The high frequency of injuries to immature internal organs and body systems of premature infants in the postnatal period contributes to the formation of chronic pathology and the violation of neurocognitive development, making a significant contribution to the global problem of the growth of non-infectious diseases and programming the future health of the population. The main goal of health care system modern reform in the Russian Federation and around the world is to find the most effective and economical way of providing medical care, to increase significance of outpatient service and to give attention to prophylaxis. The most functional and cost-effective structure of medical care for premature infants is specialized center with a three-level support system. It consists of ambulatory counselling, the oneday hospital for medical abilitation, and full-day hospital for treatment and complex diagnostic procedures, on the system of telemedicine. The organization of the center requires a clear definition of the structure, standards of staffing and methodology of approach to the organization of support for premature infants after discharge from the neonatal hospital, taking into account the specifics of the planned and regulatory and financial indicators of medical care and the complexity of setting a clinical diagnosis in the modern conditions in the Russian Federation. In accordance to stable tendency of increasing in the survial rate of premature infants, the uniform register would be created – in base of major medical scientific and practical centre as a logistic regression model, that will make possibilities for randomize clinical studies of evidence-based nature.

The transition to personalized medicine in practical terms should combine the solution of the genomics problems as the basis for possible diseases and phenotypic manifestations that are markers and early signs of emerging pathological changes. Most diseases have their first principles in childhood. Therefore, in all age groups, it is necessary to monitor the minimum deviations and their dynamics, use mobile devices for this purpose and accumulate the received data. Processing big data (Big Data) will provide more informative information. On this basis it will be possible to identify analogs for targeted therapy in similar variants of diseases in large databases of publications on the problem of interest.

In recent years, there has been a tremendous trend toward personalized medicine. Advances in the field forced clinicians, including neonatologists, to take a fresh look at prevention, tactics of management and therapy of various diseases. In the center of attention of foreign, and increasingly Russian, researchers and doctors, there are individual genomic data that allow not only to assess the risks of some form of pathology, but also to successfully apply personalized strategies of prediction, prevention and targeted treatment. This article provides a brief review of the latest achievements of genomic technologies in newborns, examines the problems and potential applications of genomics in promoting the concept of personalized medicine in neonatology. The increasing amount of personalized data simply impossible to analyze only by the human mind. In this connection, the need of computers and bioinformatics is obvious. The article reveals the role of translational bioinformatics in the analysis and integration of the results of the accumulated fundamental research into complete clinical decisions. The latest advances in neonatal translational bioinformatics such as clinical decision support systems are considered. It helps to monitor vital parameters of newborns influencing the course of a particular disease, to calculate the increased risks of the development of various pathologies and to select the drugs.

The aim of the study is to present the modern ideas about laboratory predictors of the diseases of digestive system. Analysis of native and foreign literature related to prognostic biomarkers of gastrointestinal tract diseases has been performed. Transition to personalized medicine and targeted therapy puts biomarkers in the forefront. Prognostic indicators are used to assess the likelihood of a clinical event occurring, recurrence or progression of the disease. Prognostic markers become especially important in chronic pathological conditions, such as inflammatory bowel diseases, gastroesophageal reflux disease, gastritis, oncology, etc. MicroRNA, epigenetic modifications, protein or nucleic acid signatures, glycoproteins, etc. can be assigned to this category. Detailed analysis of the role of individual molecules, compounds, mutations and gene polymorphisms significantly expands existing ideas about the mechanisms of development of gastrointestinal tract disorders on molecular level. Biomarker expression assessment allows improving diagnostics, increasing the effectiveness of treatment of digestive system diseases both in children and adults, including the use of targeted therapy, potentially reducing economic costs in health care.

The aim of the study was to identify the clinical features of obesity in children with bronchial asthma.

Materials and methods: 484 children aged 7–14 years were investigated, the main group consisted of 237 patients with asthma, the comparison group consisted of 247 children of the same age who do not have asthma. The analysis of development history, physical exam, measuring height and body mass index, in the identification of obesity – assess hereditary loading, nutritional status and physical activity, hormonal status examination, inspection of the endocrinologist, neurologist, genetics were made.

Results: obesity was more common (p=0.019) in children with bronchial asthma (18.9 per cent) than in the comparison group (11.3 per cent). More severe forms of obesity III, IV degree were more often diagnosed in children with bronchial asthma (31.1 per cent) than in the comparison group (10.7 per cent) (p=0.047). The influence of various factors (patient age, gender, severity of asthma, intake of inhaled corticosteroids) on the formation of obesity in children of the main group has not been proven. In the dynamics of the disease indicators of body mass index in patients with bronchial asthma did not differ significantly in comparison with the original data, however, there was an increase in the number of patients with severe forms of obesity III, IV degree. When assessing the nature of nutrition and physical activity in patients with bronchial asthma and obesity, an imbalance between the intake of energy and its consumption is revealed.

Conclusion: obesity in children with bronchial asthma is constitutionally exogenous, characterized by high prevalence and more severe course.

In the article on the example of phenylketonuria, modern aspects of the prevention of rare diseases are considered. Phenylketonuria is a hereditary disease, in the absence of treatment characterized by progressive mental retardation, epilepsy, severe dermatitis, but with early diagnosis and diet therapy, clinical manifestations of the disease can be avoided. Primary prophylaxis of phenylketonuria is aimed at preventing the appearance of a sick child in the family and is most effectively carried out with the help of medical genetic counseling. Secondary prophylaxis consists in prenatal diagnosis of pathology, as well as neonatal screening for phenylketonuria. Tertiary prevention includes treatment, abilitation and rehabilitation of patients. In practice, these approaches are closely interrelated, which is reflected in the article. The role of pregravid preparation of women with phenylketonuria to prevent the syndrome of «maternal phenylketonuria» in a future child is underlined.

Objective research: is to establish the prognostic value of the analysis of correlative relationships of qualitative indicators of the perinatal history. Correlative groups of interactions of the investigated qualitative indicators in the antenatal, intranatal and postnatal periods are constructed. It was shown that in antenatal history for newborns 22–37 weeks. gestation (group 1) the most important parameters are the «gestational age», «chronic respiratory diseases in the mother,» «premature birth in an anamnesis,» and «exacerbation of chronic infections during pregnancy»; for newborns 38–41 weeks. gestation (2nd group) – «cervical erosion», «ovarian cyst», «fibromyoma» and «colpitis ». In the intranatal history for children of the 1st group, the most important parameters are «anhydrous period» and «prolonged labor»; for children of the second group – only «prolonged labor». In the postnatal history for the first group, the two most important parameters are the «gestational age» and the «zonal elevation of the brain echogenicity,» and for the 2 nd group only the parameter «degree of asphyxia» is as important. The obtained results confirm the main known interrelationships of parameters of the perinatal history. At the same time, nontrivial connections between the parameters of the perinatal history: «allergic diseases in the mother» – «threatened miscarriage » – «ovarian cyst»; «chronic respiratory diseases in the mother» – «allergic diseases of the mother» – «diseases of the digestive system in the father.»

Certain role in the development of respiratory diseases is played by cytokines that possess both pro-and anti-inflammatory activity, and the balance of these factors influences the course of the disease. As shown by studies in recent years, the negative influence of environmental factors, as a rule, implemented against the background of the individual genetic predisposition in virtually any known to date pathology. Objective research: to identify molecular genetic risk factors for the development of acute bronchitis and community-acquired pneumonia in children on the basis of the analysis of polymorphisms of pro- and anti-inflammatory interleukins. A complex clinicallaboratory and instrumental examination of 110 children aged 6 to 15 years with acute bronchitis (the main group) was carried out. The control group included 163 conditionally healthy children of the same age. Significant differences were revealed by the polymorphism of the TNFA gene, which has pro-inflammatory properties. At the same time, analysis of the frequency allocation of alleles and genotypes of polymorphism (-174)C/G of IL6 and + 3953C/T gene IL1B did not reveal significant differences with the control. The results of the study can be used in the development of prognostic markers of acute pathology in children and optimization of treatment tactics and preventive measures with an individual approach for each patient.

The improvement in newborn intensive care leads to increasing of survival rate in premature infants with very low and extremely low birth weight. Adaptive characteristics of premature infants together with high risk of severe somatic and neurological diseases requires special follow-up system establishment, that could function from the birth and through the first years of life. In this article there are modern opinions of Russian and foreign managements of early intervention practices for premature infants in neonatal intensive care units, hospital stage and at home after discharge. Now research of effectiveness of different stimulations in neonatal period to improve adaptation process and remote developmental outcomes in premature infants is going on. There is very important to give attention to psychological supervision of parents for creation of strong interactions in parent-baby couple.

Currently in the literature there are insufficient data on the use of efferent hemocorrection methods in neonatal practice. The basic principle of this method is the removal of plasma containing endotoxins and exotoxins and other pathological substances, replacing it with donor plasma, colloid and crystalloid solutions. The therapeutic effect of plasmapheresis includes detoxification, anti-inflammatory and immunomodulatory effects by removing toxins and removal of circulating immune complexes, inflammatory mediators, and activated structures of the complement system. Discrete plasmapheresis in neonatal practice may be used in any body mass of the patient. This article describes a clinical case of successful application of discrete plasmapheresis in full-term newborn baby is in critical condition. The severity was due to severe early neonatal sepsis, development of multiple organ failure and accompanying RH-conflict. After two sessions of plasmapheresis was observed a positive clinical effect in reducing intoxication, systemic inflammatory response syndrome. Reducing the level of bilirubin is allowed to avoid the operation replacement blood transfusion.

The etiological structure and clinical manifestations of neonatal infections in 194 newborns hospitalized in an infectious hospital were
studied. 44 children were born by cesarean section (CS), 150 children – by vaginal delivery (VD). Children born by cesarean section were significantly more often hospitalized for mixed infections of the respiratory, gastrointestinal tract and pyoinflammatory skin diseases (CS-20.5% and VD-3.3%, p<0.01). In children born by the operative route, infectious diarrhea (CS-66% and VD-39%, p<0.01), bronchiolitis (CS-20.8% and VD-6. 25%, р<0. 05), pyodermia caused by S. aureus (CS-23% and VD-15.9%, р<0.05), severe acute respiratory viral infections (CS-20.8% and VD-6.25%, р<0.05) were diagnosed more often than in children born by the vaginal delivery. The revealed features of the course of neonatal infections in children born by cesarean section dictate the need for in-depth studies on this topic.

Research objective. Evaluation of inflammatory activity of the blood of newborns with various forms of bacterial infectious diseases with the determination of the diagnostic significance of various inflammatory markers.

Materials and methods. The study includes 50 newborns with various forms of infectious diseases: 31 newborns with neonatal sepsis (group 1) and 19 newborns with localized variants of bacterial infection. The severity of inflammatory activity was assessed by the level of C-reactive protein, the number of peripheral blood leukocytes, the level of cytokines-tumor necrosis factor-α (TNF-α), interleukins IL-2, IL-6, IL-8, IL-10, interferon-ɣ (IFN-ɣ), granulocyte-macrophage colony-stimulating factor (GM-CSF).

Results. In the group of children with neonatal sepsis, the first 2 days of the disease occur against the background of an increase in the concentration of TNF-α, IL-6, IL-8 and IFN-ɣ in the blood, the indices of which differed significantly (p <0.05) from the control group. Significant markers of inflammation were high concentrations in the blood of the C-reactive protein (RR-3.7, CI 1.7-8.1), IL-6 (RR-2.0, CI 1.4–3.0), and IL -8 (RR-1.5, CI 1.1–2.2). In the group of children with localized forms of bacterial infection, the first 2 days of the disease were accompanied by an increase in the concentration in the blood of TNF-α, IL-6 and IFN-ɣ (p <0.05). Moreover, the degree of increase of IL-6 was less pronounced than in the 1st group (p=0.007), and the median IL-8 did not differ from the control group (p=0,7).

Conclusion. The immune response for neonatal sepsis and localized forms of bacterial infection is characterized by an increase in the level of proinflammatory cytokines in the blood. Reliable markers of inflammation in sepsis are IL-6, IL-8 and C-reactive protein, the values of which were significantly high in the group of children with neonatal sepsis.

Research objective: to assess the diagnostic significance of the pulse oximetry performed by the newborn for the 3rd hour of life to identify critical conditions and to justify the expediency of further introduction of this technology in the work of obstetric institutions.

Results. In 5 maternity hospitals of the Republic of Tatarstan, from April 2016 to February 2017, 8358 88.4% of newborns were pulsometrically screened. Positive results were obtained in 95 (1.14%) patients. Because of screening, 13 newborns were diagnosed with congenital heart defects, not diagnosed in utero, in the first hours of life, five of them were critical. All newborns with critical congenital heart defects were successfully operated. Besides, 20 patients had persistent pulmonary hypertension, 30 had intrauterine pneumonia.

Conclusions. The measurement of saturation at the 3rd hour of life of a newborn allows avoiding life-threatening complications in children with critical congenital heart defects and persistent pulmonary hypertension and in a stable state to transfer them to a 
further treatment stage.

The article reports clinical case of early neonatal manifestation of a rare genetic disease – mitochondrial DNA depletion syndrome, confirmed in laboratory in Russia. Mutations of FBXL4, which encodes an orphan mitochondrial F-box protein, involved in the maintenance of mitochondrial DNA (mtDNA), ultimately leading to disruption of mtDNA replication and decreased activity of mitochondrial respiratory chain complexes. It’s a reason of abnormalities in clinically affected tissues, most of all the muscular system and the brain. In our case hydronephrosis on the right, subependimal cysts of the brain, partial intestinal obstruction accompanied by polyhydramnios were diagnosed antenatal. Baby’s condition at birth was satisfactory and worsened dramatically towards the end of the first day of life. Clinical presentation includes sepsis-like symptom complex, neonatal depression, muscular hypotonia, persistent decompensated lactic acidosis, increase in the concentration of mitochondrial markers in blood plasma and urine, and changes in the basal ganglia of the brain. Imaging of the brain by magnetic resonance imaging (MRI) demonstrated global volume loss particularly the subcortical and periventricular white matter with significant abnormal signal in bilateral basal ganglia and brainstem with associated delayed myelination. Differential diagnosis was carried out with hereditary diseases that occur as a «sepsis-like» symptom complex, accompanied by lactic acidosis: a group of metabolic disorders of amino acids, organic acids, β-oxidation defects of fatty acids, respiratory mitochondrial chain disorders and glycogen storage disease. The diagnosis was confirmed after sequencing analysis of 62 mytochondrial genes by NGS (Next Generation Sequencing). Reported disease has an unfavorable prognosis, however, accurate diagnosis is very important for genetic counseling and helps prevent the re-birth of a sick child in the family.

The article describes the clinical case of Williams syndrome with the combined pathology of many systems and organs: mental retardation, congenital heart disease (supravalvular aortic stenosis), arterial hypertension, hypercalcemia, hypercalciuria complicated by nephrocalcinosis, gastrointestinal tract injury, facial and eye anomalies, hernia of anterior abdominal wall, kyphoscoliosis. Microsatellite analysis of the loci of the critical region of chromosome 7 revealed a deletion of the investigated loci (D7S1870, D7S613, D7S2476, D7SEln), which led to the diagnosis of Williams syndrome.

The article discusses modern information about phenylketonuria in children. Standard classification of hyperphenylalaninemia is given. The etiopathogenetic aspects of the disease are examined in detail, with an emphasis on the causes of severe brain damage in the absence of treatment. The features of the state of health of children with phenylketonuria on the background of diet therapy are reflected, as well as modern approaches to diagnosis and differential diagnosis, treatment of phenylketonuria and dispensary observation of patients.

The Family Hypercholesterolaemias (FH) are a group of genetic disorders which lead to substantial increase of level of a cholesterol in a blood and an increased risk of early development of atherosclerosis and, therefore, increased mortality from coronary heart disease. FH – one of the most common metabolic disorders that occurs at the person already since the birth. Early diagnostics as identification of FH at children’s age will allow to begin early treatment is of great importance and to prevent development of cardiovascular pathology in the future. Criteria of phenotypical and genetic diagnostics of FH are given in article. Despite rough interest in this disease around the world, in Russia it remains poorly studied, especially among the children’s population. There is no detection system, routing of inspection, observation and registration of sick children, the low level of genetic consultation becomes perceptible. It testifies to need of significant improvement of knowledge and a comprehension of this pathology both for society, and among health workers.

Objective: was to establish clinical and diagnostic value of cytochemical indices of peripheral blood leukocytes (cationic protein and myeloperoxidase), fibronectin blood plasma to assess the severity, predict the course and outcome of viral meningitis in children.

Subjects and methods. In 450 patients with viral meningitis (enterovirus, arbovirus, parotitic, herpesviral, adenovirus etiology) at the age of 14 years, the parameters of the microbicidal system of leukocytes (cation proteins, myeloperoxidase) and fibronectin blood plasma were determined. Etiological diagnosis of meningitis was confirmed by release of viral RNA from blood and cerebrospinal fluid by the polymerase chain reaction, enzyme-linked immunosorbent assay (ELISA).

The results and conclusion. Found that severe, prolonged duration, lethal outcome of viral meningitis in children are accompanied by sugnificant suppression of cationic proteins, myeloperoxidase, fibronectin blood plasma, maximally expressed in lethal outcomes, compared with the severe form, but with a favorable outcome and control. Settings imbalance cationic proteins, myeloperoxidase, fibronectin blood plasma are objective criteria of the adaptation syndrome that reflects the state of the phagocytosis system in viral meningitis in children and can be considered as additional criteria for predicting the course and outcome of disease.

The purpose of the study: estimate the frequency of registration of different types of acid-base state disorders in children with acute infectious diarrhea; to determine the clinical features of acute intestinal infections that occur with metabolic acidosis (MA) and without it to choose the tactics of effective correction.

Мaterials and methods: retrospective cohort study was conducted of 246 patients hospitalized in a hospital with clinic of acute infectious diarrhea.

Results of the study: laboratory-confirmed acidosis, were recorded in 40.7% (95% CI 34.6–46.8), 100/246 children, incl. With a pH below 7.25 in 9.3% (95% CI 5–7–12.9), 23/246. The condition of alkalosis revealed in 4.9% (95% CI 2.2–7.6) of 12/246 examined. Hyperchloremic acidosis had a place in 81% (95% CI 73.3–88.7), 81/100 patients, with a high anionic deficiency in 19% (95% CI 11.3–26.7), 19/100, P <0.001. Decompensated MA with pH <7.25 was recorded in 6.2% (95% CI 0.9–11.5), 5/81 examined with hyperchloremic acidosis and in 94.7% (95% CI 84.6–104, 8), 18/19 – with keto- and lactate-acidosis. Subcompensated MA was more often detected with rotavirus infection, RVI (50.6% (95% CI (39.4–61.8), 39/77), p <0.001. Metabolic disorders with RVI were more likely to correspond to acidosis with a high anion gap (52, 6% (95% CI 30.1–75.1) 10/19, p=0.02.) Bacterial diarrheas were more often observed in children without disturbances of the KHS (22.4% (95% CI 15.3–29, 5), 30/134), p=0.014. In assessing the characteristics of different types of MA we identified that the presence of tachypnea increases the probability of detecting acidosis with a high anion gap of 3.5 times (OR 3.5 CI 1.3–9.3).

Conclusion: Our studies didn’t reveal pathognomonic clinical symptoms of various variants of metabolic acidosis.

The variants of the course of chronic herpesvirus infection in children with the involvement of several mesenteric lymph nodes in the process and the formation of inflammatory conglomerates – mesenterite (mesadenite) are considered. Possible etiological factors of mesenteritis, morphological changes in affected lymph nodes: nonspecific hyperplasia, in some cases – necrosis and suppuration, are given. Clinical cases of mesenteritis against chronic herpesvirus infections in preschool children are described with a detailed description of clinical manifestations in the form of prolonged fever, chronic intoxication, attacks of abdominal pain accompanied by an unstable stool. Dynamics of the main laboratory markers of herpesvirus activity is given, changes in the indices of instrumental methods of investigation are tracked. Possible pathogenetic mechanisms of the formation of such manifestations of the disease, the role of the systemic inflammatory response and therapeutic approaches with the use of antiviral drugs and glucocorticosteroids are discussed.

Objective research: compare the efficacy of different types of therapy for rotavirus gastroenteritis in children.

Materials and methods. A study was carried out, the design of which corresponded to the case–control type. The main group is children hospitalized in a hospital with laboratory confirmed rotavirus infection (35 cases), who were prescribed a modern regimen of therapy that included a low-carbohydrate diet, rehydration with low osmolar oral solutions, dioctahedral smectite, probiotic containing Saccharomyces boulardii. For each child of the main group was selected another patient (control), the corresponding sex, age, the period from the onset of the disease to admission to hospital, and the degree of dehydration. Patients of the control group (n=35) were assigned a traditional «old» therapy regimen, including a diet corresponding to Table No. 4 in Pevznur, oral rehydration solutions with osmolality of 282 mOsm/l, anthibacterial therapy (ceftriaxone), dioctahedral smectite and pancreatin at age-dependent doses. The duration of the observation was 5 days.

Results: By the 5th day of treatment, the normalization of the stool was recorded in 91.4% [95% CI 82.1–100.7], 32/35 in the main group and 71.4% [95% CI 56.5–86.3], 25/35 children in the control (p <0.05, OR 4.27 [95% CI 1.06–17.2]). The timing of relief of excess meteorism also had statistically significant differences and was shorter in patients receiving a «new» therapy regimen (OR 2.8 [95% CI 1.01–8])). The positive effect of the proposed scheme was also observed when assessing the duration of dehydration symptoms and the timing of hospitalization.

Conclusions: The conducted study case–control showed the advantage of modern schemes of therapy of rotavirus infections in children.

Pediatric oncology is a complex specialty, requiring the involvement of various specialists – pediatric oncologists, pathomorphologists, radiation diagnosticians, surgeons. The patient’s life depends, first of all, on the timeliness of the diagnosis, since the earlier the specialized treatment is started, the higher the probability of achieving remission. In this connection, the problem of early detection of malignant neoplasms is particularly relevant. The complexity of solving this problem is related to the atypical nature of the oncological diseases and their rarity, which leads to the lack of «oncological alertness» of primary health care physicians – district pediatricians. Early diagnosis of malignant neoplasms depends particularly on pediatricians. This lecture is devoted to the clinical manifestations and diagnosis of malignant neoplasms in children: hemoblastosis and solid tumors.

Among the products of functional nutrition, special attention is paid to probiotic cultured milk foods. When selecting these products, it is necessary to focus on the characteristics of the probiotic strains that make up their composition: microorganisms must be live, safe to use, viable and stable when stored, and also capable of surviving in the human gastrointestinal tract. The use of probiotic cultured milk foods should have a positive effect on human health: to have a proven anti-infective effect, to have immune modulating properties, to promote the normalization of gastrointestinal motility. The above provisions must be confirmed by controlled studies.

Research objective: to study the features of the cytokine profile and cytological status in children with community-acquired pneumonia, proceeding against a background of reduced resistance of the organism for improving treatment methods. 53 children aged 3 to 7 years were examined. The main group consisted of 30 children with community-acquired pneumonia, which ran against a background of reduced resistance of the body. The comparison group consisted of 23 children with community-acquired pneumonia who had good resistance. Local immunity was studied on the basis of  valuation of cytokine status parameters (tumor necrotic factor-α, interleukin-8, and interferon-γ) and cellular composition with an estimate of destructive changes in neutrophils in induced sputum. It was revealed that in the main group of children there is a depression of the neutrophils’ release into the bronchial secretion and a marked increase in the number of neutrophils with maximum signs of destruction of the nucleus and cytoplasm against the background of cytokine status imbalance, manifested in an increase in the content of the tumor necrotic factor-α and a decrease in interleukin-8 and interferon- γ. Inclusion in the traditional therapy of community-acquired pneumonia in children who have a reduced resistance, anti-inflammatory drug fenspiride, eliminates the imbalance of proinflammatory cytokines and increases the release of functionally complete neutrophils in the bronchial secret.

A complicated course of pneumonia with improperly selected initial antibiotic therapy occurs with unsuccessful constancy. According to World Health Organization, pneumonia is cause of death of 15% children under the age of 5 years around the world. In recent years, deaths have also increased in developed countries with a high level of medicine. Errors in antibiotic therapy of pneumonia in the outpatient treatment stage are still a serious problem. We present a clinical observation of complicated community-acquired pneumonia caused by multidrug-resistant Streptococcus pneumoniae. Clinical features of the course are marked, errors in initial treatment are analyzed.

Chronic kidney disease (CKD) in children is 1/3 of the nephrologic pathology, with the level of its morbidity increasing. CKD is an important factor affecting the development of cardiovascular events. Research objective was to study the structural and morphological parameters of the cardiac muscle in chronic kidney disease in children and adolescents, depending on the stage of CKD, according to the echocardiographic study. 83 patients with different stages of CKD were examined. There were statistically significant differences in the majority of echocardiography indicators depending on the stage of CKD. The study of structural and morphological parameters of the heart with the help of echocardiography makes it possible to detect changes in the cardiac muscle in patients already at the first stage of CKD. A significant increase in the volume of the heart cavities, the thickness of the walls and left ventricular myocardial mass in patients was detected in the terminal stage of CKD.

In order to analyze the prognostic significance of the clinical and immunologic indices of central nervous system (CNS) lesions of the perinatal period, 135 children with an early residual stage of infantile cerebral paralysis (cerebral paralysis) were examined. A statistically significant increase in functional phagocytic activity, tumor necrosis factor-α (TNF-α) level in blood serum and oral fluid (p≤0.01 and p<0.05, respectively) in children with periventricular leukomalacia in spastic forms of infantile cerebral paralysis. Neuroimmunological parameters of blood serum and oral fluid can be used as criteria for diagnosing the severity of structural and morphological changes in the central nervous system and predicting cerebral disorders in children with an outcome in infantile cerebral paralysis.

Acute respiratory diseases occupy one of the main places in the structure of morbidity, including among adolescents. The incidence
of respiratory infections can be seen as an indicator of the adaptation of the organism to the environment, since resistance is one of the leading mechanisms of adaptation. The aim of the study is to study the psychological problems of adolescents with recurrent respiratory infections. The psychoemotional status of adolescents was assessed using the “Clinical questionnaire for identifying and assessing neurotic conditions”, Eysenck Personality Questionnaire, a reduced multiphasic personality inventory (SMOL test). Based on a comparative analysis with the data of conditionally healthy adolescents, it was found that for patients with recurrent respiratory infections a significantly higher level of neurotization, neuroticism, and human personality are characteristic, which obviously predispose them to repeated respiratory infections.

The article is devoted to the study of the exchange of the most important bioelements for the restoration of the physical working capacity of young athletes – calcium (Ca), magnesium (Mg), potassium (K), iron (Fe), chromium (Cr), zinc (Zn). Native and foreign studies on the diagnosis and correction of diselementosis in children and adolescents involved in sports are presented. The peculiarities of the metabolism of an organism of a child experiencing extreme physical and psychoemotional loads are discussed. And also data on how the interaction of macro – and microelements is realized among themselves, and how this interaction is reflected in training and competitive activities. The violation of the exchange of minerals is one of the factors that can lead to a wide range of disorders in the condition of young athletes.

This article presents the first results of the Federal pilot project «Identification of patients and improvement of diagnostics of juvenile idiopathic arthritis», involving pediatricians clinics Kazan. It is shown that this problem is relevant, socially significant and requires further study. Early treatment of patients with juvenile idiopathic arthritis will not only prevent disablement, but also to achieve stable remission of the disease, and early treatment of juvenile idiopathic arthritis (less than 12 months from the date of the onset of the disease) is a proven favorable prognostic factor in reducing disease activity and remission. Given results draws attention to the need for continuity of medical support doctors of various specialties of the specified number of patients.

The most important condition for the correct formation of the musculoskeletal system in children is physical activity. Data on the analysis of the structure of disorders of the musculoskeletal system in children and adolescents of school age, as well as studies of the pathology of the bone system and the state of bone mineral density in adolescents aged 13-18 with different physical activity are presented. Determination of bone mineral density was performed using the dual-energy X-ray absorptiometry (DEXA) method. Analysis of outpatient medical records of the Center for Outpatient Traumatology and Orthopedics of the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan for three years demonstrates an increase in the number of patients, both with trauma and with orthopedic pathology. In the structure of referrals, the proportion of patients with bone fractures was 51.1%. Low bone mineral density in relation to age, much more often (47.06%) were found in the group of adolescents who do not engage in sports than athletes (16%).

Syndrome Sapho is a combination of hyperostosis of the sternoclavicular joint with pustulosis of the palms and/or plants, pustular/vulgar psoriasis, or deep acne, which also celebrates spinal cord injury, osteitis and arthritis, including sacroiliitis. As trigger factors, the role of infections, such as Staphylococcus epidermidis, streptococci and viruses, is considered. They are associated with autoimmune post- or parainfectious pathogenesis of the SAPHO syndrome. As with the other seronegative spondyloarthritis important for the pathogenesis of SAPHO syndrome is a factor in hypothermia. Presents a clinical case of the syndrome of Sappho from the group of seronegative spondyloarthritis. Features of the course, the complexity of diagnosis in a particular patient and the possibility of targeted therapy with genetically engineered drugs, are shown.

Dysbacteriosis of the intestine in our country is a common clinical and laboratory phenomenon. Discussion remains about the ways of correcting dysbiotic disorders, especially against the background of antibiotic therapy. Polycomponent probiotics containing enterococci have gained wide popularity, however, the evidence base for their effectiveness and safety is contradictory. We have presented a clinical observation of the case of enterogenic bacteremia caused by Enterococcus faecium in a newborn with congenital surgical pathology of the abdominal cavity with a probiotic. Risk factors for bacteraemia were the inconsistency of the intestinal barrier and transient immunodeficiency.

The article discusses the issues of etiology, pathogenesis, diagnosis and therapy of exudative enteropathy in children, and provides his own clinical observations. Exudative enteropathy is characterized by excessive loss of proteins through the gastrointestinal tract and is a rare complication of various gastrointestinal diseases. Clinical symptomatology is diverse depending on the leading cause of the pathology, but is mainly manifested by edema due to hypoproteinemia. In the presence of exudative enteropathy, it is necessary to exclude such causes of hypoproteinemia as malnutrition, a violation of synthesis or loss of protein due to diseases of other organs – kidney, liver or skin. The definition of the cause of exudative enteropathy is the key to its treatment. Therapy of exudative enteropathy involves maintaining the nutritional status of the patient with a diet high in protein and treating the underlying disease. With enteropathy associated with lymphangiectasia, a low-fat diet containing medium chain triglycerides is recommended.