The questions of support of infants with complete and high-quality nutrition as a measure of national medico-social service when switching to artificial or mixed feeding are discussed in the article. The data on the main approaches to support of the infants of the first 3 years of life with specialized nutrition in the Russian Federation is represented. The authors describe such causes of inefficiency of activity of municipal «milk kitchens» as lack of standards for children food products, out of date production technologies, risk of contamination and of breaking the sanitary regulations, irrational usage of resources and low consumer qualities of the service. Necessity of development of new approaches to provide infants with free milk products is demonstrated. Branch target program «Bәlәkәch — Malysh» on free provision of infants of the first 3 years of life with special milk products and milk formulas on pediatrician prescriptions in order to improve the quality of life and health condition, patronized by the President of the Republic of Tatarstan, is characterized, as well as its first results are assessed in the article. The main directions of this program are listed. The comparative characteristic of certain indices of the new scheme of management of free milk nutrition for infants during the period of 2011–2013 are shown. The measures of this program aimed at widening of amount of children receiving free nutrition, increase of quantity of consumed milk products, ensuring of regularity of service, significant decrease of federal resources expenses and providing of precise compliance of standard expanses and improvement of the quality of milk nutrition for children through provision them with appropriate and high-quality products are proved to be very effective.

This literature review summarizes modern data on the issue of selective appetite in children. Selective appetite is a relatively new term, which does not have exact quantitative determinations. To this kind of children (with selective appetite) are usually referred those eating unvaried food and rejecting both known and unknown products. Prevalence of selective appetite in children depends on the used criteria for evaluation of this condition and varies from 8 to 60%. Such peculiarity of eating behavior tends to maintain during all childhood. According to different studies the decrease of intake of almost all macro- and micronutrients was established in children with selective appetite. Chronic nutrients deficiency in children with selective appetite can become a cause of physical development and cognitive dysfunctions. Nutritive support is recommended to such children in order to provide them with appropriate amounts of nutrients and normalize growth processes. Nutritive formula described in this article fulfills the function of «nutritive insurance», providing appropriate and balanced nutrition to children with limited diet. To resolve the problem of selective appetite the combined work of pediatricians, nutritionists and psychologists/psychoneurologists is required.

The prognosis of allergy to cow's milk protein allows to determine the length of elimination diet, and the timing of repeated prick screening for its expansion. Aim: to identify clinical and laboratory phenotype of patients with persistent cow's milk allergy. Patients and methods: the study included 52 children with allergy to cow's milk protein aged from 3 months to 5 years. The criterion for the development of tolerance to cow's milk was negative result of open oral provocation test with cow's milk. Results: tolerance to cow's milk occurred in 15 of 52 (28,8%) patients. Tolerance was achieved in 12 months in 10 children (19%), in 24 months — in 3 children (5,8%), in 36 months — in 1 patient (1,9%) and in 60 months — in 1 child (1,9%). In patients with persistent cow’s milk allergy the concentration of specific IgE to cow's milk protein was increased (p = 0,006) compared to a group of children who develop tolerance. Also in this group clinical course of AD (p = 0,01), sensitization to allergens of grasses (p = 0,006), sensitization to inhalant allergens (p = 0,04) and the presence of asthma (p = 0,037) were significantly more severe. Conclusions: in assessing the likelihood of development of tolerance to cow's milk protein it is necessary to consider not only the degree of sensitization to cow's milk protein, but also the severity of atopic dermatitis, the presence of asthma, sensitization to other allergens such as alimentary and inhalant ones. In patients with persistent allergy to the cow's milk protein development of asthma can be expected with high probability, which causes necessity of the providing of asthma prophylaxis in this group of patients.

Aim: to determine characteristics of the hepatic morphology in children with I, III and VI types of glycogenosis. Patients and methods: 50 children with glycogenosis (6 with type I, 18 with type III and 26 with type VI) aged from 1 to 17 (6,5±0,6) years old were examined. All children were performed hepatobiopsy with determination of the histological activity index and histological index of sclerosis (Desmet). Results: in 100% of the patients hepatic parenchyma resembled «vegetative» tissue. Inflammatory changes in the liver were absent in 66,0% of the patients and were minimal in 18,0% of the children. Perihepatitis was observed in 14,0% of the patients. High degree of histological activity was found in 2,0% of the children. Portal and periportal fibrosis was detected in 100% of the patients, porto-portal bridges — in 54%, porto-central bridges — in 6,0%, hepatic cirrhosis — in 20% of the children. On PAS reaction in hepatocytes of 100% of the patients were found irregular lump-like deposits of glycogen, which was washed out on control tests with amylase.  On assessment of progression of fibrosis in 3 children with VI type of glycogenosis different variants of the clinical course were observed. In 2 cases there was no progression of hepatic changes, in 1 case — there was worsening of the histological features. Conclusions: needle aspiration biopsy of the liver is very important in diagnostics of glycogenosis and allows to detect a number of specific changes, which is necessary for differential diagnosis, treatment choice and prognosis assessment.

Aim: to compare two methods of S. pneumoniae molecular typing: classic serological method and the multiplex polymerase chain reaction (M-PCR) assay modified in accordance to the date on the serotypes circulating in Russian Federation. Patients and methods: 420 pneumococcal isolates mainly from non-sterile loci were analyzed. After microbiological identification pneumococci were serologically typed with the means of specific antiserum produced by Staten Serum Institute (Denmark) in latex agglutination test and/or capsular swelling method. At the same time we performed series of the M-PCR, which consisted of 7 consecutive reactions at the most. Results: serotype was identified by the means of serological method in all 420 strains of S. pneumoniae; in total we determined 24 different serotypes. By the means of the M-PCR we succeeded in identification of 95% (399/420) examined strains, and 90% of them were typed during the first 3 reactions. All isolates failed to be typed by M-PCR (n =21) have serotypes not included into the composition of the M-PCR. The results of serological and molecular typing were identical in 99,2% (396/399) of the isolates; 3 strains showed contradictory results: serotype 19A was found on serological assay and serotype 19F — on PCR assay. Conclusions: the introduced modification of M-PCR allows correct identification of pneumococcal serotype more than in 90% of strains circulating in the Russian Federation, including all serotypes of pneumococcal polysaccharide conjugate vaccine.

Aim: to study defects of infants and pre-school children diet, which negative consequences are aggravated by unfavorable nature and ecological conditions of St. Petersburg region. Patients and methods: diet of 119 children (53 — aged from 2 to 3 years old and 66 — from 4 to 6 years old) visiting St. Petersburg pre-school institutions of 12-hours stay (including all additional food outside the institution) was analyzed.  Analysis of diet was formed by assessment of actual nutrition and supply of nutrients. Results: actual diet of infants and pre-school children was found to deviate significantly from recommended standards which lead to long-standing imbalance of the main nutrients intake. Many defects of the diet are maintained by specific negative factors of the habitat. Combined influence of such influence causes disturbances in development and increase of ecology-dependent disorders in children. Conclusions: in organization of nutrition of children living in unfavorable nature and ecology conditions account must be taken not only of age standards of nutrients and calories intake, but weather, nature biological rhythms and specific geological characteristics.

Inconsistency of the current classification of cerebral intraventricular hemorrhages is discussed in the article. The author explains divergence of including of the subependymal (1^st stage) and intracerebral (4^th stage) hemorrhages into this classification. A new classification of cerebral intraventricular hemorrhages including their origin, phases and stages is offered. The most common origin of intraventricular hemorrhages is subependymal hemorrhage (82,2%). Two phases of hemorrhage were distinguished: bleeding phase and resorption phase. Stages of intraventricular hemorrhages reflecting the blood movement after the onset of bleeding are the following: 1 — infill of the up to ½ of the lateral ventricles without their enlargement; 2 — infill of more than ½ of the lateral ventricles with their enlargement; 3 — infill of the IV ventricle, of the cerebellomedullary cistern and its dislocation into the subarachnoid space of the cerebellum, pons varolii, medulla oblongata and spinal cord.

Breast feeding has protective effect against certain diseases both in short and long-term prospects. On the contrary, artificial milk formulas (AMF) and especially when early introduced, is associated with increased risk of infectious diseases and also is a risk factor for development of metabolic syndrome, type 1 diabetes mellitus and cardiovascular disorders in further life. The role of cow milk protein intolerance in transformation of alimentary allergy into other forms of atopic disorders («atopic» or «allergic march») is actively discussed in the article. Protective role of prolonged breast feeding is a subject of wide speculation in this article; the authors also open a question of significance of early diet for human health at the population level and consider possible ways to minimize negative influence of AMF introduction. It is well-known that different AMF are tolerated by children in different ways, in spite of the adjacency of «table» compositions. This fact most often is associated to protein components of milk formulas, as it is the most susceptible during processing of raw materials. Under the influence of high temperature and pressure, which are used by all manufacturers during AMF production, proteins are denatured. Denatured protein obtains certain characteristics, which can change its assimilation and tolerability. Awareness of these characteristics allows the key manufacturers to produce AMF with protein components of a high quality.

Many aspects of pediatric dietology have been studied recently. According to them an optimal diet can be developed both for healthy children and children with certain nutritional requirements. However some issues of physiology of nutrition remain unsolved. In particular, the problem of formation of food preferences in infancy is widely discussed in scientific literature. The results of numerous researches suggest existence of certain critical period in infancy, when genetically-based food preferences are influenced by maximal exposure of external factors. The main role among such factors has the first experience of introduction of different tastes to a child during diet widening. This determines special attention of specialists to the problem of introduction of additional baby food and development of appropriate diet since the first months of life. The results of scientific studies clearly demonstrated, that balanced diet in the first years of life, developed according to the physiological requirements, health condition and national traditions, allows not only to provide optimal growth rate of a child, but to overcome the problem of the negative attitude to new food products.

This literature review contains analysis of research results on treatment of allergic rhinitis in children according to the evidence-based medicine. Oral and intranasal antihistamine drugs along with intranasal steroids are the first-line drugs for treatment of allergic rhinitis, although the latter are more efficient in suppression of nasal stuffiness. First- and second-generation antihistamine agents used nowadays in medical practice are discussed in the article. The advantages of non-sedative 2d-genereation antihistamine drugs, especially so called active metabolites (fexofenadine, cetirizine, levocetirizine, desloratadine) are emphasized. The data on loratadine and desloratadine as ones of the most effective drugs in childhood allergic rhinitis are shown in detail. The possible directions for the further investigations in order to provide effective control over allergic inflammation in children resistant to medicinal agents are discussed.

The problems of primary immunodeficiency in Russia and the ways of solving of them are discussed in the article. Primary immunodeficiency is a group of rare diseases, so awareness of this pathology in the medical community and among patients is very low. This leads to late diagnosis and inadequate treatment of patients with such conditions. The result of the late beginning of treatment is early development of disability, and the high mortality rate of patients, as well as the high costs of the treatment of complications of primary immunodeficiency and sick-leave certificates for the government. Today in time and adequate therapy allows patients not only to reach adulthood without signs of disability, and to lead an active way of life, but to have healthy children. Given the high cost of therapy in many countries, the issue of providing patients with life-saving drugs remains unresolved. The global practice is to involve social organizations and funds. One of the foundations supporting educational programs, development of laboratories and research in the field of primary immunodeficiency is the Foundation of the Jeffrey Modell. A network of centres for primary immunodeficiency supported by the Jeffrey Modell Foundation (JMF-centers) has started its functioning over the territory of the Russian Federation since 2011 in order to improve diagnostics and treatment of patients with primary immunodeficiency. A brief description of activity of these centers is presented in the article.

Acute infection of upper respiratory tract is one of the most topical medical and social problems: it is respiratory diseases that cause the majority of children’s and adults’ non-attendance of school lessons and working days. Childhood respiratory infections are characterized by prolonged clinical course. The most common causes of upper respiratory tract infections are viruses, such as rhinovirus, respiratory syncytial virus, influenza and parainfluenza viruses, adeno-, corona- and metapneumoviruses as well as Coxsackie virus and ECHO virus. Antiviral agents are efficient only when administered during first 24–48 hours from the onset of disease, and a number of such drugs have only specific activity, therefore the limitation of possibilities of etiotropic therapy of acute respiratory infections can be established. This often leads to excessive inappropriate usage of antibacterial drugs. Such symptoms as nasal stuffiness and cough which accompany acute respiratory tract infections, can significantly affect patients’ and his family’s quality of life. Symptomatic therapy is traditionally used in order to relieve these symptoms. The article contains data on potentials of one of such symptomatic drugs in treatment of upper respiratory tract infections.

Evaluation of the growth of premature children is of great importance in neonatology and pediatrics. Evaluation of the growth is carried out taking into account the corrected age of preterm infants. Correction is performed during the first two years of life. This is especially important for children born before 32–33 weeks of gestation and weighing less than 1500 g. Evaluation of the growth is carried out with the use of growth charts for premature babies. Growth curves contain three measurements: weight, height and head circumference. Today, there are several growth curves. Lubchenco curves (1963), the curves of Babson and Benda (1976) have been used for more than forty decades. Currently, they do not accurately reflect the growth of a premature baby. In recent years, modern growth curves have been developed. Modern curves are developed on the basis of larger groups, taking into account gender differences. Fenton (2003) proposed growth charts for premature babies. They consist of graphs of percentiles of weight, height and head circumference. Graph compares the growth of preterm infants with fetal growth from 22 weeks to 10 weeks of postnatal age. Gender differences have a significant impact on the growth of children. Fenton (2013) established growth curves for girls and boys. Boys have higher weight, height and head circumference than girls. In assessing the growth of the fetus and the baby after birth national and racial differences should be taken into account. The growth curves of the fetus and preterm infant are important for population health assessment and evaluation of individual growth. The growth curves are used to evaluate the child's performance at birth and for the assessment of the growth of the baby after birth. The growth curves are used in intensive care and pediatric units. In order to achieve adequate growth it is necessary to carry out the correction of regimen, nursing and nutrition of a child.

Juvenile arthritis — is the most common chronic rheumatic disorder among children, which causes rapid development of disability, decrease of the quality of life, social and psychological dysadaptation. In the majority of cases the main pathogenetic treatment is methotrexate, however when there is resistance or intolerability of this drug, therapy with genetically engineered biological agents is indicated. Aim: to develop measures of optimization of medical support for children with juvenile arthritis according to analysis of its medical and social as well as economic consequences at regional level. Patients and methods: the epidemiologic study included screening questionnaires of 43 907 children with subsequent examination of those of them with inflammatory swelling of the joints during 1 year. Formation of regional registry of children with juvenile arthritis has been performed in the Republic of Bashkortostan since 2003, regional component of the federal on-line registry has been functioning since 2011. The prevalence of juvenile arthritis, its social and economic consequences and the «costs of the disease» were established. In total there were registered 474 patients with juvenile arthritis, among them 62 receive treatment with genetically engineered biological agents. Results: an order of providing the children with juvenile arthritis with medical agents is established — in-patient treatment is performed within the framework of specialized (including high-tech) medical care; genetically engineered biological drugs for out-patient therapy are purchased at the expense of republican state resources in the network of the social support of certain population groups («regional benefit»).

Aim: to identify features of early neonatal period in preterm infants of women with fetoplacental insufficiency (FPI). Patients and methods: we conducted a retrospective study of early neonatal period in 76 preterm infants with gestational age from 28 to 36 weeks. Of these, 31 were born by women with FPI (study group) and 45 neonates from mothers without complications during pregnancy (control group). We analyzed course of pregnancy and delivery in both groups. Infant’s conditions were assessed using Apgar and Silverman Score. Neurological status, severity of respiratory and cardio-vascular failure were take into account in the first 7 days of life. Results: women with FPI had significantly higher levels of total extragenital pathology, hypertension was found only in mothers of the main group. The extent of Doppler abnormalities in most cases was light, while the most severe 3d grade was detected only in 4 women (12,9%), which had caused the birth of infants in severe asphyxia. Pathology of respiratory and central nervous system was dominated in preterm infants of both groups. Conclusions: the number of infants with serious conditions born by mothers with FPI is significantly higher than that determined by the deterioration of the utero-placental blood flow. Preterm neonates in women with FPI form a risk group of perinatal asphyxia.

Worldwide prevalence of oncology diseases among children under 15 years old is relatively low — 8,4 on 100 000 of children population (), but they are one of the most common causes of mortality in this population. Aim: to assess epidemiologic aspects of oncology and oncological healthcare for Tomsk region children population aged less than 18 years old. Patients and methods: the assessment was performed for the period of time between 2004 and 2011 based on population cancer-registry and specialized documents using methods recommended by P.A. Gertsen Moscow Scientific Research Oncology Institute. Results: prevalence of malignant neoplasms was 12,4 in children aged under 15 years old and 12,1in children aged under 18 years old. In the structure of oncology diseases among children aged from 0 to 14 years old the most common was hemoblastosis (51,9%), in adolescents aged from 15 to 17 years old — solid tumors (65,9%). Mortality rate was 4,5with predominance of solid tumors (58,3%) Conclusions: the low degree of active and early detection of oncology diseases points out the poor efficiency of the management of specialized healthcare at the stage of primary diagnostics. The authors explain the necessity of the offered measures aimed at prevention of malignant neoplasms in children and improvement of monitoring of the patients with such diseases.

Aim: to compare efficacy of one course of reflex-lead device (RLD) at standard regimen and at regimen of temporary aggravation of pathological placing of the lower extremities during the training of patients with spastic diplegia form of infantile cerebral paralysis. Patients and methods: children aged from 8 to 12 years old with moderate spastic diplegia were included into the study. The initial pattern of locomotion was characterized by cnemial flexion in the knee joints (n =61); among them 30 patients were applied correctional regimen of RLD, in 31 patient the severity of pathological placing of the lower extremities was increased by the means of traction of RLD. Results: after the treatment course (consisting of 20 sessions in RLD), ambulation of the patients in the group of correctional regimen of RLD (n =30) was characterized by the less diversity, while in the group of training aggravation of the pathological position of the lower extremities (n =31) more significant partial normalization of kinetic pattern of the articular angles in the lower extremities was observed. Conclusions: standard correctional regimen of RLD is an optimal method of neuromotor correctional training, while training aggravation of the severity of pathological positions of the lower extremities has better effects on modulation of locomotive stereotype and should be used in order to correction of ambulance in patients with independent ability to move.

Aim: to assess clinical course of various types of mycoplasma infection during the last epidemic (September 2012 – February 2013) according to the positive results of serological analyses. Patients and methods: 3553 laboratory tests were performed, 177 (20%) positive results of mycoplasma were detected. During the study clinical types, gender and age of patients were analyzed; special characteristics of clinical course of mycoplasma pneumonia were identified. Results: among 78 patients with pneumonia severe form was detected only in one. Twenty five percent of patients had ENT-diseases. The authors performed comparative analysis of antibacterial treatment (first-line and macrolides). The duration of X-ray changes depended on treatment scheme; the best results were achieved in children who were administered combined treatment with first-line (cephalosporin) and macrolide in suspension. Conclusions: during the period of 2012–2013 yy pneumonia has had a moderate clinical course, rarely — with complications. In 25% of children diseases of ENT organs were diagnosed. Mycoplasma was most often associated with chlamydia and types 1 and 2 of herpes simplex viruses, which is necessary to be considered in determination of therapy regimen. In treatment it is preferably to use combination of cephalosporin and macrolide in suspension.

Aim: to assess efficacy and safety of etanercept in treatment of various types of juvenile idiopathic arthritis in children under conditions of real clinical practice. Patients and methods: 52 children were included into the study, among them 16 were with systemic and 36 with juvenile idiopathic arthritis without extra-articular involvement. Results: etanercept treatment was the most efficient in patients with systemic juvenile idiopathic arthritis without extra-articular involvement. In 6 and 12 months of the treatment 50 and 70% improvement according to the ACRpedi criteria were established in 31/36 (86%) and 28/36 (78%) of the patients, respectively. In 24 months in 5 (29%) of 17 children remained in the study remission stage of the diseases was confirmed. Conclusions: etanercept treatment was not associated with significant unfavorable effects, which allows to recommend this drug for treatment of juvenile idiopathic arthritis without extra-articular involvent and resistant to standard anti-rheumatic therapy.

The results of the study on production of the protein spectrum by the dermal fibroblasts in relatively healthy children and children with Crohn’s disease during consecutive passages are shown in this article. Aim: to establish characteristics of protein spectrum of supernatants derived from the repeated cultivation of fibroblasts under normal and pathological conditions. Patients and methods: supernatants of 4 fibroblast cultures obtained from cutaneous tissue samples of 2 relatively healthy and 2 children with Crohn’s diseases aged from 14 to 17 years old were examined. The assessment of protein spectrum was performed by time-of-flight mass spectrometry MALDI-TOF (Bruker Autoflex, USA); phenotyping was performed by flaw cytometry assay (FACS Cantu II, USA). Results: 5 clusters of protein distribution according to the molecular weight were distinguished by the methods of statistical analysis:  from 0,8 to 3,3 kDa, from 3,3 to 6,0 kDa, from 6,0 to 11,0 kDa, from 11,0 to 16,6 kDa and >16,6 kDa. Proteinograms of patients with Crohn’s disease and relatively healthy children differ from each other. Conclusions: certain special features of proteomic profile, characterizing supernatants of fibroblastic cultures of children with Crohn’s disease were found. The established characteristics of proteomic spectrum of fibroblast secretory components can be used as marker of their activity at different stages of cultivation.

A history case of systemic juvenile idiopathic arthritis with early onset and severe clinical case, resistant to treatment with standard immunosuppressive agents is represented in the article. This case demonstrates high clinical efficacy of adalimumab in a patient with severe course of systemic juvenile idiopathic arthritis, prolonged remission of extra-articular involvement and persistent polyarthritis. By the 4^th week of the treatment inflammatory changes in the joints had arrested, range of motions had widened, laboratory markers of activity had normalized and non-active stage of the disease had been established. The duration of the remission of articular syndrome was 2 years, no relapses were observed during the follow-up period.

A short review on modern views on abatacept usage in treatment of juvenile idiopathic arthritis is shown in this article with highlighting of the high safety of this drug in accordance with severe opportunistic infections, including tuberculosis. The authors also discuss possibility of its usage in cases of inefficiency (intolerability) of tumor necrosis factor alpha in combination with methotrexate or as monotherapy. A history case of abatacept treatment of polyarticular type of juvenile idiopathic arthritis with risk factors of unfavorable outcome, severe associated disease and latent tuberculosis infection is demonstrated.

Inflammatory diseases of the respiratory tract are characterized by changes in rheological properties of the phlegm and lower of the mucociliary clearance. Adjustment of mucoregulatory agents is of a special significance in treatment of diseases of the lower respiratory tract in children. Aim: to assess efficacy of carbocysteine lysine salt monohydrate as a mucokinetic agent in children with respiratory tract diseases. Patients and methods: 65 children (31 girls and 34 boys) aged from 5 to 16 years old with acute respiratory tract diseases received treatment in Belgorod pediatric out-patient clinic № 4 were included into the study. The results of the clinical follow-up of these children are shown in the article. Results: carbocysteine lysine salt monohydrate was found to be effective and safe in treatment of acute and chronic inflammatory diseases of the respiratory tract in children. The authors observed quicker convalescence of the patients and possibility of combination of this drug with other medicines used in pediatric practice. Conclusions: the above-mentioned drug when used in combination with antibacterial agents intensifies penetration of the latter into the bronchial secretion and bronchial mucous membrane thereby increasing their efficacy. The drug does not have toxicity, is well-tolerated even when prolonged using and can be recommended for treatment of cough in children both under out- and in-patients conditions.

Keywords: children, respiratory tract diseases, carbocysteine.