The analysis of functioning of a medico-social health care department at a pediatric polyclinic of St. Petersburg is shown in this article. The data on efficacy of this department are represented. The necessity of its allocation as a separate unit, providing the organization of practical interaction between all of the concerned structures and institutions of social protection of children at difficult living conditions, is proved.

The data on goat’s milk composition, its physical and chemical as well as immunological characteristics in comparison with cow and breast milk are shown in this article. The authors discuss beneficial properties of the goat’s milk and goat milk formulas and the experience of their usage in healthy and ill infants as an alternative of the cow’s milk. The assessment of the modern adapted and differentiated according to the age groups goat milk formulas for infants is represented in the study.

The aim of this study was to assess different clinical and genetic, microbiological and functional features of patients with cystic fibrosis living in Moscow and Moscow region on the 31^st December, 2010. The mean age of the patients was 12,1±9,6 years (0,2–43,2), the median was 11,0 (16,0) years. Adult patients (older than 18 years) accounted for 30,6%. The diagnosis was established at the median age of — 1,0 (5,0) year; 3,8% of all the patients (12,4% of adults) were diagnosed during adulthood. The prevalence of the most common mutation in the world (F508del) was 52,96%, among adult patients it was mentioned a relatively high prevalence of «mild» genotypes. Among the microbiological structure of respiratory tract involvement a special interest has a high rate of Burkholderia cepacia complex infection (8,7%). A significant frequency increase of pneumothorax, haemoptysis, hypoxemic respiratory failure and diabetes mellitus with fasting hyperglycemia development were found, while the occurrence of hepatocirrhosis and portal hypertension is comparable between children and adult patients.

The results of the open controlled prospective clinical and immunological trial indicate that including of pidotimod into the complex therapy of pyelonephritis in children (n=30) lead to reliable decrease of recurrence risk and frequency during 6 months after treatment withdrawal in comparison with children receiving antibacterial monotherapy (n=20). The duration of etiotropic treatment for arresting of the active manifestations of urinary tract infection was lower in patients who were administered the afore-mentioned drug. Immunological monitoring of the urine cytokine status during pidotimod treatment showed that there were signs of T helper 1 cells activation predominance (increase in interferon/interleukin 10 ratio), as well as decrease in granulocyte macrophage colony-stimulating factor concentration, which seems to cause the delayed influence of the drug on the course of urinary tract infection.

Nutrition of children of the second and third years of life is a topical problem nowadays. The significance of this age period for the health level formation is very high. The authors show the method and analyze the first results of the epidemiological study of nutrition character and special features of 12–36 months old children in different regions of Russian Federation. The nutrition structure of such children demands a special attention from pediatricians. The received data require the further analysis and establishment of correlations between the disturbances in nutrition structure and estimated indicators of the main nutrients, energy, minerals and vitamins intake.

Management protocol for patients with juvenile arthritis was developed with the assistance of the workers from the two largest educational scientific research institutions — Scientific Centre of Children Health and I.M. Sechenov First Moscow Medical State University. The authors summarized international and their own long-term clinical experience and showed the modern data on etiology, pathogenesis, diagnostics and treatment of juvenile arthritis.

Cryopyrin associated periodic syndrome (CAPS) can be represented by various clinical variants of disease course with different severity of clinical manifestations — from mild to severe (FCAS, MWS, NOMID/CINCA). They are caused by mutations of NLRP3 gene, encoding cryopyrin. Mutations of cryopyrin gene in humans lead to excessive and accelerated production of interleukin 1b. The key role of cryopyrin in massive secretion of active form of interleukin 1b suggested the possibility of treatment aimed against this cytokine.

The lecture deals with the most common systemic vasculitis in pediatric practice — Kawasaki disease. This disorder is associated with risk of myocardial infarction and sudden cardiac death in children and young adults and at present is considered to be the main cause of the acquired heard diseases in children. The authors give historical aspects and modern opinions on etiology, pathogenesis, clinical manifestation, diagnostics and treatment of Kawasaki disease. The data were summarized from Russian and foreign literature as well as from the own authors’ experience.

An original concept of differential diagnostics of various conditions, referred by practitioners as «frequently ill children», is shown in this article, which represents a literature review and the authors’ own data. The followed-up «frequently ill children» are referred as heterogeneous group of patients according to the high rate (20–40%) of atopic diseases (allergic rhinitis, bronchial asthma) and variable frequency of primary immunodeficiency. The authors offered simple criteria for differential diagnostics and a scheme of history collection of frequently ill children, which contribute to timely diagnostics of allergic disorder or immunodeficiency. The article contains description of recurrent respiratory tract infections. The ontogenetic and constitutional prerequisites and mechanisms of development of recurrent respiratory infections in children are given in detail. Treatment and prophylactic measures are explained according to the group of frequently ill children and heterogeneity of recurrent respiratory infections causes.

Since the moment of its formulation, the concept of prebiotics was supported and developed by many researches across the world. The usage of prebiotics for the optimization of the intestinal microflora composition and, therefore, the strengthening of infants health has an increased interest both of scientists and pediatricians. In this article the authors give briefly account on the classification and characteristics of the most common prebiotics, making an emphasis on inulin-type fructans, and show literature and their own data on clinical assessment of different prebiotic products.

The process of milk formulas for infants production is complex and multistage and includes the thermal processing. There is data, that different regimens of thermal processing influence on the structure of the protein-carbohydrate complexes, which can affect the formula’s protein uptake. It was shown, that interaction between complex protein units of the formula and the cells of the Peyer’s patches increased the risk of allergic reactions development in infants with predisposition to atopy. The influence of denaturation of milk formulas on the tolerance of them is discussed in this article.

This study covers the problem of the optimization of protein intake by infants, the development of prolonged effects of inappropriate nutrition, comparative assessment of breast and cow milk protein, as well as the modern modifications of protein components of artificial milk formulas.

The article contains data about etiological characterization of respiratory infections, peculiarities of viruses and bacteria influence on the airway epithelium and human’s immune response. The main problems of respiratory infections treatment are considered. The article presents a review of mechanistic studies, efficacy and safety trials of the topical bacterial lysate in acute, recurrent and chronic infection respiratory and otorhinolaryngological diseases in children.

Various factors influence the characteristics of children’s health, among them the nutrition type and gustatory habits. Imbalanced nutrition in children not always affect their health, more often clinical manifestations develop during stress or later in life. Changing in the character of children’s nutrition with including of products containing all the micro- and macroelements, proteins, lipids and carbohydrates which are necessary for the growing organism can contribute to decrease the negative influence of different unfavorable factors and improve the characteristics of children’s health.

Despite the constant interest of the specialists to the problem of cough, it is still very topical, as the causes of cough are continued to study, the diagnostics algorithms to its detection and approaches to its treatment are defined. Different causes of cough development in children according to their age are discussed in this article, as well as the directions of the diagnostic search and approaches to the therapy of coughing syndrome in children are explained. A special emphasis is put on symptomatic drugs. The choice of drug depends on the type of cough, of its intensity and other characteristics.

The review of clinical trials, confirming high efficacy and safety of new inhalation glucocorticoid based on ciclesonide in treatment of childhood bronchial asthma is shown in this article. Ciclesonide is an extra-fine dispersed glucocorticoid with high pulmonary bioavailability (52%), 55% of it is distributed through peripheral respiratory tract, which plays significant role in development and clinical course of asthma. High anti-inflammatory activity, minimal systemic and local side effects and one-time administration per day make this drug usage preferable in pediatric practice.

The authors show the data on current microbiological pattern in children with acute and chronic respiratory disorders and dynamics of microflora susceptibility to the most frequently used antibiotics over recent years. The principles of antibiotic choice and control for their efficiency, peculiarities of their usage in children and the most common side effects are given. New aspects of the usage of combined antibacterial agents - ecoantibiotics – are discussed. Including of the Lactulose Anhydro into their composition allows to achieve high microbiological efficacy and does not cause antibiotic-induced diarrhea, which has a great importance in pediatric practice.

Unique experience of high-dose chemotherapy with consequent autologous hematopoietic stem cell transplantation in children with severe resistant multiple sclerosis (n=7) is shown in this article. At present time there is enough data on chemotherapy with consequent hematopoietic stem cell transplantation in children with severe resistant multiple sclerosis. This method was proved to be efficient and safe with immunoablative conditioning chemotherapy regimen. In patients included in this study the mean rate according to the Expanded Disability Status Scale was 5,94±0,2 (from 3 to 9) points. All the patients had disseminated demyelination loci, accumulating the contrast substance, in the brain and the spinal cord. After cyclophosphamide treatment in combination with anti-monocytes globulin the fast stabilization of the condition and prolonged (the observation period was 3-36 moths) clinical and radiologic as well as immunophenotypic remission with marked positive dynamics according to the Expanded Disability Status Scale were noted. No pronounced side-effects and infectious complications were mentioned. The maximal improvement according to the Expanded Disability Status Scale (EDSS) was 5,5 points, the mean — 2,7±0,1 (from 2 to 5,5) points accompanied with positive dynamics on the magneto-resonance imaging.  The efficacy of the treatment was also proved by the positive changes in the lymphocytes subpopulation status in peripheral blood. The timely performed high-dose chemotherapy with consequent hematopoietic stem cell transplantation is an effective and safe method to slowdown the autoimmune inflammatory process. This method can be recommended to use in treatment of children with severe resistant multiple sclerosis.

The authors analyze the indicators of physical development (body weight, body length, chest circumference) of Perm infants at the age from birth to 3 years old and show the rational percentile charts for the physical development of children at the age up for 3 years old assessment. The comparative analysis of physical development of infants in dynamics with the results of 1968 and 2008 examinations was performed. It was established that at present time the body length of infants at the age up for 3 years and the body weight of the infants at the age up for 6 months are higher than these characteristics at 1968.

Cystic fibrosis is one of the severe childhood disorders with early manifestation of multiple organ involvement. The respiratory and digestive tracts are suffered the most, the prognosis of disease course depends on the degree of the impairment of these systems.   The results of the analysis of cystic fibrosis prevalence in Primorsky Krai according to the neonatal immunoreactive trypsin screening in 102 251 newborn are shown in the article. The age, sex, clinical and severity structure of cystic fibrosis was studied in 71 children. The prevalence of 13 mutations of transmembrane regulator conductance gene in 41 patients was determined. Correlations between time of pulmonary complications manifestation, P. Aeruginosa infection development, chronic hypoxemia degree, malnutrition, genetic status and severity of the disease were found.

The results of auditory function assessment in children with intrauterine growth retardation are analyzed in this study. The audiologic examination with distortion product evoked otoacoustic emission and auditory steady state evoked potentials methods was performed in 49 preterm infants, born at the gestation period less than 32 weeks from the monofetal pregnancy, at the age of 3 months. The observed patients were divided into 2 groups: preterm infants with intrauterine growth retardation (n=25) and preterm infants with body birth-weight appropriate for the gestation period (normotrophic) (n=24). In the group of children with intrauterine growth retardation the amount of patients who did not pass the distortion product evoked otoacoustic emission test was higher than in the group of normotrophic preterm children. The analysis of the results of the auditory steady state evoked potentials in preterm children suggest that there is no reliable hearing impairment in preterm infants with intrauterine growth retardation in comparison with normotrophic age-matched infants. For the objective description of the auditory function in preterm infants with intrauterine growth retardation and normotrophic children born at the gestation period less than 32 weeks at the age of 3 months both afore-mentioned methods should be used.

The efficacy and convenience of topical antiseptic drug usage in treatment of acute pharyngitis, laryngitis and catarrhal tonsillitis in children are described in this article.

One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. Fecal elastase 1 is a good marker of pancreatic exocrine secretion. The aim of the study was to evaluate the pancreatic exocrine secretion in children with type 1 diabetes mellitus with fecal elastase 1 test to estimate the possible need for exogenous pancreatic enzyme replacement therapy. The exocrine pancreatic function was evaluated in 54 diabetic children on the basis of steatocrite test and a determination of fecal elastase 1 concentrations. Compared to the controls, the diabetic children had significantly lower levels of fecal elastase 1 concentration (p<0,001). Steatorrhoea was registered in all patients with fecal elastase 1 level < 200 µg/g stool. All those patients were treated with pancreatin (creon) for 1 month. A reduction of fat excretion was observed in the pancreatin treated group at the end of the study. Pancreatin replacement therapy can be used safely in children with type 1 diabetes mellitus associated with exocrine pancreatic insufficiency.

The authors describe the causes and mechanisms of development of intestinal colic syndrome in infants and give the approaches to treatment of this condition with modern anti-foaming agents on the base of simethicone.

The data on acute bacterial rhinosinusitis in children at the age under 1 year of life as one of the most difficult for diagnostics and treatment disorder are shown in this article. One of the main methods of treatment of this disease is usage of antibacterial agents — both systemic and topical. However choice of such drugs is complicated due to the age limits. Topical nasal spray with wide spectrum of bactericidal activity can be indicated in patients since birth. It significantly increases the efficacy of treatment and decreases the risk of complications. That is why it can be recommended for acute rhinosinusitis treatment in children of such age group.

Characteristics of a new probiotic — a biological additive, developed specially for children – and indications for its usage are shown in this article.

The prevalence of childhood neurological disorders associated with significant mental overloads, prolonged work with computers, intensified ecological pressure and inappropriate nutrition has been increasing recently. Polyunsaturated fatty acids (particularly ω₃) included into the composition of the modern vitamin-mineral complexes for children are to play the main corrective role in solving of this problem. Technological aspects of one of such complexes production process and assessment of its composition balance and nutrients’ concentrations are described in this article. The authors also give clinical cases of this medicine usage in children with symptoms of minimal cerebral dysfunction.