Background: Currently, analyzing the economic losses caused by health problems in population is of particular importance since it stipulates calculations of the volumes invested in healthcare systems in order to improve population’s health. Objective: The aim of our study was to find out economic losses caused by traumatic brain injury (TBI) in children. Methods: The given work has utilized governmental statistical reports for Russia, for federal regions as well as for individual subjects. Direct medical expenses (medical services) and indirect expenses (losses due to a temporary disability of parents having a sick child) were calculated both in general and per patient. Results: Among all the direct medical costs of treatment of children with TBI inpatient care costs account for 85%. In the Central and Volga Federal District accounted for half of nationwide spending in general, brain injury and to provide certain kinds of healthcare. The structure of Russian costs as a result of the incidence of TBI children Moscow accounts for 20%. In Moscow, the cost of treating cases of traumatic brain injury in children is 3.2 times higher than the average for Russia. The resulting calculations of the value of health care costs attributable to a case of child head injury, behind the cost of treatment of the case of a child with head trauma, calculated according to the standards of Russia and the territories. This difference in the whole RF is 23%. Conclusion: The obtained findings have shown that in 2010 in Russia the magnitude of losses caused by TBI incidence in children amounted to 3 billion roubles or 0.008% of the gross product 1.2 billion roubles of which were direct expenses. However, this figure is considerably lower of the real amount; it becomes evident after the analysis of direct medical expenses per one case of pediatric TBI. Our calculations have shown that in Russia and in its regions the amount of expenses per one TBI patient is a quarter less of the standard sum per one TBI case what is calculated according to factual parameters. The detected incomplete sum per one case of pediatric TBI, on one hand, may be explained by a high level of hospitalization of children with minor head injury. On the other hand, it may be a result of insufficient healthcare financing in regions as well as it may be explained by unaccounted expenses for medical care and drug coverage, especially in children with severe traumatic brain injury.

Postural disorders and scoliosis in adolescents are one of the most urgent problems of current pediatrics. The article presents the existing classification of postural disorders and scoliosis, describes modern diagnostics and methods for correction of functional disorders in the spine deformations of adolescents, and discusses the complexity of the rehabilitation process associated with low motivation of adolescents in the training process and solutions, including Tergumed 3D with biofeedback.

Prematurity and, as a result, the expressed morphofunctional immaturity of all body organs and systems makes an essential contribution to morbidity and mortality rates. The efficiency of care for prematurely born children in many respects depends on adequacy of the enteral and parenteral nutrition program. The balanced and correctly organized nutrition is one of the most important components of care for the prematurely born children, which defines both immediate and remote prognosis. The review of literature on parenteral nutrition in prematurely born children is given. The main indications, dosages, beginning time, and strategies for the appointment of «aggressive» nutrition are specified. Main conclusion: it is necessary to use higher doses for parenteral nutrition, and take into account that an early appointment of amino acids and fatty emulsions is important. An early ‘aggressive’ nutrition strategy is well tolerated by preterm infants and provides proper rates of physical development in the postnatal period without adverse outcomes.

Disturbed quantitative and qualitative characteristics of the intestinal microbiota are one of the reasons for the development of a wide range of pathological conditions in any age group. To correct these disorders, probiotics (active microflora drugs) and prebiotics (oligosaccharides that promote the growth of positive flora) are used. The use of metabolic prebiotics is also promising. Metabolic prebiotics are extracts of metabolic products of positive flora that, like the oligosaccharide prebiotics, stimulate the growth of the microbiota. Comparative analysis of the metabolome of some representatives of the intestinal microflora and preparations containing metabolic products of bacteria explains the mechanisms of their therapeutic effects and opens up prospects for the development of integrated treatment with the use of vitamins B6, B2, carotenoids, selenium, and glutathione. The results of the metabolome analysis suggest that the metabolites of the microflora representatives such as Escherichia coli, Streptococcus faecalis, Lactobacillus acidophilus, and Lactobacillus helveticus promote the survival of positive flora and at the same time can inhibit the growth of pathogenic microflora.

Modern successful treatment of rheumatic diseases is impossible without the use of intravenous immunoglobulin. The use of intravenous immunoglobulin is based on strict indications developed as a result of long-term multicenter controlled studies. The article highlights the issues of using immunoglobulin in pediatric rheumatology practice, and provides the review of literature with the results from the evaluation of the efficiency of intravenous immunoglobulin confirming the efficiency of the drug only for certain rheumatic diseases.

Treatment of juvenile idiopathic arthritis (JIA) is one of the most complex and urgent problems of rheumatology. Objective: We undertook a study to evaluate the effectiveness and safety of long-term therapy with etanercept in patients with JIA without systemic manifestations. Methods and patients: Patients in the study were divided into 2 groups. Patients of the main group (n = 197) received etanercept, the comparison group (n = 200) - methotrexate. The effectiveness was assessed by the American College of Rheumatology (ACR) criteria and Wallace's criteria for clinical remission (CR) and the 4-year JADAS71 index. Results: We included 397 patients with JIA. In 6 months and 12 months a remission of articular syndrome was detected in 72 and 53 patients respectively; 83% and 65% of patients receiving etanercert and methotrexate, respectively. Laboratory indicators of disease activity corresponded with reference values in 91 and 48% in a period of 6 months, in 12 months - in 94 and 68% of patients. According to the results of Childhood Health Assessment Questionnaire (CHAQ) functional activity fully recovered in 65 and 79%; 30 and 58% of children in a period of 6 and 12 months of follow-up. Within 1 month improvement according to ACR pedi criteria 30/50/70 was achieved in 79/62/34% of patients treated by genetically engineered biological agents. After 6 months AKRpedi criteria 30/50/70 was achieved in 97/96/89% and 63/57/47% against the background of therapy with etanercept and methotrexate, respectively. Etanercept induced inactive stage of the disease / remission [6 (4, 9) and 12 (6, 18) months; p <0,0001, respectively] in significantly shorter time than methotrexate. Within 6 and 12 months of follow up inactive stage of the disease / remission was reported in 30 and 49% of patients treated with inhibitor etanercept, and 9 and 38% of patients receiving methotrexate. Disease activity index JADAS71 in children treated with etanercept was significantly lower than in patients treated with methotrexate for 1 year. Conclusion: Etanercept has a significantly faster and more pronounced anti-inflammatory effect than the classic immunosuppressant methotrexate.

The introduction of tocilizumab — a drug that blocks interleukin 6 — into the practice of pediatric rheumatologists is an important achievement in the treatment of systemic juvenile arthritis (SJA). Objective: Our aim was to identify factors associated with the level of treatment response and safety of tocilizumab in the treatment of children with SJA. Methods: We examined children with SJA (n =49) who received tocilizumab from November 2009 to June 2014. The therapy efficiency was evaluated according to the ACR_pedi criteria. Results: The initial positive response to the tocilizumab therapy was found in 100% of patients. At the end of the five-year monitoring period, 38 patients were still treated with tocilizumab with the response of more than 50% according to the pediatric criteria of the American College of Rheumatology. Steady improvement reduced the dose of corticosteroids in all patients. The dose of corticoids was cancelled in 11% of patients and non-steroidal anti-inflammatory drugs were cancelled in 14% of patients. At the end of the study, 10 patients had an inactive disease status. The lower response to the treatment was recorded at the onset of the disease in children at the age of 3 and below and in patients with longer duration of disease due to the violation of the tocilizumab administration and dosing terms and late correction of the concomitant therapy. There were no differences in response to the therapy depending on the previous use of genetically engineered biological agents. The most common adverse effects were neutropenia and infections. The reasons for the withdrawal of tocilizumab were serious adverse responses (n =6) and termination of the therapy in regional centers at the place of residence for organizational reasons (n=5). Conclusion: If there are unfavorable prognosis factors (onset at the age of 3, formation of early polyarthritis, and polyserositis), tocilizumab should be appointed at earlier dates. Violation of the terms for the drug administration and late correction of the concomitant therapy reduce the efficiency of the drug.

The article discusses the most common causes and strategies for treatment of adhesive bowel obstruction and its timely diagnostics (which consists in the need for X-ray, ultrasound and endoscopy). It is shown that laparoscopic adhesiolysis in conjunction with anti-adhesion therapy not only minimizes complications in the postoperative period, reduces the time of hospital stay and ensures a good cosmetic result, but also helps verify the nature and extent of adhesions, as well as exclude the presence of other abdominal cavity diseases.

Insufficient control of many infectious diseases using etiotropic drugs determines the relevance of a search for alternative methods, in particular based on the modulation of the immune system. The review of recent literature analyzes rational approaches to the immunity dysfunction in frequently ill children. Attention is drawn to the fact that the use of immunomodulators reduces the frequency and severity of respiratory diseases and prevents complications. The article examines the advantages of the use of inosine pranobex that combines the properties of an immunomodulator and a direct antiviral activity. It is shown that inosine pranobex can be used for the prevention and treatment of respiratory infections in frequently ill children, and the rational schemes of its application are presented.

The system of blindness prevention and visual impairment in children with retinopathy of prematurity is a multidisciplinary medical problem, and includes the prevention of the preterm birth, the correction of terms of caring for premature babies, early detection, monitoring, and treatment of retinopathy of prematurity, as well as the organization of the long clinical supervision. Patients with retinopathy of prematurity need a comprehensive approach to the prevention of the visual impairment in order to ensure high functional outcomes and improve their quality of life.

Fever is a normal physiological response to illness in young children and it is often associated with a self-limiting viral infection. Fever is not a diagnosis, but a symptom of illness. A diagnosis of the underlying illness is essential to institute appropriate treatment. Although it is a normal response, that facilitates and accelerates recovery, some people, including many doctors, believe that fever should be treated to reduce temperature without determining the underlying illness causing the fever. Antipyretics should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature. This article aims to acquaint primary healthcare workers and general practitioners with last guidelines to assist the measurement of body temperature, deciding on when to refer and the appropriate use of antipyretic medication in children, efficacy and safety of paracetamol and ibuprofen in oral and rectal forms.

Bronchial obstruction is a widespread pathological condition in children. The development of this syndrome in bronchial asthma is caused by an allergic inflammation of the mucous membranes of the respiratory tract with the participation of leukotrienes. It is found that the blocking of leukotriene receptors using the montelukast drugs has a therapeutic effect, including in children at the age of 2 and above. The drugs are well tolerated by children, can prevent a post-exertional bronchospasm and in some clinical situations can be used as an alternative to glucocorticoids.

The article is devoted to the relevant problem of pediatrics - treatment of acute respiratory infections in children. It examines the feasibility of a comprehensive treatment of colds in children with mandatory use of non-sedating antihistamines that increase the effectiveness of conventional treatment and prevent the development of allergic complications.

Objective: The aim of our study was to compare the effectiveness and tolerability of desloratadine solution vs syrup formulation in children with atopic dermatitis. Methods: Children of the 1^st group received desloratadine solution and children of the 2^nd group received desloratadine syrup 1,25 mg o.d. in complex atopic dermatitis treatment including also topical therapy, diet and emollients, for 4 weeks. Results: 40 children 12 to 24 months of age with no more than 45 points on the SCORAD scale were included in open-label comparative randomized trial. Subjective atopic dermatitis symptoms, itch and sleep disturbance due to itching, most rapidly decreased after treatment beginning. At the end of the study, itch completely resolved in most patients. Other symptoms such as erythema, papules and skin edema, excoriations, crusts and exudation also decreased. The SCORAD index decreased from 35.9 to 3.45 points and from 34.9 to 3.45 points in the 1^st and the 2^nd treatment groups, respectively. Treatment tolerability was good in both groups. Conclusion: Desloratadine application in atopic dermatitis complex treatment is effective in children and gives possibility to reach a disease remission in most patients. We did not reveal significant differences in two desloratadine preparations’ (solution and syrup) effectiveness and tolerability.

The article is devoted to the relevant problem of pediatrics - treatment of acute respiratory infections in children. It examines the feasibility of a comprehensive treatment of colds in children with mandatory use of non-sedating antihistamines that increase the effectiveness of conventional treatment and prevent the development of allergic complications.

Some congenital malformations of the gastrointestinal tract in premature infants are difficult to diagnose due to a lack of specific clinical picture. As a rule, they are masked under necrotizing enterocolitis resulting in the improper management of such patients. The article describes two clinical cases of Hirschsprung's disease and neuronal intestinal dysplasia in newborns. Both cases were regarded as necrotizing enterocolitis of newborns resulting in tactical treatment errors. We made a conclusion that the surgical tactics for patients with congenital disorders of both the enteric nervous system and muscular intestinal wall tissue, which manifest themselves as enterocolitis or perforation, should be determined only when you are fully confident in the functional usefulness of all parts of the intestine.

The article describes the experience of the application of genetically engineered biological drug and an inhibitor of T lymphocyte costimulation – abatacept – at a standard dose in a child with polyarticular juvenile idiopathic arthritis. The disease was characterized by the development of uveitis, as well as the ineffectiveness of two inhibitors of tumour necrosis factor α treatment. Successful relief of acute inflammatory reaction of the joints on the background of the normalization of laboratory indicators of disease severity in the application of abatacept in combination with methotrexate was detected. The study gave the characteristics of the dynamics of clinical recovery of the patient and described the dynamic changes of clinical and laboratory symptoms. A steady improvement of the child under nine-month follow-up on the background of the selected scheme basic anti-inflammatory therapy should be noted.