Aim: to analyze the results of prophylactic follow-ups at the fixed periods of time of children of various age groups (younger than 1 year old, 1–14 years old and 15–17 years old) attached to Moscow municipal pediatric out-patient clinic №118 during 2007–2011 years. Patients and methods: methods of medical and mathematical statistics were used. Form № 31 «Information on medical care for children and school-aged adolescents» was used. Results: children population of the region was 10 000 on average. The data on children’s physical development since their birth and their distribution among health groups on medical examinations are shown in the article.  The majority of children (both boys and girls) had normal physical development; the prevalence of such children increased during the follow-up period. The number of preterm children has been decreasing. The distribution of children among health groups has stable pattern. More than a half examined children have the second health group, about one third — the first group. The authors showed dynamics of functional deviations (hearing and vision impairment, speech disorders and poor posture) in pre-school and school children. Conclusions: determination of children among the health group has a stable pattern; yearly the amount of children and school adolescents observed in out-patient clinics has been increasing; the prevalence of revealed on prophylactic examinations disorders has been decreasing, however, in an age aspect there is an increase of children with the above-mentioned disorders.

Progress of the modern medicine science and rapid development of perinatal technologies allow bringing up severely preterm infants with very low and extremely low birth weight. The significance of appropriate nutritive support for the preterm infants at the early stages of postnatal life is very high and to a great extent determines prognosis of their further development and survival. Taking into account a special biological value of the breast milk for preterm infants and an important role of the mother’s contact with her child during feeding, the efforts of the medical staff should be aimed at the maintaining of the breast feeding to the maximal extent. Introduction of the modern medical technologies of protection and support of the breast feeding into the practice of medical institutions allows increasing the prevalence of the breast feeding among the preterm infants. However despite the certain achievements in the field of modern management technologies aimed at the support of the breast feeding, the further investigations on adaptation of the principles of successful breast feeding under conditions of departments for preterm infants are demanded.

In the article latest published and presented data on 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) efficacy and effectiveness in different regions of the world overview is provided for prognosis of expected effect of Russian infants mass immunization as anti-pneumococcal vaccination has been included into the National immunization program in Russia since January 1, 2014. Based on analyzed data conclusion about PCV10 and PCV13 high effectiveness against invasive pneumococcal diseases (IPD) in 3+1 schedule has been made. PCV10 effectiveness against IPD in 2+1 schedule has been determined as 85,8% (Finland), for PCV13 — 100% (Norway). Serotype-specific effectiveness for IPD has been established for PCV10 only for serotypes 6B and 14, at the same time PCV13 serotype-specific effectiveness in 3+1 and 2+1 schedules has been established not only for PCV7-common serotypes, but for additional serotypes 1, 6А, 7F, 19А. In comparison with PCV7 efficacy and effectiveness against pneumonia and otitis media PCV10 has not shown additional benefits (in COMPAS and FinIP trials), at the same time PCV13 has demonstrated subsequent decreasing and additional effectiveness against these diseases (USA, Israel, France, Uruguay, Argentina, South Africa). Sustained and apparent statistically significant nasopharyngeal carriage reduction and herd effect (decreasing of IPD in non-vaccinated part of the population) have been established only for PCV13 (USA, England and Wales, Israel, France).

Aim: to assess efficacy and safety of «changeover» to the second genetically engineered biological agent (GEBA) in patients with juvenile idiopathic arthritis (JIA) with resistance or intolerability to the first GEBA. Patients and methods: the results of retrospective observational research of efficacy and safety of «changeover» to the second GEBA in 136 patients with various variants of JIA aged from 1 to 17 years old with primary resistance, partial effect or loss of efficacy to other biological agents are shown in this article. Among those 41 patient have systemic and 95 — JIA without extra-articular involvement. In 32 patients with JIA without extra-articular involvement the efficacy and safety of etanercept were assessed; in 63 — of adalimumab; in 22 patients with JIA and active extra-articular involvement — of tocilizumab, in 5 — of rituximab; in 14 patients with JIA without extra-articular involvement and active arthritis — of tumor necrosis factor (TNF) α inhibitors — adalimumab and etanercept. JIA was diagnosed according to the ILAR criteria. Results: in 6 and 12 months of treatment with the second GEBA inactive stage of disease / remission was detected in 65 and 84% of patients, respectively. In 13/22 patients with JIA and insufficient efficacy of rituximab remission was achieved in 24 weeks of follow-up after switching to the treatment with interleukin (IL) 6 receptors inhibitor, in 2/5 patients with resistance to tocilizumab — after switching to rituximab. In a year of treatment with etanercept as the second GEBA non-active stage / remission was induced in 100% of children with JIA without extra-articular involvement, in 85% — after switching to adalimumab, and in 100% of patients with JIA without extra-articular involvement — after administration of anti-TNF α-therapy. Conclusions: changeover to the second GEBA in patients with primary and secondary resistance or intolerability to the first GEBA allowed achieving of remission of systemic manifestations in patients with JIA and contributed to almost complete restoration of function in the joints in patients with JIA without extra-articular involvement and articular forms of JIA. Along with its high clinical efficacy the second GEBA was characterized by good tolerability and comparable safety profile.

Aim: cost-effectiveness assessment and budget impact analysis for 13-valent pneumococcal conjugate vaccine (PCV13) in infant immunization program in Russian Federation. Materials and methods: 10 year modeling with social perspective (direct medical and indirect costs and life expectancy with discounting by 3,5% per year) and population effect based on results of clinical studies, global PCV13 use and Russian epidemiological data has been established. Budget impact has been analyzed without discounting. Direct effect was assessed by influence on pneumococcal meningitis, bacteremia, pneumonia and acute otitis media (AOM) incidence, population effect — by pneumococcal meningitis and hospitalized all-cause pneumonia incidence. Results: Possible PCV13 effectiveness was estimated as 76,6% for invasive pneumococcal diseases (IPD) and 23,7% for hospitalized cases of AOM. Vaccination (per 100 000 vaccinated infants) can prevent 13,8 lethal cases in vaccinated population and 171,1 — in unvaccinated population. Cost-effectiveness ratio for PCV13 is estimated as 32,400 rubles / LYG and 32,400 rubles / QALY. Cost of 1 lethal case prevention is 140 100 rubles, additional cost for 10 years is 111,5 rubles per child. Conclusions: PCV13 mass vaccination of infants in Russian Federation is highly cost-effective and will significantly cut expenses due to pneumococcal diseases treatment.

Aim: to study the distribution of alleles and genotypes of polymorphic markers for immunoregulatory cytokines in the development of chronic pyelonephritis and its clinical variants. Patients and Methods: in this study we analyzed a sample of 99 patients with chronic pyelonephritis. The average age of the patients was 8,01±3,26 (3,00–15,00) years. The study of gene polymorphisms was performed using PDRF analysis. For PCR were used primers structures and genotyping conditions described in the literature. Results: the analysis of associations of 2 loci in the genes of cytokines with different complex phenotypes of chronic pyelonephritis demonstrated that A2 allele and genotype A2A2 of IL1RN*VNTR polymorphism is associated with chronic pyelonephritis, vesicoureteral reflux, secondary pyelonephritis, renal dysfunction, infection with Escherichia coli and Klebsiella. Genotype A2A2 of gene IL1RN*VNTR and allele A2 of gene IL1RN*VNTR are associated with impaired renal function OR =3,07 (p =0,001). The highest risk of chronic renal failure development is associated with A1A2 genotype (OR =22,94; p=0,001). Conclusions: the discovered associations require further confirmation on larger samples and various ethnicities.

The term catch-up growth is now widely used in neonatology and pediatrics to describe the growth of preterm infants. Catch-up growth — is a compensatory strengthening of the body's growth after a period of slow growth. The lower the gestational age of the premature baby, the more intense catch-up growth in the future.Catch-up growth is considered an important criterion for evaluating nursing preterm infants. Formation of catch-up growth is seen as a favorable outcome. Evaluation of catch-up growth is carried out with the use of percentiles and standard deviations (Z-score). Catch-up growth has a positive effect on neurological outcome. Catch-up growth achieved if the growth rates are between 5 and 10 percentile. The values of growth are satisfactory if they are located at the 10th percentile and above. Catch-up growth is achieved with a standard deviation greater than minus 2 (Z-score). The optimal parameters are considered indicators located within two standard deviations of the mean.Estimation of the growth should be carried out optimally weekly. Growth curves help to determine when the catch-up growth begins. After discharge from the hospital catch-up growth continues. Catch-up growth occurs within the first year of life. The critical period for catch-up growth are considered the first 6 months. Subsequently, the growth rate decreases. The growth is not sufficient, if the values are below the 3 percentile. About 50% of the causes impaired growth is due to the shortage of supply. Premature babies can have problems with food and after discharge from the hospital. The very rapid growth may lead to the development of metabolic syndrome in later life. Low birth weight is associated with increased risk of hypertension, stroke, and diabetes. Compensatory growth often occurs with excessive deposition of fat. In assessing the growth necessary to accommodate the growth of muscle mass and fat mass. Maintaining optimal growth rate is important for the prevention of metabolic syndrome. Requires a meta-analysis of all published growth curves for premature babies to determine the optimal postnatal growth.

Constipations in infants of the first months of life are an important problem due to their high prevalence. There is no organic cause of constipation in 90–95% of all cases, so the most common are functional constipations. As the main target in treatment of constipations in infants is normalization of the intestinal contents consistency and its movement through the large intestine, in order to correct this condition a complex approach should be provided with dietary treatment and as required — medicinal treatment and mechanical evacuation of the intestine contents. One of the main methods of constipations correction in infancy is dietary treatment, which has its own special characteristic according to the type of feeding and further when additional food is introduced. If infants are on breast feeding their mothers are recommended to add vegetable oils and dietary fibers into their diet. Children on artificial feeding are switched to milk formulas according individual clinical situation and associated manifestations — such as regurgitation, colic and cow milk protein intolerance. Patients with functional constipations are indicated medicinal mixtures and additional food with prebiotics (dietary fibers, lactulose, inulin). Clinical efficacy of children food enriched with prebiotics in treatment of constipations is confirmed in various studies.

The article contains analysis of results of mechanisms of action of immunomodulators. Research focused on one of these compounds — pidotimod. Pidotimod is a safe immunomodulator, which is both efficient in prophylactic use and as a medication in controlled trials with participation of a large number of patients. Pidotimod is ministerial to a faster disappearance of signs at the same time, the drug is capable of intensify functions of immune cells both in vivo and in vitro. The improvement of research methology and acquired knowledge of clinical immunology should be the starting point for new research on pidotimod that stimulate further clinical application for the prevention of acute respiratory tract infection in paediatric age.

Currently, scientists are continuing discussions on the definition of the precise level of vitamin D in the blood serum, but there is a consensus that vitamin D insufficiency is common throughout the world and has an adverse effect on human health. To make vitamin D provided all the necessary positive effects on the human body should maintain its status in the body at the proper level. That is why it is important to evaluate the content of vitamin D in the blood for the detection of insufficiency and deficiency.

Aim: to study characteristics of electrophysiological cardiac activity in children of risk groups and to assess possibilities of Holter-electrocardiography (H-ECG) in revealing of cardiac dysfunction during the period of early adaptation. Patients and methods: 250 newborns were examined. The main group consisted of 200 children with cerebral ischemia (CI). This group was divided into 2 subgroups: 100 full-term and 100 premature (at various gestation age) infants. Control group contained 50 children born at 38–40^th weeks of gestation with physiological course of pregnancy and delivery, APGAR score of 8–9 points. Complex examination included H-ECG according the standard technic with evaluation of the hearth rate (HR) during sleep and wakefulness; HR_min, HR_max; arrhythmias, conductivity disorders, duration of the intervals; rhythm variability. Results: according to the ECG children with CI, especially premature ones, and children delivered via Cesarean section more often had ST-T disturbances, arrhythmias (sinus tachycardia, less often — sinus bradycardia) and conductivity disorders, Q-Tc prolongation. H-EGC revealed decrease of sleep HR, HR_min and HR_max in children with CI especially in delivered via Cesarean section. The most common arrhythmia was supraventricular extrasystole.  Pauses in rhythms and variability were the highest in premature children delivered via Cesarean section. Conclusions: hypoxia/ischemia is a trigger for development of cardiovascular dysfuncion in newborns. Premature and children delivered via Cesarean section form a group of high risk. H-ECG widens possibilities of revealing of symptoms of cardiac dysfunction (disturbances at the basal level of functioning, of adaptation resources of the sinus node, electric instability of the myocardium and heart rate variability) in children of risk group for development of cardiovascular disorders.

Aim: to study safety and immunological efficacy of vaccination against influenza in separate and associated immunization according to the National Calendar. Patients and methods: 100 children with various disorders as well as children with HIV subjected to revaccination against diphtheria, tetanus, measles, parotiditis and rubella, were included into the study. Children were divided into 5 groups of 20 persons each: groups of separate or associated vaccination. In order to assess safety of vaccination children were observed for 30 days after vaccination. In order to analyze immunologic efficacy participants were taken serum tests before and on the 30^th day after vaccination. Results: the study demonstrated high safety of the vaccine against influenza. Mild and moderate topical and general reactions were observed in isolated instances and did not differ in comparison groups. Simultaneous vaccination against influenza with immunization against diphtheria, parotiditis and rubella did not influence synthesis of antibodies, while synthesis of antibodies against measles was decreased; immunization against diphtheria and measles when associated with vaccination against influenza depressed synthesis of antibodies against A/H3N2 influenza. Conclusions: vaccine against influenza has low reactivity, high safety and can be used in association with immunization according to the National calendar in independence to somatic disorders of patients.

Aim: to compare clinical efficacy and safety of sublingual and parenteral allergen-specific immunotherapy in children with pollinosis. Patients and methods: 143 patients with pollinosis aged from 5 to 16 years old were included into the study. They were divided into 4 groups and received allergen-specific immunotherapy. Patients of the groups I and III were administered water-salt mixtures of extracts of tree pollen allergens. Patients from the II group received standardized adjuvant mixture of extracts of tree pollen allergens. Patients from the IV group were administered standardized extract of birch pollen allergens. Prophylaxis with water-salt solutions was performed before seasons of increased allergy risk during 3 years in autumns and winters. Prophylaxis with standardized extracts of allergens was performed uninterruptedly for 3 years. Results: allergen-specific immunotherapy prevents increase of sensitization and enlargement of allergen spectrum of elevated organism perceptibility, as well as prevents aggravation of disease course and conversion to more severe forms. It also decreases requirements of anti-allergic drugs and therefore elongates the duration of remission. Conclusions: allergen-specific immunotherapy with the use of standardized allergens is the most effective method of treatment of pollen sensitization in children. In order to increase its efficacy not less than 3 courses of immunotherapy are needed.

A rare clinical case of stomatological maintenance of 11-year old boy with Lesch-Nyhan syndrome (primary x-linked hyperuricemia) is demonstrated in the article. In order to decrease trauma risk of oral cavity organs and soft tissues (due to autoagression) individual dentoalveolar occlusive mouthguards for the upper and lower jaws were used.  As a result of this procedure pain syndrome was arrested, the child became quieter and the possibility to provide him with individual education according to the specialized correction school program appeared. Usage of such palliative measures in severe clinical cases is a method of choice in the absence of positive effect of alternative methods of treatment.

A review of the results of clinical studies on the role of pathogenic bacterial microflora in etiology of chronic adenoiditis in children is shown in this article. According to the literature data the main cause of the development of chronic diseases of the nasopharynx in children is viral infection. The role of the bacterial microflora is secondary, but nevertheless significant. The main bacterial pathogens isolated from the nasopharynx of children with chronic adenoiditis are Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumonia. However there is significant dissociation in the prevalence of these bacterial agents according to the data of different scientists. Ability of the bacteria to produce biomembranes plays significant role in formation of persistence of the above-mentioned pathogens in the nasopharynx in chronic adenoiditis. Bacterial biomembranes as well as the revealing of the large amounts of bacteria within the tissues of adenoids determines discussions on possibilities of systemic and topical antibacterial treatment.

Cough is the main symptom of the respiratory tract disorders. Mostly it occurs in viral, bacterial and mixed (viral and bacterial) respiratory tract infections. The highest rates of respiratory tract infections are among children: it is known that children have respiratory tract infections 3–4 times as much as adults. Available drugs used in acute respiratory tract infections are numerous and various and cover almost all methods of influence on the infectious process. Nowadays the problem of usage of effective and at the same time safe agents in acute respiratory tract infections in children is very topical. The modern approaches to treatment of acute respiratory tract infections in children are discussed in the article. A special attention is given to symptomatic therapy. The authors describe the approaches to treatment of cough according to its character, intensity and other characteristics.