The article focuses on the role of the State Research Institute of Maternal and Child Welfare as the lead establishment and of the Kuibyshev Regional Scientific-Practical Institute of Maternal and Child Welfare in the creation of maternal and child health care service in the Soviet Union during 1922–1940. It also presents the scientific-practical, educational, organizational-methodological activities of the central and peripheral institutions, their comparative characteristics and contribution to the creation of a broad network of institutions for maternal and child welfare (nurseries, maternity welfare centres, baby food centers, social-legal offices) and the reduction of morbidity and mortality of infants and young children.

Acute post-streptococcal glomerulonephritis is the most common form of glomerulonephritis in children, continues to be a major concern for pediatricians and nephrologists worldwide. The disease is caused by prior streptococcal infection caused by -hemolytic streptococcus of A group. Nephritis-associated plasmin receptor and streptococcal pyrogenic exotoxin B are considered to be major renotrophic antigens. Clinical findings of the disease can vary from asymptomatic gross hematuria to the full-blown acute nephritic syndrome (edema, gross hematuria, hypertension, renal failure). The main laboratory findings of acute post-streptococcal glomerulonephritis include an abnormal common urine analysis (dysmorphic erythrocytes, varying degrees of proteinuria, red blood cell casts, and segmentonuclear neutrophils), an elevated titer of antibodies to antistreptococcic antigens, and hypocomplementemia. Treatment of patients is mainly supportive and is focused upon the elimination of hypervolemia and its complications (edema, hypertension). In this situation, the most effective agents are loop diuretics and antihypertensive agents. The prognosis in children is generally favourable. The review analyses the current understanding of the pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of acute post-streptococcal glomerulonephritis.

The article presents the current data on the pathogenesis, features of clinical manifestations, and diagnostics of different variants of chronic non-bacterial («sterile») osteomyelitis (CNO). The inherited forms of the disease, such as syndromes of deficiency of the interleukin-1 receptor antagonist (DIRA), sterile pyarthrosis with pyoderma gangrenosum and acne (PAPA-syndrome), dyserythropoietic anemia with chronic non-bacterial osteomyelitis (Majeed-syndrome) are described. The pathogenesis of CNO and related diseases is based on hyperproduction of proinflammatory cytokines, particularly of interleukin-1β and tumor necrosis factor-α. Based on the literature data and our own observations, the recommendations for diagnostics and treatment of CNO are presented.

The discourse characterizes types, causes and key links of the pathogenesis of different types of hypoxia, their main manifestations and mechanisms of their development, disorders in the body under hypoxic conditions, principles of their elimination. The mechanisms of a body adaptation to acute and chronic hypoxia, as well as the idea of its superoxygenation are described.

Objective: Our aim was to study features of the drug therapy of children with systemic juvenile idiopathic arthritis (sJIA).

Methods: We conducted a retrospective data analysis included in the Register of sJIA cases, for the period from 2002 to 2015.

Results: The indicators of 384 children with sJIA are studied. Prior to the diagnosis verification, all patients were prescribed to intake antipyretic agents, 98% — antibiotics. After the diagnosis, non-steroidal anti-inflammatory drugs (NSAIDs) were intaken by 282 (73.4%) patients: diclofenac sodium — by 163 (40.1%), nimesulide — by 88 (22.9%) patients. The average duration of NSAID intake from 2002 to 2015 decreased from 81.5 ± 115.3 to 3.3 ± 3.7 months (p < 0.001). Prior to the diagnosis verification, glucocorticoids were received intravenously or intramuscularly by 265 (69.0%) patients, orally — 176 (45.8%). Totally, glucocorticoids were received by 330 (85.9%) patients: methylprednisolone — 300 of 384 (78.1%), prednisolone — 174 (45.3%), there were totally 1855 prescriptions in 668 patients. The average duration of glucocorticoid intake from 2002 to 2015 decreased from 13.7 ± 26.7 to 5.0 ± 3,8 months (p < 0.001). As a disease-modifying drug, methotrexate was intaken by 237 (61.7%), Cyclosporin — by 193 (50.6%) patients. There were totally 809 prescriptions of genetically engineered biological preparations (GIBP) in 430 patients: in 2002–2005–8, in 2011–2015–602 in 397 patients (p = 0.001). Tocilizumab is intaken by 210 (52.9%) of 397 patients, kanakinumab — 37 (9.3%) patients. The disease duration from the manifestation to the prescription of immunosuppressive drugs from 2002 to 2015 decreased from 27.3 ± 23.9 to 1.0 ± 0 months (p < 0.001), GIBP prescriptions — from 70.7 ± 26.3 to 0.5 ± 0.7 months, respectively (p < 0.001).

Conclusion: In 13 years there have been positive changes in the antirheumatic therapy in children with sJIA — the duration of NSAIDs and glucocorticoids intake reduced, the period between diagnosis verification and immunosuppressants and GIBP prescription decreased. However, it is still widely used antibiotics, non-selective NSAIDs and glucocorticoids.

Background: Probiotics are widely used in pediatrics for correcting the intestinal microflora. However, the recovery of metabolic activity of the obligate intestinal microflora has vital importance.

Objective: Our aim was to study clinical efficacy of a multi-strain probiotic in functional disorders of the gastrointestinal tract (GIT) and its effect on the metabolic activity of the intestinal microflora in infants.

Methods: The comparative placebo-controlled study included children aged from 2 weeks to 6 months with functional GIT disorders. The duration of follow-up was 21 days. We analyzed the dynamics of symptoms of functional GIT disorders, as well as indices of the metabolic activity of the intestinal microflora on the basis of GLC results of fecal samples.

Results: The main group (received multi-strain probiotic) comprised 30 children, the placebo group — 15 children. Initially, intestinal colics were noted in 21 (70%) children from the main group, and in 11 (73%) — from the control group. After multi-strain probiotic intake, intestinal colics kept in 3 (10%) children from the main group, and in all children from the placebo group. At the baseline, posseting was noted in 1/3 of children from the main group and in 3 (20%) patients in the placebo group. After 2 weeks posseting occurred only in 3 (10%) children from the main group. In the placebo group the posseting frequency did not change. After probiotic intake, 24 (80%) children had semi-liquid feces, in the placebo group stool disorders (loose stool, watery diarrhea or constipation with the need of voiding after enema) were reported in 13 (87%) children. While intaking the multi-strain probiotic, a tendency to restore the activity of the obligate colonic microflora, to reduce the activity of facultative and residual anaerobic and aerobic microflora was noted.

Conclusion: The multi-strain probiotic can be recommended as a preparation of correction of functional disorders of the GIT and metabolic activity of the intestinal microflora in infants.

Background: Diagnosis of serious bacterial infections (SBI) in young children is a difficult task for pediatricians.

Objective: Our aim was to determine regularities of the change of hemogram indicators and serum markers of inflammation for the differential diagnostics of SBI in children under the age of 5 years.

Methods: The comparative retrospective study is carried out. We analyzed diagnostic characteristics of laboratory markers of SBI during the examination of 306 children with pyretic fever. We determined the number of leukocytes, neutrophils, immature granulocytes, reticulocyte hemoglobin equivalent, C-reactive protein (CRP) and procalcitonin.

Results: The study of CRP content has the greatest diagnostic accuracy at differential diagnostics of SBI in children with infectious fever at the height of disease. It is established that the positive result of CRP ( 37 mg/L) increases the probability of SBI in patient from 17.6% to 70%, and the negative result (< 37 mg/L) reduces the probability of SBI to 4%.

Conclusion: Cut-off values of the laboratory parameters obtained in our study can be used when assessing the post-test probability of SBI in children with infections accompanied by pyretic fever.

The evaluation results of an impact of various patterns of the introduction of complementary food products on the eating behavior formation, motor function of the gastrointestinal tract and nutritional status of infants are presented. 50 children of the main group received the manufactured complementary food, 46 children of the control group were fed by home-made products. Children in groups were matched by sex, age, and weight-height criteria. The criteria for tolerance of the introduced products were appetite changes, refusal to eat the product, condition of the skin and visible mucous membranes, occurrence or worsening of posseting, colics, flatulence, changes in frequency and consistency of the stool. The period of adaptation to the introduced complementary food products ran within normal findings in most children of both groups. It is shown that the use of the manufactured content-balanced complementary food, as well as the optimal algorithm of their introduction ensure the «levelling» of indices of children's condition of flesh. In addition, by the end of the third month of receiving complementary food products almost all existing syndromes of functional disorders of the digestive system were completely arrested, except for posseting syndrome. The introduction of the studied complementary food products reduced more than twofold the incidence of this syndrome. Food intolerance reactions occurred with almost equal frequency in children of both groups, but they were lighter in the main group. Thus, the use of the studied complementary products in the food ration of infants provides the «leveling» of indices of condition of flesh, normalization of the gastrointestinal tract functions, allows to create the proper eating behavior and reduces the risk of intestinal tract colonization by pathological species of microorganisms.

In Russia, the interleukin-1 inhibitor canakinumab (fully human monoclonal antibodies to interleukin-1) is increasingly used for treating autoinflammatory diseases and systemic juvenile arthritis (sJIA). The article describes the experience of administering canakinumab in patients with autoinflammatory diseases (n = 12) and sJIA (n = 7), the efficacy and tolerability of the drug are analyzed. Canakinumab was prescribed subcutaneously in a dose of 2–6 mg/kg (maximum 300 mg) once in 4–8 weeks. The therapy duration ranged from 3 months to 4 years. All patients had a rapid clinical improvement, relief of systemic manifestations, normalization of the level of acutephase inflammatory markers. In 4 patients with sJIA we failed to achieve the relief of arthritis symptoms. While administering the drug, no serious adverse events were registered. Thus, the experience of administering canakinumab in patients with autoinflammatory diseases and sJIA showed the high efficacy and good tolerability of the drug. The canakinumab administration at sJIA can be effective in the early disease stages in patients with systemic and initial articular changes.

It’s generally known that early switching over to formula feeding leads to a number of long-term problems associated with functional disorders of the immature gastrointestinal tract and intestinal microbiota. Despite the ongoing process of compositional improvement of baby formula realized by manufacturers, it is not always possible to find the proper formula included basic functional ingredients. We have evaluated the efficacy of fermented milk formula for infants and studied its effect on the composition and formation of intestinal microbiota. The study included children under the age of 4 months being formula-fed by the studied fermented milk formula. The control group included children receiving standard infant milk formula. While taking fermented milk formula, the reduction in the incidence of intestinal colic, and normalization of defecation are stated in all children with functional disorders of the gastrointestinal tract. It is shown that feeding by fermented milk formula leads to elimination of imbalances in intestinal microbiota (the ratio of opportunistic and bifido-/lactoflora), and helps to improve the concentration of secretory IgA in the feces.

This article presents the results of experimental and clinical studies of the release active combined drug having anti-tussive, antiinflammatory and bronchodilatory effects. The mechanism of action of this drug is implemented through the regulatory (modifying) effect on bradykinin, histamine, and opiate receptors, which are directly involved in central and peripheral units of the cough formation. This feature of the drug action allows to solve different therapeutic problems in the treatment of patients with dry/non-productive and wet/productive cough during the whole period of the disease. The review also presents clinical evidence of efficacy and safety of the reviewed drug in the treatment of productive and non-productive cough at ARI in children at any stage of infectious-inflammatory process. The review of literature allows to conclude that the combined composition of the discussed anti-tussive drug providing its comprehensive effect, helps to prevent polypharmacy, minimizing the drug load on a child's body.

The article presents data on the peculiarities of the prescription of cereal complementary feeding for young children. It is emphasized the importance of manufactured cereals in young child feeding. The article analyzes data on the nutritional value and chemical composition of the most popular buckwheat and oatmeal porridge in the Russian Federation, as well as the benefits of cereal as the first complementary feeding for an infant. The characteristics of the different manufactured cereals for infant feeding prescribed to healthy children are given: dry instant, ready-to-use liquid, and fruit and grain cereals. The article also presents the rationale for the prescription of cereals at certain pathological conditions — food allergy, cow's milk protein intolerance, celiac disease, digestive problems, as well as information about the nutritional value of milk and dairy-free cereals.

Актуальность. Имеющиеся доказательства позволяют считать, что консервативное лечение неосложненного аппендицита безопасно. Однако суммарная эффективность лечения детей определяется сочетанием медицинских исходов с ожиданиями как самих пациентов, так и членов их семьи.

Цель исследования. Определить эффективность1 выбора пациентом между консервативным и хирургическим способами лечения неосложненного острого аппендицита у детей.

Дизайн, условия и участники исследования. Прове дено проспективное когортное исследование среди детей и подростков в возрасте от 7 до 17 лет с острым неосложненным аппендицитом. Исследование проводили на базе отдельно взятой высокоспециализированной детской больницы скорой неотложной помощи в период с 1 октября 2012 по 6 марта 2013 г. Пациенты и члены их семей подтверждали свое участие в иссле- довании информированным согласием, выбирая между консервативным способом лечения и неотложной аппендэктомией.

Вмешательства. Неотложная аппендэктомия так же, как и консервативное лечение, подразумевает наблюдение в стационаре в течение по крайней мере 24 ч с введением антибиотиков внутривенно и, при улучшении симптомов, завершение лечения курсом приема антибиотиков в течение 10 сут.

Основные исходы. Основным (первичным) исходом считали случаи (частоту) консервативного лечения, не потребовавшие оперативного вмешательства в течение 1 года после включения в исследование. В качестве дополнительных (вторичных) исходов анализировали частоту случаев осложненного аппендицита, число дней, в течение которых пациент имел ограничения жизнедеятельности (disability days), а также расходы на медицинские услуги в сравниваемых группах (консервативное лечение в сравнении с хирургическим).

Результаты. В исследовании приняли участие 102 пациента; 65 пациентов/семей выбрали аппендэктомию [медиана возраста пациентов 12 лет; межквартильный размах — 9–13 лет; 45 (69%) пациентов мужского пола], 37 пациентов/семей выбрали консервативное лечение [возраст 11 (10–14) лет; 24 (65%) пациента мужского пола]. Исходные характеристики групп не различались. Основной исход исследования в группе консервативного лечения был достигнут в 89% случаев (95% ДИ 75–97) по истечении 30 сут (33 из 37 детей) и в 76% (95% ДИ 59–88) — по истечении 1 года (28 из 37 детей). Частота случаев осложненного аппендицита составила 2,7% в группе консервативного лече- ния (1 из 37 детей) и 12,3% — в группе с хирургическим вмешательством (8 из 65 детей; p = 0,150). По прошествии 1 года дети из группы консервативного лечения имели меньше дней ограничения жизнедеятельности, чем дети из группы с хирургическим вмешательством [Me 8 (5–18) и 21 (15–25) день, соответственно; p < 0,001]. Ниже в группе консервативного лечения были и расходы, связанные с лечением основного заболевания и уходом за пациентами [Me 4219 (2514–7795) и 5029 (4596–5482) долл. США, соответственно; p = 0,010].

Выводы и клиническая значимость. При согласии семьи консервативное лечение является эффективным способом лечения детей с неосложненным острым аппендицитом, характеризуется меньшим риском осложнений при меньшей стоимости лечения по сравнению с хирургическим вмешательством.

Москва, 13 января 2016 г. Подразделение клинического питания Nestle Health Science представило CoMiSS — инструмент, призванный повысить уровень осведомленности и знаний медицинских работников о наиболее распространенных симптомах аллергии к белкам коровьего молока.