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The issues concerning the transfer of drugs into mothers' milk and their influence on breastfed babies have not been fully studied. Assessment of the situation should include such aspects as drug transfer into fetal blood and into mother's milk, the real risk of inhibiting lactogenesis 2 in women after birth, as well as the psychological consequences for the mother of suspending breastfeeding. The risk of feeding a newborn with formula based on cow's milk is another fateful issue. The following paper presents the pharmacokinetic characteristics of drugs which determine their transfer level through the placenta and into mother's milk during the perinatal period and lactation.

Cesarean section requires the administration of drugs that should be limited to specific medical indications. It is important to remember that most of the available and currently administered anesthetics can affect the fetus and the newborn. In obstetric anesthesia, only such medication that demonstrates a beneficial pharmacokinetic profile and maximum effectiveness should be administered. In this article, the authors reviewed the pharmacodynamic and pharmacokinetic properties of the drugs used during anesthesia in obstetric procedures. The analysis of the influence of these drugs on the clinical condition of the newborn at birth and during breastfeeding was also presented. Drug safety was determined in the aspect of lactation and natural feeding.

Streszczenie Atopowe zapalenie skóry jest przewlekłą chorobą zapalną, przebiegającą z nawrotowymi zaostrzeniami, uporczywym świądem, rumieniem, suchością skóry wskutek uszkodzenia bariery naskórkowej i zakażeniami gronkowcowymi. Czynnikami wywołującymi są mutacje w genie kodującym filagrynę, rozregulowanie układu immunologicznego, zmiany dotyczące mikrobiomu skóry i lipidów w stratum corneum, niedobór peptydów antymikrobiologicznych AMPs. Choroba dotyczy głównie dzieci, powodując znaczne pogorszenie jakości życia, a jej pierwsze objawy występują w około 90% przypadków przed ukończeniem 5. r.ż. Przez lata termin „emolienty” odnoszono do substancji natłuszczających stosowanych w celu uelastycznienia i zmiękczenia skóry w chorobach przebiegających z szorstkością, złuszczaniem i suchością skóry. Obecnie wiadomo, że emolienty mogą także działać nawilżająco poprzez zatrzymywanie wody w skórze, stąd często terminy „emolient” i „substancja nawilżająca” są używane zamiennie. Zgodnie z najnowszymi rekomendacjami towarzystw dermatologicznych podstawową terapią w atopowym zapaleniu skóry jest długotrwałe stosowanie preparatów emoliencyjnych aplikowanych regularnie na skórę oraz dodawanych do kąpieli. Emolienty mogą być stosowane w monoterapii lub –w okresach zaostrzeń –w skojarzeniu z miejscowo stosowanymi kortykosteroidami lub inhibitorami kalcyneuryny. Badania kliniczne wykazały, że systematyczne stosowanie preparatów emoliencyjnych pomaga zarówno przywrócić funkcje ochronne bariery skórnej, jak i wpływa na zmniejszenie zużycia miejscowo stosowanych kortykosteroidów u niemowląt, dzieci i dorosłych pacjentów z atopowym zapaleniem skory. Wyniki badań oraz wieloletnie doświadczenie kliniczne dowodzą skuteczności i bezpieczeństwa stosowania preparatów emoliencyjnych. W pracy przedstawiono aktualny stan wiedzy na temat emolientów, tj. przegląd składników preparatów emoliencyjnych, właściwości i mechanizmy działania emolientów, a także omówiono ich znaczenie w atopowym zapaleniu skóry oraz wyniki badań klinicznych przeprowadzonych z udziałem dzieci z atopowym zapaleniem skóry.

Children with familial hypercholesterolemia have very high total cholesterol and LDL-cholesterol levels in blood which may result in endothelial dysfunction and increase in carotid intima-media thickness. When untreated in childhood, familial hypercholesterolemia is associated with a premature atherosclerotic cardiovascular disease in adulthood. According to the results of clinical studies in children with familial hypercholesterolemia conducted in the last two decades, as well as statements of American Heart Association (AHA), American Academy of Pediatrics (AAP) and Polish Statement called Stanowisko Ekspertów Lipidowych, the recommendations of treatment were published. In children with familial hypercholesterolemia aged 8 years and more statins are one of the first-line medications, thanks to their hypolipemic and pleiotropic activities and well established position in treatment of adult patients with hypercholesterolemia and cardiovascular disease prevention. This paper provides data on pharmacodynamic and pharmacokinetic properties of statins, as well as overview of clinical studies in children with heterozygous familial hypercholesterolemia, regarding efficacy and safety of statins. The studies have revealed significant lowering of LDL cholesterol level (20-50%) and total cholesterol level (20-30%) by statins used in the lowest recommended dose (compared to placebo) in children aged 8 years and more, in a period from 8 weeks to 24 months. In addition to the fact that statin treatment is efficacious, the safety was also confirmed by the meta-analyses of randomized controlled trials in children. The results showed that statin therapy did not impair growth and sexual development in children. The adverse effects were generally mild and did not differ as compared to placebo. However, it should be emphasized that efficacy and safety assessment of statins is limited to 24 months only. Large long-term clinical studies are needed to establish the long-term safety issues of statins in children.

Lactoferrin is an iron-binding glycoprotein, which is present in most biological fluids with particularly high levels in colostrum and in mammalian milk. Bovine lactoferrin is more than 70% homologous with human lactoferrin. Most of the clinical trials have used bovine lactoferrin for supplementation. This review summarizes the recent advances in explaining the mechanisms, which are responsible for the multifunctional roles of lactoferrin, and presents its potential prophylactic and therapeutic applications. On the ground of the results of preliminary clinical observations, authors suggest beneficial effect of lactoferrin supplementation on the prevalence of necrotizing enterocolitis in infants with birth weight below 1250 grams.

Iron de„ciency anemia is the most frequently occurring anemia during the childhood period. Supplementation with adequate doses of iron remains a basic method of prevention and treatment. The various available products containing iron are characterized by a different degree of patient tolerability. Actiferol Fe® is a micronized, dispersible ferric pyrophosphate which improves its water solubility, and therefore it has better absorption and bioavailability.The assessment of tolerability of Actiferol Fe® in children who were administered this product to treat or prevent of iron de„ciency anemia. The methods of administration and the incidence of adverse effects were analyzed.Eighty children (64 boys and 16 girls) aged from one month to 6 years who met the criteria of an indication to be treated with iron were included into the study. The assessment of selected parameters was based on the questionnaire which included questions about tolerability, method of administration, convenience of usage and adverse e#ects. The questionnaire was „lled in by parents (usually by the mother).The study indicated that Actiferol Fe® has very good or good tolerability in 87.5% (70/80) of patients - 46.3% (37/80) and 41.2% (33/80), respectively. The most frequent method of administration was in liquid form after dissolving: in water - 31,3% (25/80), in orange juice - 18.8% (15/80) or in milk formulas - in 17.5% (14/80) of patients. The method of administration was assessed as convenient or very convenient by 84% (67/80) of participants. Out of the adverse effects reported, the most frequent were change in the stool consistency into harder, abdominal pain and constipation - in 20% (16/80), 11.25% (9/80), 10% (8/80) cases, respectively. Diarrhea, pain during defecation occurred occasionally. A dark color of the stool was reported by 55% (44/80) of patients. In only one case (1.25%) the parents resigned from the product administration and replaced it with another iron product (no connection with tolerability of the formulation).Actiferol Fe® is a product characterized by good tolerability, convenient usage and mild adverse effects.

Malignant hyperthermia is a genetic defect of uncontrolled hypermetabolic skeletal muscle response to anesthetic triggering drugs. Some congenital myopathies are regarded as risk increasing factors. The use of volatile anaesthetics or suxamethonium (succinylcholine) in patients who are predisposed to malignant hyperthermia leads to an increase in Ca2+ release from sarcoplasmic reticulum, which in turn causes a set of biochemical and clinical symptoms, which can be a cause of death, if dantrolene is not administered adequately. The aim of the study was to draw attention to the problem of malignant hyperthermia, which is hardly ever described in Polish literature, and requires the necessity of intensifying the cooperation between the dentist and specialists from other medical fields. The origin of the article was a case of congenital myopathy with recognized malignant hyperthermia in an 18-year-old patient, in whom surgical extraction of teeth was indicated. The course of diagnostics and treatment showed once more that contemporary medicine is in need of holistic approach, and in consequence, promising and effective cooperation of many specialists.

In recent years, despite of significant progress in the treatment of premature infants with extremely low body weight, still a significant problem remains severe, treatment-resistant generalized infections among which the percentage of fungal infections is increasing. The invasive candidiasis, especially caused by non-albicans species of Candida, are of particular importance. In the case of resistance on fluconazole and amphotericin B the use of echinocandin drug may be a useful choice. This paper reviews the pharmacokinetics of caspofungin in neonates and children, as well as the case reports and clinical trials on the use of caspofungin in neonates, including the premature infants. We describe also the premature neonate with low birth weight and a generalized infection caused by Candida glabrata, where, despite of the treatment based on the sensitivity of the fungus it did not achieve clinical improvement and sterilization of cultures. It was not until the lead-in of caspofungin in dose 2 mg/kg/day allowed to cure the patient. There was a transient increase in the activity of aminotransferases and level of bilirubin as a complication of treatment. At the end of application of caspofungin the liver functions have been slowly normalized. Caspofungin appeared to be effective in the treatment of systemic fungal C. glabrata in premature neonate with extremely low birth weight. Echinocandins, including caspofungin, appear to be a promising alternative to previously used agents in the treatment of invasive Candida infections in newborns. However, the further randomized trials on the use of caspofungin in preterm neonates, regarding long term follow-up, should be undertaken.