The microbiota plays a key role in the physiology and maintenance of homeostasis in the child’s body. It is important to know the processes of formation of the intestinal microbiota that begin in utero. The baby continues to receive the mother’s microflora during childbirth and breastfeeding. The results of molecular genetic studies indicate that the most intensive process of microbial colonization of a child is associated with dietary habits. The main factor in maintaining the stability and resistance of normobiota is microbial autometabolites. The most promising areas of probiotic biotechnology and the development of metabolic probiotics (metabiotics), probiotics in combination with prebiotics (synbiotics) are considered. Understanding the processes of formation of intestinal microflora allows developing effective methods for the prevention and correction of microecological and motor disorders of the gastrointestinal tract in the age aspect.

Proper treatment of neonatal seizures is crucial for reducing long-term neurological disorders. None of the currently used drugs to treat neonatal seizures has sufficient evidentiary base to make an unambiguous conclusion about its effectiveness. There are no results of large-scale studies that allow choosing an anticonvulsant drug for starting therapy and an alternative to it, in case the drug of choice is ineffective. The review summarizes the data on the effectiveness of anticonvulsants of different pharmacologic classes and considers their benefits, drawbacks, and possible mechanisms of variability in effectiveness when used in newborns. The review also analyzes approaches to the duration of the anticonvulsant therapy and discusses the problems and prospects of clinical trials for increasing the effectiveness and safety of anticonvulsant therapy in newborns.

Even though enterostomy in neonates is widely used in the treatment of congenital and acquired pathology, there is still no generally accepted tactics for stoma formation, prevention of associated complications, and the timing and method of stoma closure. Existing publications are few, prospective multicenter studies, systematic reviews, and meta-analyses are practically absent in Russia. The purpose of this review is to search for relevant publications on surgical treatment and complications in neonates with small-bowel stomas over the last 20 years. Study articles were identified through a search of the Scopus, Web of Science, MedLine, The Cochrane Library, Elibrary, and CyberLeninka electronic databases.

The article presents data on the current strategy for the treatment of myocarditis in children. The authors discuss the tactics of treatment of patients with unstable hemodynamics requiring emergency medical care using inotropic support. The possibilities of surgical methods of treatment of decompensated heart failure in myocarditis (artificial left ventricle, extracorporeal membrane oxygenation, heart transplantation) are clarified. Current approaches to the treatment of myocarditis with stable hemodynamics are described. Data on the effectiveness of angiotensin enzyme inhibitors and beta-blockers for the treatment of myocarditis in children are presented. Indications for immunosuppressive and immunomodulatory therapy are discussed

Changes in the traditional way of life, conditioned by socio-economic processes, affect persistent nutritional stereotypes among other aspects. This fully applies to flexitarianism. The term «Flexitarianism» was added to the Oxford English Dictionary in 2014 and denotes a direction in dietetics as flexible vegetarianism, i.e., rare consumption of meat or fish against the background of a plantbased diet. Many do not realize that they are currently following the Flexitarian diet. Its origins are known even in traditional dietetics where the protein component is limited mainly in respect to animal proteins for gout and chronic kidney disease. The article reflects the positive impact of the Flexitarian diet on gut health and microflora. The formation of intestinal microflora under the influence of plant and fermented milk products is optimal. A possible alternative to red meat can be fermented dairy products rich in minerals, essential amino acids, and essential nutrients due to lactic acid fermentation and the production of essential food components by the intestinal microflora

Purpose. The study aims at assessing and analyzing the prevalence of congenital malformations in the Republic of Sakha (Yakutia) based on the data from birth defects surveillance from 2012 to 2019.

Material and methods. The data of congenital malformations monitoring in the Republic of Sakha (Yakutia) for 2012–2019 are analyzed. There were revealed 1104 cases of congenital malformations of obligate registration. The total number of births was 122,413. The prevalence of birth defects was calculated per 10000 births.

Results. The prevalence of congenital malformations in the Republic of Sakha was obtained. The analysis of the dynamics of the congenital malformations prevalence has been carried out. No changes in the birth defects prevalence for the analyzed period have been shown.

Conclusion. Regional monitoring makes it possible to obtain and analyze congenital malformations prevalence.

The article presents the result of identification of congenital malformations in fetuses in the Republic of Mordovia for 2015–2019. A retrospective analysis of their structure, prevalence, and timing of detection using prenatal diagnostic methods was performed. According to the authors, the prevalence of defects in the region is 35.5 to 49 per 1000 newborns, which is comparable to global data. Ultrasound continues to be the basic diagnostic method.

Achievements of perinatal medicine and a higher survival rate of children born with extremely low weight require an improvement in the dynamic observation of this category of children at an early age.

Purpose. This study aimed at studying the health status of young children with disabilities caused by diseases of the nervous system, born weighing less than 1500 grams, with an analysis of morbidity, physical development, emotional status, and autonomic regulation.

Results and conclusion. A clinical and functional study of 74 children born with a body weight of less than 1500 grams made enabled the authors to identify the peculiarities of their health and physical development in the first year of life, to identify risk factors, and to develop a method for predicting the formation of cerebral palsy by one year of life in these children. Consequently, pediatricians and neurologists will be able to timely carry out preventive measures for children from a high-risk group.

Purpose. To increase the effectiveness of diagnostic predictors for the development of sudden infant death based on the study of the role of infectious agents.

Materials and methods. A retrospective analysis of 120 cases of development of children, suddenly deceased, medical charts of pregnant women, histories of childbirth of mothers was carried out, and the morphological features of the suddenly deceased children were studied. The frequency of distribution and types of viruses detected using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction test (PCR) in the examined children who died suddenly in their first year of life were analyzed. Statistical analysis of the research results was made in the MedStat software.

Results. The frequency of detection of various infectious agents among the deceased from sudden infant death is (64.4 ± 4.2) %. Morphohistological study indicated characteristic signs of catarrhal tracheobronchitis (83.0 ± 5.5) %, focal intraepithelial inflammation of the larynx and trachea (48.9 ± 7.3) %, desquamative catarrhal pneumonia (31.9 ± 6.8) %, as well as acute focal bronchitis (27.7 ± 6.5) %.

Conclusion. The performed study confirms that in the genesis of sudden infant death, along with a role of social and economic, medical and biological factors, there is an obvious negative effect of infectious agents, with the infectious activator working as the trigger and provoking sudden infant death.

The article discusses the interdisciplinary interaction of pediatricians, surgeons, orthodontists, anesthesiologists, and otorhinolaryngologists in the complex rehabilitation of newborns with bilateral cleft lip and palate. Purpose. The aim of the study was to increase the effectiveness of treatment of newborns with bilateral cleft lip and palate due to preliminary orthodontic treatment. Characteristics of children and research methods. A comprehensive diagnosis and treatment of 32 patients with a diagnosis of complete bilateral cleft lip and palate were carried out. The patients were divided into two subgroups. In the first subgroup (n=16), newborns were fed using an anatomical nipple; in the second subgroup (n=16), newborns underwent presurgical orthodontic treatment using individual obturators. Results. Early presurgical orthodontic intervention with the use of individual obturators allows normalizing the process of breastfeeding in newborns. It is proved that the interdisciplinary interaction of doctors of related specialties allows for a comprehensive diagnosis, counseling and subsequent surgical treatment of newborns with bilateral cleft lip and palate. Conclusion. The proposed approach can be useful for doctors of all pediatric profiles. The development of an integrated approach in the newborn period allows specialists to implement a competent step-by-step treatment of patients from birth to 18 years old.

Antibiotic-associated diarrhea (AAD) is a key aspect of pediatrics concerning antibiotic therapy Purpose. The article aims at investigating the effects of colloidal silicon dioxide in the treatment of antibiotic-associated diarrhea in children. Materials and methods. Using parametric and nonparametric methods of analysis, 83 patients were examined (treatment group — 41 children who used colloidal silicon dioxide and the control group — 42 children) of both sexes (mean age (13.7 ± 2.6) years) with pathology of the lower respiratory tract (acute bronchitis or community-acquired pneumonia), who developed AAD against the background of ABT. Results. When using colloidal silicon dioxide in 75.6% of children, diarrhea decreased by the 2nd day and stopped by the 4th day (median — 0 points). Against the background of taking the drug throughout the treatment, there was a marked 3-fold decrease in all AAD values. The assessment of the efficacy and safety of the drug according to the data of medical researchers was 3.4 points. Analysis of subjective data on the tolerability of the drug showed «excellent» and «good». Against the background of the full course of treatment with colloidal silicon dioxide, a 2 times more pronounced decrease in the characteristics of AAD was noted. Conclusion. The presented data are intended to focus the attention of pediatricians on the rational use of ABT, timely diagnosis of an unwanted drug reaction in the form of AAD and its correction. The studied drug showed high efficacy and safety, which makes it possible to recommend it as a symptomatic treatment of diarrhea that developed against the background of ABT treatment in the complex therapy of diseases of the lower respiratory tract in children.

The state of renal function in children with type 1 diabetes mellitus and small, up to 5 years old, disease experience was studied. The aim of the study was to determine the indicators of the initial stages of the formation of diabetic nephropathy and chronic kidney disease. A prospective cohort study of a group of 46 prepubertal patients with type 1 diabetes mellitus and less than 5 years of illness was carried out. Diabetic nephropathy at the stage of microalbuminuria was detected already in 8% of children. Signs of the first, preclinical stage of chronic kidney disease, manifested by hyperfiltration, were found in 20% of patients, impaired tubular functions — in 28%. A moderate decrease in glomerular filtration rate corresponding to stage 2 of chronic kidney disease was observed in 4% of children with diabetes. An increase in the concentration of endothelial growth factor in the blood serum and the morning portion of urine, as well as monocyte chemoattractant protein-1 in the blood serum are sensitive highly specific markers of the formation of chronic kidney disease in patients of prepubertal age with a history of diabetes mellitus of less than 5 years. The relationship between the characteristics of the course of diabetes mellitus with endothelial growth factor and monocyte chemoattractant protein-1 was not revealed, which reflects the independent mechanism of the influence of neoangiogenesis and the reaction of non-infectious inflammation on the formation of diabetic nephropathy and chronic kidney disease. The relationship between vascular endothelial growth factor and monocyte chemoattractant protein-1 with the formation of early signs of chronic kidney disease and diabetic nephropathy has been revealed. The results obtained can be used for early diagnosis of diabetic nephropathy and the formation of a risk group for kidney damage in children with diabetes mellitus.

In Russia, about 140–160 thousand children are hospitalized annually with a diagnosis of childhood traumatism. Half of the surviving children with severe traumatic brain injury become disabled. Purpose. To perform a comparative analysis of clinical and anamnestic data and neurological disorders in children with traumatic brain injury (TBI). Characteristics of children and research methods. The study involved 81 children with TBI of varying severity. Statistical processing of data was carried out using Student’s test and Fisher’s exact method. Results. The study showed that the duration of the period from the moment of TBI to the hospitalization of children due to post-traumatic complications decreases linearly with increasing age at the time of traumatic brain injury. Mild traumatic brain injury was diagnosed in 47 (58.02%) children, moderate-to-severe — in 16 (19.75%) children, severe traumatic brain injury — in 18 (22.22%) children. The EEG study showed the presence of epileptiform and paroxysmal activity in children not only with moderate and severe, but also mild traumatic brain injury. Post-traumatic epilepsy was diagnosed in 28 (46.67%) children, the risk group for developing post-traumatic epilepsy was 19 (31.67%) children. MRI examination of the brain revealed organic changes in 62.07% of children. Conclusion. A special feature in children is the presence of post-traumatic consequences even after a mild traumatic brain injury. The duration of the period before hospitalization due to post-traumatic consequences in children decreases with increasing age at the time of traumatic brain injury. Focal symptoms in children with severe traumatic brain injury were detected significantly more often than in children with mild and moderate traumatic brain injury.

Principles of nutrition for disabled children are very important. Russia’s specialized institutions and boarding schools for children with disabilities were monitored and proved to have no specific diet adapted for children with special needs (mental delay, emotional-volitional defects — autistic disorders). According to the World Health Organization (WHO), unbalanced diets along with lifestyle habits are the main risk factors for chronic diseases which can develop and accelerate disorders in intellectual and cognitive abilities. The study analyzed reference data in order to identify and summarize patterns in diets designed for children with special medical care needs. The review assessed works of foreign and domestic authors, as well as data obtained with SRC ‘Arktika,’ on nutrition status of children with disabilities under the north conditions. By meta-analysis, the authors made recommendations for optimizing the diet for children with disabilities.

Intellectual disability is a widespread group of diseases with population frequency 1–3%. More than half of intellectual disability cases are due to various genetic causes, including monogenic ones. The paper describes three clinical cases of MED13L-associated intellectual disability with an autosomal dominant inheritance. Novel probably pathogenic variants p.Cys118delinsTrpSer and p.Gln2111fs, as well as the previously described p.Pro866Leu mutation in the MED13L gene (NM_015335), were detected in patients by massive parallel sequencing. А rare familial case with two affected maternal half-siblings was of particular interest since the mutation detected in both children was not found in the mother (blood cells and buccal epithelium were investigated). We assume the presence of gonadal mosaicism in the mother, which allows to recommend families with confirmed cases of MED13L-associated intellectual disability to plan pregnancies with prenatal or preimplantational diagnostics. The disease has been shown to have a wide clinical variability, even intrafamilial.

Mitochondrial insufficiency does not always have vivid polysystemic manifestations that clinically reflect the dysfunction of these organelles. Diagnosis can be difficult both from a clinical and laboratory point of view. In this case, the authors describe a family with erased or not obvious corresponding clinical manifestations in 3 generations. Complete genomic assessment of mitochondrial DNA give enabled the authorsto identify inherited pathological changes. These findings are very important for understanding the molecular processes of mitochondrial disease development and the further development of specific therapy.

Sick sinus syndrome is characterized by a gradually progressive deficit in the function of the sinus node and may not manifest itself clinically for a long time. During anesthesia and/or surgery, it may first appear in the form of severe, atropine-refractory bradycardia or sudden asystole. The presented clinical case describes the intraoperative manifestation of sick sinus syndrome in an eightmonth-old boy. The analysis of published data on the management of surgical patients with sinus node dysfunction was carried out.

The authors observed Kazabach–Merritt syndrome in an infant with an intrathoracic localization of the tumor without vascular manifestations on the skin. The disease was detected by signs of hemopericardium during screening echocardiography in combination with thrombocytopenia and relapses of intrathoracic bleeding. The diagnosis was confirmed by MSCT and biopsy data. Treatment with beta-blockers and chemotherapy resulted in tumor reduction and the disappearance of clinical symptoms.

The article discusses the role of the central nervous system, including mental disorders, in bronchial asthma in children. This problem has been of interest to practicing pediatricians and researchers for a long time, but so far it has not had unambiguous solutions. The authors have a diverse approach to its assessment, leaning towards the modern concept of ‘psychopathological’ or ‘psychological’ diathesis put forward by S.Yu. Tsyrkin. On specific clinical examples, the authors clearly demonstrated the influence of mental disorders on the course of bronchial asthma in children, which, of course, must be taken into account in practical work by pediatric pulmonologists.

Цель исследования. Клинико-иммунологическая оценка эффективности применения азоксимера бромида у больных коклюшем.

Характеристика детей и методы исследования. Под наблюдением находились 50 детей от 6 мес до 14 лет. В комплекс терапии 25 детей (основной группы) был включен азоксимера бромид, 25 больных (группа сравнения) получали базисную терапию.

Результаты. Выраженность симптомокомплекса у больных обеих наблюдаемых групп соответствовала течению среднетяжелой формы коклюша. Клинический диагноз был подтвержден методом полимеразной цепной реакции у 60±6,9%, иммуноферментным анализом — у 80±5,7% детей. Как в основной, так и в группе сравнения преобладали пациенты, которые переносили коклюш в ассоциации с острыми респираторными вирусными инфекциями (96,0±3,9 и 92,0±5,4% соответственно). Сочетанное течение коклюша с вирусными инфекциями осложнялось развитием бронхита у 8 (32,0±9,3%), пневмонией — у 7 (28,0±9,0%) детей в основной группе, а в группе сравнения бронхиты наблюдались у 9 (36,0±9,6%), пневмонии — у 5 (20±8,0%) больных. Сопоставление результатов лечения в двух группах детей показало эффективность азоксимера бромида по основным клинико-иммунологическим параметрам. Лечебный эффект определялся прежде всего уменьшением частоты приступов кашля и исчезновением на этом фоне явлений гипоксии. Положительная динамика отмечалась в субпопуляционном составе лимфоцитов, что касалось прежде всего содержания NK-клеток. Интенсивность продукции специфических антител к коклюшному микробу в основной группе также была выше, чем в группе сравнения.

Заключение. Применение азоксимера бромида в комплексе терапии больных коклюшем способствует уменьшению и сокращению основных клинических проявлений, а так же улучшению иммунологических параметров.

Adolescents with somatic diseases are at risk due to more active progression of the carious process. The article analyzes the clinical use of calcium-glycerophosphate gel for remineralization of permanent teeth enamel as a preventive therapy in children aged 10–12 years on the background of somatic disease. The presented data indicate that the mineral density of enamel increases by 60% after 14 days, and decreases by 40% aftertwo more weeks. Thus, on average, the mineral density of enamel increased by 16% from the original values. The optimal scheme of using calcium-glycerophosphate gel, which does not require constant monitoring by a doctor, is proposed. This scheme involves performing the procedure at home, which eliminates the psychological anxiety and tension of the patient that occur during the dental appointment.