The paper presents the results of a long-term follow-up of the health status of children exposed to radiation from the 1986 Chernobyl accident. Five reference cohorts have been identified, each of which has individual features of the development of radiation-induced diseases. A cohort of babies irradiated in utero, a cohort of the children of Chernobyl accident liquidators, and a cohort of mI-irradiated children born in 1969-1986 are considered.

The literature review deals with the specilic features of physical development in extremely premature infants weighing less than 1500 g at birth. It describes the regularities of an increment in basic physical development parameters (weight, height, and head circumference) within the first year of life. Genetic factors, the specific features of a neonatal period, comorbidity, and different feeding types are shown to affect the increment rates of the physical development parameters. Emphasis is placed on the early initiation of enteral feeding and on the long-term use of fortified foods in low birthweight premature babies for the correction of energy deficiency resulting from preterm birth. The review shows that there is a relationship of the long-term outcomes of physical and psychomotor developments in low birthweight premature babies.

The paper reviews the literature on the impact of different breast milk parameters on a baby's immunity. It characterizes humoral and cellular factors and other protective components in breast milk. There is evidence for the advantage of breastfeeding for the development of the immune system in infants.

This review deals with the current epidemiological features of acute enteric infections in children. It provides the viewpoints of a number of investigators (including the authors of this paper) on the pathogenesis of infectious diarrheas and on the optimization of a set of diagnostic tests aimed to detect the pathogen of community-acquired enteric infections. The matters of pathogenetic therapy and the efficiency of using the drugs traditionally incorporated into a complex of treatment are examined. The correctness of the main points of the classification of these diseases, which is adopted in Russian practice, is discussed.

Iron-deficiency anemia is a common and, despite the available wide range of iron preparations, unsolved problem in pediatric practice. This is often associated with inadequate diagnosis in primary health care, which is due to both objective problems and underestimation of the seriousness of sequels of iron deficiency. This review gives data on the epidemiology of iron-deficiency anemia in the Russian Federation and worldwide, existing approaches to denning concepts, such as anemia, iron deficiency, and iron deficiency anemia in children, and possible diagnostic methods from the simplest to high-tech.

The review deals with the relevant interdisciplinary problem - to prevent atopic diseases, in which probiotics play an important role. Analysis of clinical follow-up studies has shown that the use of these drugs in pregnant women and newborns significantly reduces the risk of atopic dermatitis.

Extremely premature infants underwent clinical laboratory examinations to predict growth retardation at 38—40 conceptual weeks. A study group comprised 84 very low and extremely low birthweight premature infants; a control group consisted of 20 apparently mature babies. The informative signs that can predict growth retardation at 38-40 postconceptual weeks are shown to be the presence (absence) of decompensated maternal fetoplacental insufficiency during the current pregnancy, grade III maternal-placental blood circulatory disorders, the presence (absence) of maternal endocrine diseases, the level of lactate and partial pressure of oxygen at 50% saturation in the blood of a premature infant who was one month old.

Objective: to estimate the time course of changes in proinflammatory cytokines during early neonatal adaptation in infants born to women with complicated pregnancy. The authors examined 57 full-term infants born to women with complicated pregnancy, including 12 babies with the uncomplicated course of an early neonatal period, 24 neonates with the initial manifestations of maladjustment, and 21 infants with the complicated course of an early adaptation period that culminated in perinatal abnormality. A comparison group included 42 babies with the physiological course of an early adaptation period. The umbilical cord and peripheral blood levels of IL-ip, IL-6, and TNF-a were determined by an enzyme immunoassay on 1-3 and 5-7 days of life. The highest umbilical cord blood concentrations of IL-6 and TNF-a were noted in the uncomplicated course of an early neonatal period. At the same time, the level of IL-6 decreased within the first week of fife and that of TNF-a was unchanged. The concentration of IL-ip did not differ from that in the healthy babies. With the initial manifestations of maladjustment, the umbilical cord blood content of IL-ip was comparable with that in the healthy infants, the elevation in the concentrations of IL-6 and TNF-a was less pronounced than that in the neonates with an uncomplicated adaptation period. There was a statistically significantly increase in IL-ip, IL-6, and TNF-a levels in the dynamics of an early neonatal period. Obvious early maladjustment culminating in a disease was accompanied by elevated umbilical cord blood IL-ip and IL-6 levels with no changes in TNF-a. IL-6 hyperproduction persisted as long as 5—7 days of fife; the level of TNF-a significantly increased in the dynamics of an early neonatal period and that of IL-ip decreased at 5—7 days of fife.

The rare hereditary diseases encountered in the practice of pediatricians, pediatric neurologists, and geneticists include Lesch—Nyhan syndrome associated with purine metabolic disorders caused by mutations in the HPRT1 gene encoding the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). HGPRT deficiency gives rise to hyperuricemia, hyperuricemic nephropathy, and a CNS lesion reminiscent of dystonic or hyperkinetic infantile cerebral paralysis concurrent with a propensity to have autoaggressive behavior. The diagnosis is based on a range of history data, characteristic neurological symptoms, the detection of high blood and urine uric acid levels, and the identification of pathogenic mutagens in the HPRT1 gene. Early diagnosis contributes to timely therapy and assists in medical genetic counseling. The paper describes a clinical case of a boy with Lesch-Nyhan syndrome and elucidates the problems of diagnosis and treatment of this disease.

The paper gives 2 clinical examples of patients with the same diagnosis of progressive X-linked Emery-Dreifuss muscular dystrophy and the different course of rhythm and conduction disorders, which have determined various approaches to management tactics. There is evidence for a differential approach to pacemaker implantation, by confirming the correctness of management tactics in a long-term follow-up. A 27-year-old patient had no indications for pacemaker implantation. The other patient aged 13 years was found to have indications and underwent implantation; however, thrombi formed on the electrodes and the atrial electrode needed to be further disconnected.

The clinical presentation of progressive limb-girdle muscular dystrophy type 2A (LGMD2A) is due to loss of functionally active cal-pain-3, a skeletal muscle specific isoform of one of the calpain family proteins involved in the regulation of different tissue processes. The function of calpain-3 and the pathophysiological mechanism of LGMD2A are still not fully understood. The article discusses the features of the pathogenesis, clinical presentation, and diagnosis of LGMD2A and the possible administration of calpain-3 trans-genes as a specific therapy for this disease. Two clinical cases of patients with this condition are given.

The paper presents a clinical observation of two siblings with Danon's disease (lysosome-associated cardiomyopathy) verified by genetic examination. Heart lesion in Danon's disease bears a phenotypic similarity to the primary forms of hypertrophic cardiomyopathy; in this connection the correct etiology of the disease has remained long unestablished. The presence of laboratory markers as the significantly raised levels of transaminases, creatine phosphokinase, and lactate dehydrogenase was as a guide for suspecting the metabolic origin of the disease. Two siblings with a similar LAMP gene mutation were observed to have a different clinical course: a severer clinical course of cardiomyopathy with extreme myocardial hypertrophy, myocardial electric instability, and mental development retardation in one case and a more favorable course in the other; although a 2-year follow-up also revealed negative changes. For the prevention of sudden cardiac death, a cardioverter defibrulator was implanted and continuous therapy with p-adrenoblockers was performed. The specific feature of the cases was no symptoms of skeletal myopathy, moderate mental retardation only in the elder brother, no evidence of an accessory atrioventricular junction despite the fact that there were ECG manifestations of Wolff-Parkinson-White syndrome

Objective: to determine clinical and functional criteria for predicting asthma in children who have sustained acute obstructive bronchitis in infancy. Subjects and methods. A total of 125 infants aged 2 to 36 months who had experienced 1 -2 episodes of acute obstructive bronchitis and treated at hospital were examined when bronchial obstruction syndrome was being relieved. In addition to physical examination, functional studies (computerized bronchophonography and heart rate variability assessment) were used. Immunological examination included determination of the serum levels of immunoglobulin E and interleuMn-17A. The infants who had sustained acute obstructive bronchitis were followed up for 12-36 months. Results. The infants who had sustained acute obstructive bronchitis in the presence of mild perinatal CNS damage caused by hypoxia were typified by high respiratory morbidity; early-onset bronchial obstruction; long-term bronchial obstruction relief; high incidence of grade 2 respiratory failure in acute obstructive bronchitis. These patients developed asthma more often than twice and repeated episodes of bronchial obstruction. ROC analysis was used to elaborate clinical and functional criteria for predicting the development of asthma in infants. Conclusion. The proposed additional clinical and functional criteria characterizing external respiratory dysfunction and autonomic homeostatic changes contribute to the early diagnosis of asthma and substantially increase the validity of prediction of its development in children younger than 3 years, which is of great importance for goal-oriented preventive measures.

The favorable pharmacokinetic profile of an antiepilepttc drug with linear kinetics, stable blood concentration, and no clinical interaction with other agents is important in treating epilepsy in children and adolescents in the outpatient setting. Levetinol (levetiracetam) meets these requirements. Objective: to assess the use of Levetinol in outpatient neuropediatric practice. Sixty-one patients aged 2 to 17 years with different types of epilepsy were examined. Forty-seven children were observed to have concomitant (neurological, somatic, and endocrine) diseases, which required a particularly careful approach to choosing an antiepileptic drug. Levetinol was given in a therapeutic dose of 30 to 70 mg/kg/day. TVventy-three (37,7%) children were on monotherapy; 33 (54%) had duo therapy; 5 (8,1%) received 3 drugs. A positive clinical effect was achieved in 53 children - in most at 3 months of therapy: 25, 50, and 75% reductions in seizures in 2,11, and 3 patients, respectively; no seizures within 3-5 months in 38 (62,2%) patients. Levetinol (levetiracetam) demonstrated a high therapeutic efficacy and good tolerability in patients, including children with comorbidities, owing to which it has an advantage over other medicaments used in outpatient neuropediatric practice.

Antroduodenal motility disorder is a major component of the pathogenesis of most diseases of the upper gastrointestinal tract. Motility regulation is a complex process and it is accomplished by complex balanced neurohumoral mechanisms and depends on the chemical composition of the chyme and on the change in the cyclic membrane potential — slow waves that generate myogenic pacemakers. The electrical activity of the stomach and duodenum may be assessed by electrogastroenterography that shows the motor evacutory function of these digestive tract segments and helps choose therapy for its disorders.

The paper comparatively analyzes the nutritive value of fresh squeezed and reconstituted juices intended for infant feeding during the first year of fife. It presents laboratory data on the content of the trace elements copper and chromium in the fresh squeezed juices under the brand name of FrutoNyanya. Requirements for their raw materials, manufacture and technology, as well as a quality control system for baby juices and nectars are provided. Practical recommendations are given for the use of juices in the feeding of infants during the first year of fife.

The timely diagnosis and optimal treatment of long-term bacterial carriage in children with salmonellosis is a relevant problem now. Objective: to determine the clinical and immunological efficacy of the Russian immunomodulator Likopid during postinfectious carriage of salmonellosis in children. Patients. Twenty-eight children who were postinfectious Salmonella carriers and had been previously ineffectively treated were followed up. They received Likopid n a dose of 1 mg once daily as three cycles at a 20-day interval. Methods. Bacteriological fecal examination and immunologic blood tests (indicators of phagocytosis, immunoglobulins IgG, IgM, IgA, lymphocyte subpopulations, immunoregulatory index (IRI), and lymphocyte migration inhibition reaction) were carried out. Results. Likopid was found to be an effective sanitizer in 96,4% of the children, which was accompanied by increases in phagocytic indices, IRI, and leukocyte migration. To prevent and treat postinfectious bacterial carriage, a new algorithm for management of children with prior salmonellosis was proposed, which encompassed bacteriological examination of risk-group children in delaying bacterial excretion and use of Likopid in the above dose as 3 cycles with further quadruple bacteriological fecal examination.

Objective: to evaluate the efficiency of the original rehabilitation procedure developed by the author for 12—13-year-old children (и=26) with grade 1-2 exogenous constitutional obesity, by using a complex of water physical exercises. The time course of changes in the determinants of nutritional status, cardiovascular system, and vascular endothelial function was studied. The implemented rehabilitation program could lose excess body weight (p=0,04) and reduce waist (p=0,035) and neck (p=0,027) circumferences, systemic vascular tone, and the number of children with brachial artery endothelial dysfunction (p=0,009). The clinical and functional findings indicate that there are hydrokinesitherapy-induced functional changes in vascular tone and their reversibility in obese children. This allows the developed rehabilitation complex to be recommended for the treatment of this category of children to prevent the development and progression of vascular disorders.

The paper describes a clinical case of successful combination therapy in a newborn infant with severe thermal injury. When admitted to the hospital, the infant was diagnosed with third-degree flame burn covering 75% of the body surface and shock. Specialized emergency care involved antishock measures and replacement of vital functions, stepwise surgical interventions aimed to excise necrotic tissues and to restore lost skin tissue, and antimicrobial and symptomatic therapies. Topical treatment included the use of current wound coatings. Skin autocells were used for significant skin defect. Aacuum therapy was performed to stimulate repair processes and to prepare wounds for further skin plasty. The techniques of vacuum therapy included RENAS\S-GO and PICO apparatuses. Its efficiency was evaluated by microbiological, immunohistochemical, and planimetric examinations. Analysis of the decontaminating impact of a vacuum coating could establish its substantial effect in reducing wound bacterial contamination by 65% in the study group and by an average of 21% in the comparison group. That of immunohistochemical findings during vacuum therapy could reveal the high expression of two markers characterizing wound an-giogenesis. Comparative analysis of planimetric readings showed no significant differences in the use of vacuum therapy and current wound coatings. Thus, negative-pressure therapy creates favorable conditions for a wound healing process, providing effective wound decontamination and stimulating granulation tissue maturation as a factor to prepare for skin plasty.

Objective: to establish a relationship of the serum levels of the antimicrobial peptides (AMP) cathelicidin (LL-37) and a-defensins (HNP 1-3) to the clinical manifestations of atopic dermatitis (AD) in children. Subjects and methods. The investigation enrolled 70 patients aged 5 months to 17 years with AD. LL-37 and HNP1-3 levels were determined by enzyme immunoassay. Results. The level of HNP 1-3 was found to be higher in children with moderate AD than in those with its mild form. The serum concentration of LL-37 was independent of the severity scoring of atopic (SCORAD) index. However, the level of this peptide was associated with the magnitude of clinical manifestations of the disease. The concentration of LL-37 was increased with an injury over 50% of the body surface; its level rose with the higher intensity of excoriations, lichenification, and pruritus. At the same tone, as the intensity of crusts/oozing lesion increased from mild to moderate, LL-37 rose and drastically decreased at their highest intensity levels. Conclusion. The established correlation between AMP concentration and clinical manifestations of AD suggests that LL-37 and HNP1-3 play a role in the pathogenesis of this disease.