The problem of intestinal dysbiosis and its correction with the use of preand probiotics remains a subject of on-going debate. Current data on intestinal dysbiosis, its clinical manifestations, the role of the intestinal microbiota in the life of the organism are presented in the article. The characteristic of proand prebiotics, symbiotic have been given. The methods of diagnosis of intestinal dysbiosis have been presented, their informativeness has been assessed. The author presents results of his own research of the effectiveness of the symbiotic drug with infants (n = 24) having intestinal dysbiosis. It has been found that the use of a symbiotic led to normalization of stool biochemical parameters, as well as to the decrease of growth of conditionally pathogenic intestinal biota.

The article deals with the main aspects of the epidemiology and clinical course of molluscum contagiosum with children. Comparative analysis of the effectiveness  of different treatment  methods has been done. Based on the data of multicenter clinical studies, the authors concluded that the high efficiency and good tolerance  of 5% potassium hydroxide solution in the treatment  of molluscum contagiosum with children children.

Background. Pertussis is a highly contagious bacterial infection of airborne transmission type that still remains a serious problem in Russia and around the world. The only reliable means of specific prophylaxis of pertussis is vaccination. In Russia, only one revaccination from pertussis is provided at the age of one and a half years, which is done with whole-cell DTP vaccine, which is not used with children older than 4 years due to high reactogenicity. Imported acellular DTP vaccines are an alternative to whole-cell  vaccines licensed for use with older children.

Objective: Our aim was to study children’s tolerability of the vaccine containing acellular pertussis component.

Methods.  The safety of acellular DTP vaccines (DTaP, DTaP/IPV/Hib) has been analyzed in a retrospective  study with children older than 4 years at the department of vaccinal prevention of Scientific Center of Children’s Health (Moscow) in the period from December 2014  to December  2015.

Results.  The results of 123  vaccinated  children aged 4 to 9 have been studies. Among them, healthy children — 62, those having allergic disease — 30, those with other chronic diseases — 31. In the post-vaccination  period (3–7 days), local reactions (weak and/or strong) were recorded with 19 (31%) healthy children, 11 (37%) with children having allergic diseases, 9 (29%) with children having other chronic diseases. General reactions to vaccination (weak and/or strong) occurred with 11 (18%), 6 (20%), and 8 (26%) children respectively.

Conclusion. The compared groups did not differ in frequency of post-vaccination  reactions and their intensity, with the exception of strong local reactions that occurred more frequently with children having allergic diseases. 

The author  summarizes  the  results  of research  of the  antibacterial,  antiviral  and  antifungal  properties  of multifunctional  human protein  — lactoferrin,  in order  to determine  the prospects  for its use in the prevention  and  treatment  of infectious  diseases  of children in their first year of life. The mechanisms of anti-infectious effect of this protein with breastfed children have been described. Basic differences between human lactoferrin and cattle lactoferrin have been shown. Biotechnology of obtaining recombinant human lactoferrin from the milk of genetically engineered dairy animals (goat-producers) has been described. According to the studies, both by physical and chemical parameters and biological activity, human lactoferrin, obtained from milk-producing  goats, corresponds to its natural counterpart.

The article is dedicated to the 90th anniversary of the Union of Pediatricians of Russia. Studying the results of academic research, reports,  and resolutions  of congresses  and conferences  of Pediatrician  Societies,  it was observed  that discussions  organized  on pediatric forums which brought up actual problems occurring in pediatrics and clinical practice play an important role in decreasing the rate of child mortality and morbidity, saving millions of child lives in the USSR and modern Russia.

Hypophosphatasia is a rare genetic disorder caused by deficiency of tissue-specific  alkaline phosphatase as a result of mutations in the ALPL gene. Depending on the form and severity of the disease, pathology may spawn in utero, in childhood or in adult age. Given functions of alkaline phosphatase, patients experience multisystem disorders: primarily changes in bone (osteoporosis, rachitic deformations,  fractures),  lung  disease  (hypoplasia  with respiratory  failure)  and  central  nervous  system  (seizures),  hypercalcemia with development of nephrocalcinosis. Without timely treatment, the disease may be harmful to life in most cases. Patients required observation of a multidisciplinary team of physicians. The only effective treatment is enzyme replacement therapy with asfotase alpha. It is also necessary to carry out symptomatic treatment and rehabilitation of patients with the use of physiotherapy and therapeutic physical training complexes of exercises.

Background: Children with allergic diseases, especially bronchial asthma, are in need of protection from acute respiratory infections, as anti-epidemic  measures cannot prevent the spread of influenza; vaccination remains the best means of prevention. Another promising direction in the prevention of acute respiratory infections (ARI) can be immunomodulators of bacterial origin. Objective:  Our aim was to study the use of immunomodulators for prevention of respiratory infections with children having allergic diseases.

Methods. A comparative analysis of prophylactic efficiency of specific and nonspecific immunoprophylaxis of ARI with children having allergic diseases has been done during three epedemic seasons (2011–2014).

Results.  For immunization of 335 children aged 3–17 years having a variety of allergic diseases, vaccine (domestic and foreign) in combination with an immunomodulator, and without it have been used. With the help of vaccination, the number of cases of ARI during the whole observation period decreased significantly: 21 (6.3%) children did not have ARI,62 (18.5%) children had ARI once, 252 (75.2%) children — from 1–4 times in a year. Also, significant reduction of frequency of aggravation of the basic disease was observed in all treatment groups. Patients who received only immunomodulator, had significant reduction of both ARI and the basic disease (p <0,05).

Conclusion. The use of vaccines in combination with an immunomodulator or without it fully protects children from flu and significantly (1.5 times) reduces prevalence of ARI.

Background. Improving nursing methods of newborns with birth weight less than 2500 g resulted in an increase in the proportion of children at risk for the development of severe disabling conditions. Objective: Our aim was to investigate the risk factors of the mother, associated with the birth of a child with a birth weight less than 2500 g.

Methods. In a retrospective cohort study included 572 children born to 566 mothers in 5 perinatal centers. Risk assessment was carried out taking into account birth weight (in groups of children with normal, low, very low and extremely low birth weight).

Results. Sample of mothers (n = 489), whose children had birth weight     2500 g, characterized by a mean age of 31 (26; 35) years, the growth of 164 (159; 168) cm, weighing when registering for pregnancy 62 (53; 74) and 70 kg (60; 80) kg just before birth. Among the independent predictors of birth weight infants were allocated as follows: maternal education (higher/more), mother occupation (housewife/other), presence of chronic diseases, anemia during pregnancy, the threat of premature births, growth and weight of the mother’s body before birth, weight gain body during pregnancy, body mass index (BMI) when registering for antenatal care in pregnancy and before delivery.

Conclusion. Identified risk factors for maternal birth weight infants, which can be used to stratify pregnant women at risk.

Background. Patients registers help obtain the latest information about the clinical course of a disease, safety and effectiveness of the medical technology. Objective: Our aim was to analyze the efficiency and safety of omalizumab with children suffering from uncontrolled severe persistent bronchial asthma (BA) according to the data of the developed register.

Methods.  A register of patients with severe asthma of uncontrolled course receiving omalizumab in addition to basic therapy has been developed.

Results. Results of treatment of 101 children aged 6–17 have been analyzed. The duration of therapy with omalizumab lasted from 1 to 85 months, with a median of 16 (10; 44) months. The drug was used in doses of 75 to 600 mg, with a median of 300 (225; 375) mg. The therapy with omalizumab allowed achieving a better control of the disease (AST test prior to start of therapy — 14 (11; 17) points, in 1 year — 20 (13; 25); p < 0,001); reduction of the volume of daily base therapy (prior to start of therapy, average dose of inhaled corticosteroids in terms of fluticasone was 629 ± 304 mg (n = 15), in 4 years — 524 ± 342 mg; p = 0.065); reduction of the number of aggravations and the need to use short-effectiv   2-agonists.  No adverse systemic effects of the introduction of genetically engineered biological drugs have been found.

Conclusion. Register of patients with severe persistent asthma can be used as a tool for long-term  monitoring and integrated assessment of the efficiency and safety of therapy.

Background. Osteoporosis — a typical manifestation of systemic juvenile idiopathic arthritis (JIA) and aggravation of glucocorticosteroid therapy. High risk of fractures with osteoporosis remains an urgent issue of rheumatology. Objective:  Our aim was to study the effect of tocilizumab on bone tissue with patients having systemic JIA.

Methods.  History of children’s disease (< 18 years) with systemic JIA and known results of densitometry of the lumbar spine (L1–L4) before and after 12 months of tocilizumab therapy have been studied. Results.  Anamnesis of 49 patients (including 24 girls) having systemic JIA have been analyzed. The median age of patients was 14 (7; 21), the age of onset of the disease — 4 (1; 14), disease duration — 9 (2; 19) years. High activity of the disease has been noted with all chlidren; 23 (47%) had limitation of functional activity (score on the questionnaire CHAQ). 36 (74%) children took 0.5 mg/kg of glucocorticosteroids  per day orally, 32 (65%) — intravenously. Tocilizumab was applied for all children in a dose of 12 mg/kg 1 time every 2 weeks. Prior to prescribing  tocilizumab, osteoporosis  (Z-score  <-2.5  SD) was detected  with 15 (30%) children, osteopenia (Z-score -1 and -2) — with 14 (29%) children, past bone fractures — with 5 (11%) children. After 1 year of treatment, inactive stage of the disease/remission according to the criteria of C. Wallace was recorded with 100% of patients; physical activity (assessed by CHAQ) increased. Glucocorticosteroids per os dose was decreased to 0.05 mg/kg per day for all patients; pulse therapy was not performed. Along with the therapy, increase in the values of Z-score  from baseline -1.2  (-5.8;  1.9) to -0.7 (-4.7, 3.0) after 12 months of therapy (p <0.001) and mineral bone density — 0.6 (0.3, 1.3) 0.7 (0.4, 1.2) respectively (p <0.001) was observed. New bone fractures were not observed.

Conclusion. Therapy that included tocilizumab resulted in positive changes in bone status with patients having systemic JIA. 

By definition of the Global Initiative for bronchial asthma, the Global Strategy for the treatment and prevention of bronchial asthma, the main objective of asthma treatment is to achieve and maintain control of the symptoms of the disease, improvement of quality of life and reduction of risks in future. Failure to comply with the doctor’s prescription results in an increase in the number of aggravations, increases the need for hospitalization, reduces the quality of life and increases the cost of treatment. Despite advances in the treatment of bronchial asthma with children and the development of new inhalation devices with minimal difficulties in use, there exists a growing number of patients who do not comply to treatment guidelines for certain reasons. The main causes of low comliance of patients having asthma have been presented, the role of parents in the treatment process has been noted, the factors (drug and non-drug) leading to a decrease in the level of control over the disease have been analyzed, ways to eliminate poor compliance have been defined in this article.

Obesity — one of the main challenges for the public health around the world in the twenty-first  century. It is a leading risk factor for serious complications of the cardiovascular system resulting in 17 million deaths worldwide each year. In Russia only, among young people, the prevalence of the disease is 11,8–16,6% and growing, especially in the last decade. Along with obesity, the problem of sleep disorder becomes increasingly urgent. One of the main factors of sleep disorders with children is the obstructive sleep apnea syndrome (OSA), which is considered  as one of the main causes  of cardiovascular  problems  development  among adults. Depending  on the methods for its diagnosis, children’s OSA occurs in 1–13% of cases, and there is reason to believe that it often remains undiagnosed. With sleep disorders, children get stuck in a vicious circle that causes the development of insulin resistance, nocturnal hypoglycemia, and changes in carbohydrate metabolism.

Children  suffering  from  dystrophic  forms  of  innate  epidermolysis  bullosa  (IEB),  have  malnutrition  of  multifactorial  genesis.  And, despite the experience of working with this complex group of patients, many practical issues of optimal nutrition organization at IEB remain  unsolved.  The review presents  modern  approaches  to the assessment  of nutritional status  with children,  including those developed for the assessment of eating disorders with children having IEB; the formulas for calculating the nutrient requirement are presented. The analysis of the scientific data on the pathogenesis and characteristics of disturbances in nutritional status with children having IEB is done. It is noted that the complexity of nutritional support of this severe category of patients is due to a mismatch between the increased need for nutrients and limited assimilation of food, which requires a special diet with increased energy and protein value without increasing the amount of food intake. Reasonability of the organization of feeding children having IEB with specialized products for enteral nutrition and nutritional support is analyzed.

Vide-capsule  endoscopy has been used successfully in treating children to assess the condition of the small intestine in spots that are not available to conventional endoscopy. The article presents the innovative technical characteristics of the new system for videocapsule endoscopy  — Capso Vision Capsule Endoscopy  System: panoramic view, provided  by the side optics, and data storage in the video processor  of the capsule itself. The article presents  the results of the diagnostic system in treatment of 5 children with a description  of the detected pathological changes. Both the positive aspects and disadvantages  of Capso Vision Capsule Endoscopy System in treatment of children are discussed.