The paper gives an update on the health status of children who were born prematurely, particularly those who had low and extremely low birth weight, in late childhood. A range of unsolved problems in setting up a further follow-up system for babies in the first years of hfe and for preschool and school children is denned and the role of psychological and pedagogical assistance to the child and his/her family is discussed.

The paper discusses the sociomedical and economic efficiency of creating the so-called third nursing stage - outpatient follow-up. At this stage, attention is focused on the topical aspects relating to methodology for following up extremely preterm infants, such as a team of specialists within an interdisciplinary approach, a follow-up time in terms of the individual- and population- level health characteristics of these infants, and promises of their development and social integration. The problems common to Russian and world pediatric practice, which need to be solved within a collegiate approach under escort of this group of children, are indicated.

The previous requirements for baby foods are reconsidered with regards to the novel results of an investigation of breastmilk composition and properties. The need to switch babies over to formula feeding requires that the foods should be better manufactured and brought much closer to the milk of a breastfeeding mother. The possibility of optimizing the fat fraction of milk formulas for healthy babies is of particular interest. The adaptation of the fat fraction of milk formulas was previously aimed at fortifying the foods with essential polyunsaturated fatty acids, by removing butterfat completely and adding to the formula a complex of vegetable oils that are sources of arachidonic and docosahexaenic acids. Special attention is now drawn to the so-called minor components of the fat fraction of breast milk, its fat globules in particular, the core of which is present as hydrophobic triglycerides comprising 95-98% of the globules. The remaining 2-5% of the globules is the lipid-protein membrane that also contains small amounts of vitamins and enzymes. This membrane is named milk fat globule membrane (MFGM); its components are indispensable for the adequate development of a child. To fortify milk formulas with complex lipids as a MFGM component for babies during the first year of life is a promising area for the further improvement of the manufacture of infant foods.

Constipation in children remains one of the topical problems of pediatrics and pediatric gastroenterology. Functional constipation accounts for about 95% of its cases. The article deals with the main causes of constipation in babies. An algorithm for the management of an infant with functional constipation involves correction of infant feeding in addition to medical treatment. Dietary fiber deficiency in infants may cause constipation. That is why functional foods should be used for infant feeding.

The article provides information on the congenital heart disease coarctation of the aorta. It presents data on the prevalence of the condition discussed and describes its clinical symptoms and syndromes and methods for the diagnosis and correction of the defect. The possible causes of hypertension that is preserved after successful surgical correction are also suggested.

Urinary system diseases in children with differentiated connective tissue dysplasia have not been adequately investigated and the available information is extremely scarce. The diseases represent mainly minimal change disease as orthostatic proteinuria, microscopic hematuria, metabolic disturbances, structural (nephroptosis) and vascular abnormalities (aneurysms). Undifferentiated connective tissue dysplasia is an abnormality that is being actively explored by Russian investigators. Multiple organ dysfunctions attract the attention of physicians in many specialties, including nephrologists. Urinary system diseases as recurrent urinary tract infections, renal and calicopeMc malformations, bladder diseases, and severe congenital anomalies of the kidney and urinary tract (CAKUT) are often accompanied by the manifestations of connective tissue dysplasia. A number of authors have identified connective tissue disease markers (matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases, transforming growth factor-p etc.) to evaluate sclerotic processes in the kidneys. There are single studies of these markers in Alport syndrome or au-tosomal dominant polycystic kidney disease while such data on the differentiated types of dysplasia (Ehlers-Danlos syndrome, Marfan's syndrome) are unavailable.

The impact of spinal anesthesia and total intravenous anesthesia under mechanical ventilation on uterine-fetal-placental blood flow and neonatal status following cesarean section was evaluated in pregnant women with severe preeclampsia. Group 1 women («=45) were operated on under spinal anesthesia; Group 2 («=35) received total intravenous anesthesia under mechanical ventilation. A control group (Group 3) consisted of 50 pregnant women who had undergone surgical delivery for different indications. Spinal versus total intravenous anesthesia was ascertained to improve perinatal outcomes in pregnant women with severe preeclampsia, which is apparently associated with its favorable impact on uterine-placental-fetal blood flow.

The association of interleukin (IL) lp, IL-6, IL-10, and IL-18 gene promoter region polymorphisms was investigated in 50 newborn infants with intrauterine infections and in 76 healthy neonates. The allelic variants of the genes of these cytokine were established to be related to their production levels. The examined neonatal infants showed nucleotide sequence in the promotor regions of ILip gene at positions -31, +3954, and -511, IL-6 atpositions -174, -572, and -597, IL-18 at positions -656, -137, and +105, and IL-10 at positions —592, —819 and —1082. The single nucleotide polymorphisms (SNP) in the promotor regions the genes in the above-mentioned cytokines were found to influence their transcriptional activity, thus altering the level of the respective cytokines. The findings make it possible to use the results of identifying cytokine gene polymorphisms as a predictor of neonatal congenital infection.

The paper reviews literature data on the prevalence and causes of hypertension in athletes. It considers different points of view on the impact of regular physical activities on blood pressure levels. It also describes available diagnostic approaches to identifying and treating higher blood pressure in children and adolescents going in for sports. The authors give the results of their observations identifying hypertension and its risk factors in young athletes. They show it necessary to apply an integrated approach to diagnosing this condition in sports, by making 24-hour blood pressure monitoring, echocardiography, and exercise testing. Standards for a normal blood pressure response to graduated exercise have been developed in 12 -16-year-old athletes. Based on their own findings and Russian and foreign experience, the authors present an original algorithm for following up young athletes with hypertension.

The purpose of the investigation was to analyze the distribution of genotypes and allelic variants of the folate cycle enzyme genes in 102 children with congenital heart disease and functional single ventricle and in 89 healthy children. Wild-type MTHFR 677CC was found in 58 (56.9%) children with heart disease, the MTHFR 677CT heterozygous variant was present in 37 (36.3%), the MTHFR 677TT homozygous variant was in 7 (6.9%). Carriage of wild-type MTHFR 1298AA was observed in 45 (44.1%) patients with heart disease; that of the MTHFR 1298AC heterozygous variant was noted in 53 (52.0%) and the MTHFR 1298CC homozygous variant was seen in 4 (3.9%). MTR A27556G gene polymorphism in children with heart disease was distributed as follows: wild-type (AA) in 58 (56.9%) children; the heterozygous (AG) genotype in 40 (39.2%), and the homozygous (GG) genotype in 4 (3.9%). Examination of MTRR A66G gene polymorphism revealed wide-type 66AA in 19 (18.6%) patients, the heterozygous 66AG genotype in 58 (56.9%), and the homozygous 66GG genotype in 12 (24.5%). The genotype distribution did not differ from that in the healthy children. Regardless of the carriage of folate cycle enzyme gene polymorphisms, the plasma homocysteine level tended to increase in the group of patients with congenital heart disease. The mean homocysteine level was significantly higher in the carriers of the MTHFR genotype TT than in the children carrying the genotype CC: 9.0 and 6.3 umol/1, respectively (p=0.02).

A total of 150 Novosibirsk adolescents aged 15 to 17 years of both sexes (75 boys and 75 girls) were examined. The aim of the study was to identify the likely predictors of chronic somatic pathology in 15-17-year-old adolescents according to the data of a comprehensive survey involving the evaluation of physical, mental, and reproductive health. The use of a mathematical modeling method could provide logistic classification models to assess the risk of chrome somatic diseases in adolescents in relation to gender. Psychological factors are of precedence in the development of chronic somatic diseases in adolescents, which is important to be taken into account in the teaching, clinic;) I examination, and rehabilitation of children of this age.

The article deals with the important problem of metabohc syndrome and obesity and the need for atherosclerotic and diabetogenic risk stratincation in childhood and adolescence. To study the prevalence of components of the metabohc syndrome at a normal weight and to reveal metabohc phenotypes of obesity in Arkhangelsk schoolchildren, clinical and laboratory tests were used to examine 369 children and adolescents aged 10 to 15 years who were divided into groups according to the criteria of obesity and to identify different metabohc variants: metabohcally healthy normal-weight, metabohcally unhealthy normal-weight, metabohcally healthy obese, and metabohcally unhealthy obese subjects.
The important result of the investigation is the established fact that metabohc atherogenic disturbances are detected in a high proportion (43.82%) of individuals without abdominal obesity. These patients may represent a portion of the range of children and adolescents with insulin resistance syndrome, which is confirmed by the abnormal mean levels of triglycerides, high-density lipoprotein cholesterol, glucose, and blood pressure in the group of metabohcally unhealthy normal-weight children.
The study shows that the concept of early detection of predictive signs should be extrapolated to the entire pediatric population, regardless of the presence or absence of obesity when efforts are aimed at verifying the metabohc activity of different fat types. The metabohcally unhealthy normal-weight children require special attention and timely therapeutic and preventive measures as soon as any component of the metabohc syndrome is identified.

То prevent acute respiratory infections, related complications, and high death rates is one of the significant problems in the nursing of premature neonates, as well as infants with congenital heart diseases. Respiratory syncytial virus (RSV) infection characterized by a severe adverse outcome, primarily in high-risk children is particularly dangerous. The purpose of this investigation was to evaluate the efficiency of passive immunization with palivizumab (Synagis®) in neonatal and postneonatal periods in the Orenburg Region during the epidemic season. The infants were followed up in October 2013 to April 2014. Tolerability, morbidity, and mortality in the immunized infants and the organization of RSV-infection prevention in the region were analyzed. Immunoprophylaxis of RSV-infection was shown to be effective if healthcare facilities and services made well-coordinated and successive activities.

Objective: to study the clinical and diagnostic significance of urinary neutrophil gelatinase-associated lipocalin-2 (NGAL) measurement in children with urinary tract infection (я=15) and pyelonephritis (я=15). The patients' age was 1 to 16 years (mean age, 7.32+4.52 years). The diagnosis was verified on the basis of clinical and laboratory findings and medical history and instrumental examination data. Urinary NGAL levels were measured by enzyme immunoassay (a Bio\fendor Laboratory Medicine kit) and calculated with reference to mg of creatinine. Urinary NGAL levels were established to depend on the degree of renal parenchymal damage. The investigation showed a relationship between the excretion of NGAL during the acute phase of pyelonephritis and the detection of renal scarring, as evidenced by statistical DMCA nephroscintigraphy. The acute pyelonephritis group exhibited a moderate direct correlation between the renal excretion of NGAL and the degree of leukocytosis and the blood levels of C-reactive protein. The findings allow recommendations for measuring urinary NGAL levels as an additional noninvasive marker for the early detection of renal parenchymal damage.

Objective: to substantiate the importance of an etiological approach to diagnosing urinary tract infection in children in terms of the species and biological properties of an infectious agent and to evaluate the efficiency of anti-inflammatory therapy. The study included 116 patients aged 3-15 years with chronic pyelonephritis (Group 1) and isolated bacteriuria (Group 2). After 10-14-day antibiotic therapy, Group 1 patients were allocated to two subgroups: Subgroup la («=30) took furamag 5 mg/kg/day; Subgroup lb («=30) received furamag at the same dose in combination with canephron. The treatment cycle lasted 10-14 days. Subgroup 2a («=26) children had furamag 5 mgДg/day and Subgroup 2b (« =30) took furamag in combination with canephron. The duration of treatment was 14 days. The investigators established the high efficiency of therapy with furamag for renal infection in the children with the active and decrement phases and that of the drug of choice for its monotherapy of isolated highly virulent bacteriuria. Therapeutic efficiency was proven to be related to the species and biological characteristics of an infectious agent. Anti-inflammatory therapy for pyelonephritis in terms of the species of pathogenic bacteria was ascertained to improve the efficiency of treatment. A rationale was provided for the individual choice of antibiotics, followed by the use of furamag, eubiotics, and drugs aimed at inhibiting virulence factors and persistence of the pathogen to sanitize the primary focus of infection.