The paper presents the results of modern-day studies in allergology and data on the epidemiology of allergic diseases and new approaches to their diagnosis and therapy in children. It considers trends and problems in the development of pediatric allergology.

Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

The paper gives up-to-date information on hypophosphatasia in children. It represents the results of genetic studies, the pathogene-sis, clinical manifestations, classification, treatment, and prevention of the disease. Particular emphasis is placed on whether clinical trials of novel biological agents for the pathogenetic therapy of hypophosphatasia (enzyme replacement therapy) may be conducted.

The 2008—2012 survival trends were analyzed in very low and extremely low birth weight in the Voronezh Region. The official statistical data of Form No. 32 of the Federal State Statistics Service for Obstetric Facilities in the Voronezh Region and its registry office data on consecutive registration of medical death certificates were examined. In 2008 to 2012, the Voronezh Region showed reduced antenatal losses in the group of very low and extremely low birth weight infants. By 2012, along with an increasing number of live births in a group of extremely low birth weight birth infants, the survival up to 1 year doubled and amounted to as high as 43,4%. That was 92,5% in a group of very low birth weight infants. No deaths were notified among the very low and extremely low birth weight babies after primary hospital discharge. The results of the performed studies suggest that the region exhibited the improved quality of care during pregnancy and labor and care to the newborns in the early neonatal period and the increased levels of nursing care for low birth weight infants during the first months of life.

Objective: to investigate the impact of complicated ante- and intranatal periods on postnatal cardiovascular hemodynamic adaptation in surgically born babies who have suffered hypoxia-ischemia. Patients and methods. A total of 382 full-term neonatal infants were examined. A study group included 117 cesarean born babies who had suffered hypoxia-ischemia. Comparison Group 1 comprised 150 infants who had been born by cesarean section and had no signs of cerebral ischemia. Comparison Group 2 consisted of 65 vaginally born babies following hypoxia-ischemia. A control group included 50 infants of physiological pregnancy and labor. In the first 1—2 days of life, all the neonates underwent EchoCG and determination of structural and hemodynamic parameters by using the standard procedures. Impaired postnatal hemodynamic rearrangement was found in all the babies of the examined groups, particular in those who had been born via cesarean section and sustained hypoxia-ischemia; the magnitude of disadaptation correlated with the severity of hypoxia-ischemia. A delayed reduction of dysfunction beyond the early neonatal period was noted in babies exposed to a combination of perinatal damaging factors. Conclusion. A set of poor ante- and intranatal factors contributes to impaired cardiac hemodynamic adaptation. The babies who have been born via cesarean section and sustained hypoxia-ischemia constitute a group at risk for cardiac abnormality in different age periods.

The paper assesses the results of basic coagulation tests and the levels of factors VII, X, VIII, V, and I, protein C, antithrombin III, plasminogen, and D-dimer in babies who were born to mothers with physiological pregnancy and labor at 35—36 weeks' gestation and had no malformations in the early neonatal period. Early (in the first days of fife) hypocoagulation in these babies is shown to be retained during the early neonatal period, as shown by the activated partial thromboplatin time and prothrombin time tests, and to alleviate, as determined by the international normalized ratio. As compared with adults, the examined babies after birth exhibit a reduction mainly in factors VII and X, and, to a lesser extent, factor I; the levels of factors VIII and V did not differ, and there was a decrease in the concentrations of protein С and antithrombin III. Despite having lower plasminogen levels, the newborns are shown to have adequate fibrinolysis in the early neonatal period, which ensures hemostatic stability. The use of the given values will be able to improve the diagnosis of hemostatic disorders and to avoid decision delays in providing adequate care to premature infants.

The paper gives data on the characteristics of a neonatal period in infants following intrauterine blood transfusion for Rh-induced fetal hemolytic disease. It is shown that the early diagnosis and detection of the signs of fetal hemolytic disease, and intrauterine intravascular blood transfusion may prolong pregnancy, ensure the birth of a baby with normal anthropometric indicators, optimize his/her neonatal period and prognosis of severe hemolytic disease in the fetus and newborn.

Objective: to determine the effective dose and type of proton pump inhibitors in children with varying degrees of gastroesophageal reflux disease (GERD). Subjects and methods. One hundred and fifty-six children aged 9 to 17 years were examined. Therapeutic effectiveness was evaluated from clinical evidence, endoscopic results, and parietal pH-metry data. Group 1 consisted of 52 children who had received a proton pump inhibitor 0,5 mg/kg and a prokinetic; Group 2 included 56 children who had taken only a proton pump inhibitor 1 mg/kg; Group 3 comprised 48 children who had been on triple eradication therapy. In children with grade I GERD, the proton pump inhibitors in doses of 0,5 and 1 mg/kg were effective; however, their lower dosage increased the duration of a therapy cycle. In grade II GERD, the proton pump inhibitors in a dose of 1 mgAg promote the relief of clinical and endoscopic manifestations in shorter periods; preference should be given to esomeprazole. Therapy against Helicobacter pylori has a statistically more significant effect on trends in clinical manifestations and particularly in the endoscopic signs of esophageal injury. The key area in treating the disease in children is to eliminate enhanced gastric acid-producing function with proton pump inhibitors and to prescribe anti-Helicobacter pylori therapy, if indicated.

Serum ghrelin levels were determined in 164 children with primary hypertension. The investigators detected hypoghrelinemia that was more pronounced in children with stable disease and a body mass index of >85%e. Lower ghrelin levels were recorded in girls. There was no correlation between ghrelin levels and examined BP values. Eating disorders and established bad eating habits were found to favor the development hypoghrelinemia in children with primary hypertension.

Whether the type (ischemlc or hemorrhagic) of childhood stroke might be predicted from the obstetric/gynecological and perinatal history data (clinical notes from maternity hospitals, 43 indicators) of mothers and infants who had sustained hemorrhagic stroke (и=53), ischemic stroke (и=101), and transient ischemic attack (и=44) was assessed. The patients' families were interviewed using questionnaires to clarify information about family thrombophilic and hemorrhagic predispositions, the mothers were examined for carriage of 12 prothrombotic gene polymorphisms. The study showed the specific features of maternal pregnancy and labor and an adaptation period in infants with acute cerebrovascular accident; weak correlation pairs were recorded for each type of disease (r=0,41—0,58;/> <0,05); the probability of a correct recognition from this information was low. A set of maternal obstetric/gynecological, family, thrombophilic, and hemorrhagic history data and molecular genetic examination results has led to the statement of a prognostic rule that can recognize the type of cerebrovascular disorder with a high degree of accuracy, by using 13 indicators from the mentioned data block (hemorrhagic stroke (83,3%), ischemic stroke or transient ischemic attack (95,6%)). The developed prognostic algorithm may be used to seek groups at risk for acute cerebrovascular disorder in childhood.

The paper analyzes whether the basic provisions of the Federal Clinical Guidelines for the Diagnosis and Treatment of Obesity in Children and Adolescents may be and should be introduced into pediatric practice. The apphcation of these clinical guidelines will be able to unify approaches to diagnosing and denning the degree of obesity on the basis of body mass index and its standard deviation according to the WHO international measurement data with a possibility to calculate indicators, by using Anthro and AnthroPlus computer programs. To identify etiological factors and to detect complications according to the results of the recommended set of laboratory and instrumental examinations will promote the rational development of measures to treat and prevent this disease.

The paper presents the results of comparing the physical development, morbidity, and thyroid ultrasound findings of infants during the first year of life in relation to the quality of antenatal iodine prophylaxis. Group 1 consisted of 20 boys and 23 girls who had undergone optimal antenatal iodine prophylaxis with Iodomarin® initiated at less than 12 weeks' gestation and regularly used in a dose of above 200 ug/day; Group 2 included 26 boys and 23 girls with inadequate antenatal iodine prevention. In Group 1, intrauterine hypotropy was much less common in the girls at birth. By one year of fife, predominantly the boys in this group were taller than the infants in Group 2. Analysis of primary medical records indicated that Group 2 babies were more frequently diagnosed with perinatal central nervous system (CNS) lesion than Group 1 ones (61,4% vs. 37,5%). Thyroid ultrasound study performed at the age of 1 year in 18 and 19 infants from Groups 1 and 2, respectively, indicated no significant differences in the volume of the organ; however, its heterogeneous structure was found only in Group 2 (26,3%). The rate of perinatal CNS lesion and that of detection of the heterogeneous structure of the thyroid were directly dependent on the time to initiate iodine prophylaxis.

The paper provides the clinical and ettological characteristics of viral encephalitis in 103 children aged 1 month to 3 years and the results of a comparative study of the efficiency of recombinant interferon-a 2b (VIFERON®) as rectal suppositories incorporated into the combination therapy of the disease. The VIFERON® regimen and duration in the study were determined by the pattern of encephalitis. In the acute course of the latter, VIFERON® was given twice daily for 14 days; in its protracted or chronical course, the drug was used twice daily for 14 days, then thrice daily for 1 and 3 months, respectively. The administration of VIFERON® in viral encephalitis was established to accelerate sanogenetic processes and to reduce the time of progression and preservation of major extracerebral and cerebral symptoms and the length of sanitization of cerebrospinal fluid (CSF) and viremia. The use of VIFERON® resulted in better disease outcomes, prevented deaths, decreased the rate of an autonomic state from 8 to 1,8%, increased recovery rates without defects from 22 to 51%, and reduced the rate of cystic and gliotic changes in the brain by 2,1 times. Slower CSF sanitization and longer viremia were ascertained in children with chronic and protracted viral encephalitis, which necessitated the longer administration of VIFERON®. Incorporation of recombinant interferon-a 2b into the therapy of viral encephalitis in infants ensures higher serum concentrations of interferon-a and helps keep compensatory capacities for its production, leading to the promptest recovery. The findings suggest that the incorporation of VIFERON® as rectal suppositories into the therapy of viral encephalitis is effective and safe in infants.

In patients with cystic flbrosis, lower respiratory tract infections are characterized by a steadily recurrent and severe course. Recently, inhaled tobramycin has been successfully used to treat Pseudomonas aeruginosa-iniucei diseases in children aged over 6 years. In this trial, the E-test (Liofilchem, Italy) was employed to determine the antimicrobial activity of tobramycin against 40 P. aeruginosa strains isolated from 25 patients with cystic fibrosis in the period 2005—2009. At the same time MIC50 and MIC90 were 0,75 and 3,0 mg/ml, respectively. No relationship to patient age (and duration of P. aeruginosa colonization) was established. Tobramycin showed high activity in vitro against P. aeruginosa strains isolated from the patients with cystic flbrosis. The activity was related to the morphology of a strain and previous treatment with inhaled tobramycin. When initiating its inhalation treatment in cases of inoculation of moderately susceptible or resistant P. aeruginosa strains (according to the CLSI criteria), it is necessary to interpret their susceptibility test results by following the MENSURA Group criteria.

The article presents the results of studying the level of fluoride intake in relation to essential macro- and microelements in babies and young children, depending on the type of feeding. The content of fluoride and calcium in biological fluids (breast milk, urine) was determined in children aged one month to three years and in the nursing mother-child dyad. The excretion of fluoride and calcium in the urine and that of fluoride in breast milk necessitate the development of sociomedical interventions to prevent fluoride deficiency states in babies and young children.

The paper reviews the recent literature on vaccination against hepatitis В virus in the first 24 hours and on that against tuberculosis on 3—7 days of fife in all newborns, if not contraindicated. The question arises acutely as to how to organize effective vaccination in obstetric care facilities that concentrate high perinatal risk patients. Moreover, unfavorable external and internal factors change babies' immunobiological responsiveness — this cannot fail to affect the course of a vaccination process. Obviously, the tactics of im-munoprophylaxis in children with health problems should be individualized and include efforts to enhance the efficiency of vaccination and prevent possible complications.

Comments on the paper "Neonatal vaccination under present-day conditions: Relevance and safety" by N.V. Bashmakova, A.M. Litvinova, O.A. Kuznetsova

The paper presents materials on vaccination against tuberculosis in Russia. It shows the results of studies conducted by Russian scientists to elaborate different BCG administration regimens. The authors have established the need to keep the National Immunization Schedule under present-day conditions according to the age of a child and the epidemiological situation in the country. A special section is devoted to the occurrence of complications caused by the vaccine after tuberculosis. Based on the Federal Center's data on complications due to BCG/BCG-M, the authors provide information on the incidence and pattern of complications occurring in Russia. Cold abscesses are shown to be 3,3 times less frequently in the babies vaccinated in maternity hospitals than in those vaccinated in polyclinics. This has been evidence that the national schedule should be changed, by incorporating a BCG-M vaccine into mandatory neonatal immunization.