The relevance of this problem is associated with a predicted increased incidence of subacute sclerosing panencephalitis, a steadily progressive and difficult to diagnose fatal brain disease. Subacute sclerosing panencephalitis develops after measles and it does not correlate with clinical type of an acute measles infection: it affects both persons with manifest measles and ones who have had an asymptomatic or abortive disease. WHO estimates the incidence of subacute sclerosing panencephalitis as 4–11 per 100,000 measles cases. The latency period from measles to the onset of subacute sclerosing panencephalitis is between 2.5 and 34 years. As a result of measles outbreaks in 2011–2014 and 2017–2019 an increase in the number of subacute sclerosing panencephalitis cases in Russia is expected soon. Diagnostic difficulties are caused by multiplicity of subacute sclerosing panencephalitis clinical manifestation and the absence of MRI changes in early stages. Thereby, it is important to exclude SSPE in patients with neurological symptoms. Screening tests for subacute sclerosing panencephalitis should be conducted in children with acute cognitive impairment, myoclonus, or a new onset of epileptic syndrome. The specific cure for subacute sclerosing panencephalitis has not been developed yet. Most treatments aim at reducing symptoms. Up to date, the only way to conquer this disease is routine measles vaccination.

   Late preterm babies are those born between 340/7 and 366/7 weeks of gestation, constituting the largest subgroup of preterm infants. Despite the relative morphofunctional maturity, these children remain at a high risk of damage to various organs and systems, and there is also a high mortality rate. One of the top places in the structure of morbidity in late preterm is occupied by respiratory disorders. Quite often there is transient tachypnea, respiratory distress syndrome of the newborn, pulmonary hypertension, and congenital pneumonia. Currently, there are various approaches to prevention, treatment, and diagnosis of respiratory disorders in late preterm children. Until now, the issue of the advisability of prenatal prevention of respiratory distress syndrome with corticosteroids after the 34^th week of gestation has not been resolved. Non-invasive methods of respiratory support are more popular along with minimally invasive administration of surfactant preparations when indicated. The trend towards an annual increase in late preterm births determines the need to improve the methods of their nursing. The control over respiratory disorders and hypoxia is crucial in the prevention of adverse outcomes in late preterm children.

   Today, medicine is at a stage when traditional diagnostic tools no longer meet current needs, which has led to the rapid development of molecular diagnostic methods that not only complement traditional research methods but also provide insight from the point of view of molecular pathophysiology. mRNA analysis is a new field that could revolutionize the diagnosis and treatment of kidney disease. The study of mRNA can be used for diagnosing and classifying kidney diseases, predicting the progression of nephropathies, monitoring the effectiveness of treatment, and developing modern approaches to therapy. As a new field, mRNA analysis faces a number of challenges and limitations, but as technology advances, the technique becomes more accessible for clinical use.

   Breast milk is the optimal food for premature infants. However, the serious condition of premature newborns requires a complex of primary resuscitation care in the maternity unit, which makes it impossible to carry out early attachment to the breast and start breastfeeding. Currently, the neonatal community is actively discussing the immune effects of an alternative method of oropharyngeal administration of colostrum on the child’s adaptation to extrauterine existence.

   Purpose. To assess the clinical outcomes, the state of the monocytic immunity, the production of sIgA in coprofiltrates in premature infants with extremely low body weight who received colostrum in the first hours of life.

   Material and methods. 39 premature infants with extremely low body weight who received oropharyngeal administration of colostrum were examined. The expression of CD14+CD282+, CD14+CD284+, CD14+HLA-DR, CD14+CD64+, CD14+CD11b+, CD14+CD11c+ monocytes and the phagocytic ability of mononuclear cells in blood serum were determined by laser flow cytometry. The secretory IgA concentration was assessed in coprofiltrates.

   Results. In premature infants who did not receive oropharyngeal colostrum, there was an increase in leukocyte phagocytosis, the level of monocyte expression, which was due to an increased infectious morbidity. Mucosal immunity of children who received colostrum was characterized by an increased concentration of secretory IgA.

   Conclusion. It was found that children who received oropharyngeal administration of colostrum have a faster correction of transient hypoglycemia after birth, a shorter duration of parenteral nutrition, greater body weight at the time of discharge, and a decrease in the incidence of infectious pathology.

   The article presents data to discuss the peculiarities of the growth of psychomotor skills and, in particular, cognitive and speech development in children born at early pregnancy less than 28 weeks over the period of 24–48 months of life. A retrospective analysis of 50 children aged 5–7 years showed that for 42 of them (84 %) cognitive and speech development was significantly delayed at 24–36 months of life, with a subsequent «jump» in development that allowed them by this age to catch up with fullterm babies, though preserving peculiarities of behavior, that did not interfere with their social integration. The inconsistency of conditional developmental norms with the adjusted age and the need to develop new approaches to the assessment of development and prognosis for this group of children are discussed here. It is shown on a small sample that children with «delayed cognitive development,» but subsequently demonstrating a favorable outcome, had no genomic abnormalities and, accordingly, do not require the inclusion of genomic evaluation methods in the diagnostic search. In the algorithm of indications, besides impaired cognitive development at the age of more than 3 years, there should be additional markers, such as malformations, unfavorable course of specific diseases associated with prematurity (retinopathy, BPD, mismatch of the assumed reason for the severity of neurological defects).

   The postural control development is a complex physiological process, which is the basis for the development of motor functions. Approaches to the assessment of postural control and the features of its formation in infants of the first year of life have not been studied enough.

   Purpose. To reveal the features of postural control development in infants of the first year of life with the consequences of perinatal lesions of the central nervous system in the form of impaired motor development, born at different gestational ages.

   Material and methods. We examined 120 infants of the first year of life with impaired motor development and 16 infants without neurological pathology. Infants with impaired motor development were divided into 4 subgroups: 1 (n = 30) — full-term, 2 (n = 30) — very preterm, 3 (n = 30) — moderately preterm, 4 (n = 30) — late premature children depending on their gestational age at birth. The examination was conducted at 3–4 months of calendar age in full-term and corrected in premature infants and included an assessment of the neurological status, a clinical assessment of postural control, and computer stabilometry.

   Results. Violation of postural control was found in infants of the first year of life with the consequences of perinatal lesions of the central nervous system in the form of impaired motor development, born at different gestational ages. These postural disorders may be associated with changes in muscle tone and impaired sensorimotor integration.

   Conclusion. Further research will enable the development of objective criteria for diagnosing postural disorders in infants of the first year of life, depending on the gestational age at birth. This will contribute to the timely start of treatment and rehabilitation measures, reducing the frequency and severity of disabling consequences of perinatal lesions of the central nervous system.

   Purpose. To found out expressive speech disorders as a sign of neurocognitive development delay in children with congenital heart defects before and after surgery.

   Material and methods: 216 children with congenital heart defects were divided into groups according to the presence (group 1, n = 71) and absence (group 2, n = 145) of family history confounding factors, and studied before surgery and in 1 and 2 years after definitive repair under cardiopulmonary bypass. The anamnesis, clinical and hemodynamic aspects were studied before and after surgery, mental status and expressive speech diagnostics were also performed.

   Results. The predictors of neurocognitive impairment in children with congenital heart defects before surgery were identified: the level of heart failure, comorbidity, burdened family history. 76.3 % of children had «average» level of neurocognitive development (more in group 2) in a year after surgical correction, while 23.6 % had «low» and «very low» level (more in group 1); there were general expressive speech disorders in 68 % children in group 1 and in 55 % in group 2 among all children. «High» level of neurocognitive development was recorded in 2 years (13.8 % among all children), while the number of children with general expressive speech disorders was approximately the same despite of positive dynamic of clinical and hemodynamic aspects.

   Conclusion. There are «low» levels of neurocognitive development and expressive speech disorders in children with congenital heart defects in long term postoperative period despite of clinical and hemodynamic normalization. It can predict significant risks and poor quality of life in the absence of timely correction.

   Purpose. Evaluation of the impact of the physical rehabilitation program with the inclusion of ubidecarenone on the redox status in children with repaired congenital heart diseases.

   Material and methods. Markers of free radical oxidation (lactate, pyruvate, lactate-to-pyruvate ratio) and antioxidant system (catalase, reduced glutathione and glutathione peroxidase) were studied in 84 children, including 48 children with repaired congenital heart diseases and 36 healthy peers. The main group consisted of 28 patients who performed a rehabilitation program using physical activity in combination with taking ubidecarenone for a year, the comparison group consisted of 20 children who received only ubidecarenone.

   Results. After the rehabilitation program was completed, both the main group and the comparison group had a significant (p < 0.05) decrease in lactate levels, the ratio of lactate to pyruvate, and an increase in catalase and reduced RBC glutathione. The group of children who performed physical exercises had significantly lower levels of markers of free radical oxidation and higher values of markers of the antioxidant system than the patients from the comparison group.

   Conclusion. There are free radical oxidation and the antioxidant system impairments in children with repaired congenital heart diseases. The use of ubidecarenone reduces oxidative stress and increases antioxidant protection in children with repaired congenital heart diseases. The inclusion of physical activity in the rehabilitation program for children with repaired congenital heart diseases improves the redox status and increases the effectiveness of rehabilitation.

   The value of the liver–gut axis is increasingly recognized as a major modulator of autoimmunity. There is no comparative analysis of data on the taxonomic diversity of the intestinal microbiota in chronic liver diseases in children.

   Purpose. To investigate the taxonomic diversity of the intestinal microbiota in children with chronic liver diseases compared with healthy patients, to identify differences in bacterial diversity in autoimmune and non-autoimmune liver diseases, as well as the impact of immunosuppressive therapy on the intestinal microbiota.

   Material and methods. A metagenomic analysis of the gut microbiota of 24 children with chronic liver diseases (mean age 10,3 ± 4,7 years) was carried out with the identification of the V3–V4 region of the 16S rRNA gene. The group included 18 children with autoimmune liver diseases and 6 children with non-autoimmune liver diseases. The control group consisted of fecal samples of 34 apparently healthy children.

   Results. When comparing fecal samples of children with autoimmune liver diseases with samples of healthy children, the taxa of Bacteroides dorei, Collinsella aerofaciens, Ruminococcus caffidurs prevailed, and for children of the control group — Neisseria flavescens. When comparing samples of patients with non-autoimmune liver diseases and the control group, it was found that the taxa Bacteroides fragilis, Klebsiella pneumoniae, Bifidobacterium longum prevailed in healthy children. When comparing fecal samples from children with autoimmune and non-autoimmune liver diseases, it was found that Veillonella dispar, Cloacibacillus porcorum, Veillonella parvula, Prevotella histicola and Bacteroides eggerthii taxa dominate in patients with non-autoimmune diseases. No dominant taxa of the gut microbiota were found in children with autoimmune liver diseases. It has been established that the taxa Veillonella dispar, Faecalibacterium prausnitzii, Roseburia inulinivorans, Bacteroides xylanisolvens and Alistipes obesi prevail in patients receiving immunosuppressive therapy, and the taxa Phascolarctobacterium succinatutens, Bacteroides ovatus, Solobacterium mooreis and Holdemanella massilien prevail in patients not receiving immunosuppressive therapy.

   Conclusion. A recent study of the gut microbiota in children with chronic liver disease shows differences in the imbalance of the gut microbiota compared to the results obtained in adults. The gut microbiota model is capable of distinguishing autoimmune liver diseases from non-autoimmune diseases. Immunosuppressive therapy is accompanied by the dominance of taxa that reduce the production of short-chain fatty acids.

   The epidemiological situation of whooping cough in many countries of the world shows an increase in the incidence, despite the high coverage of routine immunization of the child population, which indicates the need for additional booster doses in older age groups.

   Purpose. The study aims at a comparative analysis of the intensity of specific immunity against whooping cough, diphtheria and tetanus in adolescent children after revaccination with different types of vaccines.

   Material and methods. 121 adolescents received various preparations containing pertussis, diphtheria and tetanus as revaccination.

   Results. The use of the pertussis component in preparations for revaccination of adolescents, despite the fact that they initially have a certain level of seroprotection, is not accompanied by a significant increase in specific antibody titers. Some differences related to the types of drugs used: the AbDTP-M vaccine against AbDTP had the best seroprotection after 1 month, while at the same time, as after 12 months, this ratio reversed.

   Conclusion. The situation with the effectiveness of revaccination against tetanus and diphtheria with all the drugs used had a more predictable effect, which was reflected in a significant increase in the titer of specific antibodies after 1 month.

   Foreign bodies of the gastrointestinal tract in children are a fairly common reason for seeking help in surgical departments.

   Purpose. The study aims at identifying dependencies between the type of foreign bodies, the tactics of their detection and removal in different age periods.

   Material and methods. Retrospective analysis of 100 case histories of patients with a diagnosis of «Foreign body of the gastrointestinal tract”; 64 boys included.

   Results. Preschool children were more often diagnosed with «Foreign body of the gastrointestinal tract.» The children rarely complained. The most commonly used diagnostic method is overview radiography, and the method of extracting a foreign body is endoscopy. The most frequent finds were coins. Magnetic balls and batteries led to injury of the organ where they were located.

   Conclusion. When contacting a medical and preventive institution in the first hours after swallowing the object, the risk of complications is minimal. If the foreign body is a magnetic ball, magnet, or battery, the presence of which is associated with high risks of complications, it is necessary to remove them from the body as soon as possible.

   Isolated tracheoesophageal fistula is a very rare malformation, which is a pathological communication between the walls of the esophagus and the trachea. The entry of food into the trachea causes severe obstructive and ventilatory disorders in infants. Surgical treatment of developmental anomalies includes open thoracic or transsternal access, which is traumatic, often complicated by pleurisy and mediastinitis in the postoperative period and long-term musculoskeletal deformities.

   Purpose. To demonstrate the effectiveness of minimally invasive surgery in the correction of this defect.

   Fibro-tracheo-bronchoscopy confirmed an isolated tracheoesophageal fistula in a 2-month-old child. Thoracoscopic intervention using 3 ports was chosen and performed as a surgical method of treatment. A large tracheoesophageal fistula, up to 10 mm, was found. The tracheal end of the fistula was sutured with 2 ligatures, tied and cut off. The defect in the wall of the esophagus was hermetically sutured. The postoperative period proceeded without complications. Enteral nutrition through the nipple started on the 10^th day. Control examination after 1 and 6 months: the child has no anxiety; psychomotor development corresponds to age, on esophagoscopy the esophagus is freely passable, constrictions and defects were revealed .

   Conclusion. The high resolution and ergonomics of modern endoscopic equipment made it possible to visualize the malformation in an infant in detail, to separate pathological communication with minimal trauma and to avoid early and long-term complications.

   The lingual thyroid gland is an abnormal mass of ectopic thyroid tissue visible at the base of the tongue, caused by an embryological anomaly in the development of the thyroid gland. Identification and symptom-adapted treatment of ectopia are important in preventing hypothyroidism and development of obstructive symptoms.

   Purpose. To present a case of lingual ectopia of the thyroid gland in a child with an incidentally diagnosed formation of the root of the tongue based on primary ultrasound diagnosis.

   Material and methods. A 7-year-old boy without clinical signs of hypothyroidism during a routine examination revealed a voluminous asymptomatic formation of the root of the tongue.

   Results. Along the midline at the root of the tongue there is a rounded, non-displaced, painless formation about 20 mm in diameter. Regional lymph nodes are not enlarged. The picture of ectopic thyroid tissue in the root of the tongue, in the absence of thyroid in a typical site on the neck. There is subclinical hypothyroidism with a TSH level of 12.8 mсME/mL (normal 0.6–4.84). The presence of ectopia was confirmed by scintigraphy with Technetium-99m pertechnetate. Normal TSH level of 3.37 mcME/mL and a reduction in the volume of ectopic thyroid tissue from 3.3 mL to 2.13 ml revealed 3 months after levothyroxine therapy at a dose of 50 mcg/day.

   Conclusion. Ultrasound exam with Doppler mapping is mandatory and allows not only to identify ectopic tissue, but also to identify the absence of thyroid in a typical anatomical area on the neck. The study of the hormonal profile and subsequent scintigraphy make it possible to make a final diagnosis, assess the function of the ectopic organ and determine the option of drug and/or surgical treatment.

   The article presents a clinical case of paroxysmal atrioventricular block, which is a rare and difficult to diagnose cause of syncope, which makes it difficult for specialists to make a correct diagnosis and determine the tactics of patient management.

   Purpose. To demonstrate a clinical case, in which comprehensive methods of examination were carried out to identify the cause of syncope, and to show the need of understanding its pathogenesis.

   For differential diagnosis, it is necessary to carry out not only routine examination methods, but also to use drug tests, as well as long-term monitoring devices (multi-day daily Holter monitoring, loop recorders of long-term ECG recording, smart watches, etc.), which help to find the cause of syncope. According to the clinical recommendations, patients with atrioventricular block and clinical symptomatology, require continuous cardiac pacing in order to prevent asystole with potential sudden cardiac death.

   The analysis of outpatient records of children with bronchial asthma was carried out to identify the timeliness of the diagnosis of bronchial asthma, which showed that the diagnosis was made with a delay of 3.8 years. In children with prolonged persistent cough, repeated acute obstructive bronchitis, bronchophonography revealed latent bronchospasm, the subsequent appointment of preventive anti-inflammatory therapy to these patients made it possible to clarify the diagnosis of bronchial asthma in 58.9 % of cases. Analysis of the register of patients with bronchial asthma revealed the absence of basic therapy in 2/3 of children with a mild persistent course of the disease. The frequency of emergency medical calls and hospitalizations was higher in children with mild bronchial asthma who did not receive control therapy. An analysis of the expenditure of short-acting β2-agonists in 96 children with asthma indicates their excessive use in 50% of patients. Conducting training seminars increased the knowledge of district pediatricians on modern thera-
peutic and diagnostic approaches to bronchial asthma.

   In recent years, modern models of artificial intelligence, including neural networks, have been successfully introduced into clinical practice, due to the high accuracy of functioning and the prospects of their use for the diagnosis and prediction of various diseases.

   Purpose. To improve the processes of predicting and diagnosing diseases and their outcomes in newborns using neural network intelligent technologies.

   Material and methods. The study is based on statistically reliable collection of patient history data, mathematical analysis, fuzzy logic theory and principles of trainable neural network systems.

   Results. Neural network programs have been developed to predict the course of posthypoxic disorders of the cardiovascular system in newborns; to determine the probability of occurrence and outcomes in newborns of such significant diseases as cerebral leukomalacia, intracranial hemorrhages, hydrocephalus, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, early anemia of prematurity; to predict the physical and neuropsychiatric development of a child to age of one year; and also to predict an unfavorable outcome (death or disability with persistent health problems) of children born earlier than 32 weeks of gestation.

   Conclusion. The developed artificial neural network programs can be used for personification of the therapeutic and diagnostic process and nursing of newborns, including very preterm ones.