Although viruses cause most cases of acute bronchitis, antibacterial drugs are still widely used to treat children with such diseases; this results in development of antibiotic resistance. Therefore, one of the key objectives of clinical medicine is now an effort to reduce unreasonable use of antibacterial agents. A multicenter double blind randomized clinical trial (E-BRO-PCT) involved 182 2-6-years-old children and was aimed at assessing effectiveness and safety of phytotherapy (the syrup characterized by a fixed combination of thyme herb and ivy leaf extracts) of acute bronchitis. Patients were divided into groups according to the type of therapy: phyto-, antibacterial or multimodal therapy. The level of procalcitonin (PCT) – a bacterial inflammation marker – was measured retrospectively in the blood samples of all the children obtained at inclusion to the study. Therapy effectiveness was assessed by means of overall assessment of response to treatment on day 7. The share of children with low PCT and positive response to phytotherapy was comparable to the share of children subjected to antibiotic therapy. This is also true for all the patients included in the study regardless of the PCT level. Phyto- and antibacterial therapy featured a comparable safety profile; however, according to the researchers, the former one came out slightly better. Results of this study convincingly demonstrate that phytotherapy is an effective and well-tolerated type of treatment of acute bronchitis in children.

Significance. Imbalanced diet in early childhood often results in medical issues, including mental retardation, impaired adaptation mechanisms and worsened immunological protection. The amount of studies, which could help to assess dietary peculiarities of 1-3-year-old children living in a Russian megalopolis and reveal probable deficiencies of the essential macro- and micronutrients, as well as the prevalence of eating behavior disorders. The study was aimed at assessing the nature and peculiarities of the diet of the 12-35-month-old children residing in Moscow. Patients and methods. 106 1-3-year-old children were examined at two pediatric polyclinics in Moscow; they were divided into two groups: I – 12-23-month-old children, II – 24‑35-month-old children. Results. The authors performed a comprehensive analysis of actual diets of young children, including assessment of the nature of consumed foods and dishes, as well as of nutritional value of daily rations. Conclusions. The authors established that diets of most 1‑3‑year-old children residing in the megalopolis conform to the current criteria. Excessive consumption of high-protein foods, insufficient consumption of specialized functional foods, early introduction of “adult foods” and non-observance of the dietary pattern were observed in several cases.

Inhalation therapy as means of drug delivery is a key aspect of therapy of respiratory diseases in children, which plays an important role in achieving control over bronchial asthma. Optimal clinical effect requires comprehensive selection of inhalation devices given the drug’s peculiarities, the child’s age, severity of his/her condition, the patient’s cognitive potential and capabilities of his/her parents, as well as clinical recommendations on the corresponding diseases. It is rather important to observe individual approach and the patient’s preferences in order to ensure adherence to the recommendations. One of the crucial conditions of effective inhalation therapy is a clear explanation of the inhalation technique and device maintenance by the doctor, as well as regular medical control over observation of the given instructions by the patient and his/her parents. The article presents an algorithm of selecting means of inhalation drug delivery for use in children and the review of currently marketed inhalers, their advantages and drawbacks.

The article is dedicated to food allergies. There still is no accurate estimate of the socioeconomic burden of food allergies and its impact upon the healthcare budget despite increasing prevalence thereof and lack of clear prognostic criteria. The authors present a modern classification of predominant clinical manifestations based on pathogenetic mechanisms of development. They describe therapeutic approaches, propose recommendations on diet broadening for both patients with food allergy manifestations and risk group children, define cross-sensitization and discuss a problem of non-immune reactions to foods.

Keywords: food allergy, tolerance, food allergens, cow milk protein, therapeutic formulae, panallergens, cross-sensitization, risk group children, elimination diet, supplementary feeding, diet, tolerance window.

The article is dedicated to the issues of external therapy of atopic dermatitis in children. Atopic dermatitis is a chronic allergic inflammatory skin disease; in most cases, it is the first manifestation of atopic march. Timely and adequate pathogenetic external therapy of this disease using topical glucocorticosteroids (TGCSs) helps to quickly and effectively terminate symptoms of the disease and allergic inflammation of the skin. Steroid phobia, which is prevalent among parents of the patients, reduced adherence to the TGCS therapy. The authors analyzed results of the original studies of effectiveness and safety of TGCSs, present general recommendations on TGCS use in children with due regard to morphofunctional peculiarities of children’s skin and clinical‑pharmacological description of the TGCSs featuring the most favorable therapeutic index of 0.1% methylprednisolone aceponate. Methylprednisolone aceponate available in 4 pharmaceutical forms is the optimal drug of choice for atopic dermatitis in children over 4 months of age.

Compulsory use of the 7-valent pneumococcal conjugate vaccine in the framework of national pediatric immunization schedules of the developed countries resulted in significant decrease in the prevalence of the pneumococcal infections induced by the vaccinal serotypes. However, a growth in prevalence of the pneumonia and acute otitis media caused by non-vaccinal strains has also been observed. This required introduction of a new 13-valent pneumococcal conjugate vaccine with a wider range of pneumococcal population coverage. The experience of application accumulated in various countries (2010 onwards) and results of the authors’ observations indicate high safety of the 13-valent pneumococcal conjugate vaccine for both healthy under-5 children and patients with various medical issues. The article presents results of the 13-valent pneumococcal conjugate vaccination tolerance assessment. The study involved 110 children from 2 months to 5 years of age. In most cases immunization concurred with other pediatric vaccines. The incidence of local reactions in vaccinated children did not exceed 33%, of generalized reactions – 11%. The authors observed a comparable incidence of side reactions in both virtually healthy children and children with various medical issues.

The article is dedicated to the issues of organization of long-term follow-up monitoring of the patient population in real clinical practice. Every medical intervention is analyzed from the position of positive evidence of its effectiveness, safety and clinical-economic benefits. Although randomized clinical trials (RCTs) are the gold standard of evidence-based medicine, they feature a range of drawbacks; in some cases, such trials are infeasible are extremely complicated to perform due to certain aspects. Along with that, results of RCTs may not completely correlate with clinical practice. Thus, a register – a system of long-term clinical monitoring of a patient population – is a significant source of information on effectiveness and safety of medical interventions. This tool of follow-up observation of a patient’s condition is irreplaceable in medicine, particularly, in allergology both for epidemiological purposes and to assess effectiveness and safety of therapeutic interventions: e.g., use of IgE antibodies – biopharmaceutical omalizumab.

Keywords: register, long-term follow-up monitoring system, effectiveness, safety, uncontrolled severe persisting bronchial asthma, omalizumab, children.

Optimal feeding in the early postnatal ontogenesis is especially important for premature infants with overlapping perinatal pathologies. As is known, unique properties of breast milk ensure adequate physical and neuropsychic development of children, as well as balanced development of metabolism; this is especially important for premature infants. The article presents the main stages of securing priority of breastfeeding for healthy infants: the history of development of the commonly known “ten steps” of breastfeeding for obstetric institutions and the objective impediments to implementation of these steps at neonatal resuscitation and intensive care units (NRICUs) and neonatal pathology units. A group of experts of the World Health Organization summarized experience of several neonatal inpatient hospitals in the framework of the Baby Friendly Hospital Initiative and formulated the basic principles of breastfeeding support for implementation at NRICUs. The experts emphasize utmost importance of a long-lasting contact with the mother (skin-to-skin) and teaching lactation preservation methods to mothers for the support of breastfeeding of premature infants. An attitude toward withdrawal from other feeding methods, rubber teats and pacifiers, as well as organization of breastfeeding “upon request” from premature infants is restricted due to peculiarities of health status and physiological maturity of such children. The experts state that mothers must remain with premature infants around the clock and the necessity of contact with other family members. They also emphasize the importance of preparation of parents to breastfeeding maintenance after discharge from hospital. Implementation of these modified approaches is expected to contribute to successful prolonged breastfeeding of premature infants.

Researchers around the world acknowledge a continuing growth of antibiotic resistance. Thus, it is especially important to select from a wide range of antibacterial agents in the pharmaceutical market the ones appropriate for specific regional sensitivity, only in accordance with clearly defined indications and in order of priority for each specific case. The most frequently used are wide range drugs, including the 4^th-generation cephalosporins active against gram-positive and gram-negative microbes and most anaerobes. This review is dedicated to a representative of this group – cefpirome. The authors indicate the primary indications for use thereof and present a comparative effectiveness analysis. Cefpirome is as effective as cefepime, which is important, particularly because of growth of bacterial resistance against the 3^rd-generation cephalosporins. Its significant advantage is activity against several enterococci and anaerobes. Cefpirome penetrates various body tissues fairly well and establishes there bactericidal concentrations against most known clinically significant microbes. The trials have demonstrated clinical effectiveness of the drug for various nosocomial infections, such as sepsis (62-77%), febrile neutropenia (53-84%), intra-abdominal infections (83%), complicated urinary infections (100%) etc. The drug features low toxicity: it does not exceed the one in cefepime and the 3^rd-generation cephalosporins, which makes it possible to use cefpirome as the drug of the 1^st choice for severe hospital-acquired infections given its wide antibacterial range and clinical significance.

The article presents an analysis of outpatient specialized neurological care appeals to the consultative-diagnostic center and the neurological pathology structure, as well as age and gender peculiarities of its breakdown. The authors revealed that higher mental dysfunctions are the most widespread. They also provide an analysis of underestimation of separate neurological deviations by parents. The article provides recommendations on outpatient specialized pediatric neurological care delivery optimization.

Pompe disease is a rare severe hereditary disease caused by excessive glycogen storage in organs and target tissues due to the acid α-glucosidase gene mutation. Infantile and adult Pompe disease is characterized by involvement of cardiovascular, respiratory and muscular systems in the pathological process. The only specific method of treating Pompe disease is enzyme replacement therapy (intravenous administration of recombinant human acid glucosidase), the effectiveness whereof depends on the time the therapy started. Since such a therapy was introduced into practice, Pompe disease mortality decreased by 79%. 6 children with infantile Pompe disease were observed and treated at the cardiovascular care unit of the Scientific Center of Children’s Health in 2011‑2014. The article presents a clinical case demonstrating capabilities of diagnosing infantile Pompe disease in Russia and effective application of alglucosidase alfa in 4-month-old child.

The current standards of live birth dictate new requirements for feeding of small premature infants. Native breast milk of the mothers of premature infants features a unique and balanced composition of substances required for feeding premature infants and protecting them from infectious agents. Low awareness of the real value of breast milk results in early introduction of supplementary feeding with adaptive formulae, which are not equivalent to breast milk. The article presents results of a poll of mothers of premature infants staying together at inpatient hospitals for the second stage of developmental care. The form on breastfeeding developed by the authors presents information on the development of maternal attitudes and lactation dominant. Results of the study helped to discern negative and positive factors affecting a mother’s attitude to maintenance of lactation and breastfeeding. The obtained data contribute to arrangement of conditions for targeted medical‑psychological‑pedagogic aid to mothers at inpatient hospitals in order to support motivation for breastfeeding premature infants.

Infantile cerebral palsy is an urgent issue of pediatric neurology all over the world. Adequate choice of the term and methods of rehabilitation helps children with this pathology to adapt to the society and improves prognosis of motor and mental development thereof. The article presents the optimal methods of physical rehabilitation at early stages of a child’s development based on the current understanding of neuroplasticity, reserve capabilities of a developing brain, as well as of pathophysiological aspects of recovery and compensation of the damaged structures of the central nervous system. The authors demonstrate crucial differences between approaches to rehabilitation of children under and over 2 years of age. Despite the selected methods of rehabilitation of children with infantile cerebral palsy, successful results of the therapy require a multidisciplinary approach characterized by early onset, balanced combination of methods of physical rehabilitation and drug therapy, physiotherapy and psychological-pedagogic support.

Cortical deafness is a complete absence of the function providing a person with an ability to perceive audible signal caused by defects of cortical centers of hearing of both cerebral hemispheres. This rare pathology is caused by peculiarities of bilateral organization of hearing in cerebral cortex. The article presents a case of diagnosing cortical deafness confirmed with data of a clinical trial and magnetic resonance imaging (MRI) of the brain. It ought to be observed that accurate diagnosis was provided by prescription of the child’s brain MRI despite the absence of specific indications for such an examination.

Introduction of modern information systems is one of the important objectives of medicine, as it contributes to higher availability of medical services for the population. Public relations of medical organizations involve websites of these organizations, outdoor advertising and other information sources. However, obtainment of competent inquiry answers by telephone remains a problem. People often choose between organizations depending on quality of the obtained information. Apparently, the issue can be resolved by establishing call centers that are not merely communications centers, but are staffed with competent trained personnel, who support the organization’s interaction with patients (or the legal representatives thereof). The article presents the authors’ experience of establishing a call center dedicated to the organization’s public image development, as well as higher demand of the available services and promotion thereof. The fulfilled modernization resulted in a sharp increase in the amount of calls received (1,500‑1,600 within the working hours; 900 – before modernization) and reduction in the number of complaints of busy line.