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Introduction. Informing the population about chronic kidney disease is an important factor for preventing or combating the disease, and maintaining the health of the younger generation. Objective: to study the level of awareness of parents about chronic kidney disease. Methods. In a specially designed form, an anonymous survey of 112 parents of children treated at the department regarding chronic kidney disease was conducted. Statistical processing of the obtained results was carried out. Results. In most children (91.6%), the diagnosis of chronic kidney disease was established at the stage C3–C5 in the hospital. Moreover, in 100% of cases, this diagnosis was a “random finding”; 75.9% of respondents showed lack of information about the disease and its treatment, and the level of awareness is directly related to the stage of the disease. Moreover, as a result of insufficient information, the parents admitted to fail to comply with the terms of visiting the child, a nephrologist (22.9%), the recommendations to limit the diet of protein (19.3%) and potassium (36.2%), fluid volume (61.5%). At the same time, the parents believed the cause of the progression of chronic kidney disease in the child to be the lack of follow-up (43.7%), late diagnosis (33.7%), improper treatment (13.3%), and the late beginning of the treatment (9.6%). Conclusion. The work proved a low degree of awareness about chronic kidney disease, which contributes to the late diagnosis of the disease and low adherence to treatment. This problem requires improving methods and forms of informing the population, including expanding the capacity of outpatient care (preventive examinations, health education in nephrology schools).

Early detection of such a formidable complication of bronchopulmonary dysplasia (BPD) as pulmonary hypertension (PH) is an urgent problem in pediatrics. Echocardiography is currently recognized as the most accessible and non-invasive method for determining pressure in the pulmonary artery. Disorders of alveogenesis and angiogenesis of the vessels of the small circulatory circle in premature infants forming BPD require careful echocardiographic control with using additional analysis of changes in the systolic eccentricity index (EI) as a reliable marker of PH in BPD infants. To increase the information content, it is also necessary to expand the use of EchoCG data in combination with analysis of the blood content of B type natriuretic peptide or the N-terminal pro-B-type natriuretic peptide.

Introduction. To improve the quality of surgical treatment and prevent postoperative complications, there is needed an integrated multidisciplinary professional approach including a combination of nutritional support with therapeutic methods and psychological assistance that reduces stress throughout the perioperative period. Clinical guidelines and standards to manage the patients on this issue in pediatric surgical hospitals have not been developed. Objectives: to assess the nutritional risk of malnutrition and nutritional status in children with surgical diseases, to elaborate algorithms for nutritional support over the pre- and postoperative periods. Materials and methods. The single center non-comparative study included sixty children aged from 1 month to 17 years 5 months, with diseases of the esophagus, intestine, and genitourinary system, were admitted for surgical treatment at the Research Institute of Pediatric Surgery of the Federal State Autonomous Institution «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia. All patients underwent a nutritional risk screening according to a validated Russian version of the STRONGkids. Clinical and anamnestic data were analyzed. Anthropometric indices (Z-scores: weight/age, height/age, BMI/age) using the WHO AnthroPlus program (2009), and biochemical parameters (concentrations of C-reactive protein, total protein, albumin, prealbumin, transferrin) were evaluated. Results. A high nutritional risk at admission was established in more than half (57%) of patients, moderate — in 36% of patients, low — only in 7% of cases. Malnutrition (Z-score BMI/age from –1 to –3) was diagnosed in 26 (43%) patients, 58% of them suffered from diseases of the esophagus, 37% — the intestine pathology, and 36% of the genitourinary disorders. Conclusion. Nutritional risk screening and nutrition status assessment are necessary in all patients admitted to pediatric surgical hospitals for the timely appointment of adequate nutritional support, which will reduce the incidence of postoperative complications, and allow diminishing the length of the hospital stay.

Introduction. Serratia marcescens is an opportunistic gram-negative microorganism, currently has been detected with increasing frequency in various clinical biomaterials from sick persons is the causative agent of nosocomial infections. The aim of the work is to determine microbiological and clinical features of S. marcescens in bloodstream infections in children. Materials and methods. Nineteen isolates of S. marcescens were isolated from blood cultures. Antibiotic sensitivity was determined by broth microdilution method. Carbapenemase gene were determined using real-time polymerase chain reaction. Biofilm formation was studied on abiotic surfaces using polystyreneplates. Population diversity was determined by multilocus genotypic analysis. Results. Carbapenems, fosfomycin and biseptol showed the highest antimicrobial activity in vitro. Resistance to aminoglycosides, aztreonam, cefepime, and ticarcillin/clavulanate was over 50%. According to PCR data, only OXA-48 carbapenemases were found in 11% of isolates, NDM — in 5%, and a combination of carbapenemases — in 15%. Biofilms of moderate intensity were formed in 13 (68%) isolates, and weak biofilms — in 6 (32%). According to the genotypic analysis, a large proportion of isolates with multiple resistance were included in one group. All of them were singled out over one year from one department — perhaps there was a single source. In 3 cases, patients were diagnosed with sepsis, 1 of them had an unfavourable outcome. Bacteremia occurred on the 3rd day after the initial isolation of S. marcescens. An unfavourable outcome occurred on the 10th day of bacteremia. S. marcescens in this case had multiple resistance and a combination of resistance genes, also belonged to genotypic group I, which is often found in our work. Conclusion. S. marcescens in bloodstream infections is a serious problem for pediatric patients. Natural resistance to polymyxins, as well as acquired resistance to carbapenems and aminoglycosides, cause particular alertness and attention to this microbial agent.

The problems of providing specialized nutrition and drugs for patients with rare diseases are currently one of the most discussed by medical specialists in various fields. These issues are especially relevant in light of the expansion of neonatal screening, which started in the Russian Federation in 2023, by expanding the list of rare diseases. The review highlights the current foreign practice of providing for certain categories of patients, primarily, children in need for long-term, sometimes lifelong use of specialized health food products. There is also considered the current situation in the Russian Federation, and the possibilities of domestic production of this category of food products. Currently, patients are provided with vital medical nutrition. The article discusses a number of problems associated with providing children suffered from hereditary and chronic pathologies with specialized nutrition, and first of all, these are patients identified by advanced neonatal screening. From the moment the diagnosis is established to the initiation of pathogenetic diet therapy, a certain time passes, sometimes, several months, which for patients with a high risk of metabolic crises (hereditary metabolic diseases) can be critical and, if untreated, lead to death. To solve these and other problems it is proposed to consider the possibility of centralized provision of specialized medical nutrition products to infants and young patients, attracting state charitable funds for the prompt supply of medical nutrition to patients who need it, the feasibility of optimizing the domestic system for covering the costs of specialized medical nutrition products. for patients with various pathologies who need them, regardless of the status of “disabled”. The databases of The Rare Disease State Report Card, European Medicines Agency, PubMed, Consultant Plus, RSCI were used to search for material in the review.

The goal is to assess the health of students studying according to adapted basic general education programs and the conditions of health saving in the educational institution. Materials and methods. A monitoring research in some educational institutions that provide education according to adapted basic general education programs in eight federal districts of the Russian Federation. The factors influencing on the state of children’s health in the training process were as follows: management of medical, hygienic, psychological, and pedagogical and health saving procedures. To objectivize the experimental data, questionnaire survey of teaching staff and parents, qualitative and quantitative analysis were carried out. Results. Currently, in educational institutions, regardless of the form of implementation of the educational process (in special or inclusive education), different categories of students are included in education. So far, education is carried out according to several versions of the basic general education curriculum. Such necessity is caused by the reduction of the number of children of one category and increase of another one. Education of children of different psychological and pedagogical categories in one educational institution requires creation of optimal educational conditions, taking into account the special educational needs of each student. The spatial environment that supports the health of students is created in most schools for children with musculoskeletal disorders, and less often in schools for children with hearing and vision disorders. Complete compliance of classrooms and special technical equipment of the educational process with the special educational needs of children occurred not in all educational institutions. Factor analysis has identified the most important components of a school health environment, and the data of the cluster analysis has formed its typological variants. Science-intensive health-saving technologies are used only for the correction of posture and the prevention of visual overexertion. The most acute gaps are insufficient educational and methodological equipment, material and technical condition of institutions, the volume and management of medical care for students. Existing legislative and normative legal documents do not fully regulate the management of health saving measures and technologies for students with special educational needs and children with disabilities, the process of health saving in the education system, which negatively affects their health status. Conclusion. The problems identified in the activities of educational institutions, in which children with special educational needs and children with disabilities study, to create a health-saving environment should be taken into account when supplementing and improving the content of legislative acts.

The article is devoted to the founder of Russian neonatology, one of the initiators and active builders of the Soviet system of maternity and infancy care, the manager and head of the first domestic research institution in the field of pediatrics, George Nestorovich Speransky. There are consistently described stages of G.N. Speransky multifaceted activity on the management of the national system of maternity and infancy care, the creation of neonatology as a scientific discipline, the education and advanced training of pediatricians and neonato­logists, the introduction of a new system of specialized training of pediatricians at pediatric faculties, the activation of scientific societies of pediatricians. The ways of the further development of domestic pediatrics, new horizons in the creation and implementation of domestic and global pediatric projects aimed at improving the quality of life and timely comprehensive medical care for children are indicated.

MATERIAL AND METHODS: This study was carried out on 20 male Wistar rats, of which 15 were injected with a bacterialfungal suspension into the cavity of the hock (tarsus) joint. Specifically, the rats were injected with KlebsiellaCandida suspension (1:1) with a microbial concentration of 106 CFU/ml prepared by using the museum strains Klebsiella pneumoniae ICIS-278 and Candida albicans ATCC 24433 under the control of an X-ray apparatus and digitizer FireCR+. Five intact animals served as the control. On day 15 of the experiment, a bacteriological and histological examination of the affected joints was carried out while maintaining topography after euthanasia. RESULTS: In rats infected with the KlebsiellaCandidiasis suspension, pain syndrome and functional changes typical of arthritis were noted on days 23. The bacteriological examination of the affected joints in 75% of rats isolated K. pneumonia cultures that were identical, according to polymerase chain reaction, to the original strain that was part of the bacterialfungal suspension. At the same time, fungi of the genus Candida, which was also used in the experiment to infect animals, were not detected in the affected joints of rats. The established model of KlebsiellaCandida arthritis was characterized by the pathomorphological signs of panarthritis accompanied by the purulent inflammation of all joint structures (synovial membrane, cartilage, and bone tissue) with the involvement of soft periarticular tissues. CONCLUSION: The model of Klebsiella and fungal arthritis presented by this work can be used to test new means of antimicrobial (antibacterial and antifungal) therapies, which are an integral component of the treatment of infection-associated arthritis.

Background. Currently, in the Russian Federation, the criteria for establishing disability do not take into account the assessment of the quality of life, while in developed countries this indicator is a mandatory component of examination programs and evaluation of the effectiveness of treatment and rehabilitation. In Russian pediatrics, research on the development of indicators of the quality of life in children with chronic disabling diseases has begun, this work is a continuation of this direction. Aim. To assess the quality of life of disabled children with various somatic diseases using all the possibilities of the Health Utilities Index questionnaire. Material and methods. A survey of 213 patients aged 5 to 18 years with chronic diseases with the status of a disabled child and their legal representatives was conducted using the Russian version of the international general questionnaire Health Utilities Index. Statistical analysis was performed using the SPSS software package version 26.0. The KruskalWallis test and Dunn's posterior test were used. Results. During the study, multi-attribute utilitarian indices were developed for each group of children, which ranged from 0.670.3 (95% confidence interval 0.550.78) in patients with rheumatological diseases to 0.850.21 (95% confidence interval 0.790.91) in children with heart disease and statistically significantly (p 0.001) were lower than in healthy children (0.90.17; 95% confidence interval 0.870.92). The features of one-attribute utilitarian indices depending on the class of the disease have been established. An analysis of the level and degree of functioning disorders showed that the most common and frequent for children with disabilities in the studied groups were emotional disorders; problems associated with the presence of pain; disability caused by a sense of cognitive deficit. For the first time, to determine the categories of the severity of violations an approach according to a multi-attribute utilitarian index was used. Conclusion. The quality of life in children with disabilities, reduced compared to healthy peers, has nosological features; the most pronounced decrease in the quality of life was noted in children with skin diseases and rheumatological diseases.

A unique clinical case of a combination of malformations of the anterior abdominal wall (omphalocele of large size) and malformation of the lymphatic system (congenital chyloperitoneum) is presented. Each of these defects can lead to a fatal outcome, and the combination of them has greatly increased the risk of developing an unfavourable outcome. The use of immunosuppressive therapy with Sirolimus used for the first time during the newborn period made it possible to completely stop the chyloperitoneum. This clinical example shows that in the treatment of surgical patients with multiple congenital malformations, a multidisciplinary approach and observation is necessary for timely response to the patient’s condition.

Introduction. The effectiveness of the use of TNF inhibitors in patients with inflammatory bowel diseases (IBD) has been shown. 20-40% of patients are known to fail to respond to received therapy, and 10-30% of patients experience a loss of effect by the year of therapy. Objective is to evaluate the information content of therapeutic drug monitoring (TDM) for effective treatment with TNF blockers (infliximab - IFX, adalimumab - ADA) in IBD children. Materials and methods. There were examined seventy four children on IFX therapy including 66 children on ADA therapy. The age of the children ranged from 3.4 to 18 years. Residual levels of IHF and ADA were determined using a lateral flow immunoassay. Statistical data processing was performed using the Statistica 10.0, SPSS 16 software. Differences between groups were assessed using the nonparametric Mann-Whitney U test. Results. IFX levels (less than 3 µg/ml) were detected in 64% of cases, ADA (less than 5 µg/ml) in 21% of cases. The residual level of IFX and ADA in remission significantly exceeded the level of drugs in groups of children in exacerbation. An inverse relationship was observed between the residual level of IFX (r = -0.68, p = 0.000) and ADA (r = -0.31, p = 0.000) and the number of days after drug administration. Anti-IFX antibodies were found in 27.3% in the exacerbation group and in 5.8% in remission (p < 0.001). Antibodies to ADA in children with IBD were found in 4 patients with a low concentration of the drug (2.57 ± 0.45 µg/ml) in the serum in a state of exacerbation. In patients on anti-TNF therapy, empirical dose selection revealed a residual level lower than in children in whom dose adjustment was carried out taking into account the residual concentration of drugs. Conclusion. The use of TDM TNF blockers in combination with the determination of antibodies to drugs can significantly increase the effectiveness of therapy in IBD children.

Electronic nicotine dosing systems, commonly known as electronic cigarettes or vapes, have quickly become the most common tobacco products used by teenagers and young people, largely due to the marketing and advertising of the companies that produce them. The appearance of nicotine-free vapes is a new round in the production of electronic cigarettes. Due to the widespread opinion about the harmlessness of such vapes, they are increasingly being used by children and adolescents. The review describes the composition of vaping aerosols, provides data from scientific research on their impact on human health. The danger of smoking both nicotine and nicotine-free vapes is shown. However, given the relative short duration of the use of electronic cigarettes, there are many both purely medical and legal questions. All these issues require further research, which continues all over the world. The authors recommend being wary of this habit and the newfangled hobby of teenagers and young people, applying knowledge about the dangers of vaping in everyday practice, which will indirectly help children and adolescents avoid the path of nicotine addiction, protecting the health of the younger generation.

The review is devoted to the 100-year history of the Institute of Maternal and Infant Health, renamed for the Institute of Pediatrics of the USSR Academy of Medical Sciences and then for the Scientific Center for Children’s Health of the Russian Academy of Medical Sciences. The regularities of the formation of the state system of maternity and infancy care, the peculiarities of the reorganization of the Institute in various historical periods, the contribution of the Institute’s scientists to the development of domestic Pediatrics and the formation of the system of child health care are traced. The Institute of Pediatrics is shown to be the leading pediatric institution in the country, capable of caring for children’s health, creating new generations of pediatricians and determining the future of Pediatrics. The uniqueness of the country’s leading Institute of Pediatrics is the harmonious combination of the age-old tradition of fundamental and applied research in the field of child health care with the provision of multidisciplinary high-tech medical management for children patients, and the training of scientific and medical personnel.

The review is devoted to the 100-year history of the Institute of Pediatrics, mainly there are analyzed the activities of scientific laboratories and departments, the peculiarities of their reorganization in various historical periods, the contribution of scientists to the development of domestic pediatric science and established patterns essential for the formation of the national system of child health care. The scientific achievements of the scientists of the Institute of Pediatrics were established to be noted by the Grants Committee under the President of the Russian Federation. On a competitive basis, the Institute of Pediatrics of the Russian Academy of Medical Sciences is recognized as a leading scientific school, and its director, Academician M.Ya. Studenikin, as a the leader of the pediatric scientific school. Currently, the Institute of Pediatrics is the largest pediatric institution of the National Medical Research Center for Children’s Health of the Ministry of Health of Russia, has significant scientific potential, is able to ensure the children’s health care and create new generations of pediatricians on a modern scientific basis.

The important role of the micronutrient status of the body for the formation of an adequate immune response, including to respiratory viruses, is currently beyond doubt. In connection with the beginning of the pandemic caused by SARS-CoV-2, numerous publications have appeared on the supposedly protective effect of many micronutrients, especially vitamin D in relation to the prevention of COVID-19 disease. Later, the results of most studies confirmed this assumption. From 2020 to early 2022, there were published 17 analytical reviews and meta-analyses summarizing the results of various studies evaluating both the preventive potential of vitamin D provision in various population groups and the role of vitamin D in reducing the incidence of severe forms of COVID-19 and mortality. The analysis of literature data presented in this review suggests vitamin D currently to have the greatest evidence base as a micronutrient promoting reduction the risk of disease and severe forms of COVID-19. Current recommendations on vitamin D subsidies, including in pediatric practice, are given.

Introduction. The most important area of work of medical and nursing staff is the development of children’s healthcare and the provision of qualified personnel for medical institutions. To care for patients, it is necessary to master increasingly complex medical and technical knowledge and master new skills, and improve those already acquired. High-tech medical care is a complex of medical and diagnostic medical services conducted in the conditions of research centers, one of which is the National Medical Research Center for Children’s Health of the Ministry of Health of Russia (hereinafter the Center), using complex and unique medical technologies with significant resource intensity. The purpose of the work: to establish the features of the professional activity of the specialists of the nursing link of the medical research center and to determine the ways of further development of nursing care. Materials and methods. The data of the personnel records of the Center and the data of the Federal Statistical Observation in Russia and Moscow, own data of surveys and questionnaires are analyzed. Results. 35% of the Center’s nurses were found to have the highest qualification category. The staffing of the Center with nursing staff is 84.5%, which is higher than the average in Russia. Nurses participated in providing care to 37,000 patients of the round-the-clock hospital and providing 860,000 outpatient services. They made presentations at 8 scientific and practical conferences, textbooks and articles were published with the participation of nurses, 6 patents for inventions were obtained, advanced training programs were prepared. Conclusion. The Medical Research Center is a launching pad for innovative work of nursing staff, continuous improvement of their knowledge and skills. The formation of new motivations is the key to the success of the creative activity of children’s nurses. Authors presented ways to improve the quality of the work of children’s nurses of the research Center that will ensure the expansion of the functions of nursing specialists, allow the development of average medical staff in the profession and fully use their capabilities for the qualified provision of nursing care to children.

Psychometric studies are one of the priority tasks of child psychoneurology. It makes important to update the technologies for objective control of the mental sphere of children. Obtaining quantitative characteristics of indicators of the mental activity in pediatric practice, is a convenient tool in assessing the level of development of a child’s cognitive and psychophysiological functions, both in normal conditions and in the presence of somatic and/or neurological diseases. The computer psychophysiological complex (CPPC) “Psychomat”, developed at the Research Institute of Medical Technology seems to be most widely used in children’s practice among a number of developed psychophysiological complexes. At present, an original software package created on the base of «Psychomat» allows receiving the results of the study in automatic mode (online), which is a convenient tool for mass testing in children’s institutions. The development of such software packages opens up new possibilities for psychometric research.

Introduction. Constitutionally exogenous obesity (CEO) belongs to a number of significant medical and social problems of the modern world, assumes epidemic proportions and leads among alimentary-dependent pathology in children. The aim of the work was to determine changes in indicators of endothelial dysfunction (ED) in children of different age with obesity of various severity. Materials and methods. One hundred twenty six children aged of 6 to 17 years were comprehensively examined, data on changes in the serum content of ED mediators in CEOs grade 1-3 were presented by quantitative determination of nitric oxide, endothelin-1, leptin, homocysteine, intercellular adhesion molecules and vascular cell adhesion-1, tissue-type plasminogen activator inhibitor antigen, Willebrand factor and his antigen. Results. The regularities of changes in the concentrations of these compounds in the blood depending on the age of patients and the degree of obesity, which reflect the functional state of the endothelial system and can serve as criteria for the severity of ED requiring adequate and timely correction in children, have been established. Conclusion. Indicators of endothelial dysfunction can serve as criteria for its severity, their detection will allow optimizing early diagnosis and determining the amount of timely therapy.

Introduction. Patients with cerebral palsy (CP) are especially vulnerable to the development of osteopenia. Skeletal deformities caused by immobility (prolonged bed rest, limited exercise, immobilization), antiepileptic drugs, hormonal and genetic factors can lead to significant bone loss. Diagnosis of osteoporosis includes densitometry and the study of biochemical markers to assess the state of bone mineralization at the time of the examination. However, densitometry in patients with cerebral palsy may present certain difficulties. Purpose is to determine changes in the content of bone tissue metabolism markers in CP patients depending on the severity of movement disorders. Materials and methods. We examined 32 CP patients aged 2 to 15 years for 3 months who were in rehabilitation in 2019-2021. The patients were divided into 2 groups: 18 children in the main group with motor dysfunctions of level IV-V and 14 children in the comparisons group - with disorders of I-III levels. All children underwent an analysis of anthropometric parameters using the program “WHO AnthroPlus (2009)”, determination of the blood levels of biochemical markers of bone tissue metabolism: calcium, phosphorus, alkaline phosphatase, osteocalcin, vitamin D, parathyroid hormone, bone resorption marker β-CrossLaps. Results. The indices of alkaline phosphatase, calcium and phosphorus in the majority of CP patients (88%) were within the reference values. The average concentrations of these compounds did not differ significantly in CP patients in the main group and the comparison group, including between children who received and did not receive antiepileptic drugs. There were no significant differences in 25(OH)D concentrations in patients of these groups. CP patients from the main group were found to be supplemented with vitamin D less frequently than children from the comparison group. Indicators of bone tissue resorption (β-CrossLaps) in patients with cerebral palsy increased significantly more than in patients of the comparison group, which indicates a pronounced loss of bone mass in severe impairment of motor functions. More than half of CP patients have high values of the bone resorption marker β-CrossLaps, which, together with an increase in the level of osteocalcin, indicates active osteoreparation, which is higher in children with severe motor disorders. At the same time, a close correlation (r = 0.596; p < 0.05) between the levels of osteocalcin and β-CrossLaps in patients may indicate activation of bone tissue repair in response to pronounced resorption. However, it should be noted that the determination of biomarkers of bone tissue metabolism in children with cerebral palsy is not indicative in the detection of osteopenia and osteoporosis due to the characteristics of these patients: reduced motor activity, growth retardation and psychophysical development.

Vaccines against the new coronavirus infection (COVID-19 or SARS-CoV-2) have been developed at an unprecedented pace since the beginning of the pandemic. Some of them have received permission for mass production already at the stage of clinical trials. COVID vaccines are now being used on a large scale over the world. In the review article describes the characteristics of used both abroad and in Russia COVID vaccines, differed in structure and mechanism of action. The data of clinical research on their efficiency and safety is presented. In modern conditions of a pandemic of a new coronavirus infection, vaccination was shown to be the most effective method of prevention, which can significantly reduce morbidity and mortality due to coronavirus. There are considered such nuances of coronavirus vaccination, as the need for a booster dose, vaccination of children and adolescents. Rare adverse events are described. However, given the relatively small experience and short duration of the use of coronavirus vaccines, there are many questions concerning vaccination of persons with disorders in the immune system, vaccination of infants, the impact of changes in coronavirus strains on the effectiveness of the vaccines used, and many others. All these issues require further research, which continues all over the world. The authors recommend applying the knowledge about COVID vaccines in daily practice, constantly updating them, which will indirectly help to ensure maximum vaccination coverage of the population against coronavirus, including children and adolescents.

Introduction. Currently widely adopted benchmarks of normal levels of cystatin in blood and of GFR based on those levels in young children are non-existent. Objective: to determine the content of cystatin C in the blood and the glomerular filtration rate based on it in young children. Materials and methods. Two hundred thirty seven infants aged up 3 years without kidney diseases were examined and divided into subgroups by age, degree of maturity and birth weight. The serum cystatin C was studied by enzyme-immunoassay, GFR was calculated according to Larsson’s formula. Results. Normal levels of serum cystatin C and GFR levels were determined in young children with Larsson’s formula. The dependency of the serum level of cystatin C and GFR calculated on the basis of the age of the infant was proved. The serum cystatin C level depends on the degree of prematurity and body weight at birth. The level of GFR was not influenced by the degree of prematurity, however, infants born with extremely low body weight exhibited lower GFR levels in comparison to those born with normal body weight. Conclusion. The obtained serum cystatin C levels are deemed as normal for young children - full-term infants and those with varying degrees of prematurity.

Background. The approaches to the managing of nutrition for healthy children are not always applicable to patients with neurological disorders, since their body composition, muscle tone, level of physical activity, and energy requirements significantly differ from healthy children and, therefore, must be personalized with the mandatory involvement of a nutritionist/dietitian. The purpose is to assess nutrition in children with cerebral palsy (CP) depending on Gross Motor Function Classification System (GMFCS) level. Materials and methods. Eighty-eight 2 to 16 years nine months CP children rehabilitated at the National Medical Research Center for Children’s Health from 2019 to 2021 were included in this study. Participants were divided into two groups. The main group was patients with GMFCS levels IV-V (48 children) and the comparison group - GMFCS levels I-III (40 children). The medical and dietary history of participants was analyzed. Anthropometric parameters using the WHO AnthroPlus (2009) software were assessed in all participants, the ability to eat and drink was determined by questioning the EDACS scale (Eating and Drinking Ability Classification System). Results. The mean values of weight/age, height/age, BMI/age Z-scores were significantly below 0 (p = 0.01) in all patients (88): WAZ -1.54 ± 1.9, HAZ -1.03 ± 1.48, BAZ -1.5 [-3.11; -0.35]. Children of the main group had significantly lower Z-scores. As a result of the survey, patients of the main group were revealed to have indicators characterizing eating disorders significantly more often (p < 0.001) than the comparison group. EDACS survey revealed that children of the main group were significantly more likely (58% and 10%, respectively; p < 0.001) to have disorders corresponding to levels IV-V, characterized by significant safety restrictions. We have developed a nutritional assessment and management algorithm for children with cerebral palsy, admitted for rehabilitation at the neurological department. Conclusion. Children with cerebral palsy need regular nutritional assessment and management for timely and adequate nutritional support, including enteral nutrition.

Introduction. Currently, there is an increase in the incidence and an increase in the severity of the course of COVID-19 in children. The tropism of the SARS-CoV-2 virus to the cardiovascular system has been established, while post-COVID syndrome with various manifestations is recorded in 25% of recovered adolescents. The purpose of the work was to identify the features of the electrocardiogram (ECG) pattern in children hospitalized with a diagnosis of COVID-19. Results. Significant changes in the conductivity and activity of the left heart myocardium were found in COVID-19 patients with pneumonia and respiratory failure. Pronounced changes in ECG indices were found in children of senior school age who were admitted for treatment 2.4 times more often than other children. Proarrhythmogenic ECG indices in children were detected in severe COVID-19 - with community-acquired pneumonia (ΔQTc, QTcmin) and respiratory failure (TpTe/QTmax). These ECG changes, combined with the trend in inflammation markers (an increase in the C-reactive protein level and a decrease in the number of lymphocytes) in children with a moderate course of COVID-19 may be a sign of the involvement of the myocardium in an infectious inflammatory process. This suggests that the effect on the myocardium is exerted by systemic inflammation and not by the hemodynamic overload of the right heart, which is expected in pulmonary pathology. Conclusion. The obtained data indicate the need for dynamic ECG monitoring during the acute stage of the disease and rehabilitation of children who suffered from COVID-19.

Vaccination is one of the essential areas of preventive medicine for protecting the population from diseases and infections. They have helped reduce the incidence of severe childhood diseases and, in some cases, have even eradicated some of the world’s infectious diseases. However, since the first available vaccine against smallpox, antivaccine prophylaxis has always accompanied an antivaccine movement based on various myths. More recently, the development of this movement is connected for many reasons. First of all, it is associated with forgetting the world’s population of the severity of many infectious diseases, the consequences of epidemics, and the availability of any information on the Internet. Leading to myths, parents refuse to vaccinate their children, resulting in reduced vaccination coverage, reduced collective immunity and outbreaks of diseases that have already been considered conquered. The article reviews the literature on the results of anti-vaccination research conducted in the Russian Federation and abroad concerning the causes, main postulates of this movement, trends and directions. Scientific evidence is presented that disproves anti-vaccination myths, and the primary arguments for vaccination are presented. The article describes the anti-vaccination movement’s worldwide trend and the Russian features. The position of WHO is presented about overcoming barriers to the adoption and use of vaccines.

Aim of the study: to determine the features of the formation of psychophysiological and cognitive functions in 6-17 year children using a comprehensive and screening software of the original package of the complex “Psychomat”. Materials and methods. A screening examination of 184 apparently healthy 6-17 year schoolchildren was carried out using a complex of psychophysiological tests and original methods for studying higher mental functions (24 tests, 66 parameters). To verify the screening program, a comprehensive examination of 60 apparently healthy schoolchildren of the same age was carried out. Results. The patterns of formation of cognitive and psychophysiological functions in 6-17 year children have been established. No gender differences were found in the analysis of cognitive and psychophysiological functions in children. Significant differences in the rate of formation of psychophysiological functions have been identified in children of primary school age (8-10 years) and are associated mainly with the speed of response and coordination. As the age of children increases, test parameters reflecting the characteristics of perception, memory, attention, analytical and synthetic processes also undergo changes: both the total and average time for completing tasks and the number of errors decrease, and the pace of execution increases. Conclusion. The original software package «Psychomat» allows using comprehensive and screening assessment of both psychophysiological and cognitive functions in 6-17 year children. The screening software as the sensitive method for detecting violations of psychophysiological and cognitive functions in the conditions of a mass examination of children can be used as a test system.

Introduction. Pompe disease (PD) or type II glycogenosis is a rare multisystem hereditary accumulation disease caused by a deficiency of the enzyme acid maltase (acid alpha-1,4-glucosidase), which leads to reduced activity to the accumulation of glycogen in various organs and tissues of the body. The aim of the study is to develop a high-performance method of early biochemical diagnosis of PD and optimization of its molecular genetic diagnosis. Materials and methods. The characteristics of the relative frequencies and spectrum of the detected mutations were studied using a sample of 7670 patients with suspected Pompe disease admitted to the National Medical Research Center of Children’s Health of the Ministry of Health of Russia as part of the selective screening, as well as eight patients with PD, whose laboratory diagnosis was made outside the framework of this selective screening. Results. As a result of selective screening of PD in Russian patients from high-risk groups, the detectability was 0.47%. PD’s clinical and age characteristics in both children and adults are described. The relative frequencies are calculated, and the spectrum of 47 pathogenic variants of the GAA gene responsible for the occurrence and development of Pompe disease in 44 patients is characterized. Seventeen new mutations of the GAA gene, unknown previously, have been identified and described, adding 2.7% to the HGMD database. Conclusion. Optimization of the algorithm of molecular diagnosis of Pompe disease in Russian patients is proposed.

The aim of the work is to analyze the data of Echo-CG examination of premature infants who have formed and have not formed bronchopulmonary dysplasia (BPD) to determine the frequency of the formation of pulmonary hypertension (PH). Materials and methods. A total of 199 preterm infants treated in the Department of Pathology of Newborns were examined. The first group included moderate and severe BPD children (n = 117; 59%). The second group consisted of children without BPD within clearly decreed terms (n = 82; 41%). In each group, patients were divided into four subgroups by the gestational age at birth and the timing of the Echo-CG. Results. Only two (1.1%) patients out of 117 BPD children of the first group were diagnosed with pulmonary hypertension (PH). In 3 (2.5%) of 117 infants of the same group, enlargement of the right heart without PH was revealed. Out of 82 children without BPD, two patients had signs of right heart enlargement. PH was not diagnosed in any of the patients in this group. Discussion. To aggravate the efficiency of PH diagnosis, a number of indices of screening echocardiography seem to be increased by additional analysis of changes in the systolic eccentricity index (EI), as a reliable marker of PH in BPD children. Systolic IE should be integrated into screening in preterm infants for the diagnosis of PH. The use of Echo-CG data along with analysis of blood BNP or NT-proBNP blood content be also expanded. Optimizing the diagnosis of PH at the early stages of BPD is necessary to increase the efficacy of targeted therapy and reduce the risk of severe complications of BPD.

In current conditions, the most effective method of preventing pneumococcal infections (PI) is vaccination, which can significantly reduce the incidence and mortality from pneumococcus and reduce the level of antibiotic resistance. The use of pneumococcal conjugate vaccines has reduced the incidence of invasive PIs in vaccinated children and unvaccinated populations. This is especially true for children with severe somatic pathology, including those with various forms of heart failure (HF). The data show that vaccination of sick HF children can be a clinically effective intervention to improve the treatment results of circulatory failure and improve patients’ quality of life. However, questions regarding the optimal timing of vaccination of sick children with heart failure, dose, frequency and strategies of vaccine introduction still need to be resolved. Data on the pathophysiology of cardioprotection provision during effective vaccination against PI, influenza and COVID-19 in cardiac pathology are summarized. The authors recommend providing conditions for effective vaccine prevention of PI in children with heart failure.

Introduction. The impact of prematurity on the functional state of the kidneys in infants has not yet been sufficiently studied. Aim. To determine the influence of birth weight and gestational age on the creatinine level in the blood and glomerular filtration rate (GFR) in early childhood. Materials and methods. A retrospective analysis was conducted on medical records of 316 children aged from 1 month to 1.5 years, hospitalized at the Department of Early Childhood Pathology (National Medical Research Center for Children’s Health, Moscow) from 2012 to 2020 due to consequences of perinatal CNS damage. Children without congenital kidney diseases, with normal urine values in medical history, without structural abnormalities on ultrasound were included in this study. Serum creatinine was determined by the enzymatic method, GFR - by the Schwartz’s formula using a coefficient of 0.413, as well as, previously proposed coefficients of 0.33 for premature and 0.44 for full-term infants. Results. In premature infants, notably born with extremely low birth weight and very low birth weight, at the age of 1 year, serum creatinine is reduced compared to full-term infants, GFR in deep-premature infants exceeds the level of GFR in full-term infants by the year. The results allow concluding the method of calculating GFR by formulas based on serum creatinine to be invalid. Due to possible hyperfiltration in preterm infants, they need regular monitoring urine tests, blood pressure, due to the risk of developing chronic kidney disease. Conclusions. It is necessary to search for other methods for determining GFR in extremely premature infants. The established indices of the blood creatinine content can be used as reference values for different periods of gestation and body weight at birth in institutions using the enzymatic method for determining blood creatinine. The obtained GFR indices as a reference can be recommended for full-term and premature babies born after 32 weeks of gestation and with a birth weight of more than 1500 g.

Aim: to establish the patterns of changes in leukocyte blood parameters to determine their diagnostic significance in the different activity of Crohn’s disease (CD) and ulcerative colitis (UC) in children. Materials and methods. 370 5-18-year children (198 boys, 172 girls) with inflammatory bowel disease (IBD) were examined. Leukocytic blood parameters, concentrations of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin (FC) levels were determined. Changes in clinical activity in Crohn’s disease (CD) and ulcerative colitis (UC) cases were determined using pediatric activity indices: PCDAI and PUCAI, respectively. Analysis of endoscopic activity in 160 CD and UC patients was determined using the scales: SES-CD and UCEIS, respectively. Results. It was found that with an increase in the clinical activity of CD in children, the absolute numbers of leukocytes, lymphocytes and monocytes did not change significantly. In contrast, a significant increase in neutrophil reactivity was noted. In patients with high endoscopic CD activity an increase in the absolute number of monocytes and neutrophil reactivity was found. In patients with high clinical activity of UC, an increase in the number of leukocytes and the absolute number of neutrophils was found. At the same time, the granularity and reactivity of neutrophils increased from remission to moderate and high clinical activity of UC. In children with high endoscopic UC activity, the number of leukocytes, the absolute number of neutrophils and monocytes increased. At the same time, the granularity of neutrophils significantly increased as the endoscopic activity of UC increased from remission to moderate activity. Leukocyte parameters in UC patients correlated moderately with FC level, and the absolute number of neutrophils was closely related to its content. The granularity and reactivity of neutrophils positively correlated with ESR and CRP levels in children with CD and CRP concentrations in children with UC. Conclusion. The established patterns of changes in the quantitative composition of leukocytes and their functional properties (reactivity and granularity) are directly determined by the different activity of IBD in children and have diagnostic value

Introduction. Vaccination is the primary method of preventing hepatitis B (HBV). Immunization performed according to the standard schedule often provides protective level of antibodies against HBV. However, the frequency deviation of the immunization schedule in children due to unjustified medical contraindication is the current problem in Russia. At the same time, there is currently no clear strategy for patients with significant deviations of the vaccination schedule, especially regarding extending the interval between the first and third administration of the HBV vaccine. The aim is to evaluate the immunological effects of vaccination against hepatitis B in the vaccination schedule deviation in healthy children and children with chronic diseases. Materials and methods. Eighty-one 0.7-11.7 year child with a disrupted schedule of vaccination against HBV was observed. The children were divided into two groups: children vaccinated within 12-35 months (group 1, n = 48) and children immunized more than 36 months after the first vaccination (group 2, n = 33). Children with chronic forms of pathology were included in both study groups. Blood tests for HBV antibodies after vaccination were performed 1-3 months after the third vaccination. Results. The average concentration of antibodies in the range of 10-1000 mMEd/ml in children of group 1 was significantly higher than in children of group 2 (p = 0.037). In addition, children with chronic diseases were significantly more likely to have an anti-HBs titer higher than 1000 mMEd/ml after the third vaccination than healthy children (p = 0.012). Conclusion. An increase in the interval between the first and third administration of the hepatitis B vaccine leads to a rise in the number of children who are not immune to hepatitis B. Chronic diseases fail to affect the immune response due to the introduction of the hepatitis B vaccine, even if the immunization schedule is disrupted.

The severity of the course of bronchopulmonary dysplasia (BPD) in the population changes due to the increase in the number of children born with very low and extremely low body weight, the introduction into the practice of new standards of respiratory support for premature infants, drug prevention and treatment of this pathology. The aim of the work is to determine the influence of BPD form, gestational age, birth weight, concomitant diseases on the severity of its course in children. Materials and methods. In 72 BPD children aged from 1 month to 3 years, the severity of the course of the disease was determined according to the computed tomography of the chest organs, using an assessment of the severity in points on a special scale as follows: 0-5 points for mild BPD, 6-10 points - moderate, 11-15 points - severe. Results. In children born after 2012, a moderate course of BPD prevails (8.1 ± 0.32 points), being typical for both the classical (55.1%) and new (69.7%) forms of the disease. The classical form is more severe than the new one (9.0 ± 0.1 and 7.53 ± 0.38 points; p = 0.009). BPD was more severe in children with gestational age less than 28 weeks than in children with gestational age of 29-32 weeks (9.0 ± 0.4 and 7.4 ± 0.6 points; p = 0.000). BPD was more severe in children with birth weight less than 1000 g than in children with birth weight 1000-1500 g (8.79 ± 0.49 and 7.18 ± 0.61 points; p = 0.000). When BPD was combined with patent ductus arteriosus or pulmonary hypertension, the disease progressed more severely than in the absence of these forms of pathology (9.6 ± 0.8, 10.0 ± 0.7 and 7.22 ± 0.34 points; p = 0.031). The severity of changes detected by computed tomography of the chest organs decreases by the age of 3 years, but recovery was not complete in any of the examined patients: 8.6 ± 1.0 points at the age of 6 months and 6.2 ± 0.44 points by 3 years (p = 0.009). Conclusion. In children aged 1 month to 3 years, the severity of BPD is influenced by the form of the disease, gestational age, birth weight, concomitant patent ductus arteriosus or pulmonary hypertension, and the age at which the examination is performed.

The aim is to identify parents’ (legal representatives’) satisfaction with the quality of medical care provided to their disabled children to improve this type of service further. Materials and methods. A sociological survey was conducted of 506 legal representatives of minors (aged from birth to 17 years) with the status of a disabled child. The study design is single-center, non-randomized, uncontrolled. Results. An analysis of the living conditions of a disabled child in the family, the parents’ assessment of his health status, the problems arising in the registration of disability, in the provision of medical and rehabilitation assistance, and issues of medical and social support made it possible to determine the position of this part of the child population in current legal and medical and social conditions. The main problems were the collection of a large number of documents when registering a disability, a long wait for the day of examination, the remoteness of the medical and social examination bureau, the lack of specialist doctors, problems with obtaining subsidized drugs, the lack of consideration of the individual needs of the child when conducting unique rehabilitation programs, the need to apply at the same time to various organizations and departments, violation of rights in the provision of medical services to a disabled child. Conclusion. The obtained information is very significant for further improving the provision of medical and social assistance to disabled children and children with disabilities. The main task today is to develop mechanisms for implementing the declared rights and freedoms of persons with disabilities, the obligations assumed by the State concerning them.

Timely diagnosis and monitoring of ulcerative colitis (UC) in children is extremely relevant. In recent years, much attention has been paid to improving noninvasive UC diagnosis methods, which are available and convenient in the practice of a doctor. In this regard, we analyzed the significance of changes in noninvasive laboratory parameters of sick children with different clinical and endoscopic UC activity. Materials and methods. A prospective analysis of data of 80 patients diagnosed with UC at the age of 1 to 18 years with varying degrees of clinical and endoscopic activity of the disease was performed. Results. Significant changes in the studied laboratory parameters’ levels were revealed depending on the degree of clinical and endoscopic UC activity in children. The changes in fecal calprotectin content, levels of albumin, hemoglobin, and platelets were particularly substantial and informative in the blood of sick children when comparing remission with moderate and high clinical and endoscopic UC activity. A decrease in platelet counts was also found when UC activity increased. Conclusion. The studied laboratory parameters are informative noninvasive markers of UC activity in children. These indices can be used in the diagnosis of UC activity and monitoring of the course of the disease.

Introduction. Serum concentrations of collagens I, III, IV types (K-I, K-III, K-IV) and hyaluronic acid (HA) are reported to be informative in terms of noninvasive diagnosis liver fibrosis stages. In pediatrics, there is not enough data on this. Purpose was to assess the diagnostic value of direct biomarkers in predicting the stage of fibrosis in children with chronic liver diseases (CLD). Materials and methods. A prospective single-center study included 80 children with CLD . All patients underwent marginal resection of liver tissue under laparoscopic control. The serum K-I, K-IV, and HA concentration were measured by enzyme immunoassay. The authors applied ROC curve analysis to assess quantitative signs’ diagnostic significance in predicting a specific outcome. Results.The optimal KI value for the diagnosis of cirrhosis was 144.24 ng/ml, with AUROC: 0.758 ± 0.101 with 95% CI: 0.560-0.957, sensitivity and specificity 65.2% and 77.8%, respectively. The optimal K-IV values for the diagnosis of moderate fibrosis and cirrhosis were 11.29 ng/ml and 27.40 ng/ml, respectively, with AUROC 0.807 ± 0.092 with 95% CI: 0.627-0.987, 0.685 ± 0.062 with 95% CI: 0.567-0.810, sensitivity 82.4% and 61.15%, specificity 66.7%, and 64.7%, respectively. The optimal BG values for the diagnosis of weak and moderate fibrosis were 34.9 ng/ml and 36.5 ng/ml, for cirrhosis 38.3 ng/ml, with AUROC 0.912 ± 0.050 with 95% CI: 0.815-1.00; 0.849 ± 0.064 with 95% CI: 0.723-0.974, and 0.825 ± 0.048 with 95% CI: 0.730-0.920, respectively. Sensitivity was 84.6% at all stages, specificity - 77.8%, 61.5% and 70.6%, respectively. Conclusions. LF biomarkers have diagnostic significance in the detection of the stages of liver fibrosis. LF biomarkers are informative, reproducible noninvasive indices in the diagnosis of liver fibrosis in children.

The article deals with bioethics’ problems in medical students’ training through the prism of the philosophy of education, which was formed in the middle of the XX century when the humanitarian-anthropological turn in philosophy was formed. The term “bioethics “was first used in 1970 by W.R. Potter, who proposed the concept of “bioethics” to refer to a complex interdisciplinary knowledge, the goal of which is the survival of humankind. As an independent discipline, bioethics is taught in the first years of the medical university. It is this course of bioethics in medical universities that can be called “propaedeutics of bioethics.” This is due to the fact theoretical bioethics to be studied in the context of philosophy, when the student is given the opportunity to adequately interpret philosophical abstractions in bioethics, and applied, often very acute and complex problems of bioethics are studied in the senior courses of the university and in the system of postgraduate education, when future doctors master medical bioethics in the courses of resuscitation, transplantology, medical genetics, psychiatry, etc. The professional knowledge and culture of the doctor were shown to be not identical to his humanism. In this regard, the need for the integration of humanitarian and clinical disciplines in Russian higher medical schools is emphasized. At the same time, numerous concepts and principles of bioethics serve as universal mechanisms for “fitting” modern man and his life world into the totality of life, which allows us to speak of bioethics as universal ethics.

Introduction. The XXI century’s priority is to identify potentially “weak” links in human health, which allows changing your diet, habits, physical activity in time, and choosing a personal schedule for taking vitamins and trace elements. A special mission in this context belongs to the average medical staff, represented by several generations of specialists. The aim is to develop the concept of “human capital of a medical institution” and criteria for its evaluation on the example of nursing staff. Materials and methods. Audit of work plans of chief nurses, councils of nurses, a sociological survey of 405 nurses to identify professional burnout, and respondents‘ analysis of the environment of a medical institution that promotes the development of nursing competencies from vertical and horizontal interaction. Results. Authors develop definitions of the concept of “human capital of medical institutions and proposed tools for its assessment. Conclusion. The environment that includes the organization of the workplace; management aimed at creating vertical and horizontal systems of interaction; motivation that contributes to the professional and personal growth of nursing staff determine the development of the human capital of medical institutions.

Introduction. There are not enough studies dealing with the assessment of impact of socio-economic factors on the health of the population at the interregional level. However, the instability of the economic situation requires a periodic repetition of such researches. The aim of the study is to establish the relationship between the children’s disability prevalence and the main indices characterizing socio-economic situation in the Russian Federation. Materials and methods. Official data on the prevalence of disability in children aged 0-17 years and the level of basic indices characterizing the socio-economic situation in the country were analyzed in the context of 83 constituent entities of the Russian Federation for the period 2017-2019. The socio-economic characteristics of the population were the unemployment rate, monetary income, housing conditions, and consumption of basic food products. Spearman rank correlation method was used to determine the links. Results. It was established that there is still significant interregional variability in the prevalence of children’s disability both in Federal districts and in the subjects of the Federation. It’s been revealed various degrees of severity correlation between the childrens’ disability prevalence in the subjects of the Russian Federation and many socio-economic factors including unemployment; average per capita monetary income of the population; the proportion of the population with monetary incomes below the subsistence minimum; total area of residential premises, which is on average per inhabitant; the share of young families registered as needing housing, from the total number of family cells with children under 18 years; consumption of cheaper food. Conclusion. The results should be taken into account in the development of programs for the children’s disability prevention; full responsibility should not been placed on the healthcare system only.

Introduction. More than half of children with idiopathic nephrotic syndrome have relapsed or become steroid-dependent after the disease’s onset. So far they, require long-term therapy with glucocorticosteroids and/or other immunosuppressive treatment to maintain remission. Despite the widespread use of immunosuppressive agents, there is no consensus for appropriate first-line therapy. Materials and methods. A retrospective study included children presenting with steroid-dependent nephrotic syndrome who received treatment with mycophenolate mofetil in the Nephrology department between 2003 and 2018 at the National Medical Research Center for Children’s Health (Moscow). Results. In total, withdrawal of corticosteroids was recorded in 24 (85.7%) patients, while the median remission period was 23 [12; 30] months, after glucocorticosteroids cessation - 19 [10; 24.5] months, the cumulative dose of steroids was reduced from 189 [125.9; 240] to 45.5 [19.5; 68.2] mg/kg per year and relapses rate per year from 1.9 [1.35; 2.35] to 0 during a year. Among children who did not overcome steroid dependence, the treatment failed in 3 patients, and in 1 child, the steroid dosage has been reduced to the lower dose. Conclusion. Mycophenolate mofetil has a favorable efficacy due to the significant reduction of the cumulative dose of steroids and maintenance of long-term remission of nephrotic syndrome after glucocorticosteroid cessation and may be recommended as the first-line therapy in children with steroid-dependent nephrotic syndrome.

The optimal nutrition during pregnancy and lactation is extremely important for the health of both the mother and her infant. It allows realizing the «programming» potential of breastfeeding fully. The World Health Organization (WHO) emphasizes that to achieve better optimization of pregnant and lactating woman nutrition, it is necessary to enhance the introduction of relevant recommendations into practical work. The purpose of the current study is to analyze the results of a survey of women in Russia regarding their awareness of nutrition during lactation. Materials and methods. 1282 women of childbearing age (from 18 to 44 years old) from various regions of the Russian Federation took part in the survey. The questionnaire included 19 questions regarding the socio-demographic characteristics, duration of breastfeeding the nutritional features of women during breastfeeding, as well as the women’s opinions regarding the infant’s responses to changes in mother’s diet. The results of the study indicated that, despite the availability of recommendations coming from professional medical communities, no more than 30% of women received information about nutrition during breastfeeding from doctors. The Internet resources (non-medical websites and blogs) were shown to be the main source of knowledge about this issue (up to 60% of respondents). The results suggest from 30.2% to 42% of women in different age groups regularly to adhere to dietary recommendations. Whereas, they often had false ideas about «forbidden» and «allowed» foods. Thus, 30% of respondents noted nuts, jam, fresh vegetables, juice, fresh fruits as «forbidden» foods. Moreover, mothers with a first-born were significantly more likely to follow a diet compared to women with two (p < 0.001) and three or more children (p < 0.001). Conclusion. An analysis of the survey results showed that women have enough professional information about nutrition during lactation. Therefore, the work on the implementation of professional recommendations on nutrition for pregnant and lactating women should be intensified.

Introduction. The formation and spread of antibiotic-resistant Streptococcus pneumoniae isolates is a concern. After the thirteen-valent pneumococcal conjugate vaccine (PCV13) was added to the children’s immunization program in Russia in 2014, an important task is to monitor the resistance level to antimicrobials and the spectrum of circulating antibiotic-resistant pneumococcal serotypes. Materials and methods. The study included 708 nasopharyngeal pneumococcal isolates from children patients under 5 years who recovered from 2010 to 2018, received inpatient and outpatient care at the National Medical Research Center for Children’s Health (Moscow). The determination of sensitivity to antimicrobials was performed by the disk diffusion method. The MICs of penicillin, amoxicillin, and erythromycin were determined using the E-test method. Evaluation of the results was carried out according to the EUCAST-2019 criteria. Results. In total, 33 different serotypes were identified in the S. pneumoniae collection. Six predominant serotypes accounted for 68.6% of the total distribution and included serotypes: 19F, 6B, 23F, 14, 15B/C, 6A. In general, antimicrobial resistance ranged from 3.5% to chloramphenicol to 54.8% to tetracycline. The level of resistance to oxacillin, erythromycin, and clindamycin increased by 15-20% between 2010 and 2018. However, since 2016, there has established a prevalence level of 40-46%, this process is offset by an increase in the proportion of non-vaccine pneumococcal serotypes. Conclusion. A high level of resistance to penicillin and erythromycin remains. Monitoring the resistance level to antibiotics and the epidemiology of serotypes, clarifying the laws of formation of resistance, and its spread in a dynamically changing pneumococcal population is an important area of microbiology.

Background. The growing popularity of vegetarianism in the world also affects the growth of the number of families choosing this type of diet. Adherence to a vegetarian diet in children is a concern due to the high risks of macro- and micronutrient deficiencies. Increasing interest in vegetarian diets is also relevant for our country, but there is currently no data on the prevalence of vegetarianism among children in Russia. Materials and methods. We conducted a cross-sectional controlled study of indices of physical development, body component composition, and macronutrient composition of diets in vegetarian and non-vegetarian children. The physical development of vegetarian children was assessed using the «Anthro Plus», the macronutrient composition of diets was assessed using the special computer software, body composition was assessed using the bioelectrical impedance analysis. Results. 24% of vegetarian children had physical deviations: reduced body weight (6.3%), reduced body length (1.9%), mild malnutrition (13.3%), moderate malnutrition (1.3%), severe malnutrition (0.6%), overweight (5.1%). The assessment of the body composition showed statistically lower values of % ACM (p = 0.004) and phase angle (p = 0.005) in vegetarian children. 95% of the vegetarian children had an inadequate composition of the diet: both insufficient and excessive consumption of protein, fat, and carbohydrates. Low consumption of all macronutrients was found in 15% of vegetarian children. Children who received a vegan diet consumed protein with food statistically significantly lower, compared with lacto-and lacto-ovo-vegetarians (p < 0.005), but statistically more often consumed a high level of carbohydrates. High fat intake was found in most vegetarian children, especially children under 12 years. Conclusion. The results of the study showed the need to raise awareness of vegetarian parents about the nutritional risks associated with a vegetarian diet, and to make an adequate diet for their children.

Vaccination and hygiene are currently the main strategies for helping limit the spread and impact of acute respiratory infections However, the pandemic of SARS-CoV-2 infection and its severe consequences require the search for additional measures for reducing the morbidity and mortality from coronavirus infection One of these additional prevention strategies is micronutrient status optimization, which is safe and cost-effective Vitamins and minerals are important components of the immune response The effect of micronutrients such as vitamin D, ascorbic acid, zinc, omega-3 polyunsaturated fatty acids on the immune response has been studied for several decades As a result, significant shreds of evidence have been accumulated regarding the importance of provision immuno-nutrients on the adequate immune response This implies in both contexts: the prevention of infectious diseases and their course At the same time, the problem of insufficient supply with various micronutrients is gaining global significance, affecting every country and every socio-economic class of people This review contains data on the state of micronutrient status of the global and Russian population, discussion of the role of key immunonutrients in the prevention and treatment of respiratory infections, and results of recent meta-analyses It will also provide recommendations of experts in the field of nutrition, developed in 2020 with regard to the COVID-19 pandemic Вакцинация и меры гигиены являются основными стратегиями, которые помогают ограничить распространение и воздействие инфекций, в том числе острых респираторных заболеваний Однако пандемия инфекции SARS-CoV-2 и тяжелые исходы COVID-19 требуют поиска дополнительных мер, направленных на снижение заболеваемости и смертности от коронавирусной инфекции Дополнительной стратегией профилактики, безопасной и экономически эффективной, является оптимизация микронутриентного статуса больного Витамины и минеральные вещества вовлечены в реализацию всех звеньев иммунного ответа, и недостаточная микронутриентная обеспеченность неизбежно сказывается на иммунном статусе Влияние таких микронутриентов, как витамин D, аскорбиновая кислота, цинк, омега-3 полиненасыщенные жирные кислоты, на иммунный ответ изучается на протяжении нескольких десятилетий Накоплена значительная доказательная база о значении обеспеченности этими нутриентами для адекватного иммунного ответа в контексте профилактики инфекционных болезней и особенностей их течения В то же время недостаточная обеспеченность различными микронутриентами приобретает глобальный масштаб, затрагивая все страны и все слои населения Обзор содержит данные о состоянии микронутриентного статуса населения, обсуждается роль ключевых иммунонутриентов в профилактике и лечении респираторных инфекций, приведены данные последних мета-анализов, представлены также рекомендации экспертов в области нутрициологии, разработанные в 2020 г в связи с пандемией COVID-19

Introduction. The protection of children’s health is considered to be the most important among the state priorities. The aim of the study was to study the problems of legislation and legal enforcement in the field of children’s health protection to develop proposals for further improvement of its management. Materials and methods. Analysis of information in abstract databases of scientific publications and assessment of existing legislative framework related to children’s health protection in the Russian Federation. Results. The following issues were identified: lack of mechanisms for implementing the principle of priority of children’s health protection; violation of children’s rights when providing them with medical and preventive care within the framework of mandatory medical insurance and when providing paid medical services; insufficient quality of preventive medical examinations and preventive work in outpatient clinics and educational institutions. Existing standards of time for a patient to visit a pediatrician have been shown to have a negative impact on the quality of medical (including preventive) care for children. The need to create a regulatory framework for the legitimate introduction of the “early assistance” technologies and to establish a system of medical and social support for children in difficult situations had been justified. Issues of school medicine and regulation of juvenile labor require a legislative solution. Conclusion. The enhancement of existing legislation in the field of children’s health should consist not only in new legal mechanisms development and new laws adoption but also in improving the effectiveness of existing legal norms, i.e. improving law enforcement practices.

Introduction. Krabbe disease (KD) is the lysosomal storage disease developed due to the decline of the galactocerebrosidase activity associated with mutations in the GALC gene. It leads to the development of oligodendrocytes and lemmocytes (Schwann cells) myelin-forming dysfunction. Nowadays the only possible treatment of KD is hemopoietic cell transplantation which should be performed before the manifestation of any signs of disease. That is why laboratory diagnostics has special significance. The aim of the study. To elaborate the algorithm of a molecular diagnostics of the Krabbe disease (KD) in Russian children. Material and methods. 190 patients were diagnosed for the exclusion of KD during the period from 2012 to 2019. In all cases, there was measured a galactocerebrosidase activity in dry blood spots. In cases with the declined enzyme activity, there was performed a further search of pathogenic variants in the GALC gene. The concentration of glycosyl sphingosine (Lyso-GL1) biomarker was measured in 90 patients included in the study since 2016. Results. The enzyme activity was decreased in all patients in comparison with the control group (0.330.05; 2.950.24 mol/l/h, (p0.001; CI: 95%) in 9 patients. Also, we revealed an increased concentration of Lyso-GL1 biomarker in matched controls (12.501.57 ng/ml; 1.80.33 ng/ml, (p0.005; CI: 95%) in 5 patients. During molecular genetic testing of KD, three novel pathogenic variants of the GALC gene were revealed in 3 out of 9 patients: c.265-2AG, c.1036del and c.2037_2040del. Conclusion. The Lyso-GL1 concentration measurement can be used as an additional diagnostics method of KD. The high efficiency of the presented algorithm for the KD diagnostics in Russian children is presented.

The topic of a publication is related to the outbreak of viral pneumonia in patients in Wuhan, China. This literature review reviews works and publications on the biology, detection, epidemiology, and pathology of strains of the new coronavirus 2019-nCoV/COVID-19/COVID-19. Data on the genome of the new coronavirus, its possible phylogenetic origin, and its relationship with previously known coronaviruses are considered. The problems of tropism 2019-nCoV/COVID-19/COVID-19 to human cells, pathologies caused by the virus, possible analytical scenarios of the epidemic are described. The methods for the prevention and treatment of infection in humans known at the time of writing are presented. Conclusions on the available data suggest low contagiousness of the infection and indicate the possibility of developing specific active or passive immunization.