The article examines the modern data on the importance of breast milk in nursing premature babies. It is shown that the amount of breast milk in women, who gave birth prematurely, decreases rapidly, especially when it is impossible to get a baby latched on to the breast. There is a negative correlation between gestational age and duration of lactation. According to the opinion of both doctors and the majority of mothers, pumping out breast milk and using it in feeding a premature baby is an important psychological and physiological factor linking a mother and a child at the intensive care unit. Individual breast milk banks are a new safe and effective method for long-term keeping of breast milk.

Mucopolysaccharidoses are a group of hereditary metabolic diseases, relating to lysosomal storage disorders and caused by a deficiency
of the enzymes, involved in degradation of glycosaminoglycans (mucopolysaccharides). Severe forms of mucopolysaccharidoses of types I, II and VII and mucopolysaccharidosis of type III are characterised by primary central nervous system damage and neurodegenerative course of the disease with cognitive decline, behavioural abnormalities and decreased lifespan. Neuropathogenesis of mucopolysaccharidoses is not completely studied. The question of reversibility of cellular damage is still open. There is currently no effective treatment for mucopolysaccharidoses with primary central nervous system damage. Intravenous enzyme replacement therapy doesn’t cross the blood-brain barrier and has no influence on neurodegeneration. Investigation of alternative treatment options, providing delivery of therapeutic agent to central nervous system, is currently being carried out. Preclinical studies of highdose, intrathecal, intraventricular enzyme replacement therapy; administration of modified enzyme, capable of crossing the blood-brain barrier; gene, cell therapies, stop codon readthrough approach and substrate reduction therapy show promising results.

Legg–Calve–Perthes disease is a form of femur and hip joint pathology that belongs to the osteochondropathy group. The disease is caused by disorders of blood circulation and nutrition of articular cartilage leading to necrosis of the femoral head. The etiology of the
disease has not been clearly established yet. The destruction of the cartilage and bone tissue of the femoral head occurs gradually and is most often diagnosed in children over 5 years old. Since the identification of groups at risk for this disease is difficult, patients often seek help at the height of clinical manifestations, when the bone destruction is quite significant. Late treatment leads to the development of resistant strains of the femoral head, increasing the duration of treatment and reducing the quality of life of patients. The article presents the data of contemporary literature on the basic concepts of the pathology, its epidemiological and clinical features, and diagnostic and therapeutic measures.

Infantile colic is one of the main causes of pediatric consultation for parents complaining of the anxiety and vagitus of their baby. Some pediatricians are prone to undervalue this issue mainly because of the lack of evidence based medicine guidelines. Up to now, there is no consensus concerning management and treatment. As a rule, therapy involves dietary approach, usually based on the avoidance of cow’s milk proteins in breast-feeding mothers, and as for bottle-fed infants — the use of special formulas, such as partially hydrolyzed proteins, with low lactose added, with prebiotics or probiotics. Investigated pharmacological agents are simethicone and cimetropium bromide: the first is able to reduce bloating while the second could reduce fussing crying, but it has been tested only for severe infantile colic. The possibility of the intestinal microbiota correction by some strains of probiotics are being studied. The use of alternative treatment (phyto- and manual therapy, acupuncture) is still ill-founded.

Background: A promising approach to solving the problem of widespread infections of the respiratory tract in children is the use of
specific prophylaxis against the pneumococcus.

Objective: Our aim was to examine the clinical efficacy of PCV13 of children with chronic foci of infection in the nasopharynx and the changes of local factors of protection of the upper respiratory tract.

Methods: We have evaluated the incidence of respiratory tract and ENT infections in children with chronic diseases of the nasopharynx. Research period: January 2011 — January 2015. Upper airway function examination included cytologic analysis — counting the main cell populations ratio in the common cytoplasm, lysozym activity and secretory immunoglobulin of class A (sIgA) in nasal secretions.

Results: The study involved 876 children 2–5 years old. Main group (PCV13) amounted to 448 patients, and the control group (unvaccinated) 428. Annual dynamic observation showed a significant reduction of acute morbidity by 2 times (p < 0.001), pneumonia by 2.4 times (p = 0.042), acute bronchitis by 2.5 times (p = 0.008), concomitant ENT pathology (acute otitis media and acute exacerbations of chronic sinusitis) by 2.2 times (p = 0.001) and 2.3 times (p = 0.004), respectively. There was a positive effect of vaccination on the level of local factors of protection of the upper respiratory tract (lysozyme, sIgA, the somatic cell count in nasal secretions).

Conclusion: PCV13 vaccination reduces the risk of developing acute respiratory infections and ENT infections in children with chronic diseases of the nasopharynx. This is against the background of recovery in the levels of factors of local immunity.

Objective: Our aim was to objectify structural changes in small intestinal mucosa in patients with celiac disease, with defining criteria of regeneration process forecast.

Methods: We conducted an observational, retrospective, analytical study of «case-control». The research presents results of histologic, histochemical, immunohistochemical and morphometric analyses of the small intestinal mucosa in children with proven cases of celiac disease before/after a gluten-free diet. The state of main cell types providing a structural mucosa homeostasis and their impact on the remodelling of hystoarchitecton type of atrophy was studied. Two clinical groups were formed: group I — with a complete recovery of the small intestinal mucosa (n = 10), and group II — with a permanent hystoarchitectonics disturbance (n = 7), which were put to a comparative morphometric test.

Results: Installs: cytoarchitectonics recovery against the background of diet accompanied by a decrease of between epithelial lymphocytes to 12% (p = 0.002), eosinophilic granulocytes to 0.36 cells per mm2 (p = 0.003), plasma cells — up to 1.9 cells per mm2 (p = 0.003), increase in the number of fibroblasts to 1.64 cells per mm2 (p = 0.003), and leyomiotsitov — up to 6 cells on villi (p = 0.002). If persistent structural violations against the background of positive dynamics of the diet was to reduce the number of eosinophilic granulocytes to 0.41 cells per mm2 (p = 0.009) and plasma cells per 2.9 mm2 (p = 0.009).

Conclusion: Persistent mismatch between the cell elements — epithelial, stromal cells and smooth muscle cells in the lining of the small intestine — initially hinders the successful course of the reparative process and prolongs recovery structure of small intestinal mucosa of celiac disease.

Irrigation therapy aimed at effective cleansing of the nasal cavity and elimination of pathogens and allergens is included in the standard combined treatment of diseases of the upper respiratory tract accompanied by various forms of rhinitis or its symptoms. Isotonic saline solutions used for irrigation therapy moisturize the nasal mucosa and maintain its normal physiological state. Hypertonic saline solutions reduce swelling of the nasal turbinates by reducing the nasal obstruction and greatly improve mucociliary clearance as compared to isotonic solutions, but may have a cilitoxic effect. The article discusses the results of using the drugs with different concentrations of salts for irrigation therapy of the nasal cavity.

Osteoporosis in children is an urgent problem, since it occurs at different ages. The main risk factors and causes of primary and secondary osteoporosis in children include exogenous and endogenous, modifiable and non-modifiable factors. Critical age periods of childhood characterized by a high risk of reduced bone mineral density and fractures are specified. The article describes the biological effects of calcium, vitamin D and osteotropic trace elements and shows their role in osteogenesis and bone remodeling. It also presents the results of the study of reduced bone mineral density in children, the data on the availability of vitamin D for children at different ages, and provides recommendations for treatment.

The article provides information on the unfavourable course of systemic onset juvenile arthritis, resistant to immunosuppressive therapy with methotrexate in combination with cyclosporine, and pulse therapy with methylprednisolone and methotrexate. We describe the successful use of genetically engineered biological drug tocilizumab in the patient with systemic onset juvenile arthritis. After the first injection, pain was already significantly reduced; after the second, fever was relieved and non-steroid anti-inflammatory drugs were cancelled; after the third, lymphadenopathy and splenomegaly disappeared and the child’s functional activity improved significantly. After 12 months of treatment, an inactive phase of the disease was achieved, the joints’ kinetics (with the exception of the right hip) were almost entirely restored and the patient’s quality of life had significantly improved. At the same time, metabolic disorders and changes in the cardiovascular system were reversed. This example demonstrated the high effectiveness of interleukin-6 antagonist tocilizumab in systemic arthritis, which allowed arresting joint affection as well as extra-articular manifestations of the disease, providing normal puberty, the restoration of growth and sexual development.

The problem of clinical polymorphism rises sharply in the diagnosis of the conditions which are manifested by a floppy infant syndrome.
It hasn’t nosological independence, its main clinical markers are nonspecific, and the course and outcome are variable. Diffuse muscular hypotonia can be a symptom of the majority of somatic and neurological diseases of infants, for example, genetic metabolic diseases, and degenerative diseases of the nervous system. Topically it is possible to classify it by levels of lesions to hypotonia of the central and peripheral origin, as well as to identify a number of criteria for their differences. This article describes the clinical cases of children with a floppy infant syndrome illustrating hypotonia of the central and peripheral lesion levels. It is described the opportunities and difficulties of the differential diagnosis, given the family history, prenatal and perinatal factors, the time the clinical picture manifestation. Different treatment strategy and prognosis of the opportunities in conducting habilitation determine the importance of the establishment of the topical level of the lesion. Due to the clinical significance of the floppy infant syndrome we should attract the attention of pediatricians, neurologists and parents to the question of determination of this syndrome in a child in order to promptly begin searching the causes of the condition and the complex therapy.

There are about 11–15% of non-Hodgkin's lymphomas, among all cases of hematological cancer, which derive from B and T cell lines, in children. Non-Hodgkin's lymphoma from the differentiated B cells is the most frequent clinical entity of lymphomas in children; Burkitt's lymphoma is the most common type of non-Hodgkin's lymphoma. The proliferative capacity of Burkitt's lymphoma is one of the highest in pediatric oncology: the potential time of tumour load duplication may be about 12 hours; Burkitt's lymphomas are marked by the highest malignancy and different systemic symptoms. Therefore, pediatricians of different specialities should have oncologic vigilance; clear and quick diacritic and therapeutic management should also be established by the pediatric oncologist or hematologist. Two clinical cases of B cell Burkitt's lymphoma in children of different age, and the initial status of a patient, are described in this article.

The article describes the results of the treatment of children aged 7–15 with allergic rhinitis during the acute phase of the disease. It compares the clinical efficacy of desloratadine monotherapy in children with intermittent seasonal allergic rhinitis, persistent allergic rhinitis, and persistent allergic rhinitis with non-acute asthma. It was found that the immunoglobulin concentration in nasal secretions changes when treating children with seasonal allergic rhinitis. The results obtained can be used in assigning patients with allergic rhinitis to treatment.

Acute and recurrent respiratory tract infections in children are often the reason for seeking medical help. Frequent and prolonged respiratory infections in childhood may lead to the subsequent formation of chronic respiratory diseases in adults. Susceptibility to respiratory infections is common in children with allergic diseases and other chronic diseases accompanied by a decrease in immune reactivity. In the case of acute respiratory infection, these patients, in addition to the basic treatment of the underlying disease, have to take additional cough medicines that increase the pill burden on the body. The main causative agents of acute respiratory infections are viruses. Inosine pranobex is a drug with antiviral and immunomodulatory effects. The article describes the pharmacological properties and the results from studying the efficacy of inosine pranobex in the treatment of acute respiratory viral infections in children.