The article covers the problem of the burden of rotavirus disease. Rotavirus infection is the leading cause of mortality among children under 5 years of age and is a major problem for a public healthcare. The world is actively engaged in the prevention of rotavirus infection since 2005. There is a lot of data on the efficacy and safety of this vaccine. Different foreign investigations have shown the herd immunity of the vaccine. The authors present data about the effectiveness and safety of vaccines, established during clinical studies of the foreign scientists.

The article dwells upon modern principles of diagnostics and therapy of acute tonsillopharyngitis in children given Russian antibiotic resistance peculiarities of Streptococcus pyogenes. The rate of antibiotic prescription in the event of acute tonsillopharyngitis remains unreasonably high in Russia. The disease most often has viral etiology and antibiotic prescription in such a situation is unreasonable. Prescription of systemic antibiotics is indicated only in the event of the confirmed streptococcal etiology of acute tonsillopharyngitis. Use of the express test in routine practice allows confirming or ruling out streptococcal etiology of the disease quickly and effectively; this allows selecting therapy of acute tonsillopharyngitis timely and rationally.

Introduction. Respiratory syncytial virus (RSV) is one of the main causes of lower respiratory tract infections (LRTI) in infancy. In certain categories of children the risk of development of potentially lethal severe forms of the disease requiring hospitalization, treatment within resuscitation departments and use of artificial pulmonary ventilation is significantly higher than in any other category. Palivizumab is used to prevent RSV infection in such children; its high efficacy and tolerance were proved by numerous clinical trials. The aim of this study is to assess use of palivizumab for preventing the RSV-associated LRTI in children from the groups of high risk of severe course of this pathology from a clinical economic point of view in the course of a regular stage of RSV infection immune prevention program realized in Moscow in the season of 2012/2013. Materials and methods. The study involved detailed analysis of results of LRTI immune prevention with palivizumab in a sample of 189 case report forms containing information on the children who had received 3-5 injections of the drug. The estimated number of hospitalizations and deaths in this group of children in the absence of immune prevention was calculated in the model on the basis of results of the previously conducted studies of the RSV-associated LRTI course. The authors also calculated expenses on this group of children in the presence and absence of palivizumab immune prevention, expenses per 1 disability-adjusted life year and averted economic damage due to infantile mortality increase. Results. Use of palivizumab in the group under study has possibly prevented 39 hospitalizations, including 13 hospitalizations with medical care rendering at resuscitation and intensive care units, and 1 death. Immune prevention expenses in the group under study equaled to 33,518,514.60 rubles, whereas the estimated expenses in the absence of immune prevention equaled to 1,698,103.90 rubles. Cost effectiveness increment equaled to 461,165.37 rubles per 1 disability-adjusted life year, which is only slightly more than gross domestic product (GDP) per capita in the RF in 2012 (437,476.22 rubles) and significantly lower than the triple GDP per capita (1.3 mn rubles) – the cost-effectiveness threshold recommended by the World Health Organization for application of health preservation technologies. The averted economic damage per preserved life of 1 child equaled to 29,760,927.36 rubles. Conclusion. Use of palivizumab for preventing the RSV-associated LRTI ought to be considered clinically and economically sound.

The article presents a case of a severe progressive course of a juvenile arthritis refractory to the standard antirheumatic therapy. Due to oligosymptomatic disease onset and low adherence of the patient to treatment, the disease was characterized by development of polyarticular joint syndrome with destructive changes (aseptic whirlbone necrosis) and formation of uveitis complicated by a cataract and patient’s incapacitation. Prescription of adalimumab allowed reducing activity of the inflammatory process, considerably improving function of the affected joints, terminating pain syndrome and stiffness and inducing remission of uveitis.

The article is dedicated to an urgent issue of intensive therapy in neonatology – prevention of catheter-related blood flow infections. The article dwells upon etiological factors, formation mechanisms and modern methods of preventing colonization of central venous catheters and catheter-related infections.

Organization of adequate nutrition of children and adolescents actively going in for sports is of the highest importance both for improving sports results and preserving children’s health. On the modern stage of sports neutraceuticals development, it is relevant to substantiate approaches to nutrition on all stages of the training process, develop methodological basis for individual nutrition selection and conduct demonstrative trials in order to evaluate efficacy of nutritional measures. The pediatric nutrition department of the FSBI “Scientific Center of Children’s Health” conducted a controlled trial of efficacy of a new Russian product for nutritive support of children in the training period in 2012 in order to study possibilities of nutrition optimization for young sportsmen. We noticed statistically significant alterations of bioimpedance analysis values – lean and active cell body mass – in the setting of nutrition correction – intake of 200-400 ml/day of the product for 21 days; at the same time, the fat mass remained the same. Psychological testing using WAN questionnaire (well-being, activity, mood) conducted in the recovery period of the training process also revealed positive dynamics. The product may be used in the dose of 200-400 ml at any time of day; at the same time, it is most reasonable to take it as an additional food intake in the event of considerable training stress immediately before or after training, when adequate nutrition organization is hindered.

Allergic reactions to antibiotics are a serious issue of pediatric practice and a difficult problem for pediatricians due to difficulties of diagnostics, interpretation of anamnestic data and subsequent selection of adequate antibacterial therapy. The review describes the main types of allergic reactions to the antibacterial drugs most widely used in children. Special attention is given to drug hypersensitivity development risk factors; clinical manifestations of allergy to antibiotics and peculiarities of allergic reactions to certain drugs are described. The article dwells upon clinical approaches and algorithms of managing patients with presumed intolerance to antibacterial drugs.

The article is dedicated to historical and modern trials in the sphere of mucoviscidosis in Russia, peculiarities of clinical manifestations, pathophysiological and pathomorphological disorders and of the disease course with the analysis of the first results of the register of patients in the Moscow region. The aggregate result of this evaluation is the survival rate in the Moscow region that has become almost equal to the one in the USA and Europe and is considerably higher than in the other regions of the Russian Federation. Such a result reflects many components of specialized care rendered to mucoviscidosis patients in the Moscow region: special centers for children and adults have been founded, patients are actively and regularly checked and may be examined in detail during each visit, while pharmacological support is up to world standards; this is not yet present or is developed insufficiently in many RF subjects. The article also dwells upon the genetic peculiarities of mucoviscidosis important both for diagnosing the disease (including neonatal screening) and creation of a panel for DNA-diagnostics and for determining the disease course to a considerable extent. It also presents information on the prospects of gene therapy development and the first results of clinical studies.

We conducted 60 low-flow xenon anesthesias in children of 1-18 years of age. We measured the sedation level using bispectral (BIS) index and clinically on the stage of induction, xenon anesthesia maintenance and during recovery. The trial showed that, according to the clinical and BIS-monitoring data, sevoflurane inhalational induction in children of 1-5 years of age and propofol intravenous induction in children of 6-18 years of age provides children with the required sedation level. BIS index objectively reflects intensity of the sedative component of an anesthesia both in the junior and the senior age groups on the stages of xenon anesthesia maintenance and during recovery.

The article is dedicated to an extremely important issue of pediatric nephrology and pediatric transplantology – vaccination of children with chronic kidney disease for prevention of vaccine-manageable infections. Commonplace and often mild (in healthy children) viral and bacterial infections in the patients on immunosuppressive therapy may cause development of life-threatening conditions and loss of a transplant in children with transplanted kidneys. There are no common vaccination protocols for such children neither in Russia nor in any other country. Moreover, it is presumed that vaccination should not take place in children with chronic renal diseases, especially in the stage of renal failure; however, in many cases it is unreasonable. The authors present personal experience of children’s vaccination before and after kidney transplantation.

17 children received cardiorespiratory monitoring in order to evaluate spread and dynamics of changes in the primary obstructive sleep apnea syndrome (OSAS) parameters at type II mucopolysaccharidosis. Mild OSAS [apnea/hypopnea index (AHI) – 1.5-5] was diagnosed in 4 patients (23.5%), moderate OSAS (AHI – 5-10) – in 4 patients (23.5%), severe OSAS (AHI>10) – in 2 patients (11.8%). Average AHI at Hunter syndrome was 5.3±6.9/hour. Mild OSAS (AHI – 0.8±0.3/hour) was prevalent in the group of younger children (1-3 years of age); severe OSAS was prevalent in the group of adolescents (AHI – 10.9±9.4/hour); average blood oxygen saturation (SpO₂) was 87.5±10.6%, desaturation index – 10.4±13.3/hour. In total, OSAS was observed in 58.8% of children and aggravated in direct proportion to aggravation of the disease course. Thus, cardiorespiratory monitoring is necessary to reveal children with moderate and severe OSAS course with subsequent prevention of life-threatening conditions, which may appear at this syndrome.

The article presents a case of complicated diagnostics of systemic juvenile idiopathic (rheumatoid) arthritis (JIA) starting with a fever of unclear genesis. Efficacy of interleukin 6 inhibitor tocilizumab for treating the systemic JIA resistant to glucocorticosteroid and methotrexate therapy is shown.

The article is dedicated to nephrotic syndromes in children. It is not difficult to diagnose; however, numerous variants of the clinical course and different intensity of manifestations in patients pose problems when selecting either a remission-inducing or symptomatic therapy. As practice shows, proper correction of edema syndromes is especially complicated. The article reviews the main literature data on various development mechanisms of nephrotic edemata and approaches to therapeutic measures. It gives careful consideration to the method of performing infusion therapy and diuretic prescription in relation to peculiarities of the edema development mechanism and condition of renal tubulointerstitium.

The study determined content of essential (Zn, Se, Cu) and toxic (Pb, Cd) microelements in blood serum and daily urine in 95 children of 3-15 years of age with recurrent pyelonephritis. It was revealed a statistically significant reduction in the level of essential microelements Se, Cu and Zn in blood serum in comparison with the control group (p<0.05) in the active stage and in the period of decline in activity of pyelonephritis. A statistically significant reduction in Se and Cu urine excretion was registered; at the same time, Zn excretion level was identical to the values in the control group. Study of content of toxic microelements in biological media showed increase in lead concentration in blood serum and urine excretion in children in the period of decline in activity of the disease (p<0.05) and complete clinical laboratory remission (p<0.05) in comparison with the control group. The study did not reveal statistically significant differences in cadmium content in biological media of the examined patients in comparison with the control group. Apparently, deficit of essential microelements in the setting of Pb concentration increase in the body aggravates affection of tubulointerstitial renal tissue resulting in the recurrent course of the disease with brief periods of clinical laboratory remission.

It should be acknowledged that formation of a healthy lifestyle (development, upbringing, elaboration of skills) is a task not only for the public health organs. The main bulk of work rests upon shoulders of educators and teachers within the system of education, who are actively supported by state structures, mass media, business communities, church, sports and other sociocultural organizations. The article presents practical realization of a program for preventing diseases and forming healthy lifestyle at educational institutions of the Zelenograd administrative district of Moscow by founding autonomous centers of health status evaluation on the basis of educational institutions by the teaching staff. They anonymously poll students in order to reveal health risk factors, evaluate and predict health status of students and risk of development of diseases employing heart rate variability method.