The results of historical and medical analysis are presented: they show the situation related to the famine of 1946-1947 that covered several regions of the USSR and was caused by natural (drought), objective (Second World War consequences), and political (foreign and domestic economic policy of our government) factors. The aim of the study is to analyze the famine causes and consequences and the associated increase in child morbidity and mortality. The archival materials of USSR Ministry of Health fund, the demography department of USSR Central Statistical Office (CSU), USSR State Planning Committee reports, and works of historians, economists, demographers, and children health professional were declassified and studied to cover the issue. The information provided by researchers about human losses during the famine is very contradictory. The resumptive opinion of the demographer V.B. Zhiromskaya indicates that human losses due to famine were about 1 million people in USSR in 1947, including about 0.5 million people in RSFSR. The children population reached more than one third of the total population mortality. Population losses in 1947 exceeded losses in 1946 in RSFSR by 402,480 people according to the authors calculations. Among them almost a half (49.6%) were children aged 0-15 years, and 74.6% of them were infants. The leading causes of children mortality were dystrophy, gastrointestinal diseases, pneumonia, childhood infections, typhus fever, and tuberculosis. The Soviet government has taken several measures to provide medical care for patients with dystrophy, to expand the infant-feeding center network for providing children with food, and to create children's health areas with better nutrition. The implementation of all these measures saved thousands of children's lives from famine and related diseases. However, these measures cannot be considered totally sufficient due to extremely high rate of child mortality in hunger-affected areas.

The prevalence of arterial hypertension (AH) in children and adolescents is increasing, thus it is crucial and topical to make pediatricians familiar with modern approaches in drug and drug-free therapy for AH. The aim of this review was to provide the overview of international and Russian guidelines for the AH treatment. We have searched the following keywords in PubMed: guidelines, arterial hypertension treatment, guidelines of management, pediatric hypertension. Reviews, clinical guidelines, and original articles published from 2010 to 2020 were analyzed. Detailed description of AH management in children and adolescents is presented. Approaches to drug-free correction of increased blood pressure (BP) are discussed in detail, indications for antihypertensive therapy are described, characteristics of the main classes of antihypertensive drugs are given (indications, contraindications, and possible side effects). Principles of refractory AH management and antihypertensive drugs combinations are also described.

Background. Delayed vaccination increases the period of vulnerability of children to vaccine preventable diseases. It is associated with higher risk of infectious morbidity and outbreaks (including previously controlled diseases).

Objective. Our aim was to study the vaccination of children and its timing according to the National Immunization Schedule (NIS) in Russian Federation regions.

Methods. We have performed retrospective cross sectional study. Data from 2838 maps of preventive vaccinations (form No 063/y) in children of 2015-2017 years of birth from 18 subjects of Volga and Far Eastern federal districts, as well as data from the state federal statistical monitoring forms No 6 “Information on children and adults populations vaccinated against infectious diseases" in 2016-2019 in the same subjects of Russian Federation was analyzed.

Results. The proportion of children vaccinated according to the NIS varies from 8% to 87.1% (depending on the vaccine type). 51.5-94.5% of children are vaccinated timely to decreed dates according to the age criteria used in Form No 6. Whereas, more than 95% of children were considered vaccinated against infections from the NIS list (except pneumococcal infection) according to official statistics. Significant regional differences in vaccination of children and its timing were revealed.

Conclusion. Significant numbers of children remains unvaccinated or are or untimely vaccinated against infections from the NIS list. At the same time, there is considerable difference between the data about vaccination and its timing received from the analysis of primary medical documentation and from the state federal statistical monitoring forms.

Background. The ratio of breasted children for more than six months increased from 33 to 40% in the period from 1991 to 2019 according to the Russian Federal State Statistics Service. This number has not changed in recent 12 years and remained on the level of 39-41%. Relatively low adherence to breastfeeding may be the consequence of the lack of training of future doctors in these issues.

Objective. The aim of the study was to analyse the knowledge (and its dynamics over the past decade) of medical students, interns and residents on breastfeeding support and promotion in Russian Federation.

Methods. We have conducted the survey among senior students, interns, and residents in 2009-2011 and 2018-2019. 8 medical universities participated in the study in 2009-2011, and 24 medical universities and one continuing education institute — in 2018-2019. Knowledge on breastfeeding support issues was estimated according to the results of future doctors’ responses to the proposed questionnaires.

Results. Sample of 2009-2011 has included 1088 students, interns, and residents, sample of 2018-2019 — 3694. There is still high level of mistakes in the breastfeedng issues due to the decline in knowledge of the WHO breastfeeding recommendations. The level of understanding of practical aspects has not changed significantly over the 10 years, and there is still a gap between theoretical knowledge and practice.

Conclusion. The necessity to improve quality of future doctors training in breastfeeding issues is shown.

Baclground. Pathogenic variants of the CREBBP gene have been revealed in patients with Rubinstein-Taybi and Menke-Hennekam syndromes, however, the toe walking symptom was not mentioned in these pathologies.

Clinical Case Description. The pathogenic nucleotide variant c.5600G>A in heterozygous state in the CREBBP gene was revealed in our 9-year-old female patient with refractory toe walking and developmental speech delay. There were no abnormalities typical for Rubinstein-Taybi syndrome, but there were several signs of Menke-Hennekam syndrome.

Conclusion. The genetic anomaly associated with toe walking is described. This observation allows us to critically relate to the hypothesis about the idiopathic genesis of this form of gait disorder at the absence of obvious neurological or orthopedic causes of its development.

The organized infant’s sleep schedule is the crucial part of normal individual development. On the contrary, restless sleep, nocturnal awakening, long wakefulness can lead to deviations in physical, psychomotor, and cognitive development. Feeding schedule organized according to the time of a day and circadian rhythms (chrono-nutrition concept) can be useful for prevention and correction of such disorders. You are aware of the effect of such factors as feeding before night's sleep, nutrition at dark time of a day, diet enriched with triptophane and nucleotides, on the maturation and consolidation of infants sleep. The correlation between intestinal microbiota and factors affecting the circadian and metabolic activity of the body are presented: day-night cycles, sleep and wake, diet and nutrition. Targeted regulation of the intestinal microbiota through products enriched with functional components (prebiotics) can lead to the development of healthy sleep in infants via axis “brain - intestine - microbiota".

The topicality of reforming the children palliative care (CPC) system due to the increase of the number of patients with cancer, congenital disorders, neurological damages, injuries consequences, genetically determined pathologies is discussed. The patterns of CPC service development, the importance to track those in need, to determine the required volume, forms, and methods of palliative care, and to develop human capacity were analyzed. The results of “Children's Hospice" (Saint Petersburg) activities in 2014-2019 years are presented alongside with the data on CPC development in Russia. This example shows the advantages of clear routing, establishment of indications for patients’ hospitalization, and availability of high-technology medical care and medications. All innovations have led to the significant change in medical conditions structure (over 80% of patients are children with neurological pathology), to the decrease in the number of hospitalizations, to the increase in the number of children who can get required respiratory support at home. The issues of high employees’ turnover and low staffing level in CPC institutions are discussed.

The article presents a legal analysis of the procedure for providing medical care in pediatric oncology and hematology which regulates the provision of medical care to children with neoplasms and diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. The place of the pediatric oncology and hematology profile in the system of existing regulatory legal acts and the role assigned by the new procedure to the pediatric oncologist are determined. The requirements to the structure of medical organizations providing medical care in pediatric oncology and hematology profile, the procedure of oncological and hematological diseases diagnosis and management are considered. Attention is drawn to the lack of timescales of pediatric oncologist-hematologist consultation and taking biopsic material. The algorithm of medical organizations actions on entering data into information systems is analyzed.

First published on the official website of LLC “Faculty of Medical Law” (https://kormed.ru/baza-znaniy/nashi-analiticheskie-zaklyucheniya/ novyy-poryadok-po-detskoy-onkologii-i-gematologii-slishkom-mnogo-voprosov/). Re-published with permission of the copyright holder.

Influenza vaccination coverage has been expanding in recent years in Russian Federation. The topicality of influenza vaccination becomes more significant now at the beginning of seasonal increase in its prevalence, moreover, along with active immunization against coronavirus infection. Vaccination is crucial part in combined program of influenza prevention and control. Nowadays, the priority in influenza prevention is quadrivalent vaccines that can ensure the development of the most stable immunity. Russia has all the necessary resources to create and effectively implement modern influenza vaccines that meet international standards. Despite the remaining difficulties in combating influenza, preventive vaccination is by far the most effective method of protection that has proven its safety and efficacy.