Background.In the outpatient setting, it is important for pediatricians and general practitioners to determine the indications and empirically prescribe an effective antibacterial drug in a timely manner. In the Russian Federation in recent years, clinical guidelines for various diseases have been developed and approved, defining indications for systemic antibacterial therapy, according to which amoxicillin is the starting drug for most bacterial acute respiratory infections, and inhibitor-protected aminopenicillins (amoxicillin/clavulanate) are recommended in case of ineffective therapy or drug-resistant pathogens.
Conclusion. The article presents the determining indications for the prescription of antibacterial therapy and the peculiarities of the choice of the starting antibacterial drug in such infectious-inflammatory diseases of the upper respiratory tract in children as acute tonsillitis and/or pharyngitis, acute sinusitis, acute otitis media. It is shown that the most optimal dosage form for the use of antibacterial drugs is dispersible tablets, which increases the safety of treatment and patient adherence to medical recommendations.

Background. Functional gastrointestinal disorders in the first year of life are a common problem for the child and parents. In addition to significant discomfort for the family, they often lead to a range of inconsistent behaviors that include duplicate consultations with different health care providers, frequent changes in types and names of infant formula, or the use of expensive non-medication treatments. According to current data, 54.9% of infants exhibit at least one symptom of functional gastrointestinal disorders between 0 and 6 months of age. The most common functional digestive disorders of the first 12 months of life include regurgitation, infantile colic and functional constipation.
Objective. The purpose of the study was to assess the safety and tolerability of infant formula containing locust bean gum and prebiotics galacto- and fructooligosaccharides (GOS/FOS). The study assessed the effectiveness of the mixture in reducing symptoms of functional disorders of the gastrointestinal tract in children of the first year of life also.
Results. This 4-week, open-label, non-randomized, prospective post-registration study enrolled 40 formula-fed or formula-fed infants aged 2 to 14 weeks. The tested formula contained 0.4 g/100 ml locust bean gum as a thickener and 0.4 g/100 ml prebiotics, short-chain galacto-oligosaccharides (scGOS) and long-chain fructo-oligosaccharides (lsFOS) in a 9:1 ratio. Infants receiving locust bean gum and the prebiotics scGOS/lcFOS 9:1 formula demonstrated a significant reduction in the frequency and intensity of symptoms of functional gastrointestinal disorders, including infantile colic (92%) and regurgitation (100%) over 4 weeks of use. The average parental satisfaction with diet therapy was 9 out of 10 points.
Conclusion. An infant formula containing locust bean gum and prebiotics scGOS/lcFOS 9:1 is well tolerated and ensures adequate growth. Analysis of the collected data shows that the formula leads to a decrease in functional gastrointestinal disorders, eliminating regurgitation in 100% of children and infant colic in 92% of children by the end of the study.

Background. Processes of intensive growth and development are a feature of childhood and adolescence. The speed and individuality of changes in anthropometric indicators, especially during puberty, is the reason for the difficulty of differential diagnosis of physiological growth and pathological conditions associated with diseases of the endocrine system, including pituitary adenomas that produce growth hormone (somatotropinoma), which are rare in children and young people under 19 years of age. In 2024, the International Consensus Guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence was published for the first time. It reflects data on the prevalence, clinical and genetic features, as well as approaches to the diagnosis and treatment of pituitary tumors in childhood.
Results. A clinical case of diagnosis and treatment of somatotropinoma in a 15-year-old teenage boy, who has tall relatives on his mother and father’s side, is described. The onset of the disease is in puberty. There were no complaints for a long time. An algorithm for clinical diagnosis is presented that logically substantiates the correct diagnosis and choice of treatment. Therapy for somatotropinoma was carried out in accordance with the recommendations of the international consensus, however, preoperative preparation with somatostatin analogues was not carried out, since, given the size of the macroadenoma, a decision was made on immediate surgical treatment. As a result of surgical treatment, a significant decrease in the level of growth hormone was achieved. It was noted that after 6 months the levels of IGF-1 and growth hormone remained elevated and therapy with a long-acting somatostatin analogue was justified against the background of replacement therapy for hypopituitarism, the manifestations of which persisted in the postoperative period. The patient will undergo long-term medical observation and support. The authors wanted to emphasize the likelihood of this pathology, the main aspects that make it possible to differentiate the physiological characteristics of growth in puberty from the onset of a serious illness, and recommend diagnostic algorithms at the stages of medical care.

Background. The most important achievement in modern medicine is the widespread introduction of assisted reproductive technologies. In Russia, in vitro fertilization has acquired well-known advantages. The use of this method made it possible to solve the problem of infertility for a large number of families and satisfy a woman’s natural need for motherhood. At the same time, the ultimate goal – the appearance of healthy offspring – can only be achieved through the joint efforts of reproductive specialists: clinical and laboratory specialists. The justified purpose of this study was to determine the most significant indicators of the health of newborns in Astrakhan after in vitro fertilization in relation to indicators of maternal health.
Materials and methods. The health indicators and developmental characteristics of 109 children born after in vitro fertilization in the city of Astrakhan and the Astrakhan region on the period 2017-2022, as well as the morbidity of their mothers, were studied. Methods of clinical and laboratory examination and modern methods of statistical analysis were used.
Results. It has been established that multiple pregnancies after in vitro fertilization are more often observed in women who have a history of a greater number of various pathological conditions, mainly anemia of pregnancy, endocrine diseases accompanied by edematous syndrome and obesity, as well as virus carriage against the background of multiple attempts at fertilization. A certain number of newborns after in vitro fertilization (12.4% from singleton and 18.4% from multiple pregnancies) had somatic pathology, which was accompanied by iron deficiency anemia. However, the relationship between the number of fetuses in pregnancy after in vitro fertilization, the sex of the newborn and the occurrence of early anemia in newborns has not been statistically confirmed.

Background. Several variants of congenital gallbladder anomalies are distinguished: by position (median, suprahepatic, intrahepatic), shape (kinks, constrictions), number (doubling or tripling), presence of partitions in the gallbladder. In case of doubling, gallbladders can differ in shape and size. As a rule, a smaller gallbladder is considered to be an additive gallbladder. The accessory bladder may be hypoplastic or rudimentary. Gallbladder doubling can be in the form of either a simple (simplest) form or a true (complete) doubling. Doubling of the gallbladder is a very rare pathology.
Results. The paper presents two clinical cases of gallbladder doubling detected in children during the neonatal period. Doubling of the gallbladder in infants was diagnosed using ultrasound examination on an expert-class device. In the first and second cases, doubling of the gallbladder was found in full-term boys in the early neonatal period. Newborn babies with a doubling of the gallbladder were born with intrauterine growth retardation of the hypotrophic and hypoplastic type. After birth, infants were diagnosed with neonatal jaundice of 3-4 degrees according to Kramer, hyperbilirubinemia due to the predominance of the indirect fraction of bilirubin. Data for hemolytic disease and intrauterine infection in children have not been obtained. The liver and spleen are not enlarged. The gallbladder was not palpated. There was no clinic for cholestasis in newborn children. Urine and stool were stained. One child with a doubling of the gallbladder was found to have a congenital heart defect, a defect in the interventricular septum. After phototherapy, jaundice in children was stopped by the 15th day of life. In children with gallbladder doubling, there were no indications for surgical treatment. Thus, no clinical and laboratory features of the neonatal period were found in children with gallbladder doubling. In children with intrauterine growth retardation, there is a high risk of developing pathological conditions in the neonatal period, anomalies and congenital malformations are possible.

Background. The physical development of a child is in direct dependence on the actual diet, not only quantitative, but also qualitative composition. In addition to indicators such as body weight and length, the correct formation of body composition is important. The influence of nutrition on indicators of neuropsychiatric development is the basis of the concept of neurodietology. To date, it is generally recognized that the amino acid composition of protein, oligosaccharides, omega-3 and omega-6 fatty acids and a number of other nutrients have a positive effect on the development of the central nervous system and its functions.
Objective. The paper is dedicated to the role of nutrition in infants and young children.
Results. Some nutritional aspects of physical, psychomotor, mental, emotional and cognitive development are mentioned, as determinants of somatic and psychoneurological health in the described period of pediatric age. Further, the schematic description of alimentary physiology and associated development regulation in infants and young children are provided, including brain-gut axis and humoral regulation of feeding behavior. The specifities of contemporary human milk substitutes are considered, and those of goat milk-based formulas in particular. The product line is available in Russia and is exemplified as a demonstration of contemporary infant/child food products for individuals aged from 0 to 3 years, and focused on optimizing the milestones of physical and psychomotor development. The conclusion states that the use of contemporary human milk substitutes and follow-on formulas is aimed at achieving not solely physical developmental ranges (body weight, body length), but at mental, emotional, cognitive developmental skills, and verbal faculties, as well.

Background. The present article is based on the materials of the annual report of Professor S. G. Vrublevsky, the chief freelance specialist – pediatric urologist-andrologist of the Moscow Department of Health Care, which summarizes the results of the pediatric urological service of the capital city. The article is an analysis of the performance indicators of the pediatric urological service of Moscow both with regard to the main nosological areas of its activity and specific institutions within its structure. There has been an increase in the number of specialists and beds in the pediatric urological service. The duration of a patient's stay in hospital has decreased, and all clinics within the pediatric urology service are at approximately the same level in terms of this indicator – from 3.5 to 4.5 days, which is less than in previous periods. Short-stay inpatient clinics have been actively operating.
Results. All Moscow hospitals treated 13,384 children with uroandrologic pathology in 2023. This is more than in the previous 12 months, which is due to the end of the pandemic, during which the opportunities for hospitalization were limited. An important characteristic of any unit performing surgical interventions is surgical activity. In some institutions of the capital, which are part of the structure of pediatric urological service, it is up to 100%, such as, for example, in Z. A. Bashlyaeva Children's City Clinical Hospital, which shows high figures from year to year. This is due to the fact that the main process of examination of patients occurs at the pre-hospital stage, and the child is hospitalized directly to perform surgical care. In all children's hospitals in Moscow, 10,672 urological operations were performed, not counting those performed in short-stay hospitals (about 3,500 more).
Conclusion. In general, more than 14 thousand surgeries in the profile of “urology-andrology” were performed in the capital's pediatric medical institutions during the year. At the same time, the number of surgical interventions performed in short-stay hospitals increased from 2884 in 2022 to 3526 – in 2023, when such hospitals (including in the profile of “urology andrology”) were actively working in all institutions of the capital.

Background. Connective tissue dysplasia — impaired development of connective tissue in the embryonic and postnatal periods, a genetically determined condition characterized by defects in fibrous structures and the basic substance of connective tissue, leading to a disorder of homeostasis at the tissue, organ and organizational levels in the form of various morphofunctional disorders of visceral and locomotor organs with a progressive course, determining the features of associated pathology, as well as pharmacokinetics and pharmacodynamics of drugs. Due to the ubiquitous presence of connective tissue in the body, its changes are widespread, which leads to a variety of clinical manifestations affecting all organs and systems. The comprehensive spread of connective tissue in the body determines the multiple organicity of lesions in connective tissue dysplasia syndrome. Connective tissue dysplasia syndrome is quite often combined with pathology of the organs of the urinary system. Special attention is paid to the problems of nephrology in children in pediatrics. Early detection of a real lesion in children with connective tissue dysplasia is difficult. Early diagnosis of possible renal complications in DST in children has become a very relevant issue in the modern world. The study of the features of the course of kidney pathology against the background of connective tissue dysplasia in children is necessary to identify a group of patients at high risk for the formation and progression of nephropathies.
Objective. The aim of the study was to present a clinical case of urinary system lesion against the background of connective tissue dysplasia in a 7-year-old child.
Materials and methods. Patient O., born in 2016, was examined at the State Medical Institution "CSTO". During the examination of the child, the clinical and genealogical method, functional research methods (ultrasound examination of the abdominal cavity and retroperitoneal space, electrocardiography, daily monitoring of blood pressure), clinical and biochemical examination of blood and urine were used. Conclusion. The problem of kidney damage in connective tissue dysplasia is relevant in nephrological practice. Thus, early diagnosis of kidney damage in connective tissue dysplasia and their timely correction are necessary to prevent the formation and progression of chronic kidney disease.

Background. Bismuth is a somewhat rare element, similar in content to silver and mercury, but cheaper to produce because large amounts of bismuth are extracted as a by-product of copper and tin processing. Bismuth and its compounds are considered moderately safe and relatively non-toxic. The relatively low toxicity of bismuth compounds is mainly due to their insolubility in nearly neutral aqueous solutions, such as biological fluids. In addition, most bismuth compounds have been demonstrated to be less toxic than even sodium chloride.
Objective. The aim of the article – to outline the feasibility of clinical use of bismuth preparations in the XXI century. Despite many years of using bismuth preparations in clinical practice, the relevance of their use does not weaken, but on the contrary, new niches for its use in clinical practice are opening up. In addition to the well-known cytoprotective effect, the bismuth preparation serves as a worthy alternative to standard triple therapy in the form of quadruple therapy with bismuth preparations, the main one of which is currently bismuth tripotassium dicitrate, which is reflected in the recommendations of the Russian Gastroenterological Association and the Endoscopic Society RENDO. The high efficiency of the possibility of combining bismuth tripotassium dicitrate not only with tetracycline, but also with other antibiotics is shown. The addition of bismuth tripotassium dicitrate to triple regimens containing clarithromycin, levofloxacin, metronidazole allows to increase the effectiveness of eradication by more than 92% with a 14-day course of use. Important bonuses of clinical application of bismuth tripotassium dicitrate are absence of resistance development during its application, combination of bactericidal and cytoprotective effects, as well as good tolerability. Currently, new antibacterial properties of bismuth tripotassium dicitrate are being discovered for treatment of other pathogens, besides Helicobacter pylori. One of worthy representatives of bismuth tripotassium dicitrate is Russian mediication based on bismuth tripotassium dicitrate, which has improved profile of antibacterial activity and safety.