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COMPLEMENTARY FOODS ARE A WINDOW OF OPPORTUNITY FOR THE DEVELOPMENT OF IMMUNOLOGICAL TOLERANCE, ALLERGY PREVENTION AND THE FORMATION OF A CHILD'S TASTE
I.N. Zakharova, Yu.A. Dmitrieva

Summary. The active growth rate of the infant and the increased needs for nutrients and energy in the second half of life determine the need for the introduction of complementary foods. The age range of 4–6 months has been determined by Russian and foreign experts as optimal for starting to expand the diet. The results of numerous studies have demonstrated that this period is a "window of opportunity" for the development of immunological tolerance, the prevention of allergic diseases and the formation of correct taste preferences. Given the high vulnerability of the infant's digestive system, most domestic nutritionists agree that it is advisable to use industrial complementary foods that meet strict hygienic requirements and have a guaranteed chemical composition in the nutrition of a child of the first year of life. Products that have an organic production certificate demonstrate the maximum level of security.
Keywords: complementary feeding, breastfeeding, infants, food programming, macro- and microelements, vitamins, deficient conditions, immunological tolerance, allergy, gluten, taste preferences, organic nutrition

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THE ROLE OF THE TIME OF THE FIRST ULTRASOUND EXAMINATION IN ASSESSING THE EXPANSION OF THE CALYX-PELVIC SYSTEM IN NEWBORNS
S.I. Babatova, A.B. Sugak, E.A. Filippova, Z.N. Batalova, N.A. Pekareva, V.S. Pavlova, M.V. Podguzov, M.I. Pykov

Summary. Objective – to evaluate the role of the time of the first ultrasound examination (US) (before and after the first 2 days of life) in assessing the calyx-pelvic system dilation in newborns.
Material and methods. The comparison of the US picture of the urinary tract (UT) in children examined for the first time at the age of 0 to 2 days of life (group 1, n = 115) and at the age of 3 to 10 days of life (group 2, n = 70), as well as the dynamics of its condition during the first 2 months of life, was carried out. The US data was evaluated in accordance with the UTD classification.
Results. When followed up for 2 months, patients in group 1 had a decrease in the UTD category less often (in 12%), the category remained the same less often (in 49%) and its increase more often (in 39%) than in group 2 (in 23%, 63% and 14%, respectively) (p < 0.05). Surgical intervention was performed by 22% of children from group 1 and 14% of children from group 2 (p > 0.05). In group 1, operations were performed on 6 patients with UTD 0 and I (normal and low risk of uropathies). In group 2, none of the patients with UTD 0 and I underwent surgery.
Conclusion. Due to physiological oliguria and dehydration of the newborn in the first 2 days of life, it is possible to underestimate the calyx-pelvic system dilation degree or miss the UT pathology, including severe uropathies, which will require surgical intervention.
Keywords: calyx-pelvis system dilation, ultrasonography, newborns

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PREMATURE ISOLATED THELARCHE. CLINICAL CASE
E.V. Sibirskaya, I.V. Karachentsova, A.S. Annakulieva, V.D. Ushakova

Summary. Premature isolated thelarche is an important and urgent problem of modern gynecology, as well as other diseases associated with premature sexual development. Pediatric gynecologists should conduct differential diagnostics between the forms of premature sexual development for the purpose of timely diagnosis, treatment and prevention of possible medical error. The article presents an illustrative clinical case of premature isolated thelarche in a girl, requiring differential diagnostics with other forms of premature sexual development. Patient Sh., 4 years old, was admitted to the hospital. The reason for the patient's visit to the gynecologist at her place of residence was complaints about the enlargement of the mammary glands since 6 months of life. The patient was sent to the hospital to clarify the diagnosis and further treatment. As a result, the patient was examined, the diagnosis was established, and the treatment tactics were chosen.
Keywords: clinical case, isolated thelarche, premature isolated thelarche, premature puberty, other disorders of puberty.

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PNEUMOCYSTIS INFECTION IN CHILDREN. CLINICAL CASES FROM PRACTICE
E.R. Samitova, I.M. Osmanov, L.N. Mazankova, N.V. Karazhas, N.V. Koroid, M.A. Menshikova, I.V. Zakharova, T.N. Ermak, L.O. Tarantova, T.N. Rybalkina, N.V. Loban, O.F. Kabikova, M.N. Kornienko, A.A. Nedostoev

Summary. The article demonstrates the manifestation of pneumocystis pneumonia in children aged 5 and 7 years with HIV infection from the same family using two clinical examples. In both cases, pneumocystis pneumonia (PP) was the reason for seeking emergency medical care. In the first case, during the last year before hospitalization, the child had complaints of regression of motor skills (speech, gait), which forced the parents to consult neurologists. In the second case, three years before hospitalization, the child was diagnosed with HIV infection based on a laboratory examination, but the parents did not seek specialized help and the child did not receive antiretroviral therapy.
Keywords: pneumocystosis, Pneumocystis jiroveci, Pneumocystis, HIV infection, children

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THE STRUCTURE OF GIRLS’ DELAYED PUBERTY
K.L. Kabolova, O.Yu. Latyshev, G.F. Okminyan, E.V. Kiseleva, D.S. Romakina, L.N. Samsonova, I.M. Osmanov

Summary. The study is devoted to studying the structure of delayed puberty in girls depending on the etiology and clinical picture. Analysis of the results of the study showed that the structure of delayed puberty in girls is equally represented by permanent and transient forms. In the permanent form, hypergonadotropic hypogonadism significantly predominates, while hypogonadotropic hypogonadism occurs in 1/6 of cases. Among patients with a transient form of delayed puberty, constitutional delayed puberty and functional hypogonadism occurred with equal frequency. The reason for treatment of girls with the permanent form was more often primary amenorrhea, while in the group with the transient form it was the absence of secondary sexual characteristics. Knowledge of the structure of delayed puberty helps to understand the cause of this condition and choose the correct trajectory of the diagnostic search, which contributes to a faster diagnosis and choice of further management tactics.
Keywords: hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, girls, functional hypogonadism, constitutional delayed puberty

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DIAGNOSIS OF THE CAUSES OF STRIDOR IN YOUNG CHILDREN USING ULTRASOUND SCANNING
M.V. Subbotina, M.I. Pykov

Summary. The aim of the study was to determine the diagnostic capabilities of laryngeal ultrasound (LUS) in young children stridor.
Material and methods. A prospective blind cohort examination of 23 children with stridor aged 0 to 3 years (average age 14 ± 11 months) and 10 children without laryngeal pathology was conducted in compliance with ethical standards. There were 70% of girls. Complaints, anamnesis, and LUS were collected in all patients in B-mode and color Doppler mapping (CDM) mode with a linear transducer with a frequency of 7.5–15 MHz. After ultrasound, the diagnosis was verified using fibrolaryngoscopy.
Results. An algorithm for diagnosing the causes of young children stridor is proposed. Normally, in infants, echogenic arytenoid cartilages diverged apart when inhaled, converged during exhaled. With laryngeal paresis, the stationary half of the larynx did not move in B-mode, and with CDM, this half was less colored. Larungeal papillomas and scars were detected better by CDM. Laryngomalacia was diagnosed due to paradoxical convergence of folds at the noisy inhalation by LUS. The effectiveness of ultrasound in diagnosing the causes of stridor was 88% in young children, sensitivity 91% specificity – 80%.
Conclusion. BUS with CDM can be used to examine young children with stridor, to diagnosis of laryngeal paresis, tumors and manifested by paradoxical respiratory movements laryngomalacia.
Keywords: ultrasound scanning, laryngeal echography, stridor, young children, laryngomalacia, laryngeal paresis, laryngeal papillomatosis

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SEDATION IN THE INTENSIVE CARE UNIT FOR CHILDREN
B.D. Babaev, I.F. Ostreikov, M.K. Shtatnov, D.V. Yakushev, S.F. Pilyutik, K.R. Tarasov, E.A. Shavlokhova

Summary. Sedation is one of the components of pediatric intensive care. An adequately sedated and analgesized patient has lower pain perception and demonstrates lower stress response to various invasive and non-invasive procedures. In this review, we describe our approach to various sedation techniques used in an intensive care unit, and also consider sedation techniques using inhalational anesthetics.
Keywords: sedation, pediatric intensive care, sedation in an intensive care unit, sedation using inhalational anesthetics

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MODERN ASPECTS OF HEMOSTATIC DIAGNOSIS IN CHILDREN WITH THROMBOHEMORRHAGIC COMPLICATIONS
A.A. Martynov, A.Ya. Ilyina, A.L. Mishchenko, M.V. Shabliy, A.S. Rogova, E.A. Akhalova

Summary. The article presents a literature review of hemostasis diagnosis in pediatric practice. The relevance and importance of optimal hemostasis examination is determined by new attitudes on etiopathogenetic diagnosis of thrombohemorrhagic events in children. The materials of Russian and foreign literature noting the importance of genetic examination and the role of thrombophilia, and some materials confirming the significance of special research methods (thromboelastography, aggregometry and others) are presented in our work. The review discusses the features and mechanisms of the development of hemostasis system pathological conditions and methods of therapeutic correction. In addition, the article outlines a vector for further research, as well as recommendations for improving the healthcare system to children with risk for the thrombohemorrhagic complications development.
Keywords: hemostasis, thrombophilia, thrombosis, hemorrhage, thromboelastography, coagulogram, genetic polymorphisms, children

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TREATMENT TACTICS FOR CHEMICALLY ACTIVE FOREIGN BODIES OF THE ESOPHAGUS IN CHILDREN. (CLINICAL CASE)
A.S. Koshurnikova, A.S. Kuzmin, A.E. Versina, Yu.Yu. Sokolov, A.V. Dzyadchik

Summary. A clinical case of a chemical burn of the esophagus in a 4-year-old child by a disk battery was reviewed, and conservative treatment tactics were applied using the drug Alfasoxx. The role of correct and timely tactics of endoscopic treatment and postoperative conservative treatment of a chemical burn of the esophagus in a child is emphasized.
Keywords: esophageal burn, disk batteries, children, chemically active foreign bodies of the esophagus, diagnosis, treatment of foreign bodies, esophagoprotector, Alfasoxx