Статья посвящена актуальной проблеме ― внедрению информационно-коммуникационных систем в современное здравоохранение. Информационные базы клинических случаев ― регистры — в сегодняшних условиях востребованы в различных областях медицины, и особенно в педиатрии. Важнейшим инструментом для улучшения качества оказания медицинской помощи, исключительно необходимым как для определения эффективности и безопасности длительной терапии, так и проведения клинико-экономического анализа, а также в случаях редких состояний и болезней, когда проведение рандомизированного клинического исследования затруднено, заслуженно стали именно регистры. Авторами дана предварительная оценка работ по проектированию, созданию и внедрению первой отечественной информационной базы данных клинических случаев пациентов с бронхиальной астмой тяжелого неконтролируемого течения, а также приведены результаты анализа эффективности и безопасности использования биологического препарата омализумаб в реальной клинической практике у детей с астмой.

Introduction. Possibilities of using probiotic enterococci in premature neonates undergoing inpatient antibacterial therapy remains understudied. The article is aimed at analyzing clinical and pharmacoeconomic reasonability of using probiotic Enterococcus faecium L3 strain in premature infants with very low body weight in the framework of complex inpatient developmental care. Patients and methods. 55 children randomized into 2 groups were observed: the control group (n = 26) was undergoing standard developmental care program, the primary group (n = 29) was introduced liquid probiotic Enterococcus faecium L3 strain (titer — 10⁸ CFU/ml or more) (0.5 ml TID for 14 days) after attaining the enteral feeding volume of 5.0 ml. Results. Analysis of the clinical symptoms characteristic of non-smooth course of developmental care over premature infants helped to reveal higher frequency of infectious complications in the control group children than in the primary group (14 [53.8%] vs. 6 [20.7%]; p < 0.05). Acute food intolerance was observed less frequently in the primary group than in the control group (6 [20.7%] vs. 10 [38.5%], p > 0.05). The primary group's children featured significant decrease in the frequency of monocytosis, positive changes of intestinal microbiotic composition (increase in the amount of bifidum bacteria, lactobacilli, enterococci, decrease in the amount of Clostridium difficile and antibiotic-resistant clinical Klebsiella pneumoniae strains). Conclusion. Favorable outcome of developmental care over premature infants (absence of infectious complications) was less expensive in the primary group's children.

Urgency. Juvenile idiopathic arthritis (JIA) remains one of the most urgent issues of pediatric rheumatology due to incapacitation at early stages of the disease. It has been established that the first years of arthritis are key in the aspect of progression of the pathological process. Despite significant progress in treating JIA with genetically engineered biopharmaceuticals, some patients do not respond to such a therapy and thus aggravate the disease course. The study was aimed at improving diagnosis and treatment of children with JIA by means of analyzing the main immunological factors Th17, suggesting methods of differentiating lymphocytes and developing recommendations on assessing prognosis of the disease's course and outcomes. Methods. The study included 108 2–18-yearsold children with various forms of JIA. The control group was comprised of 18 conventionally healthy 6–17-years-old children with unburdened heredity regarding autoimmune diseases and without any clinical symptoms of diseases. The total T helper population and subpopulations thereof (naive Th cells and Th memory cells, double-positive Th cells), subpopulations of Th17 cells and anti-inflammatory cytokines (IL 1β, IL 6, IL 17A and TNF α) in the peripheral blood were analyzed in all the patients, including the control group. Results. The levels of Th17 memory cells and anti-inflammatory cytokines (IL 1β, IL 6 and IL 17A) were significantly higher in children with enthesitis-associated arthritis (HLA B27+ juvenile ankylosing spondyloarthritis) and systemic JIA. The level of Th17 cells and high blood level of IL 17A affect development of an active disease; simultaneous increase in IL 6 results in higher risk of osteochondral destruction in children with JIA. Conclusion. According to the immunological data, there are at least 2 JIA phenotypes: Th17-dependent and Th17-independent. Th17-dependent JIA is characterized by the most adverse course of the disease and high risk of osteoarticular destruction, which is why children require earlier prescription of genetically engineered biopharmaceuticals. By contrast, Th17-independent phenotype features a more favorable disease outcome and low risk of osteoarticular destruction.

Condition of intestinal microbiota is a key factor of a child's health. According to the latest studies, distinctness and certain stability of every person's microbiota is to a large extent determined genetically; at the same time, microbiocenosis is sensitive to external exposure, i.e. it is labile. The article presents new data on the intestinal microflora's composition and function, as well as on the nature of interaction in the microbiocenosis-host system. Intestinal microflora directly affects formation of a child's immune system, ensures protection from pathogens and takes part in all types of metabolism. The article presents modern approaches to intestinal microflora modulation and use of probiotics to prevent and treat various pathologies in pediatric practice.

The article presents the current data on the metabolism of vitamin D and its role in the development of bone tissue in children and the further condition thereof. Natural vitamin D sources, as well as the current routine practice of preventing deficiency of this organic substance are unable to fully satisfy a child's demand for this vitamin, which is why recommendations on vitamin D intake ought to be revised. The article details schedules for prescription of vitamin D for preventing and treating the body deficiency thereof based on results of the studies completed in the recent years. The role of the main marker enabling assessing vitamin D concentration in the body — 25(OH)D — the reference values whereof are yet to be commonly established has been analyzed. The article lists recommendations on rickets prevention and treatment in children. The article presents data on the possible mechanisms of development of toxic effects in the setting of vitamin D intake.

The literature review is dedicated to the preventive role of breastfeeding in preserving long-term health of individuals and the population in whole. The issue is urgent due to high prevalence of multifactor metabolic diseases (obesity, pancreatic diabetes, hypertonic disease etc.) in adolescents and adults; these socially significant have started to set on in younger persons in the recent years. The article presents results of the studies dedicated to the association between the nature of the infant's feeding and risk of metabolic pathology conducted in the recent decades in various countries. Most works put premature infants in the high risk group, as the diets involving special formulas contributing to "catching-up" growth of neonates with low birth weight are statistically significantly associated with high risk of long-term cardiovascular diseases. According to numerous studies, artificial feeding significantly increases the risk of excess weight and obesity, hypertonic disease and atherogenic dyslipidemia. Possible mechanisms of realization of hereditary susceptibility to metabolic disorders in the setting of artificial feeding are enhanced insulin burst paired with further development of insulin resistance; preventive role of breast milk is associated with the hormones therein, which program the individual's metabolism. Along with that, breastfeeding provides metabolic and immunological programming by means of forming optimal intestinal microbiota in a child. All the studies indicate importance of prolonged breastfeeding during infancy, which is why medical administrative support provided by medical personnel of medical and preventive facilities is important for preventing hypolactasia. District pediatricians and nurses not only control, but also organize the process of breastfeeding; when necessary, they recommend special devices intended to optimize lactation (breast pumps, nipple shields); if breast latching is not feasible – feeding with extracted breast milk using bottles and pacifiers reproducing natural breast sucking mechanism.
 

The article is dedicated to an urgent issue of modern pediatrics and neurology — complex treatment of stroke consequences in children. The article details etiological aspects, pathophysiological mechanisms and clinical peculiarities of stroke consequences in children, the primary among which are asthenic syndrome (73–86% of the patients), movement disorders (33–58%), cognitive disorders (60%), paroxysmal conditions (30%), sensory disorders (14%), emotional-volitional and behavioral disorders (17–38%), vegetative dysfunction syndrome (60–74%), pain syndrome (53–74%) and syncopal conditions (12%). The article details the main spheres of complex rehabilitation of children with stroke consequences, including use of innovative medical rehabilitation technologies — kinesitherapy, dynamic proprioceptive correction, mechanotherapy using robotic systems, physiotherapy and drug correction. The article demonstrates that diagnosis and treatment of stroke consequences in children is a difficult problem, which requires a differential complex approach in order to improve effectiveness of both drug therapy and rehabilitation and quality of life of the patients.

Rapid growth of incidence of allergic diseases in the last 40 years allows us naming allergy the pandemic of the XXI century. Allergic diseases harm not only individual patients, but the society in whole in the form of progressive increase in direct and indirect costs. According to the latest estimates, more than 150 mn people suffer from allergies, whereas more than 250 mn patients in Europe are expected to suffer from allergies in the next decade. National and international documents stating rules of preventing and treating allergic diseases must become current guidelines for clinicians everywhere. The article summarizes the latest recommendations of the European Academy of Allergology and Clinical Immunology (2014) and of the National Food Allergy Guidelines. The article presents evidence-based methods of primary allergy prevention in infants. Modern primary food allergy prevention may consist of exclusively breast feeding for at least 4 6 months; if breast feeding is not feasible, prevention may be attained by means of using preventive hypoallergenic formulas with confirmed low allergenicity and not introducing supplemental feeding before the age of 4 months. Evidence-based studies do not confirm effectiveness of any dietary restrictions of pregnant and nursing women regardless of whether they belong to the risk group or not.

High prevalence of sexually transmitted diseases among the population attracts attention of specialists in all countries due to frequent development of complications resulting in reproductive dysfunction. The article presents one of the urgent issues of modern medicine — papillomavirus infection, which is the most common sexually transmitted disease. 70–80% of the sexually active persons contract human papilloma virus at one point. HPV induces a broad range of oncological reproductive diseases, including cervical, vulvar, vaginal and anal cancer and anogenital condylomae, which are observed both in men and women. The only reliable method of preventing papillomavirus infection is vaccination. The authors present new data on the use of the quadrivalent vaccine, including a new immunization pattern for 9–14-years-old girls.

Osteogenesis imperfecta, also known as the brittle bone disease, is a clinically heterogenic hereditary connective tissue disease characterized by brittle bones and high risk of skeletal bone fractures. Other observable symptoms, such as deformities of limb and spinal bones, blue sclerae, dentinogenesis imperfecta and progressive hearing loss vary in severity depending on the type of the disease. According to the original classification by D.O. Silence (1979), there are 4 types of osteogenesis imperfecta; however, the number thereof has multiplied due to discovery of new disease-inducing mutations. Type V osteogenesis imperfecta is distinguished by characteristic clinical radiographic symptoms; also, patients with this type of the disease do not feature a type I collagen gene mutation. Nevertheless, all types of osteogenesis imperfecta, including type V, are characterized by high bone brittleness, frequent fractures and further bone deformities, which is the most common cause of incapacitation of the patients.

Longitudinal medical-psychological-pedagogic examination of 60 school students (12–13 and 16–17 years of age) helped to establish that 60% of adolescents are characterized by average results of academic activity, which do not significantly change in the process of education and development. Absence of positive dynamics regarding a range of academic activity parameters is observed in 25% of school students in the settings of disabilities; the amount of academic difficulties increases as children grow up in the other 12% of students; this restricts the process of socialization and negatively affects personality development by senior grades. Complex medical psychologicalpedagogic support of adolescents at school helps to prognosticate and, in some cases, timely resolve the existing social problems of growing up of school students; thus, it helps to preserve mental and physical health, as well as to improve social adaptation thereof.

Gastroduodenal ulcer is less common and milder in children than in adults. Gastroduodenal ulcer complications, such as hemorrhage, penetration etc. are even less common. Recurrent ulcerous defect hemorrhage is a reason to expand diagnostic search and involve various specialists, primarily hematologists, into the diagnosis establishing process. The article presents a clinical case of a child with gastroduodenal ulcer complicated with recurrent hemorrhage not terminated with the standard therapy; thus, additional diagnostic testing was performed. This helped to detect a hematological disease and determine an optimal therapy amount.

Increase in the incidence of neonatal thromboses is associated not only with the possibility for women characterized by tendency to high thrombosis to carry pregnancy, but also with the increase in enforced use of invasive treatment methods, such as catheterization of central and peripheral veins and umbilical vessels. This article is aimed at bringing peculiarities of epidemiology, pathogenesis and diagnosis, clinical manifestations and treatment of neonatal thromboses to the attention of practicing physicians. The article present tactics of treating 4 children with thrombi of varying genesis and localization based on clinical observations. The decision to start heparin therapy is made on the individual basis depending on the child's maturity at birth, thrombus localization, presence or absence of complications and nature of the concurrent pathology. The given clinical cases informatively demonstrate reasonability of a multidisciplinary approach to diagnosing and treating patients with this pathology, the need in strict selection of doses of the used drugs and continuous monitoring of coagulogram parameters in the setting of the therapy.
 

Explanation. Mantoux test is used to detect the tuberculous infection; however, low specificity of this method results in a high rate of false positive responses due to cross-reactions of PPD (protein purified derivate) antigens contained in many mycobacterial species and Bacillus Calmette-Guerin (BCG) strains. New drug Diaskintest (DST) — recombinant protein CFP10-ESAT6 produced by Escherichia coli BL21(DE3)/pCFP-ESAT proved to be the best acceptable diagnostic drug. The article was aimed at studying effectiveness of tuberculous recombinant allergen tests for detecting tuberculosis in the children and adolescents, who were registered in Moscow in 2013. Methods. Mantoux tests were used to examine 1,420,100 persons; positive reactions were observed in 1,020,000 children and adolescents (71,8%); 131,361 (12.9%) of them were examined using DSTs. Results. Positive reactions to DST were observed in 3,304 persons (2.5% of the persons with positive reactions to Mantoux test). The tuberculosis detection rate among the persons with positive reactions to Mantoux tests using 2TU PPD-L (Leningrad Research Institute of Vaccines and Serums) is 0.13%, among the persons with positive reactions to DSTs — 4.9%, i.e. 40 times more often (p = 0.000). Post-tuberculosis alterations were detected in 169 persons: in 0.13% of the persons with positive reactions to Mantoux tests using 2TU PPD-L and in 5.1% of the persons with positive reactions to DSTs (p = 0.000). Conclusion. Cohort studies conducted in Moscow demonstrated high effectiveness of Diaskintests for detecting tuberculosis in children and adolescents. High sensitivity of the method helps to detect the overwhelming majority of the persons with tuberculosis.

Acute streptococcal pharyngitis is diagnosed in 15–30% of the patients seeking medical advice for fever and sore throat. The local infection is usually mild/moderate; however, it may result in severe purulent and immunopathological complications. Despite high incidence and prevalence of the disease, the issues of diagnosis and treatment of streptococcal tonsillitis and pharyngitis remain highly discussable. The literature review presents information on the modern diagnostic principles, potential of using express tests to detect Streptococcus pyogenes infection and selection of antibacterial therapy of acute streptococcal pharyngitis based on the data of evidence-based studies and systemic reviews. The article emphasizes the most discussable issues of treatment, including antibiotic therapy pattern, and effectiveness of tonsillectomy in the event of chronic or recurrent tonsillitis.

Stressful situations in the work of a pediatric medical facility's call center are associated with patients' violation of social communication norms and aggressive behavior, as well as the operator's professional/maternal conflict. The following psychological resources facilitate better stress resistance of operators: self-confidence, mature and rational attitude, personal activity, inner satisfaction, optimism, emotional breadth and emotional colleague support.