The article is dedicated to the issue of pediatric mortality at the Moscow Imperial Orphanage founded on September 1, 1763, by decree of Empress Catherine II. The authors present results of an analysis of medical statistical data and give an objective assessment of the medical service provided by the Moscow Orphanage in order to understand the positive or the negative role of the Orphanage in the preservation of children’s lives. The stated data do not confirm a myth of the Orphanage being a “factory of angels”. Despite high pediatric mortality observed in the active period of the Moscow Imperial Orphanage, the doctors succeeded in saving hundreds of thousands of the children left for dead. The care of poor infants and preservation of their lives played an important role in the development of medical care and social welfare of the pediatric population of Russia.

The growing distance between fundamental science and clinical medicine may bring risk of decreasing effectiveness of biomedical research. Translational research is a relatively new concept; it implies application of fundamental research results to practice (from bench to bedside) using a specific combination of research stages. As a result, it provides integrated information on safety, efficacy and effectiveness of a medical technology. However, there is no generally accepted view on aims and structure of translational research. This review presents analysis of different methodological approaches to translational research.

The review is dedicated to treatment of allergic diseases in children, particularly to the use of the 2nd generation antihistamine. It demonstrates that mediator histamine has the crucial role in pathophysiology of the allergic reaction. Antihistamines block histamine action aimed at H1 receptors by way of competitive inhibition. The 2nd generation antihistamines are the drugs of choice for the treatment of allergic diseases due to the absence of sedative effect. The review presents clinical and pharmacological description of the selective 2nd generation antihistamine cetirizine, efficacy and safety of which have been appraised in numerous long-term clinical studies in children with allergic rhinitis, urticaria and atopic dermatitis.

The literature review presents data on peculiarities of tuberculosis epidemiology, incidence rate and clinical pattern in children in the Russian Federation. Over the last 5 years, the age structure of the children developing tuberculosis has significantly changed: the share of children of small and preschool age increased, whereas the share of 7-14-year-old children decreased. Tuberculosis of thoracic lymph nodes predominates in the structure of clinical forms of tuberculosis of respiratory organs in children; small forms predominate, which indicates improvement of diagnostic capabilities. However, a rather large number of children with calcination stage of the tubercular process is observed. Further improvement of early detection of a tubercular infection is a powerful tool of preventing complicated and progressive forms of tuberculosis in children.

The study was aimed at evaluating effectiveness and safety of subcutaneous allergen-specific immunotherapy (scASIT) with tree pollen allergen extract adsorbed on calcium phosphate at allergic rhinoconjunctivitis in children. Patients and methods: open-label prospective study of 50 children and adolescents (5-17 years of age) with allergic rhinoconjunctivitis caused by high sensitivity to tree pollen allergens. The first group involved the patients undergoing scASIT for 2 years 6 months (n = 23), the control group – the patients (n = 27) not undergoing any specific immunotherapy. Results: scASIT was accompanied by a statistically significant (in comparison with the control group) reduction in intensity of rhinoconjunctivitis symptoms (6.1 ± 3.1; 11.8 ± 4.5; p = 0.00002), reduction in the use of symptomatic drugs (1.0 ± 0.4; 1.8 ± 0.3; p = 0.000004) and improvement of quality of all spheres of children’s life – physical (p = 0.001), social (p = 0.04), emotional (p = 0.001) and role functioning (p = 0.03). Systemic side reactions were not observed in the patients. Local reactions were observed in 23% of all allergen injections. Conclusions: the authors established high effectiveness and safety of scASIT with tree pollen allergen extract adsorbed on calcium phosphate suspension at allergic rhinoconjunctivitis in children.

The study was aimed at investigating the perinatal factors and levels of pro- (IL1α, IL6) and anti-inflammatory (IL1RA, IL10) cytokines in order to clarify their role in immune pathogenesis and prediction of bronchopulmonary dysplasia (BPD). Patients and methods: the prospective study involved 194 neonates with birth weight of 600-1,500 g and gestational age of 25‑32 weeks. The primary perinatal risk factors and their role in BPD development in children with very low (VLBW) and extremely low (ELBW) birth weight were analyzed. A special screening program consisted in determining serum levels of IL1α, IL1RA, IL6 and IL10 in the 3^rd-5^th and the 7^th-10^th day of life with enzyme-linked immunosorbent assay using test systems manufactured by Cytokine, LLC. 40 neonates with and 40 neonates without BPD underwent immunological examination. The BPD incidence was 46.6% in neonates with ELBW and 10.5% in children with VLBW. BPD risk factors for BPD in VLBW neonates were low APGAR score in the 1^st minute (p = 0.02), severe respiratory distress syndrome (RDS; p < 0.001) and pneumonia (p < 0.001). Gestational age under 27 weeks (p = 0.001) had the primary role in children with ELBW; other risk factors included body weight (p = 0.02), low APGAR score in the 1^st (p = 0.03) and the 5^th minutes (p = 0.002), severe RDS (p < 0.001) and pneumonia development (p < 0.001). According to the comparative evaluation of prognostic significance of the level of pro-and anti-inflammatory cytokines in infants with BPD, IL1RA has the highest information value when its level > 670 pg/ml and IL6 ≥ 25 pg/ml.

The study was aimed at hemodynamic effects of xenon on operative interventions in children. Patients and methods: the study involved 30 5-17-year-old children – 10 (33.3%) girls and 20 (66.7%) boys with ASA score 1-3 admitted for surgical treatment. The children underwent endotracheal anesthesia with xenon-oxygen mixture (Xe:O2 = 60-65:30%) and fentanyl (2.5‑3.5  mcg/kg per hour) for the following operations: appendectomy – 10 (33.3%) patients, herniotomy – 8 (26.7%) patients, Ivanissevich procedure – 6 (20.0%) patients, plastic surgery of posttraumatic defects of skin and soft tissues – 4 (13.3%) patients, abdominal adhesiotomy – 2 (6.7%) patients. Central hemodynamics was studied echocardiographically (Philips HD 11, the Netherlands) using the Teichholz technique along the cephalocaudal axis (parasternal access). Results: the anesthesia was notable for hemodynamic stability during the operation: as a result, a statistically significant (p < 0.05) increase in systolic, diastolic and mean arterial pressure by 10, 18 and 17%, respectively, was observed. Conclusion: the analysis demonstrated that xenon anesthesia improves lusitropic myocardial function statistically significantly increasing cardiac output by 12% by way of increasing stroke volume by 30%.

Early diagnosis of sepsis in neonates is especially relevant due to the persistently high rate neonatal mortality caused by this pathology. Active search for new laboratory markers, which would help to predict onset of a generalized infectious process with high probability, has been going on in recent years. The study was aimed at determining sensitivity and specificity of the CD64 index, evaluating the possibility of using it as an early marker of sepsis in infants after cardiac surgery during artificial circulation and comparing prognostic value of the CD64 index and the routinely used parameters. Patients and methods: the study involved 36 postoperative ICU. Retrospective analysis of bacterial inflammation markers has been conducted in groups of children at the postoperative stage: with (n = 16) and without (n = 20) sepsis. Results: the CD64 index in patients with sepsis was significantly higher than in the children without sepsis – 2.29 (p = 0.01). At the same time, blood serum C-reactive protein concentration and the absolute peripheral blood leukocyte count were similar in patients from both groups. Procalcitonin (PCT) test sensitivity for sepsis diagnosis was 65%, specificity – 67%. At the same time, the negative prognostic value of PCT reached 76%, the positive one – 63%. The performed analysis demonstrated that the CD64 index is a reliable early marker of sepsis with high sensitivity (80%) and specificity (90%); AUC – 0.895 (0.753-1.000) at cut-off point 2.00. Conclusions: C-reactive protein may not be seen as a reliable early marker of sepsis due to, it appears, peculiarities of its dynamics in the postoperative period. Specificity of this parameter is low and amounts to 50%. The study also demonstrated lower information value of the procalcitonin test compared to the CD64 index. The CD64 index over 2.00 indicates high risk of sepsis development in neonates in the postoperative period.

Acute gastric dilatation is a rare surgical condition in children, which often results from blunt abdominal trauma. This condition is characterized by the gut-brain connection disorder or gastric muscular layer damage, which results in atony. Gradual gastric stretching with fluid contents and gases in the end leads to the development of various types of intestinal obstruction. When conservative measures are not sufficient (in rare cases), it is reasonable to resort to operative intervention. Several cases of such a pathology have been published around the world. This condition has been observed not only at the blunt abdominal trauma, but also at lesions of central and peripheral nervous systems and in patients with anorexia nervosa and bulimia in the event of excessive food consumption. The article presents a clinical case study and a follow-up analysis of a child with posttraumatic acute gastric dilatation. The authors describe clinical manifestations, pathogenesis and diagnostic algorithm, which allowed establishing this rare diagnosis. Along with the conventional drugs and intensive care measures, the treatment involved a complex of mini-invasive endosurgical and endoscopic manipulations, including laparoscopic jejunostomy, which was performed in order to provide long-term enteral feeding. The clinical case study demonstrated that the use of diagnostic laparoscopy helps to establish nature of the gastric damage correctly and formulate the following optimal treatment tactics on the basis of the obtained data.

Corrected transposition of the great arteries (CTGA) is pathology of cardiovascular development rarely observed in therapeutic practice. This condition is difficult to diagnose due to the absence of both hemodynamic disorders and clinical manifestations in patients for a long time. Echocardiography is a method applied to perform timely diagnosis of this condition and develop an algorithm of dynamic observation and treatment.

The authors present their experience of immunosuppressive therapy with calcineurin blockers in the post-transplantation period (after living-related kidney transplantation). The study was aimed at determining effect of immunosuppressive drug tacrolimus on results of living-related kidney transplantation in children (group 1). The 58 children, who did not receive tacrolimus in the process of the study, constituted the control group (group 2). The following parameters were used to perform comparative analysis: Kaplan-Meier cumulative survivability of recipients and transplants, Cox cumulative hazard level, log-rank test. Moreover, we calculated the rates of transplanted kidney loss and mortality. Results: survivability of transplants and patients was higher in the main group than in the control group (p < 0.05). Conclusions: thus, results of the performed analysis allow claiming that use of tacrolimus for immunosuppressive therapy positively affects results of the living-related kidney allotransplantation in children.

The article is dedicated to the relevant aspects of complex diagnosis and treatment of cognitive disorders in children and adolescents with traumatic brain injury (TBI) sequelae in the long term. Traumatic brain injury is one of the most important issues of the modern neuroscience due to high incidence rate and incapacitation severity. A steady increase in TBI sequelae, many of which are cognitive disorders (cerebro-asthenic and psychoorganic syndromes, post‑traumatic dementia) accompanied by various symptoms of vegetative dysfunction syndrome, has been observed in children in the recent years. The factors affecting severity of TBI sequelae in children are severity of the injury, age at the injury, time elapsed since the injury and localization of the lesion. Disturbances of memory and attention (75%), hand-eye coordination, cerebro-asthenic disorders (88%) and chronic headaches (95%) are prevalent in the structure of cognitive disorders after a minor TBI. Severer cognitive dysfunctions accompanied by pathological neurological symptoms resulting in difficulties in learning, self‑service and negatively affecting social adaptation in general are observed in 94-100% of the children having suffered moderate or severe TBI. The article discusses the modern methods of complex diagnosis and pathogenetically substantiated techniques of drug therapy of cognitive disorders in patients with traumatic brain injury sequelae in detail.

The article is dedicated to the issue of preventing allergies in children. Increase in the spread of allergic diseases among children and adolescents remains one of the most significant medical and social issues and constitutes a heavy burden for healthcare budgets of many countries around the world. The Federal clinical recommendations must become modern guidelines for practicing clinicians everywhere; these are modern regulatory documents – protocols of medical care rendering to children with various allergic manifestations. The authors substantiate complex approach to the therapy of allergic diseases and determine the role of preventive measures and elimination of trigger effects. The authors traditionally distinguish between primary, secondary and tertiary measures and demonstrate their orientation. They consider the issue of preventing respiratory infections, which often constitute a factor of exacerbation of chronic allergic processes and are one of the frequent causative agents of allergic inflammation. The optimal preventive effect and maximum reduction in the incidence rate of respiratory infections may be achieved by combining vaccination and immune pharmacotherapy.

The study was aimed at analyzing prescriptions of antibacterial drugs for outpatient treatment of respiratory tract infections in children. Patients and methods. The study involved patients with acute respiratory tract infections: 158 children were undergoing outpatient treatment, whereas 30 children were being treated at the polyclinic day hospital. The children aged from 3 months to 15 years. Acute rhinopharyngitis, acute laryngitis, acute bronchitis, tonsillitis and pneumonia were registered in 66.5, 2.6, 18.1, 11.7 and 1.1% of cases. We appraised indications for antibacterial therapy, prescription terms, therapy duration and choice of an antibacterial drug. Results. Antibacterial therapy prescription was found unreasonable in 44.0% of acute rhinopharyngitis cases, 41.1% of acute bronchitis cases and 60.0% of acute laryngitis cases. In the first day of diagnosis establishment, antibiotics were prescribed in 63.8 and 100% of cases at pediatric divisions and day hospitals, respectively. The unreasonable antibiotic prescription rate in infants was 66.7% - significantly higher than in 1-7-year-old children (p < 0.05). The most frequently (66.4%) prescribed class of antibacterial drugs at pediatric divisions was penicillins (amoxicillin, amoxicillin clavulanate); at day hospitals, they were prescribed in 23.3% of cases (p < 0.01). Use of cephalosporin antibiotics as the initial therapy was significantly higher at day hospitals than at pediatric divisions (P < 0.01); the drug was administered parenterally in 90% of cases. Antibiotic prescription courses did not exceed 5 days in most cases (60.1%). Conclusions. We revealed high rate of unreasonable antibiotic use for outpatient treatment of acute rhinopharyngitis, laryngitis and acute bronchitis, especially at day hospitals and in infants.

The issue of preserving and prolonging breast feeding is relevant for many countries around the world. It is especially relevant in premature infants and the children born with various perinatal pathologies. Scientific literature features the primary reasons of weaning: work activity resumption by nursing mothers, milk deficiency, breast refusal, insufficient awareness of mothers. The article presents results of two studies performed at the Scientific Center of Children’s Health. Results of a medical-psychological-pedagogical questioning of 85 mothers of premature infants demonstrate insufficient work of medical personnel in the sphere of preserving breast feeding in whole and in the children born with perinatal pathologies in particular; and the need of young women and their families in obtaining information on the benefits of breast feeding, training and assistance in the course of parental performance. The study resulted in formulation of recommendations on breast feeding support. It is important to establish the possibility to return to full breast feeding after enforced weaning and in the event of supplementary/mixed feeding. Results of the second study (n = 33) demonstrated that the use of special medical devices (pacifiers, feeding bottles) developed on the basis of thorough research in the sphere of maternal breast sucking physiology in natural feeding termination risk group children helps to preserve children’s need therein and ensures efficient return of children to maternal breast feeding.

The program of cohort immunization of 0-1-year-old children with a pneumococcal conjugate vaccine (PCV) has been going on in Saint Petersburg with the help of the Rostropovich‑Vishnevskaya Foundation since June 2013. The need in cohort immunization against pneumococcal infection is substantiated by effectiveness of use of PCVs in previous years, when immunization therewith resulted in 9.5-fold and 1.8-fold reduction in the incidence rate of community-acquired pneumonias and acute otites mediae, respectively, at pediatric institutions. The joint program involved use of PCV13. 38,000 vaccinal doses confirm high safety thereof both for separate and combined administration. The article provides analysis of vaccination organization and demonstrates importance of individual work with the population and training of all medical professionals.

The article presents data on the history of creation of pathogenetic enzyme replacement therapy and its introduction into clinical practice of managing patients with Gaucher’s disease. 2 primary stages are distinguished: beginning of use of enzyme β-D-glycosidase analog obtained from placenta and alglucerase; introduction of recombinant glucocerebrosidase (imiglucerase). The article demonstrates that enzyme replacement therapy is the only efficient method of treating Gaucher’s disease; according to the international studies; it terminates the primary clinical manifestations of the disease, thus improving quality of life of the patients without any marked side effects. Imiglucerase is used at present; it causes hydrolysis of glycolipid glucocerebroside down to glucose and ceramide by the common way of metabolism of membrane lipids. Imiglucerase is indicated for long-term enzyme replacement therapy in patients with confirmed Gaucher’s disease (types 1 and 3).

Relevance: therapeutic tactics at infectious inflammatory conditions of oral and pharyngeal mucosae includes prescription of the drugs featuring antimicrobial, anti-inflammatory and analgesic action. A combination of tyrothricin (antibacterial agent), benzocaine (topical anesthetic agent) and benzalkonium chloride (antiseptic) has been in use in clinical practice for years. The study was aimed at comparing the clinical efficacy of the drug based on the listed active substances and other stomatological agents in adolescents with aphthous stomatitis. Results: comparable efficacy of the drugs under study has been observed. No side effects have been observed within the period of the drug’s use. A possibility to use one drug for treatment facilitates oral care and improves compliance of patients.

The study was aimed at establishing a new ultrasonic criterion of evaluating spleen dimensions in children (area of the maximum axial section) and determining the range of normal spleen dimensions. Patients and methods: We analyzed 838 ultrasonic spleen examinations in 3‑15‑year-old children and determined the area of the maximum axial section by tracing the scan obtained with a medical device. Results: on the basis of ultrasonic examination data analysis, we established a formula, which helps to calculate the spleen section area with the organ’s length and thickness. We performed retrospective analysis of 4,001 standard ultrasonic examinations followed by formula evaluation of the area of maximum axial section. Conclusion: on the basis of the comparative analysis of the measured and calculated areas of the maximum spleen axial section, we established a range of normal values of this parameter taking age and sex into account.

The article is dedicated to prevention of controllable infections in infants. This is an urgent issue, as up to 40 mln. infectious diseases are registered in Russia every year; infections are particularly prevalent in children. Infectious pathologies may take up to 70% of all health conditions in children. Vaccination is the only effective method of preventing infectious diseases. The authors present international experience of using a pentavalent vaccine, which contains diphtherial and tetanus toxoids, acellular pertussis component, inactivated poliovirus and type b Haemophilus influenzae polysaccharide. This vaccine is included into immune prevention schedules for children of 0-1 (primary vaccination) and 1-2 (revaccination) years of age in many countries. The article presents results of major clinical studies, which confirm low reactogenicity and high effectiveness of the mentioned vaccine.