Pneumococcal infection remains one of the leading reasons for infant mortality from vaccine-preventable infections. Today vaccination is the most effective way to prevent diseases caused by antibiotic-resistant pneumococci. In the article, authors present current approaches to vaccinal prevention of pneumococcal diseases. The plan of action for carrying out active immunoprophylaxis of pneumococcal infection is explained in detail for both healthy children and patients from risk groups for severe pneumococcal diseases development. The published work is based on key points of the guidelines of the Ministry of Health of the Russian Federation on vaccinal prevention of pneumococcal infection (developed and approved by the professional association of pediatricians «The Union of Pediatricians of Russia»).

The Jarisch-Herxheimer reaction (JHR) is a shock-like state in response to antimicrobial therapy due to the release of toxins from decomposing microbial bodies. The reaction mainly occurs in patients with spirochetosis, less often in patients with brucellosis, bartonellosis, rickettsiosis, and can be possibly observed in patients with sepsis or meningococcemia. The JHR in children with community-acquired pneumonia has not been previously described. The article provides the author’s own observation of a similar reaction in a child with upper lobe pneumonia associated with amoxicillin treatment and resolved after the administration of prednisolone.

Background. The assessment of the condition of a child with acute abdominal pain and a diagnostic search algorithm at the prehospital stage determine the further routing of the patient and the timeliness of healthcare delivery. Objective. Our aim was to evaluate the possibility of using immunochromatographic rapid tests (ICA) to determine the rota- and adenovirus infection in pre-hospital differential diagnosis of abdominal syndrome in children. Methods. In a retrospective cohort study, we analyzed the medical records of patients with a combination of abdominal and intestinal syndromes who applied for medical assistance to the emergency pediatric department of the FSAI “NMRC of Children’s Health” of the Ministry of Health of Russia from January 2015 to December 2017. Results. Outpatient medical records of 201 patients aged from 4 months to 17 years have been analyzed. In patients with a positive ICA, only 6% (5/88) of cases had doubtful or positive symptoms of peritoneal irritation, whereas in the case of a negative rapid test, almost all children needed a surgeon’s consultation. The frequency of leukocytosis detection in a clinical blood test was not different in patients with different results of ICA. The increase of C-reactive protein as a marker of bacterial inflammation was more common in patients with a negative rapid test. The volume of additional diagnostic care in the group of patients with a negative ICA result was significantly higher than in patients with confirmed viral gastroenteritis. None of the children with confirmed viral gastroenteritis required a surgical treatment. In the group with a negative ICA result, surgical treatment was performed in 11% (12/113) cases. Conclusion. Patients with confirmed viral gastroenteritis require significantly fewer diagnostic measures; they also have a minimal probability of acute surgical pathology. The use of laboratory rapid tests at the pre-hospital stage plays an important role in the timely diagnosis and the reduction in the frequency of non-specialized hospitalization.

The measurement of glomerular filtration rate (GFR) in intensive care unit patients is strategically important and determines the further treatment tactics. The article provides a literature review on choosing the various methods for assessing the glomerular filtration rate in children with kidney injury. We identified the main limitations of creatinine as a marker for measuring GFR; the features of laboratory methods for creatinine determination were detected.

Osteogenesis imperfect (OI) is a rare genetic disease of connective tissue, the main manifestation are fractures that are developing due to increased bone fragility in both children and adults. Currently, it is known that the genetic basis of the disease in 90% of cases are violations in the genes COL1A1 and COL1A2. Diagnosis of this disease is mostly based on clinical and radiological data; some laboratory parameters of blood and urine can provide additional information but, due to the low specificity, these tests are not widely used in clinical practice when diagnosing the bone pathology. Separate extensive problem is the realization of timely differential diagnosis followed by the establishment of correct diagnosis and development of the right tactics. Currently, the standard of management of patients with OI is a multidisciplinary approach that allows to perform the necessary examination of a child, to make an accurate diagnosis, and start the therapy in time. A practitioneer should have sufficient knowledge about the disease and be able to apply it practically to realize the treatment tactics.

Chronic urticaria in children is one of the diseases that are underestimated in their severity and impact on the quality of life. The world academic literature data gives very little information on epidemiology, etiology of chronic urticaria, and researches on application of various therapies in children with the studied disease. Second-generation antihistamines are the leading medications in the therapy of chronic urticarial; however, there are not enough studies on the use of other treatment options in children with this pathology. Resistance to standard therapy and to high doses of antihistamines is one of the problems of managing both adult patients and children. Omalizumab is the first generation of biologicals drug for treating chronic urticaria resistant to standard therapy; the pharmaceutical can be administered in children over 12 years. Further research on the drug efficacy in chronic urticaria is required including safety rate evaluation in the pediatric group of patients.

Chronic liver diseases in children are a group of pathological conditions which varies greatly in etiopathogenetic features heterogeneity and clinical picture, tends to progress if associated with cirrhosis and decompensate hepatic functions consequently following by orthotopic transplantation. Despite the introduction of many non-invasive methods of examination, biopsy continues to be a standard in the diagnosis of histopathological changes in liver tissue. The article reflects modern ideas about the efficacy and safety of various methods of liver biopsy in children. Comparative analysis results on the informative value of hepatobioptates obtained by various puncture techniques are provided.

Hypophosphatasia is a rare hereditary progressive disease caused by a mutation in ALPL gene and characterized by low activity of alkaline phosphatase. Due to the disruption of the bone mineralization process, ricket-like deformations of the skeleton occur in the clinic picture more frequently but other systemic manifestations can be also observed as respiratory insufficiency, urinary tract damage, and neurological disorders. Seizures, delayed physical and psychomotor development, attention deficit disorder, muscle weakness, fatigue, intracranial hypertension associated with the development of craniosynostosis are revealed in these patients. The severity of the disease depends on age: the highest mortality is reported in younger patients, in perinatal and infantile forms of hypophosphatasia. Diagnosis is based on the identification of specific clinical manifestations: retardation of growth and development, skeletal deformities, pain in muscles and joints, premature tooth loss. In laboratory tests, a steady decrease in alkaline phosphatase level is detected taking into account age and sex specification. If possible, alkaline phosphatase substrates are measured: levels of pyridoxal-5-phosphate in the blood and phosphoethanolamine in urine are higher at low enzyme activity. Radiographs of long bones typically reveal characteristic ‘tongues’ of lucency projecting from growth plates into metaphyses, hypomineralization, osteopenia, various kinds of deformation. All patients with suspected hypophosphatasia should be consulted by a clinical geneticist and evaluated to identify possible mutation in the ALPL gene.

Background. Laparoscopic surgery has advantages over laparotomy. In pediatric practice, only single studies have been devoted to the leading role of laparoscopy in the treatment of peritoneal adhesions in children; randomized controlled studies have not been conducted. Objective. Our aim was to assess the advantages of laparoscopic methods of surgical treatment in patients with adhesive intestinal obstruction. Results. The main group included 58 children aged from 10 days to 18 years who underwent laparoscopic surgery. The control group included 49 children with acute adhesive intestinal obstruction. The incidence of early and late adhesive obstruction was 18 (31%) and 40 (69%) cases in the main group, 21 (42.9%) and 28 (57.1%) cases in the control group. The number of previous surgical interventions in the main group ranged from 1 to 6, in the control group – from 1 to 7. The advantages of a laparoscopic approach to the treatment of acute adhesive obstruction are confirmed by a significantly lower expression of the postoperative intestinal paresis and rapid recovery of peristalsis, early onset of enteral nutrition, and relatively rapid discharge from the hospital. It is important to note the absence of early and late postoperative complications in the laparoscopic group, especially repeated cases of intestinal obstruction (in contrast to the control group where two patients required repeated operations for obstruction). Conclusion. Laparoscopic technologies are a method of choice in the treatment of children with acute adhesive intestinal obstruction regardless of the age of patients, the extent of the adhesion process, the anatomical mechanism of intestinal obstruction.

Background. Introduction of laboratory rapid tests into the practice of emergency teams (EMS) and carrying out a simple etiologic point-of-care diagnosis can affect the quality of medical care for children at subsequent stages. Objective. Our aim was to assess the quality of pre-hospital emergency care for children with acute abdominal pain using laboratory rapid tests. Methods. An open prospective comparative randomized study was conducted. Patients who called an emergency team for acute abdominal pain were randomized into two groups. In the study group (n = 243), the proposed model of pre-hospital emergency care with laboratory rapid tests was used. With patients of the control group (n = 242), the emergency teams worked according to the traditional schedule. The quality of medical care for children was assessed taking into account the emergency team specialty. We also carried out the analysis of case management in case of admission to a surgical department. Results. In the study group, the frequency of refusals of hospitalization was 2.5 times lower; the frequency of repeated calls was 75% less; unreasonable admission to a surgical department was 1.5 times less than in the control group (p < 0.05 for all parameters). Non-specialized hospitalization was 5% in the control group no cases in the study group. Conclusion. The use of a laboratory rapid point-of-care diagnosis at the pre-hospital stage helps to improve the quality of care for children with acute abdominal pain.

The current development of medicine and the results of recent large-scale academic research in pediatrics provide the convincing conclusions that the formation of human health begins in the antenatal period of ontogenesis and continues throughout the infancy. The ideas and subsequent academic research on the influence of nutrition during the first thousand days of life on the programming of metabolism and the development of some chronic somatic diseases such as obesity, hypertension, coronary heart disease have become widespread. In addition, at the same period of life immune abnormalities with a predominance of one of the subpopulations, Th1 or Th2, can possibly form in children at risk of developing allergies when immune response is developing. The predominance of the Th2 cytokine profile (hyperproduction of interleukins 4, 5, 13, etc.) suggests the possibility of stable formation of the atopic status in a child afterwards. Consequently, the application of academic knowledge on the health status programming by nutrition during early ontogenesis is an important tool in preventive pediatric practice.