The active use of assisted reproductive technologies has allowed us to achieve very impressive results, which allows us to consider this method as one of the effective approaches to infertility treatment. More than eight million children have been born worldwide with the help of assisted reproduction to date. At the same time, assisted reproductive technologies are an important risk factor, since long-term consequences for the morphology and function of the child’s heart can predispose to premature cardiovascular morbidity and mortality. These facts require a revision of traditional ideas about the long-term safety of their use, the formation of special registers. The creation of registers of the use of assisted reproductive technologies optimizes the process of long-term monitoring of children born with their use. The analysis of experimental and clinical studies presented in the review creates a theoretical basis for understanding the subtle mechanisms of the formation of postnatal health in children born prematurely and in the process of using inflammatory reproductive technologies. This review of the literature will allow doctors of various specialties (embryologists, reproductologists – obstetricians-gynecologists, neonatologists, pediatricians, therapists, cardiologists) and producers of culture media to significantly expand traditional ideas about the impact of assisted reproductive technologies on the health of the cardiovascular system in childhood, since even small changes in the conditions of cultivation and the composition of the culture medium for the embryo, the peculiarities of the course of pregnancy can have significant delayed effects on the health of children, born with the use of assisted reproductive technologies. Therefore, it is obvious the importance of monitoring children of this clinical group in order to further clarify possible long-term health consequences, a deeper understanding of the fundamental patterns of postnatal development and early diagnosis of subclinical disorders of the cardiovascular system.

Introduction. The highest level of evidence for the treatment of colic in breastfed infants is with L. reuteri monoprobiotic therapy. Recently multistrain probiotics have been used to treat colic.

Аim. Is to evaluate the effectiveness of various strategies for the treatment of infantile colic, including monoand multistrain probiotics.

Materials and methods. A total of 110 infants aged 1–5 months with colic and 20 healthy infants were examined. The effectiveness of treatment was assessed in three groups of infants with colic: Group 1 consisting of 30 children who received BioGaia Probiotic drops for baby (L. reuteri); Group 2 consisting of 40 children who received Bac-Set Baby multistrain probiotic, and Group 3 consisting of 40 children who received symptomatic therapy. The estimated parameters included duration of crying, fecal levels of zonulin measured by ELISA assays, and gut microbiota composition.

Results. Children with colic had longer crying duration compared to healthy children, higher levels of zonulin in the stool and differences in the microbiota. In group 2, colic relief occurred on average within 5 days, which is significantly faster than in groups 1 and 3 (10 and 12 days, respectively). In group 2, colic relief occurred in the majority of children (87.5%), the differences with groups 1 and 3 were statistically significant (53.3% and 10% of children, respectively). Also in group 2 there was a decrease in the level of zonulin by 41.4% from the initial level, in group 1 – by 40.1%, in group 3 – by 10.8%. Group 2 has also showed positive changes in the microbiota.

Discussion. The results confirm the effectiveness of multistrain probiotics in the treatment of colic.

Conclusions. Bac-Set Baby multistrain probiotic proved to be more effective than BioGaia Probiotic drops for baby monostrain probiotic and symptomatic therapy in the relief of infantile colic. The effect of Bac-Set Baby is associated with its ability to normalize the intestinal microbiota and reduce the permeability of the intestinal wall.

This article deals with the importance and necessity of breastfeeding for both mother and baby. The timeliness of this topic has been brought about by technological advances, which imposes its own rules and offers alternatives in which it seems much easier to neglect the main maternal responsibility – the role of the breastfeeding mother. One gets the feeling that scientific research into breast milk is limited to finding evidence of the benefits of breastfeeding to convince novice mothers to breastfeed. The article mentions the evolutionary significance of breastfeeding, explains the reasons for the mammary glands “suffering” if the only “evolutionarily assigned” function for this female organ is not implemented, which makes us look at the need for natural breastfeeding from a different angle. Evidence of the need for breastfeeding to prevent the development of breast cancer that has high mortality rates in the female population is presented. At the same time, the issue of malignant tumours is not limited only to the mammary glands. The role of the breast milk microbiota disorders in the formation of the above processes is discussed. The preventive role of breastfeeding in the development of metabolic disorders, cardiovascular and endocrine diseases in women has been shown. The article presents data on this issue from numerous clinical studies, reviews and meta-analyses. The emphasis was placed on the prenatal discussions with pregnant women about the importance and necessity of breastfeeding, which should be carried out at the stage of preparing women for childbirth. The question has been raised about the role of the local paediatrician in the prenatal nursing care for women. It explains why “early” acquaintance with the mother is far from being an additional needless burden for the local paediatrician, as it might seem at first glance, but rather, on the contrary, additional opportunities.

Cough is the most common symptom of acute respiratory infections in children. Rational approaches to the therapy of cough should be based on the diagnosis and analysis of cough features. In accordance with sputum quality and quantity, a dry (unproductive, minimally productive) and wet (productive) cough is distinguished. The cough can be acute (up to 4 weeks), subacute, chronic, recurrent in duration. Cough assessment should involve considering the following characteristics: rhythm, timbre, nature, intensity, time of onset, duration, frequency, body position while coughing, impact of cough on the patient’s condition and sleep; presence of airway obstruction, etc. All presentations of cough can change during the development of the disease, which must be considered in the diagnosis and therapy. These characteristics of cough help the therapist select a rational therapy. Particular attention is paid to the therapy of wet cough, which is based on the stimulation of mucociliary clearance, restoration of the drainage function of the lungs; improvement of sputum elimination, thinning and removal of viscous bronchial secretion from the respiratory tract; prevention of mucostasis. The article discusses the pharmacokinetics and mechanism of action for Ambroxol in terms of its indications for OTC drug delivery, clinical data on the use of ambroxol in children. The primary mechanism of action for Ambroxol involves stimulation of surfactant synthesis, a complex mechanism that is not yet fully understood, but which provides Ambroxol with effective mucokinetic and secretion-stimulating properties, thus contributing to mucus clearance, which facilitates expectoration and productive cough.

Introduction. Chronic otitis media vis effusion (COME) is a disease characterized by the presence of exudate in the cavities of the middle ear and hearing loss. Predisposing factors to the development of COME can be recurrent upper respiratory tract infections.

Aim. To study the effectiveness of the drug Sinupret® in children who have undergone surgical treatment for COME

Materials and methods. A clinical study was conducted at the Department of Otorhinolaryngology of TMU and GBUZ TO OKB No. 2 in 2020–2021. This study involved 30 children (15 boys and 15 girls) with HESO. The mean age of all patients was 6.33 ± 0.31 years. In the 1st group of children, consisting of 15 people (10 boys and 5 girls), Sinupret® was prescribed in the postoperative period, in the 2nd group of children, consisting of 15 people (5 boys and 10 girls), Sinupret® was not prescribed. Diagnosis of chronic POE was carried out on the basis of clinical and instrumental examination and integral indices of peripheral blood. Conservative treatment consisted of topical decongestant therapy and rifamycin 2.6% ear drops for a week. The observation period included 12 months.

Results. ARVI episodes during the year in group I were observed in 20%, in group II in 60% of children, the average duration of the disease in group I was 5 ± 0.71 days, in group II 7.8 ± 0.42 days (p = 0.01), stable hearing recovery in children of the 1st group was recorded in 100%. POE recurrence in children of group II was registered in 27% (4 people), which required repeated shunting to restore hearing.

Conclusions. Prophylactic use of the drug Sinupret® in children who have undergone surgical treatment for chronic OME allows you to achieve a stable restoration of hearing and contributes to complete recovery.

Interdisciplinary interaction between phthisiatricians and pediatricians on the issues of detection and diagnosis of tuberculosis provides basis for the reduction of duration of the diagnostic process and the early identification of disease progression. The purpose of this review and comments is to systematize the knowledge of pediatricians about the detection and diagnosis of tuberculosis in children and adolescents in primary health care (PHC) facilities to improve the diagnostic process. We have performed an analysis and systematization of the current directive and methodological documents, articles on the detection and diagnosis of tuberculosis in PHC facitlities. The significance of skin immunological tests (Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L and a test with recombinant tuberculosis allergen (RTA)) during mass and selective screening to form groups at high risk for Tuberculosis and detect the disease is emphasized. The doctor’s actions based on the current guiding documents and laws are presented for cases when parents/legal representatives or the patient himself refuses from immunological skin tests. Positions that determine the need for interdisciplinary interaction for pediatricians on the issues of detection, diagnosis and differential diagnosis of tuberculosis are clearly articulated. The pathway to diagnosis begins with the formation of groups at high risk for tuberculosis in PHC facilities and with seeking medical help from a pediatrician in the presence of clinical signs similar to those of tuberculosis. Particular attention is paid to the detection of the disease when patients with clinical symptoms similar to those of tuberculosis seek medical help, and the missed opportunities for its early diagnosis are presented. Predictors allowing pediatricians to suspect tuberculosis and promptly refer a patient to a phthisiatrician to confirm / exclude the disease are provided.

Cough is one of the most common symptoms in paediatric practice. Cough nature, duration, intensity, frequency, time and cause of occurrence should be considered in the differential diagnosis of its causes. Sputum evacuation disorders and changes in its rheological properties are indications for the prescription of mucoactive drugs. Despite the fact that the drugs included in this group have different mechanisms of action, all of them restore mucociliary clearance and lead to effective evacuation of secretions from the respiratory tract. Herbal medicinal products can be used along with classic mucoactive drugs (mucolytics, mucopegulators and mucokinetics). Ivy leaves are an example of a well-known and meticulously researched source of phytopharmaceutical products, they are included in the ESCOP monograph and entered into the positive list of the German Commission E. The efficacy and safety of ivy leaf products have been demonstrated in various controlled clinical studies. The authors presented a review of published clinical studies and non-interventional studies involving a total of 65,383 patients suffering from both acute and chronic respiratory diseases. The studies demonstrated the efficacy of ivy leaf extract preparations as achievement of a higher level of bronchodilation and surfactant production, which led to bronchospasmolytic, secretolytic, expectorant and, in turn, antitussive action. Herbal medicinal products are now actively used in the treatment of new coronavirus infection. Hedelix is one of the ivy leaf extract pharmaceutical preparations approved for use in children over the age of two years.

Introduction. Taking into account the changeable viral landscape of pathogens, the persistence of seasonal morbidity at a high level, and the refusal of a number of parents to be vaccinated against influenza, the interest of scientists and practitioners in the use of endogenous interferon inducers is increasing. Studies by domestic authors have proven that Kagocel® is highly effective in the prevention and treatment of influenza and other ARIs.

Aim. Evaluation of the efficacy and safety of Kagocel® for the prevention of influenza and ARIs in children aged 3–18 years old on an outpatient basis during the epidemic rise of respiratory viral infections in 2022–2023.

Materials and methods. A prospective comparative analysis of cases of prevention of influenza and ARIs by Kagocel® in children was carried out: group 1 – main (n = 32). Kagocel® was prescribed according to the scheme for a month. The comparison group consisted of patients vaccinated against influenza, who did not receive drugs for the prevention of acute respiratory viral infections: group 2 – comparison (n = 28).

Results and discussion. The index of preventive efficacy of Kagocel® was 3.0, the efficiency ratio was quite high – 66.7%. The elimination of the main clinical symptoms of the disease was noted on average by the 2nd–3rd day of illness. Prophylactic  administration of the drug allowed to reduce the incidence of influenza and ARIs by 3 times; reduce the number of complications from these diseases by 4 times. The economic feasibility of prophylaxis with Kagocel® has been proven, direct costs for the treatment of one patient have decreased by 3.6 times. The interferon inducer was well tolerated, no side effects of the drug were detected.

Conclusion. Endogenous interferon inducer Kagocel® can be used for prophylactic purposes during the seasonal rise in the incidence of influenza and ARIs.

In 2022, ARVI rates among the paediatric population were 72281.8 per 100,000, which is 6.2% higher than such rates in 2021 (68062.5 per 100,000; p < 0.05). Estimated influenza rates among the paediatric population were 165.8 per 100,000, which is 2.9 times higher than this rate in 2021. Impaired mucociliary clearance makes a significant contribution to the pathogenesis of acute and chronic bronchopulmonary diseases. Slowing of mucociliary clearance that results from chronic mucus hyperproduction leads to airway obstruction and infection, which acts as a cause of aggravation of the disease. There’s no question, the choice of a drug that can affect the secretory function of the mucous membrane or the bronchial mucous itself and its evacuation requires an individual approach to each patient. The article presents a detailed review of modern literature, as well as the authors’ own experience about cough therapy methods, including those used in broncho-obstructive syndrome. At the same time, the use of combination drugs that have a simultaneous effect on various pathogenetic mechanisms of respiratory diseases are justified more than ever before. Due to synergistic interactions of its components, the modern combination therapy, including a fixed-dose combination of salbutamol, bromhexine, guaifenesin (Bromhekomb), contributes to the productive treatment of acute bronchopulmonary diseases and exacerbations of chronic bronchopulmonary diseases accompanied by cough, mucostasis and events of mild bronchial obstruction, as well as ensures high compliance, including due to consideration of the syrup dosage form, which is especially important in outpatient paediatric practice

Paracetamol (acetaminophen) and ibuprofen are commonly used to relieve fever and pain in children. Their effects are similar, but differ in strength and mechanisms of action on the body. Acetaminophen, a para-aminophenol derivative, has antipyretic and analgesic properties. Despite the fact that paracetamol has been officially used as a drug for more than 75 years, its mechanism of biological action has not been sufficiently studied. In paediatric practice, paracetamol is more often used as an antipyretic, but in recent years, with the development of technology and emergence of new dosage forms on the market, it came into common use as an analgesic in many diseases, including oncological, rheumatological, etc. Ibuprofen is the most commonly used non-steroidal anti-inflammatory drug with pronounced analgesic and antipyretic properties. Ibuprofen, a non-selective inhibitor of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), affects the hypothalamic thermoregulatory center via inhibition of prostaglandin synthesis. In the paediatric population, the most common indications for the use of ibuprofen are fever, sore throat, ear pain, headache and toothache, post-traumatic and musculoskeletal pain, and inflammatory joint diseases. Paracetamol and ibuprofen are safe for use in paediatric practice, if dosing rules are observed, and are approved for use by the World Health Organization, FDA and other expert organizations. In addition, the emergence of new presentation forms of these drugs is most important in paediatrics.

Sore throat is the most common reason for visiting primary care doctors, pediatricians, and ENT doctors. Acute sore throat, as a rule, is not an independent disease and most often accompanies tonsillopharyngitis caused by respiratory viral infections. In childhood, the share of acute respiratory viral infections among other infectious diseases can reach up to 90%, and the proportion of frequently ill children ranges from 30 to 50%. A feature of frequently ill children is a high incidence of illness, regardless of seasonality, and a tendency to a protracted course of the inflammatory process. Uncontrolled systemic antibiotic therapy for acute sore throat in frequently ill children leads to the development of dysbacteriosis and a decrease in mucosal immunity. The use of the topical antibacterial drug Faringazon for sore throat in children reduces inflammation in both viral and bacterial infections and reduces the need for systemic antibiotic therapy. The active substance of Ambazon has a bacteriostatic effect when is kept in the mouth until it resorbs and is effective against Streptococcus haemolyticus, Streptococcus pneumoniae, Streptococcus viridans, and also has antifungal effects against Candida albicans yeast fungus, which is a saprophyte, but exhibits pathogenic properties in decreased body’s immune defence and dysbiosis. The use of topical antimicrobial therapy helps reduce inflammation and speed up the recovery of patients without prescription of systemic antibiotics, and also ensures the preservation of microbiome, reducing the probability of emergence of antibiotic resistant strains to the minimum.

Asthma is a common heterogeneous disease, which often starts at a young age and has a reversible airway obstruction as its hallmark. Phenotypic differences in children with asthma may influence concomitant diseases and treatment choices. Despite the availability of effective drugs, asthma is poorly controlled in many children, which gives doctors the power to increasingly customize therapy from a personalized medicine perspective. The Global Initiative for Asthma (GINA) 2023 preserves and develops the agebased approach to diagnosis verification and therapy choice, which is supported in the All-Russia national program: Bronchial Asthma in Children and in the national clinical guidelines on bronchial asthma. Three age groups of patients were identified: zero to five years, six to eleven years and 12 years and older. Leukotriene receptor antagonists (in particular, montelukast) are often used in paediatric practice in children with asthma. The current guidelines show that leukotriene receptor antagonists (montelukast) are an alternative to inhaled glucocorticoids in mild, intermittent and persistent asthma. This is the first mediator-specific therapy for bronchial asthma. The best strategy in prescribing this group of drugs is to assess the severity of asthma, age and presence of concomitant diseases in children. The article uses clinical examples to discuss approaches to the asthma treatment with montelukast. The lack of asthma control tools results in high morbidity, mortality and costs of treatment, which justifies the search for new therapeutic options to improve control and reduce the risk of future exacerbations. 

Type 1 diabetes is a highly prevalent disorder worldwide and the commonest form of diabetes in children and adolescents. The incidence rates are steadily increasing, despite numerous efforts aimed at finding the possibility to detect and interrupt autoimmune inflammation in the pancreas at preclinical stages. Modern technologies make it possible to set metabolic control goals that are increasingly closer to physiological ones. The article presents recommendations regarding new technologies for glycaemic control and criteria for compensation of T1DM in children and adolescents in accordance with the updated guidelines of the International Society of Diabetes Mellitus in Children and Adolescents (ISPAD, 2022) and the Russian standards for self-monitoring of glycemia using an individual blood glucose meter associated with the use of continuous glucose monitoring technologies to assess the accuracy and/or calibration of monitoring data and address treatment adjustment issues. The possibilities and advantages of modern blood glucose meters are highlighted both in terms of accuracy of readings and functional expandability. Clinical cases demonstrating the importance of using blood glucose meters in decision-making by patients (adolescents) with type 1 diabetes who receive insulin pump therapy are presented. Excessive haste in decision-making by patients resulting in non-target results on glycaemic levels, which could have been avoided with timely measurement of blood glucose levels with a glucose meter was stressed. The great role of continuous education of children and adolescents with T1DM together with assessment and analysis of the significance of new and existing technologies for diagnosis, treatment, and monitoring of this chronic disease is emphasized, so that the patients and their parents can fully and effectively use constantly emerging opportunities.

Introduction. Type 1 diabetes (T1D) is a chronic autoimmune disease requiring constant insulin therapy under regular continuous monitoring of glycemic parameters. The use of domestic insulin bioanalogues in CSII therapy is currently not sufficiently covered in the literature.

Aim. To evaluate glycemic control parameters in children with T1D treated with the domestic fast-acting insulin aspart biosimilar by CSII.

Materials and methods. Retrospective study was carried out on the basis of K.A. Raukhfus center St. Petersburg State Medical and Biomedical Center VMT. Fifty-five children with T1D aged 6 to 17 years (mean age 12 ± 4) were examined, including 29 boys (52.7%, mean age 11 ± 3 years) and 26 girls (47.3%, mean age 13 ± 4 years). Insulin therapy was carried out by systems of CSII Glycemic parameters were monitored by continuous and flash glycemic monitoring systems. The center visits frequency was once a month.

Results. During dynamic follow-up after 3 and 6 months, children showed statistically significant (p < 0.05) improvement in glycemic control parameters–decrease in HbA1c level from 8.0 ± 1.8% to 7, 1 ± 1.2% and 6.8 ± 0.6%, increase in TIR from 60.4 ± 20.6% to 71.5 ± 13.0% and 75.9 ± 9.4%, decrease in TAR from 31.1 ± 22.1% to 23.0 ± 12.8% and 20.3 ± 9.3%, decrease in TBR from 9.1 ± 8.2% to 5.8 ± 4.3% and 4.1 ± 1.8%, and decrease in CV from 40.0 ± 9.1% to 33.7 ± 6.7% and 32.5 ± 5.6%.

Discussion. The use of domestic biosimilar insulin aspart in insulin pumps iis associated with significant improvement in glycemic control in children and adolescents with T1D. Dynamic observation together with therapeutic education contribute to the maintenance of the achieved parameters at a high level.

Conclusions. Therapy with the domestic fast-acting insulin aspart biosimilar by CSII allows achieving target glycemic control in children with T1D.

Introduction. The nutrition of young children determines the vector of the physical and neuro-psychological development of the child, forms the characteristics of eating behavior.

Aim. To study the features of the nutritional practice of young children living in Belgorod, and to evaluate the success of the implementation of the Program for optimizing the nutrition of children aged 1 to 3 years in the Russian Federation in pediatric practice.

Materials and methods. We interviewed 307 women with young children born at 38–41 weeks of gestation with an Apgar score of at least 8 points. In addition, we developed a questionnaire that allows retrospectively assessing the regime and diet of young children.

Results. We identified the following problems of young children nutrition: non-compliance with the diet – only 18.1% of the respondents strictly adhered to the regime, the use of confectionery and sweets as snack products in almost a third of children (27%) which were introduced into the diet in 44% of children aged 1–2 years, and in 43% of children after 2 years. According to the survey data, 38.2% of respondents used industrial food products for young children in the form of milk-based drinks, but the duration of their use was limited to the second year of life. 14% of children used other industrial food products for young children.

Discussion. The presented dietary habits of children lead to the formation of incorrect eating habits, aggravating the imbalance of the diet, increasing the risk of health problems.

Conclusion. The results of the study show the need for further work on the active implementation of the existing recommendations for optimizing the nutrition of young children. The FrutoNyanya brand includes a wide selection of industrially produced baby food products, allowing you to achieve a wide variety, but also healthy food products.

According to the World Health Organization report, in 2019 47 million children under 5 were wasted, of which 14.3 million were severely wasted. In most cases, the main reason for nutritional deficiencies in the world is a child’s diet low in calories, dietary protein deficiency and inferiority, as well as inadequate intake of vitamins and minerals. The article presents a modern literature review devoted to the main problems in creating adapted formulas for infants who are deprived of the opportunity of getting breastfeeding. Among the most pressing problems are: difficulties in bringing the total protein concentration in the formula to the breast milk level while keeping an adequate amino acid profile, the high risk of animal milk protein allergies in infants, unfulfilled hopes for the preventive effect of partially hydrolysed formulas in relation to the development of allergic diseases, as well as the high prevalence of functional gastrointestinal diseases in children who are formula-fed. At the same time, it was emphasized that the use of goat’s milk as a protein base for basic infant formulas may in the future help solve some of the above problems. The protein component of goat’s milk compares favourably with cow’s milk, and the amino acid composition helps reduce protein concentration in the finished formula enriched with whey fraction to the recommended level. The article stresses that there is a need to continue studies on the effectiveness and safety of adapted goat’s milk formulas in infants to give definite answers to the questions posed.

Irritable bowel syndrome (IBS) is one of the most common functional conditions among children and adults. At the basis of IBS, as well as other functional disorders of the digestive system, is the disorder of brain-gut-microbiota axis. In recent years, the latter has been given particular importance not only in post-infectious IBS, but also in classic stress-induced IBS. The intestinal microflora determines the state of the enteric nervous system, visceral sensitivity, intestinal motility. In addition, the intestinal microbiota interacts through the transmitters it produces with the central nervous system, which also affects intestinal motility and the state of the microflora. Updated guidelines for the diagnosis and treatment of IBS in children of the Russian Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists in the treatment section include psychotherapeutic correction, diet therapy and drug therapy. Correctors of intestinal motility (trimebutine), probiotics and antispasmodics have proven effectiveness. The efficacy and safety of use in IBS in children Lactobacillus rhamnosus GG, L. acidophilus LA­5, B. infantis, B. animalis, L. plantarum, L. casei, L. bulgaricus, Bifidobacterium lactis BВ­12, B. breve, B. longum, S. thermophilus, Saccharomyces boulardii CNCM I­745. In this case, it is advisable to use multi-strain probiotics. Thus, the intestinal microbiota is directly involved in the pathogenesis of IBS, and the need for the use of probiotics as part of complex therapy is beyond doubt. Their effectiveness has been proven in many serious studies, which was the reason for their inclusion in practical recommendations for the treatment of IBS in children and adults.

The article discusses the problems of using products containing whole grains in the nutrition of young children. Among the most controversial are the issues of the optimal quantity and timing of inclusion of the whole grain component in baby food. The results of studies are presented confirming the effectiveness of including whole grains in children’s diets, as well as the level of their consumption in the world, demonstrating significant national differences (from 2 to 58 g per day). In general, despite the obvious benefits of whole grains, actual consumption of whole grains by children is not enough to realize their health potential. As one of the ways to solve the problem, the early inclusion of whole grains in the diet, starting from the first year of life, is considered. Aspects that limit the use of whole grains in nutrition are noted inconsistency in the identification of whole grain products and their sanitary and hygienic safety. Currently, both 30 and 50% have been proposed as the level of whole grain content in a product that allows it to be classified as whole grain. The issue of safety is especially relevant for baby food, since the outer layers of grains can concentrate contaminants (heavy metals, mycotoxins, arsenic, pesticides). It has been established that the arsenic content in whole rice products is higher than in refined analogues. In this regard, specialized baby food products have advantages for organizing nutrition for young children, the production of which involves special approaches to the selection of whole grain raw materials and technological processing modes to ensure the requirements for its quality and safety. Domestic and foreign documents regulating the requirements for safety indicators for specialized grain-based products for baby food are presented.

The article is devoted to one of the urgent problems of pediatric gastroenterology – inflammatory bowel diseases (IBD), which currently include ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of IBD is inferior to other gastroenterological diseases, but according to the severity of the course, the frequency of complications and the level of mortality, IBD occupy one of the leading places in the structure of diseases of the gastrointestinal tract. The problem of IBD constantly attracts the attention of doctors of various specialties – pediatricians, gastroenterologists, surgeons and others. This is due to an increase in the incidence of this pathology, a variety of clinical manifestations, including extra-intestinal manifestations, faced by doctors of various specialties. In childhood, there is more often a greater prevalence of the lesion, a less specific and erased picture, there is an impact on the physical development of the child. The article provides information on the prevalence, significant factors in the development of the disease; research data revealing the relationship between taking med ications and the risk of IBD onset. The problems of the pathogenesis of the disease, the significance of the genetic status in the development of CD and UC are described. The article presents data on the features of the clinical picture of UC in childhood, recommendations for the primary diagnosis of IBD, including modern laboratory and instrumental research methods. The article also describes the recommended international criteria for assessing the severity of IBD and the problems of differential diagnosis. As a demonstration, the authors’ own observations are presented. The clinical example describes an atypical case of UC in a teenager, occurring with the involvement of the cardiovascular, bronchopulmonary and urinary systems with the development of polyserositis. Early diagnosis of IBD is necessary to prevent disability of patients, ensure further development of the child, improve the quality of life.

The article presents the pathogenetic features of dermatitis in children of the first year of life, features of the clinical picture and approaches to therapy. Contact dermatitis is a fairly common pathology in young children. Previously, it was believed that the clinical manifestations in this group of children were mainly associated with simple contact dermatitis (SCD), but in recent years, studies have shown that contact sensibilization is quite common, and currently the diagnosis of allergic contact dermatitis (ACD) is not uncommon, but timely anti-inflammatory therapy prevents the formation of a focus of chronic inflammation. The prevalence of SCD and ACD in children of the first year of life, as well as the severity of skin inflammation, is associated with the existing structural features of the skin. Changes in the structures of the epidermis and dermis, characteristic of this age period, lead to easier skin damage when exposed to various irritants, both mechanical and chemical in nature, and the penetration of allergens into the skin. The peculiarity of the structure of blood vessels and increased vascular permeability is an important factor in the development and longer existence of local inflammation. The main condition for the effectiveness of treatment of dermatitis is the cessation of exposure to the substances that caused their development, and the main means of treating these conditions are topical glucocorticosteroids (TGCS). The article discusses cases of SCD and ACD in children of the first year of life, in which methylprednisolone aceponate in the form of 0.1% cream was used for external therapy. The choice in favor of this TGCS was made due to the absence of halogens in the methylprednisolone aceponate formula, the possibility of use from 4 months of age and in sensitive areas. During treatment, all patients had a good clinical effect and no side effects. The use of methylprednisolone aceponate in the form of 0.1% cream for SCD and ACD in children of the first year of life is a highly effective and safe remedy.

In February 2023, a meeting of the Council of Experts was held, attended by leading specialists in the fields of allergology, pediatrics and dermatology. The Working Group discussed the problem of sensitization to pollen allergens in patients with atopic dermatitis and exacerbation of the disease during the pollination season of plants, as well as the formation of epicutaneous sensitization through a damaged epidermal barrier. The experts comprehensively considered the criteria that a modern emollient used for the care of atopic dermatitis patients’ skin should meet, discussed the role of moisturizers in preventing seasonal exacerbations of atopic dermatitis based on previously conducted research, and developed unified recommendations on the principles of managing this type of patients. Suggestions were made for further informational and organizational measures aimed at expanding the knowledge of patients and medical specialists about the problem of epicutaneous sensitization to aeroallergens in atopic dermatitis patients, their role in the development of seasonal exacerbations of atopic dermatitis, and the possibility of their prevention using modern emollients.

According to statistics, the acute respiratory diseases incidence in the paediatric population is much higher than in the adult population, due to immature immune system, beginning of active contacts in organized groups, and often the lack of habits and skills in sanitary hygiene. Given the anatomical and physiological features, children often have more pronounced symptoms, which causes not only a faster visit to a doctor, but also more reports of polypharmacy in paediatric practice. The article presents a detailed differential diagnosis of acute respiratory viral infections, including influenza and COVID-19, according to the leading clinical symptoms and syndromes. The possibilities and features of the action of the main drugs used for the treatment of influenza and ARVI in children’s practice – oseltamivir, umifenovir and interferon alpha-2b are described. Using clinical examples, the tactics of choosing a treatment regimen in the routine work of a pediatrician, taking into account the impact of the ongoing COVID-19 pandemic in modern conditions, are considered. The advantages of using oseltamivir for influenza in children are shown. The first clinical case report: a 6-year-old child diagnosed with an acute upper respiratory infection: acute nasopharyngitis, clinical and epidemiological diagnosis – moderate to severe influenza. Severe fever and leukopenia syndrome on the third day of illness pointed to the possibility of disease progression and the development of complications, which justified selection of oseltamivir as the most effective and well-established anti-influenza drug. The second clinical case report: a 3-yearold child diagnosed with acute upper respiratory infection: acute nasopharyngitis, clinical and epidemiological diagnosis – influenza. High-grade fever, severe neutrophilia in the absence of elevated levels of leukocytes, a high level of C-reactive protein in the absence of signs of bacterial infection, determined the choice of oseltamivir. The practical administration of oseltamivir demonstrates reduction in the risk of developing severe influenza, reversing the intoxication syndrome and other manifestations of influenza, as well as prevention of the development of complications, if used in a timely manner.

Introduction. Post COVID-19 condition in children causes variety of persistent symptoms such as fatigue, post-exertional malaise, cognitive problems, muscle pain and can affect different aspects of patient’s life.

Aim. The aim of this study was to describe the prevalence and characteristics of persistent symptoms of COVID-19 in non-hospitalized pediatric patients one year after infection.

Material and methods. This is a single center case-control study including children and young people (COVID-19 as cases and other acute respiratory infections as controls). A survey using ISARIC Global COVID-19 paediatric follow-up questionnaire was conducted by a pediatrician in person or via telephone interview one year after infection. Post COVID-19 condition was defined using WHO case definition.

Results and discussion. 206 cases and 176 controls were analyzed. The mean ages of cases and controls were 8.8 years and 8.4 years accordingly, with 55% and 50% being females. The most frequent persistent symptoms in cases at 1 year were loss of taste – 8.7% [5.3%; 13.1%], fatigue – 8.7% [4.9%; 13.1%], chest pain – 4.9% [1.9%; 7.8%], headache – 2.4% [1.0%; 4.9%], tingling – 2.4% [0.5%; 4.9%]. Controls had similar persistent symptoms, but cases had significantly higher rates of sensory disturbances (taste/smell alterations) and fatigue. There were no statistically significant differences between other groups of symptoms found. Prevalence of post COVID-19 condition in cases group was 1.5% [0.0%; 3.4%].

Conclusion. Prevalence of post COVID-19 condition in children one year after mild infection is low. However, compared to other respiratory infections, COVID-19 may cause persistent taste/smell disturbances and fatigue.

Introduction. High incidence and great social significance of attention deficit hyperactivity disorder (ADHD) in preschool children determines the search and development of new options for their rehabilitation.

Aim. To analyse the patient outcomes of the most up-to-date treatment and rehabilitation complex (biofeedback, sensory integration, psychological and speech, physiotherapeutic effects) and the possibility of its widespread practical application for the rehabilitation of preschool children with ADHD.

Materials and methods. A total of 63 children (33 boys and 30 girls) aged 5–8 years were included in the prospective study. Patients were divided into two groups: Group I – 34 children aged 5 years – 5 years 11 months, 29 days with ADHD, and Group II – 29 children aged 6 years – 6 years 11 months, 29 days with ADHD. The follow-up period for each patient was 15 months. The children were examined by a neurologist, rehabilitation therapist, neuropsychologist, and speech pathologist with an assessment of active attention measures using the B. Bourdon scale for children of Group I and the Toulouse-Pieron scale (adapted by L.A. Yasyukova) for children of Group 2. Parents were surveyed and questioned using special questionnaires. Results. Before initiation of treatment, all children were diagnosed with active attention disorders of isolated (26.5 and 23.8%) and mixed (73.5 and 62.5%) nature in Groups I and II, respectively. After the rehabilitation activities complex was provided, a significant decrease in not only isolated, but also mixed attention disorders in children with ADHD was detected in both groups. Evaluation of electroencephalograms after the rehabilitation activities complex showed a decrease of theta power and an increase of low beta frequency power in 18.7% of children of Group I and in 16.2% of children of Group II, which indicated an improvement in neurodynamic functions and sufficient cognitive potential in that cohort of children.

Conclusion. Early start and prolonged use of the proposed rehabilitation complex will enhance learning ability and prevent school and social maladjustment of children with ADHD.

Introduction. Connective tissue is highly organized system, its disorders are characterized by a pronounced polymorphism of morphological and clinical manifestations. The cardiovascular pathology in patients with nonspecific connective tissue disorder attracts attention due to the high risk of complications: rhythm and conduction disorders, infective endocarditis, vascular thromboembolism and sudden cardiac death. Therefore, it’s very important to use up-to-date equipment and methods of early diagnosis of a high risk of fatal events in young.

Aim. To investigate the structural features of the heart and their relationship with the process of myocardial remodeling in children with arrhythmic syndrome and nonspecific connective tissue disorder.

Materials and methods. Sixty-five children were examined, 40 of them had arrhythmic syndrome in combination with nonspecific connective tissue disorder, and 25 had only minimal manifestations of nonspecific connective tissue disorder without arrhythmic syndrome. Such up-to-date methods as assessment of myocardial remodeling and longitudinal strain, natriuretic peptide assessment were included in the diagnostic algorithm.

Results and discussion. The study showed a variety of phenotypic and visceral markers of nonspecific connective tissue disorder in children with arrhythmic syndrome. Arrhythmic syndrome was manifested by monotopic and heterotopic heart rhythm disorders, and structural changes of the heart: mitral valve prolapse and myocardial wall thinning were correlated with a more frequent increase in natriuretic peptide. Speckle-tracking echocardiography showed a significant decrease in longitudinal myocardial strain with predominance of myocardial strain in the anterior basal segment in children with arrhythmic syndrome.

Conclusion. Our study showed a variety of phenotypic and visceral markers of undifferentiated connective tissue dysplasia in children with arrhythmic syndrome. The data obtained require further mathematical analysis and the establishment of a possible relationship between the external manifestations of the disease and cardiac rhythm and conduction disturbances.

According to WHO, pneumococcal infection (PI) is considered one of the most dangerous of all vaccine-preventable diseases and, before vaccination, led to the death of up to 1.6 million people per year, of which from 0.7 to 1 million were children. In the prevention of PI, specific prevention occupies a special place. For the first time in 2014, vaccination against PI with pneumococcal conjugate vaccine was included in the national calendar of preventive vaccinations. International practice of using pneumococcal vaccine has shown that timely vaccination can produce positive results in the fight against PI. Under observation were 55 children who were vaccinated against PI with the pneumococcal polysaccharide conjugate vaccine (adsorbed), 13 valent according to the national calendar of preventive vaccinations of the Russian Federation. It was revealed that post-vaccination complications after vaccination did not occur in any child. General post-vaccination reactions were observed in the form of a short-term increase in temperature, loss of appetite and sleep disturbances, as well as local reactions in the form of edema, hyperemia, and hardening at the site of vaccine administration. We studied the incidence of community-acquired pneumonia (CAP), acute otitis media and acute respiratory infections among 55 children of the first year of life vaccinated at 2 months and 4.5 months (main group) and 50 children for various reasons not vaccinated against PI (comparison group). A study of the long-term results of 2-fold vaccination in the first year of life and revaccination at 15 months against PV based on observation of children for two years showed that children of the main group, compared with the comparison group, were 3.3 times less likely to suffer from PV, 2.7 times acute otitis and 1.7 times acute respiratory infections, p < 0.05. The data obtained show the high efficiency and safety of vaccinating children against PI with the pneumococcal vaccine.

Coarctation of the aorta is a congenital malformation characterized by the presence of narrowing of the aorta, which can be localized in any part of it. In this publication, we present a clinical case of coarctation of the aorta before and after surgical correction in a newborn. The child was admitted to the cardiosurgical hospital at the age of 6 days. Congenital heart disease of a low category of complexity was diagnosed prenatally. After birth, the condition is satisfactory. After 3 hours, the negative dynamics due to the clinic of respiratory failure. According to echocardiography – hypoplasia of the aortic arch, coarctation of the aorta? Open ductus arteriosus, ventricular septal defect. On the 3rd day of life, a diagnosis of congenital pneumonia was made and the child was transferred to a cardiosurgical hospital. Upon admission to the FCSSH in Astrakhan, the condition was regarded as severe, due to heart and respiratory failure. The child is examined. On echocardiography – Pronounced preductal form of coarctation of the aorta. Hypoplasia of the proximal arch and isthmus. Open ductus arteriosus. Ventricular septal defect. biventricular hypertrophy. Severe dilatation of the right chambers of the heart. Relative hypoplasia of the left ventricle. Tricuspid regurgitation. On the 7th day of life, surgical correction of the defect was performed plasty of the arch and isthmus of the aorta, plasty of the VSD. The early postoperative period proceeded with a clinic of moderate respiratory and heart failure. Against the background of the expansion of the volume of feeding, chylothorax was detected, drainage of the right pleural cavity was prescribed. Enteral feeding has been replaced by parenteral nutrition. The child was extubated on the 4th postoperative day. However, oxygen dependence was noted. The pleural drainage was removed on the 11th day after the operation. On the 12th day, the newborn was transferred from the intensive care unit. Discharged from the hospital on the 20th day after surgical treatment. After 4 months the child was examined in the hospital. The general condition was regarded as satisfactory. This clinical example shows the complexity of prenatal diagnosis of obstructive pathology of the aortic arch and the rapid manifestation of clinical manifestations after birth against the background of an unfavorable combination with a large septal defect.

The authors raise an issue of job responsibilities of a district paediatrician in case of a home visit, as well as of the standards for packing first-aid kits and emergency medical care kits. The provisions of the applicable legal acts are provided. The proceedings of international conventions on primary medical care for children, current federal clinical guidelines, paediatric medical care standards and procedures, orders of the Ministry of Health of the Russian Federation were analysed. We paid attention to the experience of foreign countries, as well as the regions of the Russian Federation in providing emergency medical care to the paediatric population. A survey among local paediatricians was conducted: 30 district paediatricians (10 persons from each of three children’s outpatient departments in different districts of St. Petersburg) answered questions on the algorithm for activities during home visit if emergency care was required. The results of the survey and analysis of the applicable legal acts showed that the district paediatrician is responsible for the life and health of his/her patients. However, there is no single standard regulating the responsibilities to provide emergency care to the child by the district pediatrician during home visit, and the volume of this care has not been established. Urgent conditions require immediate medical care right when they are detected by a paediatrician on call, until an ambulance team arrives. In conclusion, the authors determined that the creation of unified algorithms for emergency medical care to be provided by a paediatrician on call encompasses a number of medical, ethical and legal aspects. The development of this document is certainly a necessity and requires a balanced, judicious approach.

Mesadenitis (mesenteric lymphadenitis, mesenteritis) is a common cause of acute abdominal pain syndrome in children. At the same time, the cause of acute mesadenitis is far from being established in all cases. Diagnosis of mesenteric lymphadenitis presents a certain problem. Differential diagnosis is always carried out with acute surgical diseases of the abdominal cavity, primarily with acute appendicitis. Special attention is paid to ultrasound examination in the diagnosis of mesadenitis. Given the absence of statistically proven diagnostic criteria for changes in abdominal lymph nodes in mesadenitis, it is relevant to determine their ultrasound characteristics. The article is presented in the form of a lecture for practicing pediatricians based on a literature review. The characteristics of mesentery lymph nodes in various pathological processes are collected from various sources. The features of ultrasound characteristics of mesenteric lymph nodes in normal and acute mesadenitis with herpes infection, coronavirus infection, tuberculosis, as well as features of lymph nodes with lymphogranuloma are presented. A table has been developed that indicates such characteristics as the shape, number of lymph nodes in the section, echogenicity, blood flow status, capsule, contour, as well as additional characteristics in some conditions (such as the tendency to form conglomerates or the presence of calcinates in the structure of lymph nodes in tuberculosis lesions). A detailed description of the lymph nodes makes it possible to conduct a preliminary differential diagnosis of mesadenitis using ultrasound, which makes it possible to determine the vector of further diagnostic search in children with acute abdominal syndrome, and then to select pathogenetically justified therapeutic tactics and preventive measures.

Introduction. It is known that the presence of the CagA gene in Helicobacter pylori is associated with its increased pathogenicity. However, in children, studies on the effects of this strain on the gastric mucosa are insufficient.

Aim. To compare effects of different Helicobacter pylori (HP) strains on the gastric and duodenum mucosa in children to optimize indications for eradication.

Materials and methods. 397 adolescents (169 boys and 227 girls) aged 11–18 were examined on the basis of the hospital gastroenterological department: the content of antibodies to the CagA strain of HP was determined by ELISA, esophagogastroduodenoscopy (EFGDS) was performedwith a biopsy of the gastric mucosa and determination of the HP contamination degree, and also HP gene was detected in the feces.According to the results obtained, all children were divided into 3 groups: 131 children (57 boys and 74 girls) infected with CagA by negative HP strains (CagA “-”); 119 children (52 boys and 67 girls) infected with CagA positive HP strains (CagA “+”); 94 children (36 boys and 57 girls) who are not infected with HP (HP “-”).

Results. When we analyzed the endoscopic-histological picture of the gastric mucosa in the CagA “+” group, in contrast to the CagA “-” group, it was found that the chances of developing highbacteria contamination of the mucosa increased 4.7 times, II and III degree of gastritis activity – 6.6 times, chronic inflammation – 2.6 times, hyperplastic gastritis – 2.8 times, erosive gastritis or duodenitis – 2.7 times, peptic ulcer – 3.6 times, andalso signs of concomitant candidiasis (the presence of structural elements of the Candida fungus) – 4.1 times.

Conclusion. Thus, it is advisable for all children with gastroduodenal pathology to recommend an examination for the detection of the CagA HP antigen with subsequent eradication.