacy and safety of nutritional support in various conditions accompanied by protein-energy malnutrition in children.

Materials and methods. 62 cases were analyzed: including 29 with antibiotic-associated diarrhea, 8 with celiac disease, 14 with gastrointestinal allergy (allergic enteropathy), 11 with hypostature against the background of low gestational age with birth. Age – 1–10 years. All patients were divided into groups identical in age, nosology, gender, duration of the pathological condition, degree of malnutrition. In the main group (31 children), the main treatment included a low-microbial diet, sips, parenteral nutrition with glucose-salt solutions (7–10 days), enteral nutrition. The control group consisted of 31 children, in whose therapy there was no enteral nutrition. Anthropometry, clinical, laboratory and instrumental examination were used to assess the nutritional status.

Results and discussion. The main syndromes during treatment are: underweight, loss of appetite, intestinal dyspepsia and malabsorption. Analysis of the diet indicated the monotony of the set of products. The course of nutritional support was 15 days. The survey was conducted on the 1^st, 5^th, 10^th, 15^th days of the study. The effect of using enteral nutrition in terms of physical development, clinical and laboratory parameters was more significant in the main group compared to conventional methods of nutrition optimization.

Conclusions. The use of enteral nutrition in combination with drug therapy shows more significant effectiveness compared to conventional methods of nutrition optimization.

Introduction. According to information from various literature sources, Escherichia coli is the most common (80–90%) causative agent of urinary tract infection (UTI) in children, it also significantly exceeds the frequency of occurrence of other bacteria, although there is a tendency to gradually decrease its specific gravity, especially against the background of other pathogens of the intestinal group.

Aim. To determine the specific gravity of E. coli as the causative agent of UTI, depending on age against the background of other pathogens.

Materials and methods. The study involved 133 children aged 1–17 years with UTI, girls – 107, boys – 26. The bacteriological method determined the pathogen, its sensitivity to standard antibiotics and the ability to produce extended-spectrum beta-lactamases (ESBL). Statistical processing was carried out in the Excel program. In the statistical study of the conjugacy of the signs age and infection, the Kruskal – Wallis criterion was used. Patients are grouped into the following age categories: 1–3, 4–7, 8–11, 12–14 and 15–17 years.

Results. The authors of the article provided information that E. coli, although it is the leader, but its share is not as large as is commonly believed and is only 26–29%, while 18% of the total are producers of ESBL. The article shows the distribution of UTI pathogens by age groups of children and calculates the empirical probability of detecting various pathogens at different ages. It is shown that the age group of 8–11 years is most susceptible to mixed infection. According to the structure of mixed infections, these are combinations of pathogens of the intestinal group: E. coli with E. faecalis or E. faecium or with Klebsiella pneumoniae.

Conclusions. The authors raised the question of the need in the near future to correct the schemes of empirical antibacterial therapy in connection with the excess of the justified 10–20% resistance of E. coli to cephalosporins of the 3^rd generation due to an increase in the frequency of ESBL production.

Neurogenic disorders of the bladder are diverse in their mechanisms and difficult to treat. Researchers around the world have step by step discovered new aspects of the pathogenetic mechanisms responsible for detrusor dysfunction. Naturally, with the understanding of these mechanisms, new lines of therapy appeared, making the treatment of such children more effective and justified. Only complex therapy, considering all pathogenetic mechanisms, can give the best result. To date, the degree of influence and ways to solve the problem of impaired blood supply to the bladder have not been fully studied. For a long time, this issue has not been given due attention, due to the complexity of an objective assessment of the sufficiency of blood supply to the bladder. However, those few studies suggest that it is impossible to count on success in the treatment of such children without including in therapy components aimed at normalizing the angiological factor and, as a consequence, correcting detrusor hypoxia and energy metabolism disorders. Angiological disorders have a multidirectional character from vasospasm and circulatory hypoxia to vasodilation and congestive hyperemia. Therefore, the diagnosis and treatment of blood supply disorders of the bladder is a very important and difficult task. Since neurogenic disorders of the bladder are very common, a universal method of assessing the condition of its vessels is needed, which will be convenient and accessible to doctors in routine practice. Such a method is rheopelviography. The introduction of this method into routine practice will lead to the accumulation of experience and improve the diagnosis and treatment of bladder dysfunctions.

Modern pathogenetic therapy of psoriasis is the use of suppressive methods aimed to suppress immune reactions in the dermis, synovia, enthesis and eliminate the imbalance between anti-inflammatory and pro-inflammatory cytokines, chemokines. Today, genetically engineered biological drugs are one of the most promising pharmacotherapy achievements for the management of psoriasis, psoriatic arthritis in the group of immunosuppressive agents. Knowing the pathogenetic mechanisms that underlie the development of these diseases allows us today to highly selectively target the top key links of the immunopathogenetic cascade using genetically engineered biologicals, while barely affecting the protective factors of the patient’s immune system unlike the standard backbone (what is referred to as traditional) anti-inflammatory therapy. The treatment of psoriasis in children and adolescents practically involves the same drugs and methods as in adults. However, most of them are used in paediatric practice for conditions for which they are not clearly indicated, and studies on their efficacy and safety are still missing. Currently, it is possible to treat children and adolescents with genetically engineered biological drugs. Ustekinumab, etanercept, adalimumab, secukinumab, and ixekizumab are approved for use in moderate to severe psoriasis in the Russian Federation. In paediatric practice, the genetically engineered biological drug ustekinumab is one of the most effective, safe and convenient for the delivery of therapy (short induction cycle, rare infusions of the drug during maintenance therapy). The article describes the case study of the effective treatment of a 17-year-old patient with severe, continuously recurrent psoriasis. The targeted therapy, including the use of genetically engineered biological drugs, is increasingly being used to treat childhood psoriasis. Moreover, there are now more and more supporters among dermatologists who believe that genetically engineered biological drugs can be prescribed as the first-line drugs for the treatment of moderate to severe psoriasis in children and adolescents.

Contact dermatitis in paediatric population is a fairly common pathology, which occurs where the skin comes into contact with irritating factors. It refers to steroid-sensitive dermatoses, therefore, the prescription of topical glucocorticosteroids in this pathology is a proved method of treatment. 0.1% methylprednisolone aceponate cream that has anti-inflammatory and anti-allergic effects is a medium-potency effective topical glucocorticosteroid. In this article, the authors presented their own experience and clinical cases of the effective use of 0.1% methylprednisolone aceponate cream in contact dermatitis in paediatric population. The first clinical case demonstrates the use of 0.1% methylprednisolone aceponate cream once a day as part of the combination therapy in a 5-month-old baby with moderate contact dermatitis caused by cosmetic substances (massage oil). The treatment resulted in a pronounced improvement and the achievement of remission on the 8^th day from the start of therapy. The second clinical case demonstrated the effectiveness of 0.1% methylprednisolone aceponate cream used once daily as part of the combination therapy in a 6-month-old baby with mild diaper contact dermatitis. The use of barrier medications (5% dexpanthenol ointment) for 3 days showed no positive changes, due to which 0.1% methylprednisolone aceponate cream was prescribed. The treatment resulted in the relief of acute signs of inflammation in the buttocks and complete remission on the 5^th day of the use of the cream. The third clinical case demonstrated the effectiveness of topical glucocorticosteroid in the form of 0.1% methylprednisolone aceponate cream used once daily as part of combination therapy in a 4-month-old baby with severe contact dermatitis, which developed after washing the perineum and feet with laundry soap. The pronounced positive changes in the skin improvement process were observed from the 5^th day of the therapy, and a remission was achieved on the 10^th day of the therapy, which was demonstrated as relief of acute inflammatory process in the buttocks and lower extremities, and disappearance of itching and scratching. Overall, the above clinical cases showed the high effectiveness of the use of the topical glucocorticosteroid in the form of 0.1% methylprednisolone aceponate cream as part of the combination therapy of contact dermatitis in pediatric population (at any severity level).

Our society is still struggling with the spread of the SARS-Cov-2 virus, the cause of the development of the new coronavirus infection (COVID-19). Vaccine prophylaxis of this infection in children under 12 years old is not yet available in Russia. In many children, COVID-19 occurs against the background of concomitant pathology, including bronchial asthma (BA) as the most common chronic disease among children. BA treatment is successfully carried out by pediatricians due to modern clinical guidelines and the availability of medicines. This is one of the examples when the introduction of new methods of diagnosis and treatment made the disease controllable in most cases. Despite the obvious successes, the treatment of asthma is currently undergoing changes, and this applies specifically to mild asthma. When revising the guidelines in 2021–2022, GINA experts drew particular attention to the need for early prescription of anti-inflammatory therapy, mainly with low doses of ICS, regardless of whether asthma progresses with persistent or intermittent symptoms. Since children often suffer from ARVI and viral infections are the most frequent trigger of BA exacerbation in children, basic BA therapy in children is of particular importance, which can reduce the number of virus-induced exacerbations. Along with ICSs, generally recognized leaders in the basic therapy of BA, in the treatment of children with mild asthma with virus-induced exacerbations, montelukast, oral Cysteinyl Leukotriene Receptor Antagonist (LTRA), does not lose its importance. In recent years, additional properties have been described that allow pediatricians to use montelukast for mild asthma in children in the current context of the COVID-19 pandemic.

Introduction. Interferon-containing drugs are frequently used, but their effect on the innate immune cells response and adaptive immunity parameters is not well known.

Aim. To investigate the effect of interferon-alpha-containing drugs on the production of neutrophil extracellular traps, the population and subpopulation composition of peripheral blood lymphocytes in cell culture conditions.

Materials and methods. We used peripheral blood from 12 healthy donors and 6 patients with acute inflammation, which was used as a neutrophil and lymphocyte source. Neutrophil extracellular traps were induced by two methods: either spontaneously, without stimulation, or by lipopolysaccharides.

Results and discussions. The investigation of innate immunity responses showed that neutrophils from healthy donors demonstrated a slight spontaneous production of neutrophil extracellular traps during incubation (4 h). The significant NET increase was observed after stimulation with lipopolysaccharides up to 31.59 ± 2.32% after 2-hour incubation period, and up to 42.93 ± 3.56% after 4-hour incubation period. Viferon does not have a significant effect on the number of neutrophilic extracellular traps, but significantly increases their size. Kipferon limits the excessive production of neutrophil extracellular traps, reducing the number of these structures, and also significantly reduces their size and changes their morphology. Ergoferon causes not only a rapid increase in the number of neutrophilic extracellular traps, but also significantly changes their morphology. The extremely long DNA fibers that go beyond the scope of view are observed when exposed to Ergoferon. Kipferon stimulates the production of several morphological forms of neutrophilic extracellular traps at once.

Conclusion. The development of innate immune responses is mainly maintained by Viferon and Kipferon. At the same time, Kipferon restrains the intensity of the inflammatory reaction and increases the number of active NK cells. The conducted multilevel study allow researchers to identify new properties and mechanisms of action of administered pharmacological products containing interferon-α, which confirm the effective stimulation of individual components of the immune system due to their action.

Introduction. Peritonsillar abscess (PTA) is a suppuration of the peritonsillar fiber, which is more often a complication of acute tonsillitis, requires urgent medical care. Issues of diagnosis and treatment of PTA are one of the urgent problems of pediatric otorhinolaryngology. The main peak of the incidence occurs in adolescence, which is associated with a change in the immunobiological properties of the body at this age. In children under 3 years of age, the disease is extremely rare, but the increase in the number of PTA in children from 4.2 to 12.1% and the development of peritonsillitis in children under 3 years of age are alarming about the severity of post-streptococcal complications. Timely diagnosis, treatment and prevention of PTA are essential to prevent potential serious complications.

Aim. To study the prevalence of PTA in children, to analyze the results of prevention with a herbal preparation.

Materials and methods. A sample of medical histories of 19,017 people hospitalized in the children’s ENT department of Regional Clinical Hospital No. 2 (Tyumen) was carried out, the prevalence of PTA and other diseases of the pharynx was studied. The duration of prospective observation of patients was 10 years (2009–2019). Clinical data such as sore throat, enlargement of the cervical and submandibular lymph nodes, fever, dysphagia, nasality of the voice, trismus of the masticatory muscles were analyzed. Gender, age characteristics, data on relapse were evaluated. All patients with PTA were opened and drained of the purulent cavity with the appointment of antibacterial therapy and the herbal preparation in the postoperative period.

Results. The highest incidence of PTA is observed in children of middle and high school age, more often girls are sick – 52% of cases. A more rapid relief of the main symptoms and relapses of PTA was recorded in the group of children who received the herbal preparation as a prophylaxis.

Conclusions. The prevalence of PTA in childhood does not tend to decrease. Prophylactic use of the herbal preparation in the postoperative period contributes to a more rapid relief of the main symptoms of PTA and prevention of recurrence of the disease.

Introduction. The problem of instability in the cervical spine in children has been repeatedly discussed in the medical literature and has become the subject of discussion. This is due to a significant increase in the number and recurrence of subluxations in the C1–C2 segment. An assumption is made about the relationship of this pathology with systemic connective tissue dysplasia, but evidence-based studies are required.

Aim. To make a statistical analysis of individual somatometric indicators in children with recurrent subluxations of the C1–C2 vertebrae and signs of connective tissue dysplasia.

Materials and methods. The analysis of measurements of selected body parameters in pre-pubertal children with acute and recurrent torticollis against the background of systemic connective tissue dysplasia was carried out. The data of 186 children aged 9–11 years in comparative groups for the period 2016–2021 were studied. Modern methods of statistics were used.

Results. Dependences were obtained confirming the hypothesis of the relationship between asthenic physique (high height, low weight and chest circumference) and recurrent dislocations in the C1–C2 segment

Conclusions. When comparing the average values for two independent samples made up of the indicators of the main group and the comparison group, the conclusion obtained during visual examination and somatometric examination of patients diagnosed with torticollis at admission to the hospital was confirmed: relapses are inherent in children with high growth, low weight, smaller chest circumference and smaller wrist circumference.

Introduction. Progression of pulmonary and heart failure often causes death in patients with cystic fibrosis (95%). Therefore, monitoring of lung condition is very important for patients with cystic fibrosis (CF). Structural changes are visualized by computed tomography of the chest (CT) and are scored using the Brody scale. For children older than 5 years, pulmonary function tests (PFTs) tests (which are evaluated in percent of predicted (%) values) are available, such as spirometry, body plethysmography (BP), diffusion capacity of the lungs (DL) test. The results of the single-breath (SB) DL for carbon monoxide test are DLCO-SB, alveolar volume (VA-SB) and their ratio (KCO-SB). In the presence of non-communicative zones for gas perfusion, VA-SB may not present true VA. For patients with CF, it is proposed to use VA determined by BP for calculating KCO-BP, or to adjust the predicted DLCO-SB and KCO-SB for VA.

Aim. To assess the informativeness DLCO-SB, KCO-SB and KCO-BP in children with CF.

Materials and methods. 28 children with CF (8–18 years old) were examined in the department of pulmonology of the National Research Center for Children’s Health. PFTs included DLCO-SB, spirometry and BP. Additionally, we evaluated the data of the blood gas and acid-base values, age, body mass index and CT scores.

Results and discussion. We found that in most patients DLCO-SB and KCO-SB were within the normal range, and decreased in children older than 14 years with background of severe bronchiectasis.

Conclusion. Thus, in children with CF the DL test is informative, and adjustment for VA is useful.

Introduction. Mucopolysaccharidosis type III (Sanfilippo syndrome) is a rare multi-stem disease caused by the accumulation of glycosaminoglycans (GAG) in the cells of various organs, leading to a violation of their function, specific phentopic signs and progressive neurocognitive disorders. Neurologic manifestations are leading in the clinical picture of the disease, as by the time of manifestation, and by severity. In most patients, in the first and even second years of life, children have normal development or indistinctly pronounced deviations. In the absence of substitute enzyme therapy for this type of MPS, a severe delay in intellectual and speech development develops rapidly, recurrent respiratory episodes in the form of pneumonia and bronchial obstruction are observed, the child is disabled early. Polymorphism and non-specificity of clinical manifestations, lack of alertness of doctors to orphan diseases are a common cause of late diagnosis of MPS. The article presents an overview of data on the prevalence, genetic and phenotypic variants of type III mucopolysaccharidosis, features of patient management and presentation of clinical observation of a child with this pathology.

Clinical observation. We present our own prolonged clinical observation of a type III MPS case in a patient who has been under our supervision for 12 years. The diagnosis was established and confirmed at the age of three years. The disease was manifested by neuropsychiatric regression and systemic somatic manifestations. Motor deficits, cognitive impairments with the development of dementia and recurrent aspiration syndrome progressed in the dynamics of the child.

Conclusions. The classical clinical picture of type III MPS is distinguished by the aggressive development of cognitive and motor disorders at 2–3 years of life, characteristic phenotypic and somatic manifestations of the disease. This case demonstrates the multiplicity of problems and the need for interaction between doctors of various specialties.

The article presents current data on the role of therapeutic nutrition in the treatment and rehabilitation of children with acute viral diseases. The main violations in the nutritional status of children with viral diseases of the upper respiratory tract, as well as those caused by coronavirus infection, are described. The paper describes in detail the properties, indications for the use of new health food products in the complex therapy and rehabilitation of young children and older with various viral diseases. The developed therapeutic food products contain plant components with antiviral, immunotropic, antioxidant, anti-inflammatory activities. The clinical and biochemical effects of a specialized product of general strengthening action for children from 12 months of age, containing vitamins and a biologically active phytocomplex, which provides a decrease in ASL-O titers, an increase in the concentration of serum IgA, and indicators of phagocytic activity, are described in detail. A clinical study of a new domestic medical food product used for colds showed its effects in improving the general condition and accelerating the recovery time, reducing inflammation in the ENT organs and coughing. The authors of the article recommend that in the course of viral diseases (influenza, COVID-19, etc.) with symptoms of dysfunction of the gastrointestinal tract, as a therapeutic food for children from 1 year old, therapeutic jelly for disorders in the gastrointestinal tract, which helps to reduce inflammation of the gastrointestinal mucosa and normalizes microbiota. For older children (from 12 years of age) the following have been developed and clinically studied: a healing drink for viral diseases with vitamin D and a detoxification drink with immunotropic and detoxification activities, respectively. All studied domestic health food products are clinically safe. The article provides detailed recommendations on the use of new therapeutic food products for viral pathology in children.

Introduction. After an infection with the SARS-CoV-2 virus, in some cases, the so-called post-covid syndrome is formed, which includes conditions and symptoms that develop during and / or after the disease, lasting more than 12 weeks, occurring in waves or on a permanent basis, and without a confirmed alternative diagnosis. Vegetative, psycho-emotional disorders, as well as disorders of the cardiovascular system, digestive and some others can be considered as manifestations of the post-covid syndrome. The variety of clinical manifestations of post-COVID syndrome in children can have a significant impact on their quality of life (QoL).

Aim. To estimate the quality of life of children aged 5 to 17 years after COVID-19.

Materials and methods. The study included 92 children aged 5 to 17 years, divided into two groups. The study group included 62 children (31 boys, 31 girls; mean age 12.0 (7.4; 14.5) years) after a new coronavirus infection. The control group consisted of 30 children who had acute respiratory tract infection of a different etiology and did not have COVID-19 (16 girls and 14 boys; mean age 12.5 (7.5; 15.1) years). The assessment of QoL in children of the study groups was carried out using the Russian version of the PedsQL 4.0 questionnaire. Parental and child forms of the questionnaire were used.

Results. The average follow-up period after a coronavirus infection was 6 months (from 3 to 12 months). 92 patient questionnaires were analyzed: 14 in the group of children 5–7 years old, 36 in the group of children 8–12 years old, 42 in the group of children and adolescents 13–17 years old, and 14 parental questionnaires in the group of children 5–7 years old. The indicators of the quality of life of children after COVID-19 were statistically significantly reduced compared to the control group in all age groups. Differences in the assessment of the quality of life by preschool children and their parents were revealed.

Conclusions. A significant decrease in the life quality was revealed in children with COVID-19 history after six months (3–12 months) of the disease manifestation in comparison with control group.

The issues of improving the quality of treatment of children with acute respiratory infections combined with minimization of the adverse effects and reduction of polypragmasy are high on the agenda. The safety and efficacy of therapy are the key quality criteria, which allows to use complex bioregulatory drugs with antiviral, anti-inflammatory and immunomodulatory effects in the combination therapy of acute respiratory infections in children. The article presents clinical cases of effective treatment of acute respiratory infections using bioregulatory therapy. Clinical case 1: a 3-year-old child, general condition of moderate severity during initial presentation, rise of body temperature up to 38.4 ºС, catarrhal manifestations. Diagnosis: J00 – ARVI, acute nasopharyngitis. Clinical case 2: a 5-year-old child, complaints of fever up to 38.3 ºС, nasal breathing difficulty (especially at night) reported, nasal discharge, wet cough with difficulty in expectoration of sputum. Diagnosis: J00, J35.2, J35.8 – ARVI, grade 2 pharyngeal tonsil hypertrophy, adenoiditis. Clinical case 3: a 12-year-old child, complaints of fever for 3 days (temperature 38.3–38.7 ºС). General condition of moderate severity due to intoxication syndrome, hyperthermia. Complaints of sore throat that was exacerbated by eating. Pharyngoscopy showed hyperemic, enlarged, edematous palatine tonsils, yellowish overlays located in lacunae. Diagnosis: J03.9 Acute tonsillitis, unspecified? All patients were prescribed combination bioregulatory therapy with a high compliance profile, good tolerance and absence of side effects. This therapy contributed to the reduction of polypragmasy and the prevention of recurrent upper respiratory infections.

Introduction. Pathologies of thyroid dysfunction associated with iodine deficiency remain one of the urgent problems throughout the world and are mainly associated with natural iodine deficiency in places where about 30% of the world’s population lives.

Objective. Study of the dynamics of thyroid hormones in infants born from mothers with diffuse endemic goiter.

Materials and methods. A retrospective study of 68 infants from mothers with diffuse endemic goiter (DEG) was carried out. Research methods included: analysis of anamnestic data, palpation, and ultrasound in mothers, with a study of the level of thyroid hormone in newborns and parturient women.

Results. Infants from mothers with DEG have characteristic changes in the level of thyroid hormones in the blood, in particular, in the cord blood, the level of thyroid-stimulating hormone (TSH) is 22.4% higher than in the control group (p < 0.05). The difference between free triiodothyronine (T3) and thyroxine (T4) is on average lower by 8.6% and 4.3%, respectively, (p < 0.05 and p < 0.1). On the 3rd day of life, these fluctuations persist, and the level of TSH in the peripheral blood exceeded up to 20.9%, but there were no pronounced clinical signs of congenital pathology associated with the thyroid gland. At the same time, in the first months of life in infants, there is a lag in weight gain by an average of 9.6% about practically healthy newborns.

Conclusion. In infants born to mothers with DEG, there is an increase in the umbilical blood level of TSH up to 22.4% about practically healthy newborns, with a simultaneous decrease in T4 to 4.3%, T3 to 8.6%, without pronounced clinical signs of congenital pathology. In these children, in the first months of life, there is a lag in physiological weight gain of up to 9.6%, which should be taken into account when managing children in an outpatient setting.

Introduction. The circadian rhythms of the nasociliary system of children with bronchial asthma have not been practically studied.

Objective. To evaluate seasonal variations of circa-annual rhythms of the nasociliary system in healthy children and children with year-round bronchial asthma.

Materials and methods. 134 children were examined; the main group consisted of 99 children aged 1.5–7 years with mild and moderate bronchial asthma, the control group was represented by 45 healthy children of the same age. The biorhythms of the nasociliary system were studied for three years, 4 times during each year (in October, January, April, July): smears-prints from the nasal mucosa were studied with the calculation of the specific gravity of neutrophils, eosinophils, cylindrical and squamous epithelium as a percentage, the calculation of the cytolysis index of cells and the average destruction index for each type of cell. To study the near-seasonal rhythms, the KOSINOR program and the computer system of intra-laboratory control “VlCC” were used.

Results. The presence of seasonal changes in cytological parameters of the nasal mucosa with the maximum values of the average values of the average destruction of the flat, cylindrical epithelium, neutrophils in January and acrophases in January was revealed. If eosinophils on the nasal mucosa were not detected in healthy children, then the presence of this type of cells was noted in children with asthma throughout the year. The period of fluctuations of the average destruction index in the flat epithelium (1.7 months) was 4 times shorter, and in the cylindrical epithelium (21.6 months) – 3.5 times longer in children with asthma compared with healthy children. The periods, amplitude and mesor of the average neutrophil destruction index in children with asthma and healthy peers did not differ significantly. Acrophases and bathyphases of the average index of destruction of the flat, cylindrical epithelium, neutrophils in patients with asthma and healthy children were recorded at different times.

Conclusions. The study showed that in children with AD there are no patterns of rhythmological organization in the work of the nasociliary system, characteristic of healthy children.

Introduction. The study of the set of mechanisms of inflammation regulation plays an important role in shaping understanding of the local and general protective and adaptive processes in paediatric respiratory infections. The cytokine system is taken as universal, pleiotropic regulators of the cascade of inflammatory, immune and metabolic processes. Nowadays, the drugs with the potential for effecting the course of cytokine reactions are of great interest.

Aim. To evaluate the efficacy of the impact of low molecular weight interferon inducers with a wide range of biological activity on the severity of clinical symptoms and the level of pro- and anti-inflammatory cytokines of peripheral blood in paediatric respiratory infections.

Materials and methods. 98 children with ARVI aged 4 to 11 years were examined, of which 57 children received meglumine acridone acetate as etiotropic antiviral therapy at recommended age-related doses and were included in the treatment group. 41 children receiving only symptomatic treatment were included in the comparison group.

Results and discussions. Clinically, the use of meglumine acridone acetate resulted in decreased duration of the major symptoms of acute viral respiratory infections among children, reduced risk of complications, and decreased inflammatory manifestations. It was shown that the minimum levels of interleukin-1, -4 and -8 were typical for healthy children, which confirmed the activation of cytokine reactions only in the process of development of pathological symptoms from various organs and systems. An increase in all the studied cytokine levels was observed in ARVI, while the dominance in growth of pro-inflammatory cytokines with underlying slightly increased level of anti-inflammatory interleukin-4 was observed in severe general toxic syndrome and catarrhal signs. In similar cases, a balanced decrease in the levels of anti- and pro-inflammatory cytokines and a relatively rapid regression of clinical symptoms was noted during the meglumine acridone acetate therapy.

Conclusions. The use of meglumine acridone acetate contributes to the rapid relief of the major clinical symptoms of acute respiratory viral infections, and shortens the duration of the disease. The nature of cytokine reactions can serve as a marker of an unfavourable course of ARVI. The prescription of low-molecular interferon inducers balances an increase in the levels of pro- and anti-inflammatory cytokines of peripheral blood.

The aim of the study – to analyze the clinical case of a child with distal intestinal obstruction syndrome in cystic fibrosis. A 9.5 year old patient was admitted to the Gastroenterology Department of the Republican Specialized Scientific and Practical Center of Pediatrics with complaints of an increase in abdominal circumference, increased peristalsis, weakness, lethargy, swelling in the limbs, loose stools, and weight loss. From the anamnesis: from the age of 6 years it was observed periodic vomiting, not associated with food intake. At the age of 8 years, the condition worsened, bloating joined the vomiting. At the place of residence, the diagnosis was made “Acute intestinal obstruction. Volvulus of the sigmoid colon”. Over the next 6 months, the condition was relatively satisfactory, and then stool disorders began – 3–4 times a day and bloating. Considering the presence of steatorrhea, changes in the pancreas on ultrasound and MSCT, the child was referred to a geneticist, the result of a sweat test was 86.0 mEq/l. The diagnosis was made: Cystic fibrosis, mixed form. Syndrome of distal intestinal obstruction. Partial intestinal obstruction. Severe PEI, celiac disease and HIV were excluded. On the background of the therapy, the child’s condition improved relatively. Within a month after discharge, the condition was satisfactory, and then worsened again. After 3 months, the girl was re-hospitalized with the same complaints. After consulting the surgeons, recommendations were given to perform the operation due to the appearance of signs of partial lower intestinal obstruction, but the relatives signed a voluntary refusal of the operation, the child was taken home against receipt. The girl was discharged with the final diagnosis: Cystic fibrosis, mixed form, severe course. Syndrome of distal intestinal obstruction. Partial lower intestinal obstruction. Syndrome of exudative enteropathy, severe PEI. The girl died 2 weeks after discharge. Distal intestinal obstruction syndrome (DIOS) may be misunderstood by those who are not familiar with cystic fibrosis. Pediatric gastroenterologists, surgeons should be alert when this condition is detected in combination with other symptoms indicating cystic fibrosis.