Introduction. Choroid plexus cysts are incidental findings on ultrasound examination of the neonatal head usually. Nowadays, choroid plexus cysts refers are known as “soft markers”, which do not have a direct pathological effect on the infants themselves, but may be associated with an increased risk of other perinatal pathology, including intrauterine infections or genetic anomalies.

Aim. To identify the features of developing early neonatal disadaptation in newborns with choroid plexus cysts, including subependymal pseudocysts.

Materials and methods. Between January 2023 and August 2023, routine brain sonographic examinations were performed on 760 neonates who were born at term without disturbances in neurological status and vital functions. The adaptation in the early neonatal period (the first 3–7 days) was assessed according to the following generally accepted criteria: weight dynamics in the early neonatal period; laboratory markers of inflammation as a predictor of intrauterine infection, the level of bilirubinemia and other metabolic indicators.

Results. According to the results of neurosonography, choroid plexus cysts, including subependymal ones, were initially diagnosed in 96 (12.63%) patients. When studying the correlation between localization of cysts and signs of disadaptation reveals that in cases of bilateral location of cystic formations, 55% of newborns with choroid plexus cysts had at least one criterion of maladaptation listed above. Moreover, only in 35.71% of cases signs of maladjustment were observed in children with unilateral choroid plexus cysts. In the group of patients with subependymal pseudocysts, signs of disadaptation were found more often – in 72.72% of newborns with identified bilateral, and in 39.31% with unilateral subependymal cysts.

Discussion. We noticed an increase the frequency of initially diagnosed choroid plexus cysts among full-term newborns (12.63%). We conclude that bilateral choroid plexus cysts and subependymal pseudocysts are a high risk factor of developing early neonatal disadaptation than in children with unilateral choroid plexus cysts (p < 0.05).

Conclusions. It may play greater diagnostic value of bilateral choroid plexus cysts and subependymal pseudocysts as a risk factor of developing early neonatal disadaptation and require more careful monitoring of newborns with such ultrasound findings.

Introduction. The article discusses the problem of bottle feeding – a method of feeding infants with breast milk or formula, which has been used for many years and plays an important role in feeding a newborn, and this fact cannot be ignored.

Aim. To evaluate the possibility of maintaining breastfeeding when temporary feeding of the child is necessary using the bottle.

Materials and methods. A non-comparative observational prospective study was conducted in 30 full-term and late preterm infants, as well as in premature infants who reached 38–40 weeks of postconceptual age.

Results and discussion. Prior to discharge, all 29 mothers (100%) awarded 5 scores for the appearance, ease of feeding, ease of washing and sterilizing feeding nipples and bottles. Everybody reported the overall impression as positive. The assessment was based on the questionnaire results. Also, we evaluated the following parameters: general assessment of infant’s bottle sucking activity – satisfactory; infant’s breast sucking activity after transition to breastfeeding – satisfactory. The risk of aerophagia has been reduced, no symptoms were observed in 95% of cases, according to questionnaire results. The use of Pigeon SofTouch Peristaltic PLUS allows to the possibility of breastfeeding during mother’s transition to lactation, mixed feeding, temporary weaning because of mother’s health condition or for other reasons, and during transition from tube feeding to breastfeeding.

Conclusions. The results demonstrate the safety and efficacy of Pigeon SofTouch Peristaltic PLUS, the use of which reduces the risk of aerophagia and discomfort in newborns during temporary weaning due to the mother's health or other reasons. The most important factor in maintaining successful breastfeeding is that mothers receive quality counselling and appropriate training with a special emphasis on the child's behaviour and the practice of so-called “responsive feeding”.

Introduction. According to the literature, the main reason for premature termination of breastfeeding is hypogalactia. Much attention is paid to the treatment of hypogalactia with non-drug natural remedies.

Aim. To evaluate the efficacy and safety of using different forms of a lactogonic phytocomplex for hypogalactia in lactating women.

Materials and methods. The comparative study included 68 women in labor, average age 27.3 ± 7.6 years, with a history of hypogalactia. All women were divided into 3 groups: 1st – the main (n = 30), who received Lactogon in tablets, 2nd – the main (n = 16), who received «Lactogon» in the form of a specialized product of dietary preventive nutrition – herbal tea and 3rd – the comparison group (n = 22). Observations were conducted during the mother and child’s stay in the maternity hospital and during the following month at home (for dietary supplements and herbal tea) and the following 3 months (for dietary supplements). The criteria were: tolerance; health status of the mother and child; on what day the effect of the treatment occurred; the amount of breast milk that the baby receives in one feeding and per day; sucking activity, weight curve dynamics, the presence of dyspeptic and allergic manifestations.

Results. The results of the study showed that already on the 2nd day of taking the phytocomplex Lactogon the volume of milk increased by 1.6–1.7 times compared to the same indicators in the control group and continued to gradually increase significantly exceeding the indicators of the control group. Thus, by the 30th day of using Lactogon, the volume of milk in women was 1.5–1.6 times higher compared to the control group. Good sucking activity and normalization of stool were observed in the infants of mothers in the main groups. The intake did not cause intolerance or allergic reactions.

Discussion. The results of this study correlate well with the results of a previously conducted study, which showed the highest levels of increase in milk volume in nursing women compared to other specialized products and dietary supplements for increasing lactation.

Conclusions. The study showed that the use of the phytocomplex Lactogon in women with hypogalactia is effective and safe.

Adequate nutrition during the first months of life is essential for newborns and infants to ensure their growth and development. If women are unable to breastfeed for medical or social reasons, milk formulas become the primary source of nutrition for infants. Modern infant milk formulas are developed with due account for the latest discoveries in science regarding the growing body needs and include various functional components that contribute to a baby’s healthy growth and development. However, the histories of creation and evolution of milk formulas are always interesting. The article describes how different nations approached the issues of feeding babies using alternatives to the breast milk, including goat’s and cow’s milk, as well as plant-based formulas. Special attention is paid to the research discoveries in the field of nutrition and medicine that inspired the creation of safe nutritional formulas. Currently, rapid technological advancements can provide modern formula-fed infants with oligosaccharides with structures identical to human milk oligosaccharides, polyunsaturated fatty acids (omega-3 and omega-6) such as docosahexaenoic acid (DHA) and arachidonic acid (ARA) and other useful components. New infant formulas for artificial and/or mixed feeding from birth stand out particularly. Their composition meets all the requirements for the production of infant formula and is enriched with a combination of 2′-fucosylated oligosaccharides (2′-FL) and galacto-oligosaccharides (GOS), which can give a long-range outlook for the use of infant formulas.

Introduction. The article substantiates a comprehensive bioregulatory approach to the treatment and immunorehabilitation of infectious respiratory diseases of the upper respiratory tract in pediatric practice.

Aim. To study the efficacy and tolerability of a bioregulatory drug in the complex treatment of children with infectious lesions of the upper respiratory tract.

Materials and methods. A prospective single-center study was conducted, 63 children: the main group of 32 children, the bioregulatory drug Tonsilgon® N 14 days was included in the complex of generally accepted therapy; 31 – the control group, only a complex of generally accepted therapy providing an anti-inflammatory effect was carried out. The age of children was 3–5 (4.3 ± 0.37) and 6–12 (9.2 ± 1.48) years in equal numbers by gender. Verification of the pathogen was carried out upon admission: in the main group, group A β-hemolytic streptococcus was detected in 7 (21.87%) patients, in the control group – in 6 (19.35%) patients; In the main group, Ig to Chlamydophila pneumoniae and Mycoplasma pneumoniae were in 9 (28.12%) patients, in the control group – 8 (25.8%), systemic antimicrobial therapy was prescribed.

Results. In the main group, on the 3rd day of examination, the treatment was assessed as highly effective in 21 (65.62%), effective in 10 (31.25%), and moderately effective in 1 (3.12%). On average, the effectiveness score for the group was 2.61 ± 0.14 points. Discussion. The broad spectrum of action, due to the diverse composition of the phytoimmunomodulator, has a stimulating effect on the activation of phagocytosis of macrophages and granulocytes, accelerating the elimination of pathogens, which is consistent with our data and with literature data.

Conclusions. An integrated approach to the treatment of inflammatory diseases of the oral cavity in children with the inclusion of a bioregulatory drug has a beneficial effect on the course of the inflammatory process in the oropharynx and stimulates the body’s resistance.

The article focuses on the issue of non-allergic rhinitis. Non-allergic chronic rhinitis is an umbrella diagnosis and contains all other chronic rhinitis phenotypes of different aetiology and pathogenesis, which are not associated with allergic and infectious inflammation, but are permanently or periodically manifested by similar clinical symptoms: nasal congestion, anterior and posterior rhinorrhoea, sneezing/itching in the nasal cavity. The recent studies on the epidemiology of non-allergic chronic rhinitis in the general population show that 10.9% to 28% people have this disorder. In Russia, there are about 100,000 patients diagnosed with vasomotor rhinitis according to the Russian rhinologic society experts’ opinion. Not questioning the statement that the chronic rhinitis mainly affects adults, we however can observe this disease in children. The trigger factors of rhinitis are described in detail as follows: low-molecular substances with molecular weights of <5 kilodalton (kDa), which provoke non-allergic inflammatory reactions of the mucous membrane of the nasal cavity or contribute to the current inflammatory process. The attention is also paid to the primary mechanisms minimizing the influence of these factors, especially in paediatric practice, focusing on the regular use of irrigation and elimination therapy. The nasal cavity irrigation results in reduced number of antigenic structures and trigger molecules that enter the nasal cavity and come in contact with the mucus membranes when you breathe. Today, the irrigation and elimination therapy with saline solutions is an integral part of the therapy for healing the inflammatory rhinological disorder, which is reflected in some national clinical guidelines and international consensus documents. However, the studies on the use of irrigation and elimination therapy in non-allergic chronic rhinitis are rare.

The problem of determining the tactics of prescribing topical therapy in respiratory pathology remains relevant in pediatric practice. Local therapy is one of the components of complex treatment of respiratory diseases of upper respiratory tract, ENT organs, however, in the presence of appropriate indications according to the current federal recommendations for the appointment of antibacterial drugs of systemic action can not replace them. The article presents a modern review of scientific literature data on the role of topical drugs in respiratory diseases. Numerous clinical and experimental studies confirm the effectiveness of topical preparation benzydamine, which has a unique combined action, simultaneously influencing various pathogenetic links of inflammation. Benzydamine exhibits antiseptic and anti-inflammatory properties, effectively inhibiting the growth of both Gram-positive and Gram-negative bacteria, as well as some types of fungi, demonstrating resistance to the mechanisms of antibacterial resistance. The key advantage of benzydamine is its ability to penetrate into the focus of inflammation, reaching the necessary therapeutic concentrations. The mechanism of this action is associated with modulation of the activity of various inflammatory mediators such as cytokines and prostaglandins, resulting in a reduction of the inflammatory response. Moreover, benzydamine has immunomodulatory properties, stimulating local immunity and enhancing the activity of local immune cells. This contributes to faster and more effective elimination of the infectious agent and accelerated repair of damaged tissues. Prospective results and detailed evaluation of clinical efficacy of benzydamine, which has a complex of anti-inflammatory properties, were the basis for recommending it as a safe and effective topical drug in the treatment of infectious and inflammatory diseases of the respiratory tract, ENT organs, oral cavity.

Cough is an interdisciplinary problem and there are various possible reasons for its occurrence: pulmonological, cardiological, otolaryngological, gastroenterological, neurological and others. Despite the large number of causes of cough in pediatric practice, cough is most often caused by acute respiratory viral infections of both the upper and lower respiratory tract. At the same time, in the differential diagnosis of acute cough, it is important to make sure of its connection with infection (fever, presence of catarrhal syndrome). This article discusses differential diagnostic criteria for cough in pediatric practice in various diseases. Rational antitussive therapy is based on: establishing a diagnosis of the disease; analysis of cough characteristics; intensity of the cough act, its duration; its impact on the patient’s condition, and also taking into account the presence of obstructive respiratory syndrome. The use of combined mucoactive drugs that can have a complex effect on various pathogenetic mechanisms is one of the important areas in mucolytic cough therapy. Such an effective combination drug is a drug based on salbutamol, bromhexine and guaifenesin. Salbutamol promotes relaxation of the smooth muscles of the bronchi, which can prevent or eliminate bronchial obstruction; bromhexine has a mucolytic effect, which is indicated for respiratory infections occurring with hypersecretion of viscous sputum; guaifenesin is a mucoactive drug that liquefies sputum in the respiratory tract and helps increase cough productivity. These components have a synergistic effect on various pathogenetic mechanisms of inflammatory processes in the respiratory tract, which are accompanied by a cough with difficult sputum and an obstructive component.

The publication presents current information on pyretic situations in pediatric practice. Along with known data, attention is drawn to terminological features and the need for a differentiated approach to conditions accompanied by an increase in body temperature, and pathogenetic and clinical aspects of both hyperthermia and fever are considered. The terms hyperthermia, pyrexia, pyrogenic fever, which are not synonyms, are described in detail. High body temperature can be caused by fever or hyperthermia. The differences between these definitions are obvious and fundamental, since they have different causes, clinical manifestations, and therapeutic strategies. The work identifies indications for antipyretic therapy with an emphasis on the mechanisms of action of recommended drugs, presents the main characteristics and distinctive features of the main antipyretic drugs. An important section of the article is devoted to the analysis of priority randomized placebo-controlled studies on the comparative evaluation of the effectiveness of various approaches to the treatment of fever with monotherapy with paracetamol or ibuprofen, as well as the alternate or combined use of these drugs. The data of a number of studies, which show some differences in the clinical effect, support the expediency of using the two drugs simultaneously. It has been shown that paracetamol has a faster antipyretic effect, while ibuprofen has a longer-lasting effect. The results of the review are of scientific interest, deserve the attention of practicing doctors, confirm the importance of the problem of antipyretic therapy in childhood based on a personalized approach. The article draws attention to the fact that paracetamol and ibuprofen recommended for use as antipyretic agents and are officially recommended by the World Health Organization, clinical and national programs for use in pediatrics as antipyretic agents.

An acute cough that develops against the background of a respiratory viral infection is the most common symptom in childhood. It can significantly affect the quality of life of patients and their families. Currently, there is a growing interest in using natural remedies to treat this type of cough. To solve this problem, many medicines based on natural, including herbal raw materials, can be successfully used. The article demonstrates the possibilities of some natural remedies in the treatment of acute cough in children. Ivy leaf extract (Hedera helix L.) occupies a special place among such preparations. It has a very wide range of therapeutic effects, including expectorant, bronchospasmolytic, anti-inflammatory, and antimicrobial properties. The medicinal product based on Hedera helix L. has proven efficacy and safety in childhood. Thus, a multicenter observational study involving 5,162 children who were prescribed a herbal medicine containing ivy leaf extract for the treatment of cough in acute respirato-ry diseases showed a pronounced positive therapeutic effect in the form of a decrease in the intensity and frequency of cough episodes, as well as high parental satisfaction with the treatment process. A meta-analysis of two double-blind, randomized, placebo-controlled trials in patients with acute respiratory tract infection who received dry ivy leaf extract for 7 days demonstrated an effective reduction in the severity of acute cough associated with acute respiratory viral infection and a significant acceleration of patient recovery. In the group receiving ivy leaf extract EA 575, the proportion of patients without cough was 18.1% at the end of treatment and 56.2% at the end of follow-up, compared with 9.3% and 25.6% for placebo, respectively.

Acute tonsillopharyngitis is a common disease (2–5% of paediatric outpatient visits) for which systemic antimicrobials are often prescribed. However, streptococcal tonsillopharyngitis, infection caused by group A beta-hemolytic streptococci (GABHS), is one of the main indications for antibiotic therapy in acute tonsillopharyngitis in children. When developing a treatment regimen for the disease, preference is given to topical therapy (except in cases of streptococcal tonsillopharyngitis), and the topical antimicrobial therapy methodology recognises that laryngospasm may occur in young children, and the microbiome of the oral cavity and pharynx may need correction in frequently ill children after intensive antimicrobial therapy. Aerosol therapy in the form of inhalation of pharmacological agents that have higher chemical and physical activity than their liquid counterparts due to larger total surface area of the dispersed phase is the optimal method for delivering pharmacological agents into the oral cavity and pharynx. In recent years, a new generation antiseptic benzyldimethyl-myristoylamino-propylammonium chloride has become increasingly common. It showed pronounced activity against Gram-positive and Gram-negative bacteria, fungi, complex viruses, including the SARS-CoV-2 coronavirus, protozoa, aerobic, anaerobic flora in the form of monocultures and microbial associations, including strains with multiple antibiotic resistance. This antiseptic agent refers to drugs of low-toxicity, and does not have any local irritating, allergenic, mutagenic, carcinogenic or embryotoxic effect. It has been identified as having immunoadjuvant effect. The review of clinical observations showed that an aerosolized form of benzyldimethyl-myristoylaminopropylammonium chloride had a favourable clinical effect in patients with tonsillopharyngitis of both streptococcal and other, in particular viral, etiology. The aerosolized form of the drug provides a wide spray angle and finely dispersed diffusion, as opposed to a spraying device, due to which the drops of the drug cover the mucous membrane in a more accurate way. The findings of the analysis of systematic reviews on the etiology, clinical picture and diagnosis of acute tonsillopharyngitis, updates on the oropharynx microbiocenosis and methods for its correction, and clinical studies on the efficacy and safety of the aerosolized form of benzyldimethyl-myristoylamino-propylammonium chloride have led to the conclusion that its application as topical therapy is useful for the treatment of acute tonsillopharyngitis in children.

The implementation of clinical guidelines in daily practice has not made the desired progress as yet and is restrained by various factors, a significant part of which are subjective. The leading factor among them is that the doctors underestimated the practical benefits of their use in clinical settings. Antibiotic indications for the most common acute bacterial infectious and inflammatory respiratory diseases, such as acute streptococcal tonsillitis/pharyngitis, acute purulent otitis media, community-acquired pneumonia, acute bacterial sinusitis, are presented in the context of current clinical guidelines. The article discusses the principles of choice of first-line antibiotics, the mode of administration and recommended dosage regimens, taking into account the class of recommendations and the level of evidence. Amoxicillin and amoxicillin/clavulanate are the main antibacterial drugs for the treatment of these diseases, which in these cases should be used orally in accordance with clinical guidelines. However, taking into account the availability of these antibiotics in many dosage forms (dispersible tablets; film-coated tablets; powder for suspension), it is advisable to pay attention to a variety of advantages of drugs that are available as dispersible tablets. Again, we emphasise that due to the implementation of clinical guidelines into everyday clinical practice, the rational initial antibiotic therapy will not only significantly increase the effectiveness of treatment of acute bacterial respiratory infections, but will also contribute to solving one of the global challenges facing healthcare right now i.e. reduction of the rate of development of antibiotic-resistant strains. All these considerations require paediatricians to pay close attention to the mandatory implementation of clinical guidelines in addressing the issues of prescribing antibiotics when treating acute respiratory infections in pediatric patients, which has become the essence of this publication.

Functional gastrointestinal disorders (FGIDs) are a common problem in paediatric practice. Symptoms of this disorder in infants account for 25 to 55%. Presence of these symptoms in children has significant impact on their quality of life and also, affects the parents’ quality of life. Functional GI disorders are characterized by pronounced clinical manifestations, despite the absence of organic GI pathology and metabolic disorders. The article presents the major types of functional disorders such as infantile colic, functional constipation and infantile regurgitation, as well as their prevalence, pathophysiological mechanisms and clinical presentation. Particular attention is paid to dietary recommendations that can help improve the health condition of children. Cow’s milk-based infant formulas are popular, while goat’s milk-based formulas are a newish alternative nutrition. It should, however, be noted that goat milk protein has a range of health benefits compared to cow’s milk protein, especially in terms of digestion, as it is more efficiently digested than proteins from cow milk. Recommendations for the management of patients with functional GI disorders on modern milk formulas in the absence of breastfeeding are presented using the example of a clinical report of a 2-month-old baby (K.) with his mother’s complaints about loud crying after eating, irregular bowel movements, regurgitation, short and restless sleep episodes. The CoMiSS (Cow’s Milk-related Symptom Score) scale showed that goat’s milk-based infant formula may be a promising alternative to cow’s milk-based infant formula for this baby.

Today, tuberculosis (TB) remains an urgent global public healthcare challenge. According to WHO estimates, about 1.3 million child population under age 15 fell ill with tuberculosis worldwide in 2023. An estimated 166 thousand children (0–14 years of age) died for this period. The TB incidence in children and adolescents is an important prognostic indicator that reflects the overall epidemiological situation in the region. A timely detection of the health condition, when the risk of developing active TB disease becomes the highest is an important factor for the reduction of the TB incidence. The implementation of preventive measures, including preventive treatment, will be quite effective in preventing development of TB disease. In the Russian Federation, different immunological diagnostic tests are used for preventing and early detection of TB in children according to their age. That has led to a significant reduction in the incidence in not only the child and adolescent population, but also a decrease in indices in the age group of 18-25 years. An intradermal ATP test and/or alternative in vitro tests such as IGRA tests are used, among other things, as part of diagnostic and differential diagnostic measures when tuberculosis is suspected. The use of a combination of all available methods to establish an accurate diagnosis would be appropriate in the most complex diagnostic cases. The presented clinical observation highlights a rare case of calcifying fibrous tumour in a 17-year-old boy, which required a multifaceted diagnostic approach, including modern IGRA tests (TigraTest®TB), to exclude tuberculosis involving multiple systems and select the correct treatment and diagnostic strategy to verify the diagnosis.

Introduction. Anaphylaxis in children is considered as a serious issue due to severe clinical manifestations and potential adverse outcomes.

Aim. Тo analyze clinical features and causes of anaphylaxis in children of different age groups.

Materials and methods. We performed a single-center study. Of 3887 children hospitalized in the department of allergology of Republic Children’s Hospital from January 2022 to August 2024, 68 children aged 6 months to 18 years who met the criteria for diagnosis of anaphylaxis were included to the study. Clinical findings and allergy testing results of different age groups were evaluated.

Results. In our study, 94.1% of children with anaphylaxis were diagnosed with allergic diseases. Seventy-five percent of those had concomitant allergic asthma, allergic rhinitis, and atopic dermatitis. Most patients were male (60.3%). Involvement of skin/ mucosal tissue (94.1%) and respiratory system (86.8%) was predominant anaphylaxis symptom. The spectrum of clinical manifestations expanded as the child’s age increased. Recurrent episodes of anaphylaxis were observed in 26.5% of children. Cow’s milk (27.9%) and tree nuts (23.5%) were leading causes of anaphylaxis among food allergens (79.4%). Drugs were estimated as a probable cause of anaphylaxis in 6 cases (8.8%), insect venom allergy – in 4 cases (5.9%). According to medical records epinephrine was administered in 2 cases.

Conclusion. Clinical manifestations and triggers of anaphylaxis in children differ in various age groups. Due to the severity and variety of clinical symptoms of anaphylaxis, and the risk of recurrent episodes, the awareness concerning signs of anaphylaxis is essential for healthcare professionals to provide acute management and prophylaxis.

Tuberculosis as a socially significant disease is the most important medical and social problem of the modern world, including our country. Children and adolescents from socially vulnerable groups require special attention. The high significance of the impact of social factors (standard of living and social protection of families, availability and effectiveness of medical care to the population, the degree of health literacy and cultural competence, migration processes) on the incidence of respiratory tuberculosis in children and adolescents is stressed. Particular attention is paid to the causes of MBT infection and tuberculosis in children and adolescents residing in new Russian regions: high probability of unidentified contact with a tuberculosis patient, often unsanitary living conditions, overcrowding, stress. The level of medical care and anti-tuberculosis measures carried out in these socially vulnerable groups is insufficient due to personal and impersonal reasons. This review is aimed to systematize knowledge about immunodiagnostics of tuberculosis infection in socially vulnerable groups of children and adolescents, to present the principal directive documents and comments on this issue for phthisiologists and paediatricians, taking into account interdisciplinary interaction. We conducted the analysis and systematization of data from current directive, methodological documents, articles, which present the concept of socially vulnerable groups, reflect approaches to the use of skin immunological tests and laboratory diagnostic tests based on the in vitro interferon gamma (IFN-γ) release by T-lymphocytes (IGRA tests) in mass-scale and selective screening in different socially vulnerable groups of children and adolescents. Non-routine situations on the use of immunodiagnostics in socially vulnerable groups are presented.

Introduction. Familial hypercholesterolemia is the most common monogenic disease in the population with a predominantly codominant type of inheritance. For the purpose of early detection of familial hypercholesterolemia, various screening methods are used, including the cascade screening method, which can be direct: from parent to child and reverse: from child to parent. Aim. To analyze the effectiveness of child-parent cascade screening for the early detection of new patients with FH.

Materials and methods. The study was conducted at the State Budgetary Healthcare Institution “Z.A. Bashlyaeva Children’s City Clinical Hospital of the Moscow Health Department” from January 2022 to August 2024. Child-parent cascade screening was performed in the families of 364 index patients (0–18 years old) with verified familial hypercholesterolemia.

Results. During the cascade screening, 581 new patients with familial hypercholesterolemia were identified, including 43 children (7.4%) aged 1 to 18 years, 28 young adults (4.82%) aged 18 to 30 years; 332 people (57.14%) aged 31 to 50 years and 178 people (30.64%) over 51 years of age.

Discussion. The use of child–parent cascade screening is an effective diagnostic tool engineered for early identification of patients with familial hypercholesterolemia. The effectiveness of cascade screening is limited by the method of communication with the index patient’s relatives. In our country, the only way to perform cascade screening is an indirect contact with family members through the index patient or their legal representatives.

Conclusion. Evaluation of the effectiveness of cascade screening allowed us to determine that there are 1.6 newly diagnosed patients per index patient. More than half (69.36%) of newly diagnosed patients were under 50 years of age. The advantage of the parent-child cascade screening option is the possibility of early detection of patients with familial hypercholesterolemia. This approach allows us to diagnose a significant number of new patients at a young age, when primary prevention of atherosclerotic cardiovascular diseases can bring the greatest benefit.

Congenital malformations constitute one of the most pressing medical and social problems in the world. This is due to the high incidence of pathology and the severity of the formed anatomical and functional disorders. Apert syndrome is a rare malformation characterized by syndromic craniosynostosis, which is a group of disorders in which various malformations and ossification features of the bones of the facial and cerebral skull are combined with abnormalities of other organs and systems. The cause of the gene mutation has not yet been determined. The disease occurs as a result of an autosomal dominant mutation in a gene that is localized on the long arm of chromosome 10, at the 10q26 locus. Aper syndrome is caused by one of two missense mutations of the FGFR2 gene involving two adjacent amino acids: S252W and P253R. Severe syndactyly and mental retardation are expressed in patients with the P253R mutation. On the contrary, cleft palate is more common in carriers with the S252W mutation. Aper syndrome is characterized by a clinical triad: brachycephalic skull; hypoplasia of the middle part of the face and limb abnormalities (syndactyly of the hands and feet). The main diagnostic signs of the syndrome – acrocephaly and syndactyly of the fingers and feet – are noted in 100% of cases. Often, patients are found to have malformations of the brain (dystopia of the tonsils of the cerebellum, stenosis of the jugular foramen, arachnoid cysts in the posterior cranial fossa, malformation of the corpus callosum and/or limbic structures). The brain is enlarged vertically and reduced in anteroposterior dimensions. All children have an oblique location of the temporal bones. The article presents literature data on the clinic, diagnosis and treatment of Aper syndrome, as well as clinical observation of this syndrome.

Fever in a child is one of the most common reasons for seeking medical care, while fever is an important symptom of the body’s defense reaction, signaling changes in the body that require attention from specialists in various specialties. A pediatrician should know the norms of temperature reactions depending on the child’s age and measurement methods, circadian rhythms, remember the physiological increase in body temperature, the differences in the thermometers used. The causes of febrile conditions can be extremely diverse, there are 2 main groups: infectious and non-infectious. Infectious – the most common causes of fever in children, but we must not forget about the rarer non-infectious causes. The article demonstrates 2 clinical cases of children with fever (a child with Marshall syndrome and with chronic granulomatous disease), shows the difficulties of diagnostic search and treatment of such patients. Marshall syndrome is a periodic syndrome that includes fever, aphthous stomatitis, pharyngitis and cervical lymphadenitis, the most common variant of periodic fever in our country, criteria for diagnosis and treatment methods are given. Chronic granulomatous disease is one of the common primary immunodeficiencies, the main manifestation of which is bacterial and fungal infections of the lungs, liver, lymph nodes and other organs, while the manifestation of symptoms occurs, as a rule, up to 5 years. Possible algorithms for diagnostic search in a child with prolonged fever are given, taking into account the anamnesis data, clinical examination, previously conducted laboratory and instrumental examination methods. Issues of safe and effective treatment of fever, including symptomatic treatment with ibuprofen and paracetamol, indications for prescribing antipyretics in real clinical practice are discussed.

Introduction. Over the last decades, various surgical methods have been proposed for the treatment of congenital choanal atresia, but to date there is no consensus on the optimal operation for the treatment of this nosology. This is due to the frequent complication of surgical treatment of children with choanal atresia – restenosis of the newly created choana.

Aim. To develop the most optimal method of surgical correction of congenital choanal atresia in children to improve the effectiveness of treatment, prognosis and quality of life.

Materials and methods. 157 children aged from 1 day to 17 years with congenital choanal atresia were divided into two groups: Group 1 was represented by previously unoperated children who underwent endoscopic choanoplasty without stents, Group 2 – children with congenital choanal atresia with recurrence (previously underwent choanoplasty with stents) who also underwent stentless choanoplasty. The obtained results were compared between the groups.

Results. Bilateral choanal atresia was diagnosed in 61 (38.9%) patients, unilateral – in 96 (61.1%). Among the patients with unilateral choanal atresia, right-sided atresia was recorded in 54 (34.4%) children, left-sided atresia – in 42 (26.7%) of the studied patients. After surgical treatment, comparing the quality of life, indicators between the 1st and 2nd groups, both in the immediate and distant periods, no statistically significant differences were revealed, with the median general health score in the 1st group being 92 (90; 94), in the 2nd group 90 (88; 93) points already one month after surgery.

Conclusions. High efficacy of new surgical technologies for the treatment of congenital choanal atresia in children, including the absence of recurrences when using choanotomy without stents in both groups, has been proved.

The article is devoted to the study of probiotics, their principle of action and clinical application. Particular attention is paid to the mechanisms of action of probiotics, including competition with pathogens in nutrient substrates and adhesion sites, synthesis of antimicrobial metabolites (bacteriocins, organic acids), intestinal barrier and modulation of the immune response. Additional considerations of the risks of using probiotics, including the possibility of developing systemic diseases, metabolic abilities and hyperstimulation of the immune system. The need for strict control of the safety of strains, including their identification, study of functional activity and confirmation of effectiveness in randomized economic studies is emphasized. Particular attention is paid to the benefits of multi-strain probiotics, which exhibit a synergistic effect due to different strains that increase therapeutic efficacy. In providing research data confirming their benefits in the fight against intestinal infections, antibiotic-associated diarrhea, respiratory diseases and other conditions. 14 species of live probiotic bacteria in high concentrations: L. casei, L. plantarum, L. rhamnosus, B. bifidum, B. breve, B. longum, L. acidophilus, L. lactis, St. thermophilus, B. infantis, L. bulgaricus, L. helveticus, L. salivarius, L. fermentum in the studies confirmed the ability to significantly increase the effectiveness of standard treatment for diarrhea regardless of etiology, reducing the risk of prolonged diarrhea. Eight studies demonstrated that multi-strain probiotics enhanced immune defense and protective properties of the mucous membranes in both infectious diarrhea and respiratory diseases. The results of the conducted analysis indicate the importance of using multi-strain probiotics for the prevention and treatment of infectious diseases in children, but it is necessary to monitor the need for research to clarify their long-term effects and safety.

Introduction. Heterozygous familial hypercholesterolemia (heFH) is a disorder with a high risk of early cardiovascular events and a fatal risk of myocardial infarction at the age of 20–39 years.

Aim. To assess the efficacy and safety of the use of ezetimibe in real-world settings in children and adolescents with heFH, and to compare the efficacy of ezetimibe monotherapy and combination therapy with statins in this population

Materials and methods. A retrospective descriptive analysis study was conducted from August 2021 to December 2024. The study assessed the efficacy of ezetimibe monotherapy and ezetimibe and atorvastatin combination therapy in 130 children with dyslipidaemia (average age 13.2 ± 3.1 years). Prior to treatment initiation all subjects followed a lipid-lowering diet, after which their baseline lipid profile was determined.

Results. The results showed that 3-month ezetimibe monotherapy led to a decrease in the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C), which was statistically significant. The average LDL-C reduction was 1.6 ± 0.6 mmol/L (21.3%), and LDL-C targets (<4 mmol/L for children <10 years and <3.5 mmol/L for children ≥10 years) were achieved in 70% of patients. In patients with an inadequate response to ezetimibe monotherapy, atorvastatin or combination therapy were prescribed, which demonstrated a 46.9% and 53.1% decrease in LDL-C levels from baseline, respectively, which were statistically significant.

Discussion. Ezetimibe monotherapy resulted in a decrease in TC, LDL-C and non-HDL-C levels. These results were consistent with the results from the previous studies and showed the efficacy of ezetimibe as a first-line drug to treat hypercholesterolemia in children. However, the monotherapy was less-than-adequate in 30% of patients.

Conclusion. The results of the study have confirmed the efficacy and safety of ezetimibe monotherapy in children with dyslipidaemia. It was difficult to achieve target values in patients with high baseline LDL-C levels using monotherapy, which justifies the necessity of combination therapy.

Constipation occupies one of the first places in the structure of the general morbidity. Unfortunately, there are no clear statistics on the indicator. The reasons are different: the multiplicity of constipation, the absence of columns in the official tables of morbidity reporting by healthcare institutions, insufficient vigilance among pediatricians / narrow specialists, the silence of parents and patients about such a delicate topic. In general, the incidence of constipation in the world is almost the same-from 16 to 37% among school-age children. This disease has been known since ancient times. Thus, Hippocrates, Avicenna, and Paracelsus pointed out in their writings constipation as one of the causes of internal diseases. In 1929, Evans formulated the definition of constipation, which is close to the concept according to the Roman criteria. Children of the 21st century have quite a lot of risks for the development of constipation, and this is determined primarily by changes in the macro and microsociety, lifestyle, physical inactivity, stressful situations, the consequences of viral infections, including SARS-CoV-2, violations of the rules and procedures for applying the principles of dietetics in pediatrics, somatic diseases, etc. The quality of life of such patients is comparable to that of patients with diabetes, hypertension, and depression. Today, specialists are assisted by a number of documents that define the concept, criteria for verifying the diagnosis, tactics for managing and preventing constipation. The research results of foreign and domestic scientists indicate that stimulants are effective and safe for the treatment of functional constipation, including in children’s practice. One of the drugs in this group is sodium picosulfate. A case from practice is given when untreated constipation caused a child to develop a urinary tract infection with pronounced activity.

Inadequate quantitative and/or component nutrition of children remains an urgent problem worldwide. The General Assembly of the United Nations formulated the “Global Monitoring Framework for Nutrition”, as a result of which the level of acute nutritional deficiencies in the general child population should be reduced to 5% by 2025. A systematic analysis was conducted on the basis of scientific publications in the electronic databases PubMed, EMBASE, Cochrane Library, eLibrary.ru. The data obtained showed that in developed economies protein-energy deficiency is registered in 2.4–26% of patients admitted to medical inpatient facilities. Nutritional deficiency in pediatric patients is polyetiological and can influence the outcome of the disease. Critical conditions (trauma, severe infectious diseases and their complications, destructive pancreatitis, etc.) contribute a significant part to the etiologic structure of protein-energy deficiency in patients. Understanding the pathogenesis of protein-energy deficiency in patients in critical condition allows to optimally approach the organization and provision of care and, in particular, nutritional support. Analysis of the results of studies has shown that malnutrition in children in critical conditions causes a violation of all types of metabolism: carbohydrate, protein, fat, and vitamin metabolism. On the background of hypermetabolism there are changes in hormonal and immunologic status, shifts in water-electrolyte balance. A wide range of specialized products is presented for organizing both tube and oral nutrition in children who need nutritional support.

Drug fever is a febrile reaction that coincides in time with and is pathogenetically associated with the use of a drug. The review presents publications of epidemiological and clinical studies on various variants of fever development due to the use of pharmacological agents. Febrile reactions associated with both immune hypersensitivity and those with other mechanisms of development, as well as drug hypersensitivity syndromes, including fever as one of the syndromes (drug-induced hypersensitivity syndrome, serum sickness, drug-induced lupus), are considered. Most often, the term “drug fever” is used to define cases with isolated febrile increase in body temperature, not accompanied by other clinical symptoms (for example, rash or organ damage), and having an immune genesis. An association of drug fever with an extremely wide range of drugs has been established, but most often it is caused by beta-lactam antibiotics. There is a high probability of drug fever in intensive care unit patients who have a high risk of bacterial infection and receive long courses of antibiotics. Underdiagnosis of drug fever leads to unjustified continuation and intensification of antibacterial therapy, increased risk of iatrogenic complications and economic costs. The review also presents variants of drug hyperthermia: malignant neuroleptic syndrome, malignant hyperthermia, serotonin syndrome, propofol infusion syndrome and some others. Despite the long history of studying the issue, the pathogenesis of the pathology remains not entirely clear, there are no specific diagnostic markers and the diagnosis is still made by exclusion.

Pulse oximetry has been used in medicine since the 1980s. Currently, it is widespread in all areas of medicine. There are many cases when low pulse oximetry readings are the consequence of impaired ability of the respiratory organs to oxygenate venous blood flowing to the lungs. On the other hand, low pulse oximetry readings can be associated with hemoglobinopathies that alter the binding properties and absorption spectrum of hemoglobin. The article describes a clinical case of a 13-year-old patient. During a routine examination regarding the course of an acute respiratory viral infection during the SARS-CoV-2 pandemic, asymptomatic low oxygen saturation was detected when measured with a pulse oximeter. The boy underwent extensive testing to look for cardiac or pulmonary causes of desaturation. During the examination, a discrepancy was found between pulse oximetry readings and partial pressure of oxygen with arterial blood saturation, which suggested that the patient had hemoglobinopathy. Considering the possible hereditary nature of hemoglobinopathy, pulse oximetry was performed on the patient’s parents. Mother had asymptomatic desaturation. Hemoglobin electrophoresis revealed an abnormal structural variant. Subsequent DNA analysis revealed a 1-nucleotide substitution in exon 2 of the HbA2 gene, which led to the substitution of histidine for aspartame. This genetic variant has not previously been described in the Human Polymorphism Database. Thuswise, the diagnosis of hereditary hemoglobinopathy was confirmed.

The article is devoted to a comprehensive analysis of the legal system of the Russian Federation on the issue of the duty of a medical worker to provide first and emergency medical care in educational institutions. The authors emphasize the special importance of the first minutes-hours in providing assistance in emegency situations, which are often accompanied by a high risk to the health of schoolchildren. The problem is aggravated by the lack of clear algorithms of action for teachers and medical professionals, which creates significant risks for both sides: students – in terms of health, and employees – in terms of legal responsibility. The relevance of the topic is due to the growing number of students and insufficient staffing of educational institutions by medical workers. The article examines key aspects of the regulatory framework, including recent legislative changes, such as the new Order of the Ministry of Health No. 220n defining the list of first aid measures. The features of the legal status and responsibilities of medical workers and teachers in the conditions of educational organizations are analyzed, attention is paid to the problems of interdepartmental interaction between health and education systems. The authors focus on the difficulties associated with the lack of resources and the lack of standard contracts and regulations, which leads to the need to develop internal protocols of interaction. The research methodology is based on the analysis of regulations, scientific literature and statistical data. The results show that the lack of clear legal regulation and unified standards leads to disorientation of participants in the process in emergency situations. To minimize these risks, specific measures are propose: the development of standard regulations, updating the resource base, reviewing personnel policy, and introducing educational programs for teachers and medical staff. The authors conclude that the development of legally verified algorithms of actions for employees of educational institutions and medical organizations is of key importance for ensuring the health of schoolchildren. The proposed measures are aimed at creating a safe environment in schools, reducing risks and improving the effectiveness of interaction between medical and educational organizations.

Introduction. Kawasaki disease (KD) is the most common cause of acquired heart disease in children. Diagnosis of CD is based on the clinical manifestations of the disease, however, a number of its features and low awareness of doctors can make diagnosis difficult.

Aim. To study epidemiological indicators, patient routing and clinical and laboratory features of the course of Kawasaki disease in children hospitalized at the City Children’s Hospital No. 1 of Kazan with this diagnosis in the period 2015–2022.

Materials and methods. An empirical description of a patient case series was conducted on a group of 19 children hospitalized with a diagnosis of full-blown CD.

Results and discussion. Late periods of diagnosis were identified (14.4 ± 7.3 days) and administration of intravenous immunoglobulin at a dose of 2 g/kg body weight (16.1 ± 7.9 days, the mode of the indicator was the 13th day), as well as a large percentage detection of coronary anomalies in the study group (68%, n = 13) and residual coronary anomalies at discharge (32%, n = 6). The referral diagnosis was correct only in 21% of cases; most often, the diagnosis of an infectious disease was made at the prehospital stage and in 79% of cases antimicrobial drugs were prescribed. At the prehospital stage, patients were diagnosed with rash syndrome (84%), changes in the oral mucosa (74%) and conjunctivitis (63%). Laboratory abnormalities in all patients before hospitalization were typical for Kawasaki disease: accelerated erythrocyte sedimentation rate (41.4 ± 14.3 mm/ hour), increased C-reactive protein (98.2 ± 47.6 mg/l), leukocytosis (23.0 ± 8.4 x 10⁹/l), decreased hemoglobin (100.0 ± 8.9 g/l) and thrombocytosis (630.6 ± 215.5 x 10⁹/l).

Conclusions. The study included only children with the full form of CD; therefore, the most likely reason for the late diagnosis is the low level of awareness of the disease criteria among non-rheumatological doctors. It is required to conduct educational activities among pediatricians, infectious disease specialists, and general practitioners to increase alertness for the purpose of early diagnosis of CD.

Introduction. With insufficient oxygen concentration and changes in the blood circulation of microvessels, the processes of transcapillary gas exchange and the supply of energy substances to tissues deteriorate, which leads to disruption of the mechanisms of vascular autoregulation.

Aim. To study the features of microcirculation in the period of convalescence of ARVI in primary school children who have started classes.

Materials and methods. A prospective comparative study was conducted at the State Budgetary Healthcare Institution “Leningrad City Children’s Hospital No. 1” of the LPR in the period from 2019 to 2024. 246 children aged 7–10 years (average age 8.4 ± 0.5 years) who resumed the educational process after acute respiratory viral infections were examined. Of these, 119 were boys and 127 were girls. Perfusion indices, standard deviation of blood flow oscillation amplitude and variation coefficient were determined depending on the etiology of respiratory disease using laser Doppler flowmetry.

Results. A decrease in the arithmetic mean values of skin perfusion was recorded both immediately after discharge from the hospital (by 23.93 ± 3.71%), and a month later (by 20.58 ± 0.34%) and 2 months later (by 13.9 ± 2.57%) after resumption of school, compared to healthy subjects. The severity of the disorders depended on the pathogen and were more often recorded during the recovery period of COVID-19 and infectious mononucleosis. Prolongation of microcirculatory disorders was recorded up to 5 months after returning to school. The pathological form of microcirculation was determined in 64.41% of children, with the registration of the hyperemic type.

Conclusions. A decrease in perfusion parameters and deviations in perfusion fluctuations were significantly more often observed during the convalescence period after infectious mononucleosis and COVID-19. A decrease in the contribution of active regulatory systems of microcirculation was noted against the background of impaired trophism in tissues.