Introduction. There were conducted numerous studies to assess the management of nutrition in young children living in the Russian Federation. However, this problem remains poorly studied in the regions of the North Caucasus Federal District and requires further development. Aim. To determine the features of nutrition management and the frequency of alimentary-dependent conditions in young children living in the regions of the North Caucasus Federal District (using the cities of Stavropol, Nalchik, and Cherkessk as examples).Materials and methods. A multicenter non-randomized cross-sectional study was conducted: a survey of pediatricians and parents on the management of rational nutrition in, children from 1 year to 3 years of age from health groups I and II based on questionnaires developed by the researchers.Results. The data of the study demonstrated significant differences in the opinions of pediatricians and parents on the adequacy of nutrition in young children (p < 0.001). A significantly high frequency of overweight/obesity was revealed in Stavropol (39%) compared to Cherkessk (22%), iron deficiency conditions, including anemia: 30%, 52%, 21%, respectively, while in Stavropol it was more common compared to Nalchik and Cherkessk (p < 0.001), as well as rickets: Stavropol — 39% versus Nalchik — 37% and Cherkessk — 20% (p = 0.029). A significant increase in the consumption of “unhealthy” food products by children over the third year of life in Cherkessk (p = 0.015) and Stavropol (p < 0.001) was revealed, as well as a direct effect of the level of mothers’ education on the consumption of such “harmful” products for children as carbonated sweet drinks (p < 0.001) and sausages (p = 0.013).Conclusion. The identified violations in the nutrition of young children living in the North Caucasus region can be the cause of a high frequency of alimentary-dependent conditions, which requires increased attention to educational work in primary outpatient care using popular information materials available to the population to introduce the principles of healthy nutrition for children into practice and form correct eating behavior in them.Contribution: Bushueva T.V., Borovik T.E., Skvortsova V.A. — concept and design of the study; Khubieva M.U., Lukoyanova O.L., Guseva I.M., Chernikov V.V., Komarova O.V. — collection and processing of the material; Bushueva T.V., Khubieva M.U., Chernikov V.V. — statistical processing of the material; Bushueva T.V., Borovik T.E., Khubieva M.U. — writing the text; Fisenko A.P. — editing the text.All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.Acknowledgment. The study had no sponsorship.Conflict of interest. The authors declare no conflict of interest.Received: August 11, 2025Accepted: October 02, 2025Published: October 30, 2025

Children with Crohn's disease (CD) are at high risk for developing nutritional deficiencies. According to studies in adult patients with CD, loss of lean and skeletal muscle mass and decreased bone mineral density (BMD) are unfavorable prognostic factors for the course of the disease; among children, the prevalence of these changes has not been sufficiently studied as yet. The purpose of this research was to study the frequency and correlation between disorders of body composition and decreased bone mineral density in children with CD. Materials and methods used: medical records of 163 aged 5 to 17 y/o with a confirmed CD diagnosis were assessed for the risk of nutritional deficiency using STRONGkids screening tool, anthropometric parameters, body composition with bioimpedance measurements as well as the disease activity index with PCDAI and endoscopic activity with SES-CD. BMD was assessed in 145 using densitometry. Results: depending on the degree of risk of malnutrition, children were divided into 2 groups as follows: G1 with high and G2 with moderate risks for malnutrition. G1 patients had significantly lower values of both anthropometric indices (Z-scores BMI/age, mid-upper arm circumference/age) and lean and skeletal muscle mass (p<0.001) along with more severe course of CD according to PCDAI (p<0.001). According to bioimpedansometry data, a significant increase in catabolic processes was found in G1 children as a decrease in Z-scores for both the phase angle (p<0.001) and the active cell mass (p<0.001). A decrease in BMD was detected in 9 (37%) of G1 and 26 (21.4%) of G2. A correlation was found between Z-scores lean body mass/age and BMD/age (p<0.001, Rs=0.612). Among children with reduced BMD values, the indicators for BMI, lean, skeletal muscle and active cell mass according to bioimpedance measurements were significantly lower (p<0.001). Conclusion: the data obtained during the study proposes high incidence of decreased bone mineral density along with pathological changes in body composition in children with CD. The use of STRONGkids tool to identify children at high risk of developing malnutrition, especially in the absence of the technical ability to conduct a detailed assessment of nutritional status with determination of body composition and BMD indicators, makes it possible to timely identify patients requiring individual nutritional support aiming to optimizing diets and, if necessary, prescribing addition of specialized food supplements.

Breastfeeding is commonly acknowledged as being the biological norm. In cases when a child cannot be latched to the breast, freshly expressed mother's milk is the first choice that in specific conditions may require pasteurization. In accordance with the Russian sanitary rules and regulations as of 2021, “human milk is processed by boiling it in a water bath,” which is extremely destructive for the most of its biologically active and important components. The global practice of thermal processing of human milk is its low-temperature pasteurization according to the Holder method for 30 minutes at the temperature of +62.5°C. Currently there are no Russian domestically produced breast milk (BM) pasteurizers whilst it is not always possible to purchase imported equipment as yet. The purpose of this research was to assess the bacteriological safety of BM pasteurization using the laboratory water bath PE-4300 domestically produced by “ECROSKHIM” in Saint Petersburg, Russia, which allows the reproducing of the Holder method. Materials and methods used: a prospective single-center study of 153 lactating mothers was conducted with 306 BM samples being subjected to bacteriological analysis prior to and after the pasteurization. Results: before pasteurization, the growth of opportunistic bacteria was detected in all BM samples mainly due to the growth of S. epidermidis. After pasteurization, 96.1% of BM samples turned out to be sterile. In the remaining 3.9%, the scant growth of S. epidermidis (2.6%), Streptococcus oralis (0.65%) and Acinetobacter (0.65%) was not clinically significant. Conclusion: BM pasteurization in the laboratory water bath ECROSKHIM PE-4300 demonstrated high bacteriological safety of the device’s final revision, which in its turn allowed Authors to recommend this method of processing of both maternal and donor BM in pediatric and perinatal facilities.

Введение. В комплексном лечении недоношенных детей важная роль принадлежит питанию, от адекватности которого в значительной степени зависят их рост и развитие. Цель работы. Оценка антропометрических показателей и состава тела детей с очень низкой и экстремально низкой массой тела при рождении и в 38-40 недель постконцептуального возраста. Материалы и методы. Нами проведено когортное амбиспективное рандомизированное исследование. В него включены 70 недоношенных детей (28 девочек и 42 мальчика), рожденных с массой тела менее 1000 г (1-я группа, n = 40) и от 1000 до 1500 г (2-я группа, n = 30). Антропометрические данные при рождении и на момент исследования оценивались с помощью международных стандартов роста INTERGROWTH-21st. Количество и соотношение жировой и безжировой массы тела определялись с помощью воздушной плетизмографии. Результаты. При оценке нутритивного статуса недоношенных детей обеих групп на сроке доношенности (38-40 недель постконцептуального возраста) установлено значимое снижение показателей стандартизированной оценки z-scores – массы, длины тела и окружности головы к возрасту в 1-й группе, а также массы и окружности головы к возрасту во 2-й группе, более выраженное в 1-й группе. Недостаточность питания (z-score массы тела к возрасту менее 1 SD) выявлена у 77,5% детей 1-й группы и 23,3% – 2-й группы. Анализ показателей состава тела не выявил значимых различий в процентном содержании жировой и безжировой массы тела детей 1-й и 2-й групп, но безжировой массы тела было на 440 г меньше у детей с экстремально низкой массой тела при рождении. В 1-й группе установлены статистически значимые прямые корреляционные связи между z-score массы тела и безжировой массы тела, выраженной как в процентном отношении, так и в кг, а также значимая обратная корреляционная связь с жировой массой тела в процентах. Заключение. Формирование постнатальной задержки роста у значительной части детей, родившихся с массой тела менее 1500 г, диктует необходимость тщательного динамического контроля их нутритивного статуса для проведения своевременной коррекции. Background. In the complex treatment of premature infants, nutrition plays an important role, the adequacy of which largely determines their growth and development. Objective. Assessment of anthropometric parameters and body composition of children with very low and extremely low body weight at birth and at 38-40 weeks of postconceptional age. Materials and methods. We conducted a cohort ambispective randomized study. It included 70 premature babies (28 girls and 42 boys), born with a body weight of less than 1000 g (group 1, n = 40) and from 1000 to 1500 g (group 2, n = 30). Anthropometric data at birth and at the time of the study were assessed using international growth standards INTERGROWTH–21st. The amount and ratio of fat and lean body mass were determined using air plethysmography. Results. When assessing the nutritional status of premature infants of both groups at term (38-40 weeks of postconceptual age), a significant decrease in standardized z-scores was found – weight, body length and head circumference for age in group 1, as well as weight and head circumference by age in the 2nd group, more pronounced in the 1st group. Malnutrition (z-score of body weight for age less than 1 SD) was detected in 77.5% of children in group 1 and 23.3% in group 2. Analysis of body composition indicators did not reveal significant differences in the percentage of fat and lean body mass in children of groups 1 and 2, but lean body mass was 440 g less in children with extremely low birth weight. In group 1, statistically significant direct correlations were established between the z-score of body weight and lean body mass, expressed both as a percentage and in kg, as well as a significant inverse correlation with body fat mass as a percentage. Conclusion. The formation of postnatal growth retardation in a significant proportion of children born weighing less than 1500 g dictates the need for careful dynamic monitoring of their nutritional status for timely correction.

Introduction. Postnatal growth retardation in premature infants with very low birth weight (VLBW) remains an unresolved problem. There are different approaches regarding the duration of use of breast milk fortifiers during breastfeeding and specialized formulas during formula feeding, as well as the timing of the appointment of complementary feeding. Objective: to evaluate the physical development and component body composition in VLBW infants, depending on nutritional support over the first year of life. Materials and methods. The study included ninety three VLBW premature infants of 2 to 11 months postnatal age (PNA). The main (1st) group included infants (n = 74) who received dietary correction depending on the nutritional status, while no such intervention was performed in the (2nd) comparison group (n = 19). Up to 64 weeks of postconceptional age (PCA), weight, body length, and head circumference were assessed using INTERGROWTH-21st international growth standards, then in the software “WHO Anthro (2009)”. Fat and fat-free (lean) mass were determined using the air plethysmography method (PEA POD, LMi, USA). Results. The analysis of the nutritional status revealed a moderate deviation, not exceeding 1 sigma, decrease in indices (Z-scores) of anthropometric indices in infants of the 1st and 2nd groups by PNA of 2–3 months. Further in infants of the 1st group on the background of prolonged use of fortified nutrition (breast milk fortifier or specialized formulas for preterm infants) and timely introduction of complementary foods, nutritional deficiencies throughout the first year of life in general were not revealed. In the 2nd group of infants without additional correction of nutrition by 4–5 months of age, the development of mild nutritional deficiency was noted by 6–7 months of age. By 6–7 months of age, it turned into moderate nutritional deficiency, which persisted until 8–9 months of age and then turned into mild nutritional deficiency. Analysis of the component body composition showed that during the observation period, the fat-free body mass (FFM) gain in infants in the 1st group was 3.40 kg, in Group 2 infants — 2.2 kg. At the same time, % body fat mass (FM) in infants in groups 1 and 2 had no significant differences (%FM 1 = 19.3 [15.3–22.5], %FM 2 = 19.9 [16.7–24.6], p = 0.769) and did not exceed the values characteristic of preterm infants. Conclusion. A comprehensive assessment of the nutritional status of VLBW infants during the first year of life allowed us to eva­luate the positive impact of long-term use of fortified diets and timely introduction of certain complementary foods. Optimization of nutrition made it possible to prevent the development of nutritional deficiency, which can have a significant positive impact on their further growth, development, and health status.

Children with cerebral palsy (CP) often have feeding and swallowing difficulties, which can lead to malnutrition and low body weight gain and negatively affect growth and development. In order to identify feeding difficulties and malnutrition in children with CP and timely access to specialists, the FNST (Feeding Nutrition Screening Tool) English-language questionnaire has been developed and validated. The purpose of the research was to translate into Russian and carry out a cross-cultural adaptation of the FNST screening tool. Methods used: the translation and cross-cultural adaptation of the questionnaire content consisted of seven stages in accordance with the standards of the International Society for Pharmacoeconomics Research and Evaluation of Results (ISPOR). Preliminary testing of the pre-final version of the tool was conducted with the participation of 30 parents/caretakers of CP patients and 10 practitioners. The stages of the work were carried out at the National Medical Research Center for Children’s Health, I.M. Sechenov First Moscow State Medical University and Moscow State Linguistic University (all three are located in Moscow, Russia). The pre-final version was adopted with minor changes. Results: the final Russian-language adapted 4-point screening tool represents a short and simple questionnaire to identify feeding disorders and malnutrition in children with CP aged 2 to 19 y/o and to ensure the possibility of timely dietary intervention. The translation of the questionnaire into Russian and its cross-cultural adaptation have preserved functional, structural and operational equivalence. Conclusion: a Russian-language version of the FNST questionnaire has been created and adapted for screening for eating disorders in children with CP, which is the first necessary step for its further official validation and implementation.

Thiamn-biotin dependent basal ganglia disease is a rare inherited disorder. The earliest possible diagnosis plays a crucial role in prevention of death or brain damage due to the severity of the disease. Neonatal screening is not adequate because of the extreme rarity of this disease. The demonstrated familial record showcases the need for selective screening in cases of a burdened familial anamneses in patients with undifferentiated encephalitic crises, including undifferentiated mitochondrial encephalopathies, and confirms the importance of the earliest possible start of metabolic therapy with thiamine and biotin in order to reaching the satisfactory compliance from the family. The severe importance of regular dispensary observation and testing coupled with the timely correction of treatment in such patients is shown as well.

Adequate nutritional status in a patient with cystic fibrosis (CF) positively correlates with the normal function of the bronchopulmonary system. Many domestic and foreign studies have been conducted so far to assess the nutritional status of children and adults with CF. However, there is no data as yet on the phenotypic characteristics of children from different ethnic groups of the North Caucasus depending on their genotype. The purpose of this research was to study the peculiarities of nutritional status in children with CF of the following Russia’s North Caucasus ethnic groups: Chechen, Karachay-Circassian, Dagestani, Ingush and Ossetian-Alanian. Materials and methods used: a single-center open prospective study of 117 children with CF aged 2 months to 17 years old (Me 6 y/o) of various North Caucasus ethnic groups was conducted. All patients have undergone molecular diagnosis and assessment of both nutritional status and exocrine pancreatic function. Results: 50.4% of pediatric patients with CF in the Russia’s North Caucasus have had pathological mutations in c.1545_1546delTA, p.(Tyr515*) and c.3846G>A, p.(Trp1282*) in homozygous state. These mutations were most often found in the Ingush (100%) and Chechen (82%) ethnic groups and somewhat less frequently in the Dagestani (57.1%) and Karachay-Circassian (54%) ethnic groups. In the Chechen and Ossetian-Alanian ethnic groups, when these mutations were detected, severe pancreatic insufficiency was established in 40.5% and 100% of cases, respectively. Pseudo-Bartter syndrome was diagnosed in 60% of cases with this genetic variant in a homozygous or compound heterozygous states during the patients’ first years of life. Indicators for the nutritional status of children with CF from different ethnic groups were significantly lower compared to those recorded officially in the 2021 Russian National Register of Patients with CF. Conclusion: it is necessary to study the course of CF and the state of nutritional status separately in each population and its connection with the identified genetic characteristics of the Russia’s North Caucasus ethnic groups. The genotype and phenotype patterns for these patients were the reason for the development of disorders of the exocrine function of the pancreas and pseudo-Bartter syndrome at an early age, which in its turn could lead to further development of nutritional deficiency.

Propionic aciduria (PA) is an autosomal recessive hereditary disease from the group of organic aciduria, caused by a deficiency of propionyl-CoA carboxylase, leading to impaired metabolism of methionine, threonine, valine, isoleucine, and fatty acids with an odd number of carbon atoms and cholesterol. The neonatal form of PA manifests itself during the first week of life, is characterized by an acute onset and a crisis course, which is accompanied by severe metabolic acidosis, hypoglycemia, hyperketonemia, hyperammonemia. Clinical symptoms are dominated by neurological disorders up to stupor or coma, which can lead to death. Since 2023, expanded neonatal screening has been introduced throughout the Russian Federation, which includes 36 groups of nosologies, as well as a number of hereditary metabolic diseases. Despite the inclusion of this pathology in expanded neonatal screening, doctors’ awareness of clinical manifestations and necessary therapy remains insufficient. Often such patients are diagnosed with, for example: hypoxic-ischemic damage to the central nervous system, acute meningoencephalitis, and others, which leads to inadequate therapy with the development of fatal neurological consequences. Therefore, the totality of knowledge and alertness of doctors regarding diseases from the group of hereditary metabolic diseases will help not only to suspect this pathology in a timely manner, but also to prescribe adequate therapy in time, which in the future will make it possible to prevent serious consequences and neurological disorders, as well as disability of patients.

Introduction. The results of treatment of children who are preparing or have already undergone major surgery depend on many factors, including the nutritional status — the presence/absence of malnutrition. Aim: to assess the nutritional risk and nutritional status in children with surgical diseases during pre- and postoperative periods. Materials and methods. A prospective, single-center, non-comparative study included 60 children aged from 1 month to 17.5 years with diseases of the esophagus, intestines, urogenital system, admitted for surgical treatment. In all patients, the anamnestic data of life and disease were analyzed, screening of nutritional risk was assessed according to the validated Russian version of the STRONG-kids screening tool, nutritional status was evaluated using the WHO AnthroPlus program (2009) and the anthropometric indices (Z-scores: weight/age, height/age, BMI/age), the biochemical parameters (concentrations of C-reactive protein, total protein, albumin, prealbumin, transferrin) were estimated. 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 24 (40%) patients, 58% of them suffered from diseases of the esophagus, 37% had pathology of the intestine and 36% — the genitourinary system. 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 decreasing the length of hospital stay.

Background. Numerous studies aimed at assessing the nutritional status and organizing nutritional support for surgical patients cover the adult patients, only a handful assess underaged patients with surgical pathology in the pre- and postoperative period and their needs for assessment of the nutritional status and approaches to their dietary correction. Aim. To assess the possible risks of developing malnutrition in children with various pathologies of the chest organs during the preoperative period, and to conduct a comprehensive assessment of their nutritional status. Materials and methods. The single-center non-comparative cross-sectional study included 50 children between 5 months and 17 years 7 months, hospitalized in the thoracic department of the National Medical Research Center for Children's Health of the Ministry of Health of the Russian Federation. All patients underwent an assessment of clinical and anamnestic data, somatometric and clinical laboratory parameters, and Z-scores analyzed: body weight/age, height/age, BMI/age, shoulder circumference, skin-fat folds above the triceps and under the scapula, as well as a number of biochemical parameters (concentrations of total protein, albumin, prealbumin, transferrin and C-reactive protein). Results. When assessing the nutritional status of children upon admission to the thoracic department, acute malnutrition was detected in 21 (42%) patients (of which 10% had mild, 14% moderate, and 18% severe malnutrition), chronic malnutrition was found in 18% of children. For the first time in Russia, using a validated Russian-language version of the STRONGkids screening questionnaire, nutritional risks of malnutrition have been assessed. The vast majority of patients were at moderate (28%) or high (70%) risk of developing malnutrition or its aggravation. Z-scores of skin-fat folds above the triceps and under the scapula, as well as the circumference of the shoulder were within the reference values. 16 (36%) patients had a decrease in the concentration of total protein, 10 (22%) had a drop of prealbumin accompanied by an increase (40%) of the C-reactive protein level. The levels of other proteins were within the reference values. Conclusion. The identified risks of malnutrition and its moderate/severe manifestations in children with surgical pathology are able to contribute to the development of infectious and non-infectious postoperative complications, increase the length of stay in the clinic, and require nutritional support from the first day of hospitalization in a surgical hospital.

Objective. To determine the safety, tolerability, and clinical efficacy of the specialized dietary product “Clinutren Junior” in children with cystic fibrosis at the age of 1 to 10 years. Patients and methods. This study included 20 patients with cystic fibrosis (CF) aged 1 to 10 years who underwent treatment and rehabilitation at the Pulmonology Department of the National Medical Research Center for Children’s Health. According to the Shwachman index (SI), a severe course of CF (SI = 34.24 ± 1.97) was observed in 4 (20%) patients, a moderate course of CF (SI = 49.53 ± 1.76) in 12 (60%) patients, and a mild course of CF (SI = 61.5 ± 2.05) in 4 (20%) patients. All patients had malnutrition of varying severity. During dynamic observation, the children’s general health condition, nutritional status, including anthropometric and biochemical parameters, biological and nutritional value of the diet were evaluated. Results. Beneficial organoleptic properties of the formula and its good tolerability were noted. The analysis of the actual nutrition showed that the study product increased the protein quota and energy value of the age-differentiated standard sparing diet by 23-24%. Against the background of using the specialized formula, there was a tendency to improve the physical development of children, as evidenced by the complete elimination of mild malnutrition in 3 (3.8%) patients and a decrease in the number of patients with severe malnutrition. Conclusion. Inclusion of the specialized dietary product “Clinutren Junior” in the therapeutic diet for CF patients enhances and maintains their nutritional status at a satisfactory level, which in general provides a positive prognosis of the disease and improves the quality of life of patients and their families. Key words: cystic fibrosis, children, malnutrition, specialized food products

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.

Due to the new legislative sanitary and epidemiological rules and norms that came into effect in Russia in 2021 and the obvious advantages of breast milk (BM), there is an increasing trend towards its use in neonatal clinics in the form of BM banks (BMBs). The purpose of this retrospective research was to assess the impact of BMBs in a neonatal hospital on the prevalence of breastfeeding (BF) of infants at discharge. Materials and methods used: the study included 692 infants at the age of the first 28 days of life who were hospitalized in the Neonatal Pathology Department with the National Medical Research Center for Children’s Health (which is located in Moscow, Russia) prior to the opening of BMB (Group 1) and during the BMB functioning (Group 2). Results: it was found that mothers from G2 pumped BM statistically significantly more often than mothers from G1 (64% vs. 43%). The incidence of exclusive BF (EBF) at discharge statistically significantly increased compared to the same indicator at admission, in both groups: from 41% to 51% in 2013 (p<0.001) and from 48% to 65% in 2015 (p<0.001). The prevalence of EBF at discharge during the BMB functioning in 2015 (65%) was therefore statistically significantly higher compared to this indicator in 2013 (51%), p=0.009. Conclusion: the strong positive effect from BMB on the prevalence of BF at discharge from the hospital was recorded.

With the purpose of successful rehabilitation, reduction of concomitant diseases, improvement of nutritional status and the quality of life of patients with cerebral palsy (CP) it is necessary to develop therapeutic nutrition technology, which would include methods for nutritional status assessment, choosing of enteral nutrition formulas, methods of their delivery and the duration of nutritional support. The purpose of this research was to substantiate the nutritional support for patients with CP. Materials and methods used: 98 children aged 2 to 16 years and 9 months old (Me 5.7 y/o) with a spastic form of CP that had been admitted for examination, treatment and rehabilitation at the National Medical Research Center for Children’s Health (Moscow, Russia) were examined. Depending on the level of motor activity calculated with GMFCS, the participants were divided into two groups: G1 of 51 (52%) with severe motor impairment (GMFCS IV to V) and G2 of 47 (48%) with mild and moderate motor impairment (GMFCS I to III). Clinical and anamnestic data, information about the severity and the course of the disease, concomitant pathology were analyzed as well as the anthropometric data (Z-scores: weight/age, height/age, BMI/age) using the WHO AnthroPlus application (2009 revision). EDACS survey had also been carried out. Results: Patients with severe motor impairments were significantly more likely to have problems associated with food intake, such as: prolonged feeding (over 30 minutes), predominance of semi-liquid and pureed food in the diet as well as frequent choking, vomiting, wheezing and coughing during the feeding process. All patients in this group needed external assistance in feeding. 75% had respiratory and 72% had gastrointestinal complications. Severe impairments (EDACS IV to V) characterized by significant restrictions on food safety were identified in 24 (23%) children, that met statistically significantly (p<0.001) more often in patients from G1 than from G2 (41% vs. 4%, respectively). Dietary analysis children with CP had showed that the quality and quantity of food consumed were monotonous and deficient. Consumption of pasta, cereals, and baking was 1.5 times higher than recommended whilst vegetables, fruits and healthy dairy products were reduced by 3 and 1.8 times, respectively, on the contrary. The WHO recommendations for children on the mandatory daily intake of 3 to 4 servings of various vegetables and fruits were not followed: in the majority (80%) of cases they’ve only had it once per day, and they even were completely absent in some cases. Nutritional assessment revealed that patients with severe movement disorders, regardless of the gender and nutritional status, had significant deficiencies in energy and protein intake. All studied anthropometric indicators in G1 patients were significantly (p<0.005) lower compared to G2 children. Prevalence of undernutrition was 72% and 32% (p<0.001), respectively. Individual nutritional program was developed for each and every studied patient with identified malnutrition and oropharyngeal dysphagia, followed by its clinical effectiveness assessment. Conclusion: enteral nutritional support with specialized formulas based on both whole and hydrolyzed proteins using the sipping/gastrostomy method, as well as with the use of a food and liquids thickeners, proved to be highly effective in the treatment and rehabilitation of CP children. Indicators characterizing food intake (time taken for feeding, frequency of choking records during meals, episodes of vomiting and regurgitation) have improved as well as the anthropometric indicators improved accordingly.

Background. Appropriate prescribing of complementary food allows to optimize the intake of macro- and micronutrients, provides adequate indicators of growth and development of the child, reduces the risk of non-infectious pathology. Taking into account the significance of this problem, World Health Organization (WHO) experts, together with The European Society for Paediatric Gastroenterology Hepatology and Nutrition, carried out a research where they studied issues related to the appointment of complementary food for children in the European Region and their compliance with existing recommendations. Aim. To study the features of the introduction of complementary food in the Russian Federation on the basis of an assessment of the implementation of the recommendations of the "National program for optimizing the feeding of children in the first year of life in the Russian Federation", 2009 and to conduct a comparative analysis of the results obtained and the data presented in the study carried out by WHO experts. Materials and methods. A multicenter retrospective, uncontrolled, non-randomized study was conducted in 7 cities of the Russian Federation. Results. The median age at which complementary foods were introduced was 5 [46] months; vegetables (51.0%) and cereals (31.2%) were the first complementary food products; children began to receive fruit mainly (77.3%) in the second half of life; the age of introduction of meat puree was 7 [68] months, while every 4th child by 9 months did not receive meat; juices were introduced at 7 [69] months, but in 8.8% of children juices became the first product of complementary foods; median age for yolk administration was 8 [710] months, fish 9 [810] months. Only 14.0% of mothers used products of exclusively industrial production in the nutrition of their children, 33.9% prepared it themselves. Correlation analysis did not revealed any relationship between the body weight of a child at the age of 12 months and the time of introduction of the first complementary food product, as well as with the age of introduction of each of the introduced products. A connection was established between the body weight of a child at the age of 12 months and the volume of individual products that children receive between the age of 6 and 12 months. The recommendations of the National program for optimizing the feeding of children in the first year of life in the Russian Federation were generally implemented. Our analyses revealed the most frequent violations during the introduction and use of complementary food products: late start of their introduction (after the age of 6 months) in 41.3% of children, delayed prescription of meat, frequent use of home-made cereals not enriched with micronutrients, dilution of dairy-free porridge with water, irregular inclusion in the diet of egg yolk. Conclusion. The results obtained confirm the importance of implementation of the Program for Optimizing Feeding of Children in the First Year of Life in the Russian Federation updated in 2019 and approved by the Ministry of Health of Russia and indicate the need for further work on its improvement.

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.

Perioperative nutritional support reduces the healthcare burden of pediatric malnutrition and its risk. Strategic preventive, diagnostic and therapeutic nutritional management guidelines are now available for their optimization. The global needs for pediatric surgery are vast, amounting to millions of children and adolescents, with a corresponding workforce requirement, especially in less socioeconomically developed regions, and where malnutrition is endemic. Acute and elective surgery from neonate to adolescent, for congenital to infective, neoplastic and traumatic conditions, are involved. To identify, highlight and critique current perioperative pediatric nutrition guidelines with regard to availability, utility, affordability and accuracy. Advantages and limitations of nutritional methodologies are taken into account in an algorithmic approach to perioperative decision-making to optimise outcomes. Routine documentation, monitoring and surveillance of pediatric nutritional status as a contributor to surgical risk management should increase its benefits, and reduce costs.

Malnutrition (MN) is common in children with acute and chronic illnesses. The use of questionnaires to assess nutritional risk in children admitted to hospital is a simple and quick way to identify patients who need nutritional advice and nutritional support. Various English-language screening questionnaires, such as STRONGkids nutritional risk screening tool for children, in particular, have been developed and validated. The purpose of the study is to adapt the STRONGkids nutritional risk screening tool for the Russian language speaking audience and to determine the reliability and validity of its new language version. Materials and methods of research: linguistic ratification of the STRONGkids questionnaire was carried out and the Russian language version was created. This single-center prospective study included 419 children admitted from October, 2019 to March, 2021 for treatment in Therapeutic Pediatric (cardiac, nephrological, gastroenterological, pulmonological etc.) and Surgical Pediatric (abdominal, thoracic, otorhinolaryngological, cardiosurgical etc.) Departments of the National Medical Research Center for Children’s Health (Moscow, Russia) with a hospital stay longer than a single day. The reliability of the questionnaire was assessed in 50 children. The anthropometric indicators were used to assess the current validity; the duration of hospitalization was used to assess the predictive validity. Body mass index-for-age (BMI-for-age) <-2SD and Length/height-for-age <-2SD z-scores were criteria for acute and chronic MN, respectively. Results: almost complete (κ=0.84) inter-expert agreement was found during the evaluation of reliability of the STRONGkids questionnaire. The validation study included 419 patients (51% boys/49% girls) aged from 1 month till 17 years and 11 months old (8 years old as median) with hospitalization duration from 1 to 100 days (10 days as median), of which 314 (75%) and 105 (25%) therapeutic pediatric and surgical pediatric patients, respectively. The frequency of acute and chronic MN at admission was 9.1% and 7.4%, respectively, and the percentage of children at low, moderate and high risk (assessed by the questionnaire) was 22.7%, 66.6% and 10.7%, respectively. Children at nutritional risk had statistically significantly (p<0.05) lower BMI-for-age and Length/height-for-age z-scores, greater incidence of MN and longer hospital stays than patients without nutritional risk. A chronic disease addendum, complications and high nutritional risk according to the questionnaire are independent unfavorable factors for an increase in the duration of hospitalization. Conclusion: the Russian language version of the STRONGkids nutritional risk screening tool for children was adapted and validated to assess nutritional risk in children admitted to hospital for treatment. Since right now it can be of use for identifying patients at high risk of MN for the purpose of their additional examination and timely administration of nutritional support and can be used both in routine pediatric clinical practice and in purpose of further scientific research.

Breastfeeding (BF) in the first 6 months of a child’s life with the addition of other foods until the age of 12–24 months is globally recognized as the “gold standard” for infant feeding. For children with cystic fibrosis (CF), it is particularly relevant that breast milk contains a wide range of protective factors against pathogenic bacteria colonization, thermolabile lipase, which facilitates fat digestion, and polysaccharides, which are essential for the trophism of colonocytes and the formation of normal gut microbiota. Objective. To study the effect of BF and its duration on the course of the disease, nutritional status of children with cystic fibrosis. Patients and methods. Questionnaire results on the duration of breastfeeding in 60 mothers of children with cystic fibrosis were analyzed, with further retrospective assessment of the severity of CF in these children. Results. The nutritional status of children who did not receive breast milk at both 1 and 3 years of age was lower than the mean age standards in contrast to patients who were breastfed; the number of bronchopulmonary exacerbations was significantly greater compared with children who received breast milk. The longer the duration of BF was, the later Pseudomonas aeruginosa was isolated from the sputum of CF patients (r = 0.68, p < 0.005). Conclusion. Maintenance of BF leads to a milder course of the disease in later years, which becomes especially important for children with CF. Key words: cystic fibrosis, children, breastfeeding