The article is devoted to the problem of timely diagnosis and current principles of management of children with bronchial asthma. Given the  increase in the prevalence of allergic pathology stated over the past  decades, the issues of differential diagnosis, integrated approach to the  treatment and management of children with allergies are extremely  relevant. Strategies of sequential therapy and monitoring of the  patient’s condition, adherence principles are key links in achieving and  maintaining control over bronchial asthma. The publication presents the  main provisions of national clinical guidelines developed and approved  by the professional association «Union of Pediatricians of Russia».

Bone mineral metabolism disorders are one of the most frequent late complications after allogeneic hematopoietic stem cell transplantation (HSCT) in children.

The aim of the study was to detect the incidence and risk factors for bone mineral metabolism disorders in children who underwent allogeneic HSCT.

Methods. We analyzed the data of medical charts of 294 children aged 0–17 y.o. who were hospitalized in 1994–2011, received  allogeneic HSCT, and survived for at least a year after intervention.  We determined the cumulative incidence and revealed risk factors for the development of osteopenia/osteoporosis and avascular necrosis.  Osteopenia/ osteoporosis was diagnosed after X-ray examination and annual computer X-ray osteodensitometry of the lumbar spine (during a 5-year period since 2003). The criteria for osteopenia is  bone density z-score 2.0, for osteoporosis — z-score 2.0 and  suffered fractures of the bones of the legs, compression fractures of  the spine and / or 2 fractures of the tubular bones of the hands (for both diagnoses). Avascular necrosis was diagnosed  radiographically and basing on magnetic resonance imaging results  (if there were complaints of pain or limb dysfunctions).

Results. After the allogeneic HSCT during the median follow-up of 7.5 years bone mineral metabolism disorders developed in 48  patient (16%). Osteopenia / osteoporosis development was  associated with the following factors: the age 10 years (frequency  23.2% vs. 12% in children under 10 years, p = 0.014), acute graft- versus-host disease (GVHD) grade II–IV (24.2 vs 8.7% at GVHD  grade 0–I; p = 0.001), chronic GVHD (36.0% in extensive form vs.  14.5% in restricted form and 8.4% in the absence of chronic GVHD; p<0.001), immunosuppressive therapy >12 months (31.9 vs. 6.9% for therapy <3 months; p<0.001), glucocorticosteroid intake >3  months (93.8 vs 8.1% with GCs administration 3 months and 3.2% without GCs administration; p<0.001).

Conclusion. Bone mineral metabolism disorders are revealed in 16% of cases in children who underwent HSCT. Determination of risk factors provides the possibility for timely diagnostics and improvement of therapy results.

Background: It is assumed that the severity of the multiple organ dysfunctions syndrome (MODS) in children who have experienced critical conditions in the neonatal period is a risk factor for the development of acute respiratory infections (ARI). Objective.

The Aim was to study the relationship between the severities of  organ dysfunctions in children who had undergone critical conditions  in the neonatal period, with an ARI frequency at preschool age.

Methods: The study included children with MODS, the severity of which was assessed on the NEOMOD scale (moderate dysfunction 4  points, severe 5 points). An infectious index (II) was calculated since the discharge from the hospital till the age of 7: the ratio of  the number of cases ARI during the past year to the age of the child  that year, and the proportion of often ill children (OIC) — the  number of ARI 4, 6 and 5 cases per year at the age of 1, 1–3 and 4– 5 years respectively. Data on cases of ARI are obtained from the history of child development (form № 112/y).

Results: The study included 198 children, 100 of them with severe  manifestations of MODS and 98 with moderate manifestations of  MODS. The groups were comparable by sex, age, social factors (age  and level of education of parents), place of residence (city / village).  II (median and 95% confidence interval) in children with severe and  moderate manifestations of MODS under 1 year were 2 (2; 3) and  1.5 (1; 2) respectively (p=0.006); 1–2 years — 1.5 (1–2) and 1 (1– 1.5) (p=0.008); 2–3 years — 1 (0.7–1.2) and 0.7 (0.5–1)  (p=0.006); 3–4 years old — 1,1 (0,8–1,3) and 0,8 (0,6–0,8)  (р=0.003); 4–5 years — 0,6 (0.6–0,7) and 0,4 (0.4–0,5) (р=0.001); 5–6 years — 0.5 (0.3–0.5) and 0.3 (0.2–0.3) (p=0.001); 6–7 years  — 0.3 (0.3–0.3) and 0.1 (0.1–0.3) (p=0.025). The OIC in the groups for the entire follow-up period was 60 (60%) and 42 (43%) respectively (p=0.011).

Сonclusion: Severe manifestations of MODS in the neonatal period are associated with a higher susceptibility of children to ARI.

Providing the body with micronutrients — vitamins and minerals — is an indispensable component of human health and is essential in the  early stages of ontogenesis. However, studies conducted abroad and  in our country show that due to the fact that the content of  micronutrients in the daily ration can vary significantly, it is  impossible to provide the necessary consumption them with food.  This is confirmed by data on the high incidence of insufficient  provision with vitamins and minerals of all strata of the population.  In February 2017 at the congress of the Union of Pediatricians of  Russia, the consensus paper «The National Program for Optimization of Provision with Vitamins and Minerals of Children in Russia» was  presented. It sums up the results of the work of expert group  including pediatricians, nutritionists, clinical pharmacologists,  biochemists, vitaminologists, neonatologists, gastroenterologists, allergologists-immunologists, psychoneurologists, and others from several cities of Russia. The first chapter of the document highlights  general issues including a definition of concepts, current  epidemiological data on provision, and methodological approaches.  The second chapter presents the evidence base for the use of  vitamins and minerals in different areas of pediatrics. The purpose of this publication is to acquaint a wide range of the pediatric  community with the main provisions of the document.

The human papillomavirus (HPV) infection is one of the major risk factor of development of genital warts, a cervical dysplasia, a cervical cancer, and also some other oncologic diseases. The usage  of quadrivalent HPV vaccine in girls reduces the corresponding case  rate and the mortality significantly.

The objective of this study is to analyze the cost-effectiveness of quadrivalent HPV vaccination cases of 12-year-old girls in Russian Federation.

Methods. A Markov model is used on the basis of epidemiological data in Russian Federation. In base case the cost-effectiveness was  estimated from societal perspective. We assumed that the effect of  vaccination remains throughout all life. The analysis is performed for survival of 12-year-old girls. We considered only effect in the  vaccinated population. Costs for therapy of the diseases associated  with HPV infection corresponded to compulsory health insurance  rates across St. Petersburg for 2017. Costs and life expectancy have been discounted for 3.5% a year.

Results. Quadrivalent HPV vaccination of 12-year-old girls in Russian Federation will allow to prevent counting on 100 000 the  vaccinated persons 2918 cases of genital warts, 5095 cases of  cervical dysplasia, 893 cases of invasive cervical cancer, 56 cases of  vulvar cancer, 18 cases of vaginal cancer, 13 cases of anal cancer, 7  cases of oropharyngeal cancer. The vaccination will provide cost  reduction, caused by HPV-associated diseases, for 453.9 million  rubles on 100 000 vaccinated, and 86.5% of the predicted prevented costs will be caused by decrease in incidence of cervical cancer, 9%  — cervical dysplasia, 2.9% — genital warts. The quadrivalent HPV vaccination is associated with an incremental cost-effectiveness ratio (ICER) of 247 560 rubles per quality adjusted life-year (QALY) and  334 200 rubles per life-year gained (LYG). Thus, in both cases, cost  effectiveness of rotavirus vaccination per 1 QALY will not exceed the  generally accepted threshold willingness-to-pay equal to three times  the gross domestic product in Russia (2016 — 1.76 million RUB).

Conclusions. Quadrivalent HPV vaccination of girls prior to the beginning of sex life could be considered in Russian Federation as an economically effective technology for preventing HPV-associated diseases.

One of the main causes of the incidence of intestinal infections in children under 5 years infection is rotavirus. Vaccines against rotavirus infection substantially reduce morbidity.

The objective of this study is to analyze cost-effectiveness of vaccination of children with 5-valent vaccine against rotavirus infection in the Russian Federation.

Methods. The evaluation was carried out using modelling on the  basis of published data on the effectiveness of vaccines and  epidemiological data for the Russian Federation. In the base case analysis was performed from the position of the society as a  whole. During the sensitivity analysis cost-effectiveness was also  evaluated from the position of the health system. The evaluation was performed on the period of survival of vaccinated children. The cost
of therapy corresponded to the rates of OMS in St. Petersburg in 2017, the price of 1 dose of vaccine accounted for in the calculation
of 1450 rubles. Costs and life expectancy with regard to quality were discounted at 3.5% per year.

Results. Taking into account the accepted assumptions, the mass  vaccination will prevent the vaccinated population in the average  4675 RVI outpatient cases and 1732 RVI cases requiring  hospitalization per 100 thousand children the first year of life, with  90% coverage. In unvaccinated populations will be prevented 4128  outpatient cases and 1212 RVI cases requiring hospitalization. The  projected amount of avoided costs in general — 2.94 thousand RUB  per 1 child (54% in the vaccinated cohort, 46% in unvaccinated  population). Cost-effectiveness will be in the evaluation from the  perspective of society as a whole of 260.1 thousand RUB counting on an quality adjusted life year (QALY), and the evaluation from the perspective of the health system — 653.0 thousand roubles/QALY. Thus, in both cases, costeffectiveness of rotavirus vaccination per 1  QALY will not exceed the generally accepted threshold willingness-to- pay equal to three times the gross domestic product in Russia (2016  — 1.76 million RUB). The projected economic efficiency of selective  vaccination 4.94 times lower than one of mass vaccination.

Conclusions. Mass vaccination of children with 5-valent vaccine against RVI will not only reduce the incidence in the Russian  Federation, but, given the adopted assumptions, may also be  considered as a cost-effective intervention.

Antibiotic overuse in clinical practice not only leads to an increased amount of healthcare costs and a risk of side effects, but also causes an increase of antimicrobial resistance. This is a global problem and an  effective fight bacterial infection depends on its solution. This article  provides a brief overview of the primary situations of irrational antibiotic use among pediatric population and the reasons why doctors  overprescribe antibiotic. The literature based strategies for antibiotics  restrictions are proposed and some generalized rules for a rational antibiotic therapy for physicians and for patients are formulated.

The article describes the main characteristics of local glucocorticosteroids (GCS) which are the «gold standard» for external therapy of atopic dermatitis allowing to achieve control over  the disease quickly and effectively. Methylprednisolone aceponate 0.1%  — non-fluorinated local GCS, the drug with the most favourable  therapeutic index, the efficacy and safety of which has been  demonstrated in numerous randomized trials — is the optimal  therapeutic option in the treatment of AtD in children from 4 months.

The analysis of the prevalence, clinical manifestations, diagnosis, and treatment of functional gastrointestinal disorders (FGID) in  infants was carried out. According to the analysis results the  development of FGID in infancy is caused by disorders of motor function and somatic sensitivity of the digestive organs,  changes in the secretory and suction functions of this system, largely due to anatomophysiological features of an early age. The  peculiarities of posseting, colic, and constipation are considered as  the most frequent FGID manifestations in infants. The current  approaches to the treatment of the specified manifestations are  analyzed, including a number of activities, in particular, psychological preparation of parents, support of breastfeeding, rational nutrition of the mother during breastfeeding, if necessary, the selection of  formulas for mixed or artificial feeding, the use of medicines and probiotics. We noted that the high incidence and adverse effects  of FGID in children determine the urgency to research on the mechanisms of their development in order to improve preventive and curative interventions.

We analyzed the factors influencing the formation of motivation for breastfeeding in maternities basing on the data analysis of clinical records and questionnaire among patients of postpartum departments of the maternity hospital.