The topical article gives the results of the long-term experience of the Research Institute of Children’s Infections, Federal Biomedical Agency of Russia, and the Department of Neuroinfections and Organic Pathology of the Nervous System in diagnosing and managing children with infectious diseases of the nervous system. It reflects the epidemiological and clinical aspects of bacterial purulent meningitides, meningococcal infection, serous meningitides, encephalitides, neuropathies, and myelitides in children. There is an etiological view of neuroinfections. The specific features of infections transmitted by Ixodid ticks are specified. Some aspects of the course of Ixodid tick-borne borreliosis and tick-borne encephalitis and the rate and pattern of chronic forms of the disease are set forth. The authors have reflected their experience in managing patients with neuroinfections, the role and place of cytokine therapy, extracorporeal methods in the treatment of neuroinfections, in emergencies in particular, the possibilities of robotized mechanotherapy in rehabilitating children with movement disorders. The role of current noninvasive methods, such as transcranial magnetic stimulation, evoked potentials, and electroneuromyography in diagnosing neuroinfections and monitoring rehabilitation processes, is shown. Tendencies and prospects for the development of the problem of neuroinfections are defined.

The paper gives a detailed review of the updates available in the literature on the specific features of mucociliary clearance in health and disease and on expectorant and mucolytic therapies. It sets forth practical recommendations on mucoactive therapy algorithms for acute and chronic bronchopulmonary diseases in childhood. The analysis of the modern literature and the data of the authors’ own investigations suggest that mucoactive therapy used in combination with therapeutic measures (etiotropic and basic therapies, etc.) must be differentiated and determined by the pharmacological properties of drugs; the type, severity, and course of bronchopulmonary diseases; a child’s age; the nature and magnitude of cough and expectoration; unfavorable environmental factors (in particular, passive smoking), and patient compliance.

Most cardiologists are familiar with current echocardiographic techniques — the latter study myocardial deformity, rotation, torsion, etc. However, not all practitioners realize the possibility of introducing the results of these current examinations into clinical practice. The introduction is hampered by a lack of platform-independent technologies and reference values in different age ranges and an investigator’s high subjectivism during data extraction. The paper presents the specific features of an echocardiographic procedure for analyzing the values and lower normal limit for myocardial (longitudinal, lateral, and circular) deformity, rotation, torsion with consideration for differences in gender, age, etc., as well as the specific features of changes in the study indicators in the main groups of myocardial diseases.

Obstructive sleep breathing disorders in children encompasses a wide range of pathological conditions, among which obstructive sleep apnea is the most severe disorder. The paper gives data on a relationship of the above disorder to the higher risk for childhood cardiovascular disease. It indicates the link of obstructive sleep apnea to impaired autonomic regulation, which manifests itself
as hypersympaticotonia determined by cardiac rhythm characteristics, metabolic parameters, and blood pressure levels. Myocardial electrical instability is detected, which appears as increased QT interval dispersion on ECG. The observed changes raise the risk of cardiac arrhythmias. Obstructive sleep apnea in children is accompanied by increases in vascular tone and blood pressure, change in the endothelial structure, and activation of a systemic inflammatory response, which contributes to atherogenetic processes. The above disorders can be persistent if timely treatment is absent. The diagnosis and correction of obstructive sleep apnea in children are constituents in the prevention of cardiovascular disease.

Juices are of great importance in human rational nutrition during the first years of life. In accordance with the generally accepted recommendations, they are introduced into the infant diet no earlier than 4 months of age, usually after the first complementary foods. Juices provide essential macro- and micronutrients for the infant, promote his/her adaptation to a new eating pattern, and play an important role in the formation of taste preferences and food programming. Juices are a source of vitamins (primarily vitamin C), some minerals (iron), fibers, and water. At the same time, juices contain significant amount of other organic compounds important for the human body, such as polyphenols that are an important component of plant products. They are present in vegetables and fruits, both fresh foods and drinks. Polyphenols include phenolic acid and flavonoids: flavonols (catechins and proanthocyanidines), anthocyanins, etc. Fruit juices contain an average of 34 mg/ 100 ml polyphenols and tomato juice does 69 mg/100 ml. Polyphenols play the most important role in the body’s antioxidant defense mechanisms. Their anti-atherogenic and anti-cancer effects (reducing the risk of myocardial infarction and that of lung and rectal cancers) are shown in the long term.

Klebsiella is one of the most common causes of neonatal sepsis. Cases caused by extended-spectrum β-lactamase-producing Klebsiella strains are of the most relevance. The infections caused by these bacterial strains are resistant to the majority of cephalosporins commonly used in practice and lead to significant mortality. The development of their clinical forms, including severe ones, is determined by a number of virulence factors that include capsular antigen, lipopolysaccharide, pili, and siderophores. Despite the fact that the probability of sepsis is highest in premature infants, full-term ones are equally at risk in the situations associated by the infection due to extended-spectrum β-lactamase-producing Klebsiella. Our investigation of the specific features of the course of neonatal sepsis caused by Klebsiella established that hemorrhagic syndrome evolving in the presence of thrombocytopenia is the most common condition developing in Klebsiella-induced sepsis that determines the severity of a patient’s condition and affects the outcome of the disease.

The federal reporting forms over 1986–1995 and the official statistics over 2009–2014 were analyzed using the methods of descriptive statistics and correlation analysis to identify the relationship of neonatal health status to reproductive problems in adulthood. The investigation showed that at the end of the 20th century, the overall structure of newborns showed a larger proportion of very low (1000–1499 g) and low (1500–2499 g) birth weight babies from 0,42% in 1986 to 0,47% in 1995 and from 4,9 to 5,46%, respectively. Moreover, the common neonatal abnormalities were birth trauma, intrauterine hypoxia, birth asphyxia, congenital abnormalities, growth retardation, and malnutrition. Further, there was a decline in the number of people coming of active reproductive age, men and women alike (24,77% in 2009 and 23,77% in 2014). With this, in 2009–2014, the adult population exhibited increases in the incidence of newly diagnosed cases of diseases of the endocrine, circulatory, and urinary systems (by 6,61, 15,07, and 4,14%, respectively), and female infertility (by 21,25%). Correlation analysis indicated that there was a negative relationship between neonatal hemolytic disease and adult-onset circulatory diseases and anemia (r =–0,45; p<0,05 and r =–0,48; p<0,05); infections specific to the perinatal period, salpingitis and oophoritis (r =–0,30; p<0,05); there was a direct correlation between congenital pneumonia in the newborn and diabetes mellitus, diseases characterized by high blood pressure in adults (r =0,31; p<0,05 and r =0,36; p<0,05); respiratory distress syndrome and insulin-dependent diabetes mellitus (r =0,38; p<0,05). Pathological processes result in a vicious circle: a neonatal patient — a female and/or male patient — pregnancy and/or labor pathology — a sick child.

The representative data of the results of epidemiological surveys (the International Study of Asthma and Allergies in Childhood, ISAAC) were selected during a meta-analysis of the 1994–2013 published investigations estimating the prevalence of asthmalike and asthma among 7–8- and 13–14‑year-old children in Russia. Phase I ISAAC was conducted in 1993 to 2000, which covered 96241 schoolchildren (57185 children aged 13–14 years and 39056 ones aged 7–8 years) from 17 regional centers of Russia. The prevalence of asthma-like symptoms in Russia in 1993–2000 in both groups was comparable with the worldwide average and northeast European rates. According to the results of Phase II ISAAC, the prevalence of asthma in Russia averaged 5,3% in 13–14‑year-old adolescents and 4,7% in 7–8‑year-old first formers. Phase III ISAAC was performed in 2001 to 2008. Group 3A included studies done in the Novosibirsk center only. Over 6 years, the old age group showed a steady-state trend for an annual increment in asthma-like symptoms, such as severe attacks with speaking-related dyspnea by 0,15% per year, as well as nocturnal cough by 0,42% per year. The parents of the first formers more frequently reported that their children were diagnosed with asthma (an annual increase of 0,15%). Both age groups displayed average annual reductions of 0,5 and 0,37% in bronchospasm symptoms in response to exercise. Based on the results of Phase 3B study, it is pertinent to note that there is a slight change in the prevalence of asthma-like symptoms and asthma in Russia’s children in the past 20 years.

The paper presents an investigation of airway resistance with bronchodilator response and time course of changes in the levels of proinflammatory (IL-1β) and anti-inflammatory (IL-4, IL-10) cytokines and the indirect marker of fibrosis — matrix metalloproteinase 3 (MMP3) in order to specify their role in the immunopathogenesis and course of bronchopulmonary dysplasia. 15 healthy full-term infants aged 3 to 20 months and 39 premature infants (a study group) with bronchopulmonary dysplasia were examined. The infants of the study group were divided into 3 subgroups: 1) 11 babies of less than 55 weeks postconceptual age; 2) 11 infants of 55–75 weeks postconceptual age; 3) 17 ones of 76–141 weeks conceptual age. Airway resistance and bronchodilator response were investigated using the Rint method; oxygen saturation and the presence of RS virus in nasal secretions were determined. An enzyme immunoassay was used to estimate the blood levels of IL-1β, IL-4, IL-10, and MMP3. It was ascertained that the increased level of IL-10 were more common in Subgroup 1 and that of MMP3 in Subgroup 2 as compared to the group of healthy infants. As this takes place, a 10‑fold and more increase in IL-10 levels in the infants from Group 3 (the old group) is a poor prognostic factor. The infants in Subgroups 1 and 2 showed higher Rint and more marked bronchodilator response, suggesting respiratory failure. Conclusions. As the infant grows, there are decreases in the frequency of exacerbations and in the magnitude of bronchodilator response and an increase in saturation, but the proportion of infants with greater responsiveness remains high and fails to reach the values observed in healthy babies. Immunological heterogeneity and mosaicism of changes in the levels of biomarkers of bronchopulmonary dysplasia suggest that there may be different inflammatory phenotypes in this disease.

According to the literature, nearly one-third of patients with congenital heart diseases have signs of heart failure. Objective: to assess the possibility and results of using a modified Harvard step test (MHST) for the evaluation of exercise tolerance in children with a functional single ventricle. The investigation covered 110 healthy children aged 6 to 16 years and 29 patients aged 3 to 16 years with a functional single ventricle after total cavopulmonary connection with an extracardiac conduit a year after surgery and fenestration closure. MHST using a complete protocol was carried out in 44,8% of the patients. In the other examinees, the reason for stopping the test was premature muscle weakness and dyspnea. This could establish Functional Class (FC) II heart failure in 55,2% of the sick children. In the examinees, the MHST index (MHSTI) characterizing exercise tolerance ranged from 22,4 to 111. The median MHSTI scores significantly differed between the groups of patients with FC I and II heart failure (p=0,021). Exercise tolerance was lower in 17,2% of the patients with a functional single ventricle; in the others it was average and above average (41,5 and 41,3%, respectively), which was suggestive of good hemodynamic adaptation in patients after surgery. The findings prove the safety and efficiency of using the above test in the evaluation of exercise tolerance in children 3 years of age and older.

Objective: to examine the autonomic nervous system in 15–17‑year-old adolescents.

Subjects and methods: 2015 adolescents (1080 boys and 935 girls) aged 15–17 years were examined. The tables developed by A. M. Wayne, cardiointervalography, wedge orthostatic test, and heart rhythm variability were used to evaluate the autonomic nervous system. Results. The study showed that the adolescents of both sexes (82% of boys and 84.8% of girls) showed an imbalanced autonomic nervous system as sympathicotonia, vagotony, and vegetative vascular dystonia of mixed-type.

Conclusion. The adolescents belong to a group at risk for psychosomatic diseases in the future and therefore require a special followup and prevention activities.

Objective: to examine the blood levels of homocysteine in children with different courses of chronic pyelonephritis. The study covered 60 children with secondary chronic pyelonephritis. Homocysteine levels were estimated using an Immulite-2000 system (Siemens Healthcare Diagnostics Inc., USA). Statistical nephroscintigraphy was used to detect the foci of nephrosclerosis. The mean homocysteine level in the children with pyelonephritis was 7,9±4,27 μmol/L; at the same time this did not statistically differ from that observed in healthy children (6,1±2,8 μmol/L) have been identified. Significant differences were obtained only between children with signs of sclerosed kidney tissue and those without the signs (9,68±5,23 and 5,97±0,9; р=0,001); this was typical of all age groups. Detection of hyperhomocysteinemia in children with chronic pyelonephritis determines their allocation to a group at risk for early nephrosclerosis.

The paper deals with an association of connective tissue dysplasia with vesicoureteral reflux and its complications in children. Highgrade vesicoureteral reflux was found to be typical of children with severe connective tissue dysplasia; moreover, its repeated endoscopic correction is required in 27% of cases. The frequency of vesicoureteral reflux complications as hypertension and focal nephrosclerosis did not depend on the degree of connective tissue dysplasia. Urinary tract abnormalities were more specific to children with severe connective tissue dysplasia. The children, mainly girls, with severe connective tissue dysplasia showed a propensity to have recurrent urinary tract infection.

To study the specific features of the pathogenesis of urticaria and to clarify the mechanisms maintaining its chronic course, complement 
components (C3a, C4, and C1‑inhibitor (C1inh)) were examined in the blood of 50 children with chronic urticaria and 15 healthy children without manifestations of allergy and pseudoallergy. The magnitude of disorders of the complement system was estimated in relation to age, disease duration, and the presence of comorbidity. The serum concentrations of С3а, С4, and С1inh were determined by enzyme immunoassay. Children with an exacerbation of chronic urticaria were established to have elevated C3a and C1inh levels. Decreased C4 levels were associated with autoimmune urticaria and observed in children with a disease duration of more than a year. The levels of C1inh and C4 exhibited a negative paired correlation detected in most children with a positive autoserum test.

Molecular allergy diagnosis makes it possible not only to identify allergic sensitization to peanut as a whole, but also to establish the specific allergen the specific IgE is synthesized to. The purpose of this study was to establish a relationship between sensitization to certain molecules of peanut and allergy as anaphylaxis after eating the product. An immunofluorescence assay (Immuno CAP 100 Phadia AB, Switzerland) was used to determine specific IgE to whole allergen in the peanut and its components (Ara h1, Ara h2, Ara h3, Ara h8, and h9 Ara). Children diagnosed with peanut-induced anaphylaxis were found to be significantly more sensitized to the recombinant allergens Ara h8 and Ara h9 (p=0.019). The detected combination of sensitization to the recombinant peanut allergen Ara h8 and Ara h9 indicates a high probability that an allergic reaction may manifest as anaphylaxis. Determination of specific IgE against peanut proteins will optimize patient management tactics.

As of now, constipation in children, especially in babies during the first years of life, is a common complaint during a visit to a pediatrician and a gastroenterologist. Despite the fact that the current guidelines for the management of this patient group have been elaborated, there has been no consensus of opinion among parents and specialists regarding the therapy and prevention of constipation in children so far. The article discusses the diagnosis and treatment of functional constipation in children. The authors give their own observations and experience with the rectal suppositories Glycelax® pediatric in the therapy of proctogenic and mixed constipation in infants.

Joint pathology without signs of inflammation must always arouse suspicion of lysosomal storage diseases, mucopolysaccharidosis (MPS) in particular. It is these orthopedic diseases in mild MPS type I, which are an early sign of the disease; moreover, somatic disorders may be absent or present slightly. Joint contractures are currently chosen as the starting point of an algorithm, a developed diagnostic algorithm for the examination of patients with MPS type I, which is also applicable to the early diagnosis of all forms of mild MPS.

Children with rare diseases may be found to have various malformations, including those of the gastrointestinal tract. The authors followed up a 9‑year-old child with Cornelia de Lange syndrome, who was found to have esophageal stricture with the development of gastroesophageal reflux and esophagitis.