The paper touches upon the urgent problems of modern pediatric gastroenterology. It considers the origins of pediatric gastroenterology as one of the relevant areas in pediatrics. The development of this area is favored by laboratory, morphological, and instrumental studies. Their use in children, including young ones, has improved the early diagnosis of diseases of the esophagus, stomach, duodenum, intestine, pancreas, and hepatobiliary system. The treatment of childhood digestive diseases has improved substantially.

The paper gives an update on the problem of studying the gut microbiota and a classification of the representatives of the intestinal microflora and describes its positive and negative functions. The authors depict indications for the use of drugs, such as probiotics, to treat different childhood diseases from the clinical standpoint of evidence-based medicine in the age aspect. Particular attention is given to the side effects of probiotics and to contraindications to their use in children.

This article considers the psychophysiological and neuroendocrine differences characteristic of premature children, which are as a result of long-term perinatal consequences. Particular emphasis is laid on the effects of the hypothalamic-pituitary-adrenocortical stress system, the performance of which is reprogramed during complicated pregnancy, labor, and postnatal period under pain stress due to medical manipulations. Being extremely sensitive to all these exposures, the brain of a premature infant develops during activation of the stress system and takes on a few distinctive properties in addition to independent neuroanatomical distinctions due to premature birth. The altered neurohormonal patterns revealed in very prematurely born children and adolescents involve the regulation of mental processes, behavior, metabolism, and circadian rhythms (sleep-wake regulation), which differ from those in their maturely born peers. These cases allow learning and behavior problems and lower cognitive estimates to be considered in normally developing children born extremely prematurely who have also hormonal dysregulation.

The health status was analyzed in extremely preterm infants at a postconceptual age of 38–40 weeks and in the first year of life. All the infants in the analyzed group were shown to have respiratory disorders, severe perinatal CNS lesions, and the high incidence of bronchopulmonary dysplasia and infectious and inflammatory diseases. In the first year of life, these children belonged to a group of the frequently ill. Dysfunction of the digestive system and intestinal microflora and residual signs of rickets were detected in the majority of the patients; the manifestations of bronchopulmonary dysplasia persisted in 50%. 40% of the infants had disabling complications.

The efficiency of a fluorometric method for measuring the total and effective concentrations albumin and toxicity index in capillary blood was investigated in 60 neonates having a birth weight of 864 to 4020 g and bacterial pneumonia to evaluate the severity of endogenous toxicosis and to monitor detoxification therapy. The method can rapidly, objectively, and exactly estimate the adequately enhanced albumin functional activity that corresponds to an increase in total and effective blood albumin concentrations and a decrease in toxicity index by 20% or more. To alleviate the symptoms of pneumonia and infectious toxicity and to normalize both absolute albumin values and toxicity index are a ground to discontinue detoxification therapy. The method can substantially improve the objective monitoring of the efficiency of therapy for infectious toxicosis that complicates the course of bacterial pneumonia in newborns and ensure their adequate treatment.

The paper presents data on the characteristics of red blood cell morphology in infants who have undergone intrauterine intravascular blood transfusion for hemolytic disease of the fetus. The infants are shown to have a reduction in the mean volume of red blood cells and in their mean level of hemoglobin, a decrease in the fraction of fetal hemoglobin and an increase in oxygen tension at half saturation. The above morphological characteristics of red blood cells remain decreased during the neonatal period after exchange transfusion or others, as clinically indicated, which seems to suggest that the compensatory-adaptive mechanisms to regulate hematopoiesis are exhausted and a donor’s red blood cells continue to be predominant.

The time course of changes in the serum levels of matrix metalloproteinases (MMP-8, MMP-9) was studied in neonatal infants after perinatal exposure to herpes simplex virus in the early neonatal period to elaborate criteria for the early preclinical diagnosis of its infection and to define the severity of the pathological process. Fifty-seven infants born to mothers with chronic herpes virus infection were examined. MMP-8 and MMP-9 were determined by a solid-phase enzyme immunoassay using specific reagents (R&D Diagnostics Inc., USA). Different changes were found in MMP-8 and MMP-9 levels in relation to the onset of clinical symptoms of congenital herpes virus infection. The elevated plasma metalloproteinase levels in the first 24 hours after birth in newborn infants at risk for herpes virus infection may be regarded as preclinical markers for the manifestations of congenital infection. The magnitude of changes in serum metalloproteinase levels correlates with the severity of the disease.

Objective: to establish the clinical and functional characteristics of extremely premature newborn infants with patent ductus arteriosus and prognostic criteria for its function after 72 hours of postnatal life to determine a differentiated treatment policy for this category of patients. Sixty-nine extremely premature neonates with very low (n=37) and extremely low (n=32) birth weight and patent ductus arteriosus were followed up. Physical, neurological, laboratory, and instrumental examinations were performed. It was established that hemodynamically significant patent ductus arteriosus was detectable in 79.7% of the cases on day 3 of life, in 50.9% on day 5, and in 15.9% at the end of the neonatal period. Specific features were found in these patients compared to patients with hemodynamic insignificant patent ductus arteriosus. They showed a lower gestational age, lower Apgar scores, neurological disorders, moist rale, and crepitation, an increased lung pattern due to interstitial and vascular components, as well as a propensity to have thrombocytopenia, the significantly higher mean values of the diastolic and systolic diameters of the left ventricle, left atrium, right ventricle, and aortic root. A procedure was developed to predict a poor trend in patent ductus arteriosus. Conclusion. Taking into account the clinical and functional characteristics of extremely premature neonatal infants permits the longterm persistence of patent ductus arteriosus to be predicted in them, which is of importance in defining a therapeutic policy.

The paper gives the data available in the literature, which reflect the manifestations, diagnosis, and treatments of the rare inherited disease Allgrove syndrome in children. Emphasis is placed on major difficulties in the differential and true diagnosis of this severe disease. The authors describe their clinical cases. Particular emphasis is laid on the clinical symptoms of the disease and on its diagnostic methods, among which the DNA diagnosis is of most importance. The probands were found to have mutations in the AAAS gene: in one case there was a mutation (c.856 C> T, p.Arg286Term) in homozygous state, which is described in the International Human Mutation Database (CM 10151); in other case there was a change in nucleotide sequence (c.709 delC), which is undescribed in the mutation and polymorphism databases and which leads to premature termination of the protein. It is shown that awareness of Allgrove syndrome among clinicians is low and the interdisciplinary approach is of importance.

The given clinical case report of a child with Barth syndrome demonstrates the severe heart injury – a concurrence of dilated cardiomyopathy, myocardial non-compaction, and signs of endocardial fibroelastosis. The disease was manifested in the first days of life; however, it was long masked by congenital myocarditis. No cardiac arrhythmias, myocardial electrical instability, or long Q–T syndrome were detected in this case. The disease was unstable with frequent episodes of decompensation in the presence of intercurrent diseases. The paper gives a modern view on the problem of cardiac injury in Barth syndrome and discusses current treatment approaches, prognosis, indications for heart transplantation, and possibilities of metabolic therapy.

Children and teenagers are a group in which congenital heart disease (CHD) is most commonly considered as a contraindication to sports activities. In this connection, 440 athletes aged 15.6±1.8 years, who had been going for sports for 6.4±2.5 years and who had undergone echocardiography, were examined. The rate of congenital heart disease according to the preliminary diagnoses was 77 (17.5%), that after echocardiographic verification was 238 (54.1%) (p<0.0000). Training volume and intensity limitations were recommended in 114 (47.9%) athletes because of cardiac morphological and functional changes. These changes contradicting sports activities were not found in 124 (52.1%) athletes. Conclusions. 1. EchoCG screening for congenital heart disease is required to define contraindications to sports activities, for it is impossible to establish its diagnosis only on the basis of clinical examination and ECG. 2. The mere fact of CHD is not a contraindication to athletic activities; is necessary to evaluate hemodynamic disorders associated with this pathology. 3. Abnormally located chordae and trabeculae are neither followed by any complications and nor a contradiction to sports activities.

The paper discusses prospects for developing a rehabilitation medical care system for premature infants in the Russian Federation. It shows approaches to setting up treatment and diagnostic departments to further follow up preterm infants. A physician’s qualification characteristics at the department are formulated; the principles in the evaluation of premature infants’ development are shown. The results of the activities of the Center for Correction of Preterm Infant Development are given.

The paper gives the results of a study project at the Infant Neurology Department, which has shown the urgency of nutritional rehabilitation in children aged 3 months to 5 years with infantile cerebral paralysis. Thirty patients were followed up to study the causes of malnutrition, to assess and correct their nutritional status, and to show the efficiency of the measures implemented. A diet corrected by a nutritionist was combined with nonsurgical interventions, such as positioning, a decision on the transition to nasogastric tube feeding, and maternal work. The complementary foods were FrutoNyanya products as the latter are low-immunogenic, cause no allergic reactions, and may be used both in the feeding of high-risk group children and as ingredients of a therapeutic diet for patients with different diseases. This resulted in 305-g weight gain within 7-10 day of hospital stay in those whose underweight averaged 28%. The emotional status of the patients and their caregivers was improved by 2-3 scores on 5-point rating scale. There were improvements in their emotional tone (in 75%), chewing (in 28%), and swallowing (in 35%) and reductions in reflux episodes (in 19%) and stress in the caregivers (in 86%).

Objective: to update the diagnosis and treatment of acute stenosing laryngotracheitis (croup) in children. The paper presents data on the comparative therapeutic efficiency and safety of nebulized budesonide for the relief of croup symptoms in children.

Acute respiratory infections remain one of the most common diseases in children. In spite of a huge range of medications available to treat and prevent acute respiratory diseases, investigations, the objective of which is to enhance therapeutic efficiency in children with acute respiratory diseases, are being continued. Objective: to enhance the clinical efficiency of treatment using the warming gel “Dyshi” in children with acute rhinosinusitis. A total of 60 children aged 3 to 7 years with mild acute rhinosinusitis were followed up. The children were divided into 2 groups of 30 in each. Group 1 received the warming gel “Dyshi” for children in addition to standard combination therapy; Group 2 had standard combination therapy alone. The clinical efficiency was evaluated based on the changes in rating scores of the severity of the major symptoms of the disease. The application of the warming gel “Dyshi” for children as part of combination therapy enhances the clinical efficiency of therapy for mild acute rhinosinusitis can more promptly ease the major symptoms of the disease, shorten the duration of therapy, and reduce the number of used decongestants and the risk of complications. There was no case of intolerance or allergy due to the application of the gel “Dyshi”. The latter alleviates nasal breathing and causes reductions in nasal swelling and the magnitude of cough, which may be recommended for use in the combination therapy of rhinosinusitis in children.

The paper presents the results of comprehensive examination and treatment in 514 children who have developed a persistent cough lasting for more than 3 weeks after acute respiratory disease. The cause of persistent coughing was a concurrence of infectious and somatic diseases in the majority of cases (62.8%). Among the somatic diseases, there were most common allergic diseases of respiratory organs (32.4%) and ENT diseases (27.4%). 311 (60.5%) children were found to have markers for Mycoplasma (43.9%), herpesvirus (42.2%), Pneumocystis (21.4%), and Chlamydia (6.25%) infections as mono- or mixed infections. Combination therapy with Cycloferon had a positive clinical effect. Based on the findings, the authors elaborated a diagnostic algorithm and proposed a treatment policy in children with a persistent cough after acute respiratory infection.

The paper contains a review of available literature on neonatal feeding devices. It considers in detail the design and composition of materials to manufacture feeding bottles, pacifiers, and nipples.