The article presents features of physiological processes and pathological conditions in under one-year children that predispose the development of iron-deficiency anemia. Basic methods of iron deficiency prophylaxis and principles of iron drug selection and dose selection for iron-deficiency anemia treatment for children in the stated age category are described in the article. Particular attention is paid to the prevention and treatment of iron deficiency anemia in preterm infants; foreign and domestic recommendations on this issue are presented. A practicing pediatrician needs to know the features of the disease’s development and treatment caused by differences in physical conditions accompanied by a high activity of metabolic processes and the immaturity of the young patients’ anatomic structures in order to identifiy and select the right iron-deficiency anemia treatment strategy.

Enteral (tube) nutrition has demonstrated its superiority in comparison with parenteral nutrition for patients with a preserved function of gastrointestinal tract who are in intensive care units, or ICU, and who cannot eat or are not allowed to eat by medical indications. International guidelines recommend enteral injections of mixtures for patients in critical conditions in need of nutritial support. The first twenty-four hour is considered the optimal period for starting nutritional support. It is known that costs of the enteral nutrition are much lower than costs of intravascular supply for patients who are in the ICU. The usage of special-purpose dietary products — half-elemental mixtures with high energy density — is the most physiological for children in ICU from 1 year and for adults in critical conditions.

Background. Drooling (sialorrhea) is a complex medical and social problem of patients with cerebral palsy (CP). During the last decade many methods for drooling correction in CP are under active development.

Aim: to evaluate the effectiveness and safety of the first and repeated injections of botulinum toxin A (BTA) for correcting drooling in children with CP.

Methods. 13 children (2 years — 14 years 7 months) with spastic forms of CP and drooling resistant to non-drug treatment. Drooling was evaluated with the Drooling Impact Scale — DIS before, 1, 3 and 6 months after the BTA injections. Parotid and submandibular salivary glands were injected under ultrasound control with Dysport — 1 group (5 children) or Botox — 2 group (8 children). The total dose of Dysport for the all glands was 120–320 U (3,8–14,5 U/kg), Botox — 30–100 U (2,5–4,5 U/kg). The median of the basic DIS index was 77 (64–90) points in the first group and 58 (53–66) points in the second group.

Results. One month after the BTA injections the DIS index decreased by 20 and more points in 6 (42,2%) patients, by 10–19 points in 7 (53,8%) children. There were no persistent side effects and no difference in the BTA effectiveness between the two groups. The mean decrease of DIS was 30% in both groups. 3 months after the injections 2 patients (15,4%) kept 20 points decrease of the DIS index, 6 patients (46,2%) demonstrated 10 points decrease. 6 months after injections nearly all patients returned to the basic level of drooling. Repeated injections of the BTA demonstrated the same tendency and duration of the DIS changes. There was no significant correlation between the GMFCS level and the drooling intensity.

Conclusion. BTA injections into salivary glands of children with CP was an effective and safe method of drooling correction with the maximum effect taking place 2–4 weeks after the injections and a stable effect — 3 months after the injections.

Background. Identification of markers of chronic kidney disease and its progression in the early stages of the disease is important, however, the most of research concerns late (3–5) stages of the disease.

Objective. Identification of the markers of chronic kidney disease (CKD) and its progression in the early stages of the disease in children with obstructive uropathy and vesicoureteral reflux.

Methods. Prospective follow-up (for 5 years) of 92 children with obstructive and reflux uropathies (1st to 4th stages of CKD). All patients had episodes of urinary tract infections, mostly pyelonephritis, minimum once a year.

Results. High prevalence of proteinuria (60.9%), reduced renal functional reserve (88.7%) and disorders of cortical renal blood flow (by Doppler Color Flow Imaging) (69.6%) were found in children with 1st stage of CKD. Groups of children with proteinuria and a reduced renal functional reserve had a higher level of systolic and diastolic blood pressure in comparison with the patients without proteinuria and the reduced renal functional reserve (p < 0.05). In patients with 2–4 stages of CKD the glomerular filtration rate (GFR) correlated with atypical flora in the etiology of urinary tract infections (rpb = 0.66; n = 23; p = 0.0006), sex (boys had lower levels of GFR, rpb = 0.61; n = 23; p = 0.001), bilateral renal abnormalities (rpb = -0.53; n = 23; p = 0.009) the level of hemoglobin (r = 0.45; n = 23; p = 0.02).

Conclusion. Markers of CKD of children with obstructive and reflux uropathies are: proteinuria, arterial hypertension, reduction of renal functional reserve and the impaired cortical renal blood flow (by Doppler Color Flow Imaging). The importance of arterial hypertension and proteinuria as markers of the progression of CKD of children with urinary tract obstruction and vesicoureteral reflux was confirmed. Additional markers for the progression of CKD in children with obstructive and reflux uropaties might be: male sex, bilateral renal abnormalities, anemia and atypical bacteriuria during relapses of urinary tract infections.

Arterial hypertension in children is a serious socially important problem, because it holds a position within the top of cardiovascular diseases, beginning from the adolescent age. A timely start of preventive measures based on appropriate forecast assessment in children from risk groups will make it possible to reduce the disease burden in elder age groups.

Research purpose. Based on comprehensive assessment of clinic-anamnestic, genealogic, psychologic data, peculiarities of daily profile of arterial tension in the course of adaptation to education in educational institutions, to characterize the markers and single out the factors associated with AT increase in children that are considered relatively healthy.

Patients. On a voluntary basis, 199 children of 1–2 health groups were included in the research at the age of 10–12 years (11.3 ± 0.02 years) who had just started their education at a cadet educational institution or middle school. The children did not have any complaints by the time of the research, nor did they have the necessity of taking medicines which could have an effect on the cardiovascular system and acute infectious diseases during the previous month.

Methods. The research was carried out during the period from September 2013 until May 2014 in 2 successive stages corresponding to the first and second academic terms. The examination included clinic-anamnestic and genealogic methods, anthropometry, three-fold measuring of arterial pressure by Korotkoff’s method, 24-hour ECG and AP monitoring, monitoring of motion activity volume, study of general and school levels of anxiety and psychic tension, assessment of the vegetative nervous system condition, nature of exercise tolerance and volume of additional sports load, volume of additional academic load.

Results. The most important predictors of AH development and elevated AP persistence in children aged 10–12 years of 1 and 2 health groups are: values of SAP and/or DAP 90 and 95 percentile taking into account sex, age and height at one-shot measurements, the presence of AH in relatives within the immediate family, excessive (over 75 percent for this age and height) body weight and high (over 96 bpm) values of average day-time heart rate following results of HM. The previous data concerning a quick enough adaptation of children to increased daily loads was confirmed, including an authentic increase of motion activity volume within educational programs of cadet educational institutions.

The high frequency of infectious complications in the early neonatal period of adaptation in infants with extremely low (ELBW) and very low birth weight (VLBW) attracts particular attention.

The aim of our study was to evaluate the sensitivity (Se) and specificity (Sp) of C-reactive protein and procalcitonin in congenital pneumonia and congenital sepsis in newborn infants with extremely low and very low birth weight.

Methods. In 160 preterm newborns that were included in our prospective study, 33 had early neonatal sepsis, 42 children had congenital pneumonia, and 85 infants were without neonatal infection. A comprehensive clinical and laboratoryinstrumental examination of the newborn was done, including determining the concentration of C-reactive protein and procalcitonin at the age of 48–72 hours of life.

Results. Low sensitivity of CRP at the age of 48–72 hours of life in congenital sepsis and congenital pneumonia was observed. However, under these pathological conditions CRP and PCT are characterized by high specificity. It should also be noted that PCT has a high sensitivity in children with congenital sepsis aged 48–72 hours. Moreover, PCT also has a high specificity (Sp 80,6%), which determines its advantage in the use of sepsis diagnosis in extremely premature infants compared to CRP.

Conclusion. Maximum specificity reaches 100%, co-located with the assessment of CRP and PCT, which determines the feasibility of using this combination for verification of congenital infectious conditions such as sepsis and pneumonia in children ELBW and VLBW aged 48–72 hours.

The article is dedicated to the problem of food allergy in children. The number of patients with this pathology continues to rise, which can be explained by multiple factors, which speaks for the relevance and the social importance of the matter. For food allergy, the causesignificant allergens are both simple and complex food proteins. Wheat is one of the most prevalent source of food allergens not only for children, but for adults too. The article contains the main information concerning the ley characteristics of this product; the protein content and the different roles of individual components in forming allergic reactions and cross activity are thoroughly investigated. The authors provide recommendations for the diagnostics and treatment of wheat protein allergy, and various difficulties in different clinical cases are examined. The article also contains main treatment approaches, which are relevant to the modern data. An individual approach in each case means regular monitoring of the main figures, preventing the negative consequences of an eliminative diet at wheat protein allergy through using specialized gluten-free products.

Anaphylaxis is an immediate hypersensitivity reaction. It is characterized by the rapid development of life-threatening conditions caused by circulatory and respiratory disorders, in some cases with lesions of the skin and mucous membranes, and is associated with serious complications, including death. A steady increase in the incidence of various forms of anaphylaxis has been noted in recent decades. Experience shows that many specialists tend to make mistakes after facing severe forms of anaphylaxis (and especially the most severe its manifestation — anaphylactic shock),. These mistakes can not only affect the patient’s quality of life, but also in some cases lead to serious and even fatal consequences. The article deals with the epidemiology and pathogenesis, describes the clinical picture of anaphylaxis/anaphylactic shock, and gives an algorithm for the treatment of the disease. The algorithm is based on European Academy of Allergy and Clinical Immunology recommendations published in 2014.

The article is dedicated to the problem of acute bronchitis in children. The relevance of this problem is obvious: according to conservative estimates, more than 150 million cases of bronchiolitis are registered annually. 7–13% of these cases require hospital treatment and 1–3% — hospitalization in an ICU. The most common etiologic factor is the virus — respiratory syncytial (the vast majority of cases — 90%); rhinovirus and influenza viruses A and B, parainfluenza, adenovirus, coronavirus, metapneumovirus, and human bocavirus are also important agents. A number of factors can cause the evolution of bronchiolitis in 0–2-years-old children. Premature infants, children with bronchopulmonary dysplasia, bottle-fed children, and patients with congenital malformations and immunodeficiencies undergo bronchiolitis especially hard. Specialists of the Professional Association of Pediatricians — The Union of pediatricians of Russia — have formulated and summarized fundamental criteria for the diagnosis, treatment and further management algorithms for patients with this pathology in accordance with the principles of evidence-based medicine.

The hemolytic uremic syndrome (HUS) is a serious therapeutic problem in pediatrics and pediatric nephrology. HUS is one of the leading causes of acute renal failure with the potential of transforming into terminal chronic renal failure at various periods from the disease onset. The typical form of HUS with a diarrheal prodrome associated with Shiga toxin (STEC) is the most common form. Despite this fact, it requires careful confirmation of infectious etiology to exclude atypical HUS and HUS associated with pneumococcal infection in time. In respect of STEC-HUS it is recommended to conduct adequate symptomatic therapy with a timely dialysis connection if needed. The prognosis here will depend on the anuretic period duration and on the related central nervous system injuries. Atypical HUS is often based on genetic mutations leading to the complement cascade disfunction with uncontrolled activation of the alternative pathway. The overall prognosis for this prone to recurrence form is unfavourable, however, it is recommended to conduct aeculizumabum treatment which will block the terminal components of the complement cascade.

The article presents the monitoring of a severe course of CINCA/NOMID syndrome diagnosed at late stages. The use of monoclonal antibodies to IL 1 — kanakinumabum — in a patient with chronic neurological cutaneous and articular syndrome was successful: fever, cutaneous and pain syndromes were completely stopped, joint contractures decreased after one week of therapy. Laboratory parameters of the child’s disease activity (ESR and CRP) became normal after 8 weeks of treatment. Movements in the affected joints recovered completely after 24 weeks; the audiologist noted an improvement in hearing. The above clinical example demonstrates the high efficiency of kanakinumabum for a patient with chronic neurological cutaneous and articular syndrome, and shows the perspective of therapeutic application of IL 1 blocker for patients with CINCA syndrome including advanced stages of the disease. No adverse effects were noted during kanakinumabum therapy.

The article presents a seven-year-long monitoring of a patient with juvenile arthritis and eye problems who is refractory to the standard basic immunosuppressive drugs therapy. High efficiency of both tumor necrosis factor (TNF) receptor blocker etanercept and recombinant antibody to TNF- adalimumab for joint syndrome therapy was noted. It is emphasized that in case of rheumatoid uveitis it is more appropriate to use adalimumab as a drug with proven efficacy. When selecting the biological agent it is necessary to pay attention to changes in the organ of vision, including those that can be interpreted as the outcome of the previously experienced uveitis, and to the laboratory data such as antinuclear antibodies and antibodies to native and denatured DNA, which may serve as predictors of eye damage.

The article describes a case of polyarticular juvenile idiopathic arthritis lesions of the cervical spine. This clinical example demonstrates the high efficiency of tocilizumab in a patient with polyarticular juvenile idiopathic arthritis with lesions of the cervical spine. After the first injection of tocilizumab a decrease in the following was observed: pain in the cervical spine and affected joints, severity of functional disorders in the temporomandibular joint and the interphalangeal joints, cervical spine; a 30% improvement in the JADAS, ACRpedi30 was achieved. By the 8th week of therapy the proliferative changes in the joints of the hands and arthralgia decreased, as well as the duration of morning stiffness. After 3 months there was a decrease in the activity of Jia (DAS28), and the erythrocyte sedimentation rate and serum concentrations of C-reactive protein. Adverse effects during therapy with tocilizumab were not observed. The disease activity decreased, (assessed using the visual analog scale (VAS)), as well as the functional impairment (assessed using the Children Health Assessment Questionnaire (CHAQ)). The emotional status and quality of life of the child and her family improved significantly.

Relevance. The only way to reduce the incidence of vaccination-controlled infections and to prevent epidemics at the current stage is a 95% preventive vaccination coverage. It means that not only healthy children are subject to vaccination, but also children with various diseases.

Object: to justify the need of specific and nonspecific immunoprophilaxis of respiratory infections and flu for children with allergic diseases.

Patients and methods. Comparative analysis of domestic and foreign-made polymer subunit vaccine tolerance was conducted among 335 children aged 3–17 years with various allergic diseases. The research was conducted during three seasons of epidemics — 2011–2014 years. The subjects of analysis were vaccination tolerance, course of the underlying disease and the frequency of acute respiratory infections within one year after immunization. Specific immune response was assessed 1 and 6 months after vaccination.

Results. The lower quantity and severity of weak local and general reactions was observed in all groups of children (both healthy and with allergic diseases) immunized by the domestic vaccine. No significant differences in immunogenicity of domestic and foreign-made influenza vaccines were detected. Furthermore, the level of postvaccination immunity remains high after immunization of patients with both bronchial asthma and atopic dermatitis. No cases of exacerbation of chronic disease associated with influenza vaccination are detected. Reduction of bronchial asthma frequency was associated with a reduction of acute respiratory infections frequency.

Conclusion. Vaccination of healthy children and children with bronchial asthma and atopic dermatitis is an essential and secure measure that increases the efficiency of patients with current treatment of various allergic diseases and decreases the frequency of flu and acute respiratory infections.

The evolution of postoperative wound infections complicates the postoperative period, prolongs the hospitalization and increases the cost of treatment. The most effective way to prevent the development of infection complications in the world is antibacterial prophylaxis. In surgery, that means the injection of an antibiotic immediately before and during twenty-four hours after the surgery. The article presents a characteristic of risk factors for postoperative complications, indications and the basic principles of antibiotic prophylaxis, and recommendations for the selection of antimicrobials, depending on the particular clinical case.

Relevance. The reception of various vitamin and mineral supplements, dietary supplements and other approved drugs, which enhance physiological capacities of the body, helps to achieve good results in sports.

Object of the survey: to study the opinion of sports doctors concerning the usage of approved drugs by young sportsmen.

Methods. An anonymous survey of 120 doctors of sports medicine.

Results. According to the surveyed doctors, the reception of stimulants is often being started before the age of 10 and thereafter it only escalates. With all this going on it is not feasible to assess follow-up negative effects. Sports doctors do not pay enough attention to that.

Conclusion. Sports doctors should control the reception of drugs that enhance physiological capacities of the organism by young sportsmen more strictly.

Relevance. In recent years the powers of nurses have been considerably expanded, which determines the increase of their responsibilities and the need of permanent improving of their skills.

Object: determination of directions, forms and contents of training courses for increasing psychological competence of pediatric nurses in connection with their status and work experience.

Methods and the object of research. The main method was a questionnaire developed by the article’s authors. 59 pediatric nurses from different regions of the Russian Federation who participated in remote educational cycles in Moscow and Yekaterinburg have been included in the survey. Nurses were divided into two groups based on their status and experience in the specialty. The group consisted of 31 respondents (average age 41,2 years). 28 respondents were Managers of nursing (average age 40,8 years).

Results and conclusions. Stress management skills are more essential for nurses than for nursing managers and nursing staff with work experience of up to 10 years and over 20 years. Communication skills are relevant for nursing managers and nursing staff with experience of over 20 years. For all the nurses, situational assistance in complicated communicative situations and stress management is a priority compared to the long-term psychological support. The choice of education form (seminar, training) does not depend on the nursing staff’s status and work experience.