This article provides an overview of child abuse, describing the scale of the problem and the factors that put children at risk of abuse and neglect. It also discusses the trauma experienced in childhood and how it contributes to the development of disorders in the physical and mental health of victims later in life. After examining the legal definitions of child abuse, common clinical findings and diagnostic strategies are reviewed to enable the pediatrician to differentiate between accidental and intentional injury to a child. An algorithm for further doctor’s actions is presented. It is shown that a three-tiered system of medical and social support is effectively operating in the Republic of Tatarstan to assist children in difficult situations and prevent socially dangerous situations. Family, administrative, and criminal laws establish responsibility for violation of parental obligations.

According to global statistics, the number of cases of community-acquired pneumonia in children exceeds 150 million per year, and despite the introduction of vaccinations, this figure has not significantly decreased. Respiratory viruses, particularly respiratory syncytial virus, are recognized as the main cause of community-acquired pneumonia among preschool children during non-epidemic periods. Pneumococci also continue to play a significant role among bacterial pathogens. There is a significant increase in the prevalence of M. pneumoniae in the etiological structure of community-acquired pneumonia in recent years. Modern clinical guidelines for the use of antibiotics recommend taking into account patient age, vaccination status, and data on circulating pneumococcal strains when prescribing treatment. The COVID-19 pandemic and its subsequent relaxation of strict restrictions in the last two years have led to changes in the structure of infectious diseases, including the causes of lower respiratory tract infections.

The article discusses the issue of the use of vape pens and electronic cigarettes, particularly among children and teenagers. The authors analyzed 58 scientific articles that discuss the damage to the lungs caused by smoking electronic devices, in order to identify symptoms and pathological changes. The study highlights the various clinical manifestations of lung damage associated with vaping and using electronic cigarettes (EVALI, e-cigarettes or vaping-associated lung injuries), and the need for a differential diagnosis with other respiratory illnesses, including COVID-19. It is essential to conduct educational and awareness campaigns in society to spread information about the risks of using electronic devices. Further research is needed to understand the long-term effects of vape pens and e-cigarettes on human health.

The urgent task of modern pediatricians and neonatologists is to predict the course of the early neonatal period, during which the basic adaptive mechanisms of newborn children are in an unstable state. This is particularly important for the study of premature newborns, who are at high risk for an unfavorable outcome.

Purpose. The aim of this study was to investigate the nature of early neonatal adaptation in children born between 32- and 36-weeks’ gestation, from mothers with burdened obstetric and gynecological histories and concomitant medical conditions.

Material and methods. Out of 75 patients, we divided children born against a background of placental abruption and pre-eclampsia into separate groups. We provide a comparative analysis of their obstetric, gynecological, and medical histories, as well as their pre-dictive factors, somatic status dynamics, and laboratory and instrumental examinations

Results. Analysis of the data showed that in late preterm newborns, the presence of placental abruption in the history of 100% of cases led to the development of general somatic distress, with deterioration in hemodynamic and respiratory parameters, requiring transfer to the second phase of care. In children born preterm due to severe preeclampsia or other causes, stable severe conditions were observed in 33.3 and 39.6%, respectively, and 53.9 to 60% of infants required respiratory support.

Conclusion. These findings allow for individualized assessment of a newborn’s condition in the first few days of life, based on predictive factors that may lead to a breakdown in compensatory responses.

The role of breastfeeding in the development of the cellular immune system, antimicrobial strategies of neutrophils, and local cytokine levels was evaluated in a single-center, prospective, open-label, uncontrolled study of healthy infants who were either naturally or artificially breastfed. The main group included practically healthy children who were exclusively breastfed for the first year of life. Thirty-six children were examined during the first stage and 25 from this group during the second stage. The comparison group included children who received an adapted cow’s milk formula during the first half-year of their lives and a different formula during the second half-year. Thirty-one children were examined during stage one and 27 from this group were examined during stage two. A comprehensive study of mucosal immunity was conducted, assessing the cytokine profile and cellular components using the method of smear prints from the nasal mucosa. The results showed that the nature of feeding during the first year of life influences the formation of mucosal immunity and programming the postnatal development of the child’s immunological reactivity. In the absence of the immunomodulatory effects of breast milk, there is an imbalance in the cytokine profile, with a physiological deviation of the immune response linked to the predominance of Th2 profiles. In contrast, breastfeeding promotes the optimal cellular composition of the upper respiratory mucosa and a cytomorphological neutrophil profile with minimal destructive changes. Breastfeeding programs the optimal functional profile of neutrophils, including the level of receptor activity, intracellular biocidal activity, cytotoxicity, ability to complete phagocytosis. This natural infant feeding method has a long-term protective effect, preventing neutrophil destruction under the influence of environmental factors and respiratory viral agents, and ensuring optimal mucosal immunity development in the respiratory tract.

The clinical and laboratory effectiveness of a biocomplex of probiotic bacteria (Bifidobacterium BB-12, Streptococcus thermophilus TH-4) in preventing the development of microecological and gastrointestinal disorders in children born by cesarean section has been studied. A prospective open comparative study was conducted. The main group consisted of 16 healthy newborns born by cesarean section who were treated with a probiotic (Bifidobacterium BB-12, Streptococcus thermophilus TH-4) at 1 dose once a day. Oral administration of the probiotics began immediately after delivery and continued for 14 days. A control group of 21 healthy babies born by caesarian section who did not receive the probiotics during the study period was also included. Bacteriological analysis of fecal samples and assessment of the health status were performed at the ages of 4–5 days, 1 month, and 3 months. In children receiving probiotics, the incidence of infantile intestinal colic was lower at the age of 1 month, opportunistic microflora were less frequently isolated (p<0.01), and signs of inflammation in the intestines were less often detected during the follow-up period, as shown by a coprological study.

Conclusion. The effectiveness of using probiotics (Bifidobacterium BB-12 and S. thermophilus TH-4) to prevent microecological and gastrointestinal problems in children born by cesarean section has been demonstrated.

Citrulline is an amino acid that is not found in protein and does not enter the body through food, enteral or parenteral nutrition. It is instead synthesized exclusively by enterocytes. Therefore, citrulline concentrations in the blood can reflect the process of biosynthesis in the intestines and are directly related to changes in the function of these cells.

Purpose. The aim of the study was to assess citrulline levels in children who had undergone intestinal resection during the neonatal period.

Material and methods. The study included 22 children with short bowel syndrome, diagnosed by a doctor (main group; average age 3.7 months). We also included 20 children who had undergone surgery to remove less than 50% of their intestine but did not have short bowel syndrome (comparison group; average age 3 months 1 day). The control group consisted of 23 healthy children who had never had surgery on their gastrointestinal tract and did not have any congenital malformations or clinical signs of enteropathy (average age 5 months 3 days). High performance liquid chromatography-mass spectrometry (HPLC-MS) was used to measure the level of citrulline.

Results. The average level of citrulline in the blood of children in the main group was 18 μmol/l (95% CI 10–22.8), in the comparison group – 17.5 μmol/l (95% CI 16–21), in the control group – 26 μmol/l (95% CI 22–3). Citrulline levels in patients who underwent surgery in the neonatal period were significantly different from those of children in the control group There were no differences in the content of citrulline between the main and comparison groups, depending on whether the colon was preserved or not and whether the ileocecal valve was present (p>0.05).

Conclusion. An increase in citrulline level in the blood of children receiving therapy with a glucagon-like peptide-2 analog indicates the possibility of using this marker to monitor changes in intestinal absorption associated with physiological or pharmacological adaptation of the intestine.

The urgent task of modern pediatrics is the study of the etiology and pathophysiology of community-acquired pneumonia in school-aged children due to difficulties in diagnosis and treatment, as well as the high risk of life-threatening complications and death.

Purpose. To investigate the activity of pro-inflammatory and anti-inflammatory responses as measured by cytokine levels in the peripheral blood of children with community-acquired pneumococcal and non-pneumococcal pneumonia.

Material and methods. The etiology of community-acquired pneumonia was confirmed by comparing the results of rapid testing of pneumococcus in urine and data from traditional bacteriological methods. The study included 118 children (57 boys and 61 girls) aged 7 to 16 years with various morphological variants of community-acquired pneumonia, which were divided into 2 groups. The first group included 28 children with pneumococcal etiology of community-acquired pneumonia, and the second group included 90 patients with non-pneumococcal community-acquired pneumonia. Levels of interleukins IL-1, IL-4, IL-8 and TNF-α were determined in all children by enzyme immunoassays.

Results. In the etiology of community-acquired pneumonia in school-age children, atypical pathogens are responsible for more than 50% of cases. The clinical effectiveness of rapid testing of pneumococcal antigens in urine has been shown, and their use in routine pediatric practice has made it possible to timely identify a group of severe community-acquired pneumonia and reasonably prescribe antibacterial medications. It has been demonstrated that pneumococcal-induced pneumonia is characterized by higher levels of proinflammatory cytokines. These levels, along with the clinical course of the disease, confirm the high level of systemic inflammation. Relatively lower levels of proinflammatory cytokines corresponded to a more mild clinical picture of community-acquired pneumonia of non-pneumococcal etiology, which on the one hand may reflect a relatively «balanced» inflammatory response, and on the other hand determine the protracted and polyclinic course of the infectious process.

Conclusion. The etiology of community-acquired pneumonia in school-age children is dominated by atypical pathogens. Community-acquired pneumonia of pneumococcal etiology has more severe clinical courses, and their early identification will allow for the appropriate prescription of initial antibacterial treatment.

Nephrotic syndrome is one of the most common glomerular diseases in childhood. It is known that about half of patients with nephrotic syndrome develop dependence on steroid therapy, which requires the inclusion of a treatment regimen of selective immunosuppressive therapy. Mycophenolic acid (MPA) has been identified as a promising drug for steroid-resistant nephrotic syndrome, and it forms the basis of immunosuppressive therapy for this condition. The present study evaluates the importance of determining the expression of genes responsible for the metabolism of mycophenolic acid in patients with steroid-dependent nephrotic syndrome to maintain stable clinical and laboratory remission of the disease. The article demonstrates the significance and role of MDR1, UGT1A7, UGT1A9 and UGT2B7 gene expression as potential markers of increased risk of relapses and opens up prospects for the use of a transcriptomic approach to identify patients who require careful selection of pharmacotherapy. Although the results obtained are promising, changes in the expression of metabolic enzymes are only one of several factors that contribute to the effectiveness of treatment. Based on these data, it may be possible in the future to develop personalized monitoring strategies that can help tailor treatment to individual patients and increase its effectiveness.

Dyslipidemia is a metabolic disorder in which the ratio of lipid particles in the blood changes. It is often associated with other conditions and diseases during childhood. Lipid metabolism disorders in children can be divided into two categories: primary, which are inherited from parents or occur de novo, and secondary, which occur during life. Familial hypercholesterolemia is the most common type of primary disorder, characterized by an increase in blood lipoprotein levels. However, the lipid composition in children with established familial hypercholesterolemia can vary. One factor that may contribute to higher lipid levels in these children is the presence of mutations in the apolipoprotein E gene.

Purpose of the study was to investigate the phenotypic and genotypic features of children with familial hypercholesterolemia in order to better understand this condition.

Materials and methods. Children with a clinical diagnosis of familial hypercholesterolemia underwent DNA sequencing to identify mutations in genes related to LDLR, APOB, LDLRAP1, and APOE genes.

Results. Children with familial hypercholesterolemia most often carry the polymorphism c.388T>C in the ApoE gene (g.45411941T>C, p.Cys130Arg, rs429358). Also, 24.1% of children were found to be isolated carriers of various ApoE haplotypes, which are risk factors for dyslipidemia. In children with a pathogenic mutation characteristic of familial hypercholesterolemia and carriage of polymorphisms in the ApoE gene, the LDL level was statistically higher compared to non-carriers.

Conclusion. Carriage of various polymorphisms in the ApoE gene in children with familial hypercholesterolemia may lead to an increase in the already elevated levels of LDL and total cholesterol.

One of the common childhood illnesses is reactive arthritis, which develops during or soon after an infection.

Purpose. The aim of the study was to study the etiology, clinical and laboratory manifestations of arthritis in children.

Material and methods. The study included 37 children with arthritis aged 1 year 10 months to 15 years who were hospitalized at Kazan City Children’s Hospital № 1.

Results. Reactive arthritis was diagnosed in 26 children, and juvenile idiopathic arthritis in 11. In 20 patients, reactive arthritis manifested itself as monoarthritis with predominant damage to the hip or knee joints – in 11 and 9 cases, respectively. Two children had ankle arthritis. In 4 cases there was oligoarthritis. Markers of infectious diseases were identified in 10 out of 26 children with reactive arthritis (38%). In 5 children (19%) IgM to Mycoplasma pneumonia was detected, in two (8%) – IgM to capsid antigen of Epstein–Barr virus, in one child (4%) – IgM to Chlamydia pneumonia. Two children had elevated ASLO values (more than 400 IU/ml). Inflammatory in the blood in 33 cases (89%) were characterized by increased erythrocyte sedimentation rate, the median of which was 22 mm/hour. Increased level of C-reactive protein and leukocytes in the blood were observed only in 9 (24%) and 7 (19%) children, respectively.

Conclusion. Reactive arthritis in children mainly manifests as monoarthritis, with predominant damage to the hip or knee joints and in most cases was associated with Mycoplasma pneumonia.

The incidence of complications from acute otitis media in children, such as mastoiditis, tends to increase. We analyzed 57 case histories of children who had undergone an anthromastoidotomy. The main reasons for treatment failures in acute otitis media include underestimating the vaccination status of the child, lack of antibiotic therapy, prescribing antibiotics in low doses or for a short period of time, using drugs that are not active against pneumococcal infections, and prescribing only topical therapy. Considering these factors can reduce the need for surgery in pediatric patients with this infection.

Medical and biological support for the training of young athletes is a separate specific part of medical science and practice. This area of medicine includes determining the health and physical development of athletes, as well as diagnosing, treating and preventing diseases and injuries associated with physical education and sports. The main goal of medical and biological support for children’s and youth sports is the harmonious development of the child within the chosen sport, taking into account his age characteristics, functionality, physical development, including puberty.

Objective. The purpose of the study is to investigate the characteristics of the physical development of young athletes of various specializations.

Materials and methods: 102 young teenage athletes took part in the study. The control group consisted of 28 schoolchildren who were not involved in sports professionally. The first group of the study included 35 young athletes from the «Children and Youth Sports School of Swimming». The second group of the study consisted of 47 teenagers, students of a specialized children’s and youth sports school of the Olympic reserve in field hockey. The third group of the study included 20 young athletes, students of a specialized children’s and youth sports school of Olympic reserve fencing.

Results: In terms of physical development parameters, young athletes have indicators above the average values of children in the control group. The percentage of body fat in boys and girls in the control group was significantly higher than in young athletes. At the same time, the level of muscle mass of boys who do not engage in sports is lower than that of the group of athletes.

Conclusions: Based on the results of the work, it was established that the physical development of young athletes has significant differences from their peers who do not play sports professionally.

Hereditary pathology makes up a significant part of the structure of childhood morbidity, disability and mortality. Mucopolysaccharidosis type I is a hereditary lysosomal accumulation disease, with an autosomal recessive type of inheritance. At birth, children with Gurler syndrome look normal, but in the future, they develop symptoms characteristic of mucopolysaccharidosis, and the first clinical manifestations of the disease are often hernias and hepatosplenomegaly. The presented clinical case demonstrates the difficulties of early diagnosis of mucopolysaccharidosis type I, which lead to a later prescription of enzyme replacement therapy and the inability to use a more effective method of therapy – hematopoietic stem cell transplantation, due to the development of serious manifestations of the cardiovascular system. While the positive effects of enzyme replacement therapy in the early stages of treatment may seem promising, it does not guarantee a favorable prognosis for the future.

Conclusion. Currently, early diagnosis of mucopolysaccharidosis type I is difficult due to the lack of early manifestations. Often, the progression of clinical manifestations leads to disability, and in severe cases, to death. Therefore, it is important to have early diagnosis and appropriate treatment.

A possible manifestation of intrauterine infection with herpes viruses can be severe eye damage. Various visual disturbances with negative consequences have been described in Prader–Willi syndrome. The article describes bilateral chorioretinitis in a child with Prader–Willi syndrome, which developed against the background of congenital herpetic infection of CMV etiology.

The paper analyzes data from scientific publications and presents a clinical case study of a rare genetic epileptic encephalopathy caused by a mutation in the SYNGAP1 gene. The case study focuses on a 4-year-old girl who has been diagnosed with epileptic encephalopathy due to the mutation. The paper describes the anamnesis of the child’s illness, including family history, neurological, neuropsychological, and speech assessments, as well as the results of genetic testing, electroencephalography, and magnetic resonance imaging (MRI). The findings indicate that the main symptoms of the condition are typically epilepsy, autism spectrum disorder, difficulty with phrasal speech, and mental retardation. Common types of seizures include atypical absence seizures, myoclonic seizures, atonic seizures, and eyelid myoclonia with absences. On the electroencephalogram, there is a slowdown in occipital activity and diffuse, prolonged «peak-polypic-slow-wave» complexes. Pathognomonic neuroimaging changes in the brain are typically absent. Valproic acid, levetiracetam, and ethosuximide have been shown to be the most effective treatments for controlling epileptic seizures. Due to the rarity of this syndrome, the authors have provided a detailed clinical case report from their practice.

Conclusion. SYNGAP1-related epileptic encephalopathy has a specific clinical presentation, including characteristic EEG findings and a particular pattern of seizures. The diagnostic approach for children with this condition, autism spectrum disorder, and delayed language development should include video electroencephalography with sleep deprivation, as well as genetic testing if necessary, using next-generation sequencing, to ensure early detection and appropriate treatment planning.

The diagnosis of inflammatory bowel diseases (IBD) in children can be challenging for pediatricians. Extra-intestinal manifestations, such as hepatobiliary pathology, often complicate the diagnosis of these conditions. Hepatobiliary pathology is often an extraintestinal manifestation of inflammatory bowel disease. Patients with combined liver pathology (autoimmune hepatitis and primary sclerosing cholangitis) and inflammatory bowel disease have a higher risk of resistance to treatment, the need for liver transplantation, and a worse prognosis for liver cirrhosis compared to those with isolated liver disease. The article presents a clinical case of the development of overlap syndrome (a combination of autoimmune hepatitis and primary sclerosing cholangitis) in Crohn’s disease in a 7-year-old patient.

The issue of autism spectrum disorder (ASD) in children is a significant concern at present. In the Russian Federation, there has been a rapid increase in the incidence of ASD and the number of children diagnosed with this condition, making childhood autism a major medical and social issue. Pediatricians need to be trained in the diagnostic criteria for early identification of this disorder. The main diagnostic methods involve monitoring the child’s development, with the district pediatrician playing a crucial role. The knowledge and expertise of the doctor significantly influences the timeliness of diagnosis and the prescription of appropriate interventions, which can lead to positive outcomes and prevent further symptom progression. It is essential for pediatricians to carefully listen to families’ concerns about any developmental or behavioral issues in their children. According to our research, 32% of families did not receive timely assistance. The most common complaint made by parents was delayed speech development and impaired communication. To identify autism spectrum disorders, doctors should regularly assess a child’s neuropsychiatric development and monitor them in various situations to assess their behavior and interaction with others. If any deviations are detected, a questionnaire such as the M-CHAT (a modified list of questions for detecting autism in children) should be used and the patient referred to a psychiatrist for further consultation. Our study highlighted the need for pediatricians to better understand the signs and symptoms of autism spectrum disorders.

The article discusses the practical aspects of caring for children after heart surgery. It provides information on the timing of follow-ups, the frequency of pediatrician visits, and describes the most important aspects of patient management for different groups. The article identifies several groups of patients based on their postoperative risks and follow-up needs. Purpose of the article is to present the observation features of patients who have undergone surgery for congenital heart defects, from the perspectives of surgeons and pediatricians.