Background. Changes in microbiocenosis during critical periods of ontogenesis are of particular importance, as they create prerequisites for the formation of delayed pathology. However, in infants with allergies, the association of changes in the intestinal microbiota with certain allergens has not been sufficiently studied.The aim of the study is the determination the composition features of the intestinal microbiota in young children with IgE-mediated and non-IgE-mediated food allergies.Methods. In infants 6–12 months old with food allergy symptoms, the composition of the intestinal microbiota was studied (culture method), the presence of IgE was determined by chemiluminescence immunoassay, and the levels of sensitization were studied by the ImmunoCAP ISAC method. The data obtained has been subjected to correlation analysis.Results. There were 56 full-term infants with allergy symptoms, of whom 15 (27%) were born by caesarean section, 12 (21%) received antibiotics in the perinatal period, and 30 (54%) stopped exclusive breastfeeding early. When assessing the intestinal microbiota, a decrease in symbiont levels was noted in 32 (57%) patients. An increased content of Klebsiella spp. was revealed — in 21 (38%), Clostridium spp. — 5 (9%) have Enterobacter spp. — in 5 (9%), Escherichia coli lactose-negative — in 11 (20%), Citrobacter spp. — in 4 (7%), Escherichia coli hemolytic — in 7 (13%). According to the results of immunological studies, patients were divided into 2 subgroups: with IgE-mediated (n = 10) and non-IgE-mediated food allergies (n = 46). In patients with IgE-mediated allergy, significant positive associations were found: SiGe to alpha-lactalbumin and casein (Bos d4, Bos d8), lysozyme (Gal d4) with hemolytic Escherichia coli content (R = 0.31; 0.35; 0.37); SiGe to casein (Bos d8), lysozyme (Gal d4) containing Clostridium spp. (R = 0.30; 0.32).Conclusion. The interrelationships of IgE-mediated sensitization to food allergens and the composition of the intestinal microbiota are the basis for the development of methods for individualized correction of the allergic phenotype.

This review summarizes stages of intestinal microbiota development in infant and immune responses modulation associated to these stages. The leading role of breastfeeding in the optimal microbiota and associated immune responses development during the first half of child’s life is presented. The biological feasibility of supplemental feeding implementation at the second window of opportunity (4–6 months) is justified, as well as role of supplementation products (including cereal) in adult microbiota development.

This literature review provides data on antibiotic therapy (AT) consequences that child may be exposed during the perinatal period considering the development of the most crucial body system — intestinal microbiota. The main characteristics of the intestinal microbiota disturbance in infants due to various AT exposure time and volume are presented. Moreover, antibiotics' effects on the intestinal microbiota development in full-term and premature babies are covered. Modern data on the development of pathobionts and symbionts resistome within intestinal microbiota in «mother-child» complex and variants of vertical (from mother to child) and horizontal (between microorganisms) transmission of antibiotic resistance genes are presented. The major strategies for minimizing the negative consequences of perinatal AT are described

This article presents practical data, topical for pediatricians, on the child’s body provision with the essential trace element — iron; and on iron deficiency conditions development and staging in children. Clinical and laboratory criteria for the identification of such conditions are defined; data on their prevalence in tender-age infants is outlined. The results of modern studies showing the correlations between iron deficiency and delayed developmental conditions in children (including cognitive ones) are presented. Alimental factors (associated with body provision with iron) and nutritional strategies (associated with supplemental feeding timely administration, adequacy, and diversity) are described in detail. They are focused on effective and safe prevention of latent iron deficiency.

Background. For now, there is little data on sensitivity features to specific allergen antigens in infants with initial allergy manifestations. Objective. The aim of the study is to determine the features of the primary molecular sensitisation profile in infants with risk of atopic disease according to their postnatal age. Methods. Full-term infants with burdened familial allergic history and/or skin/gastrointestinal allergy symptoms were examined: Group 1 — 50 children, age — 2.0 [1.0–3.0] months; Group 2 — 35 children, age — 9.0 [8.0–11.0] months. Results. The hereditary atopy risk was observed in 74% of cases (37/50) in Group 1 and in 71% of cases (25/35) in Group 2. 38% of children (19/50) in Group 1 were breastfed, in Group 2 — 60% of children (21/35). Supplemental feeding was implemented in 5.5 [5.0–6.0] months. Sensitisation was reported in 10% and 37% of children. Children of Group 1 were sensitised to food allergen antigens: cow's milk/meat (Bos d 6, Bos d 8), egg-white (Gal d 1, Gal d 2, Gal d 3), soybeans (Gly m 6), shrimps (Pen m 4); airborne allergens: house dust mite (Blo t 5, Der h 10), Anisakidae (Ani s 3), cockroach (Bla g 7). Children of Group 2 were sensitised to food allergen antigens: cow's milk (Bos d 6), egg-white (Gal d 1, Gal d 2), soybeans (Gly m 6), peanut (Ara h 1, Ara h 2, Ara h 6), kiwi (Act d 1), corn (Tri a 19); airborne allergens: cat (Fel d 1, Fel d 4), birch pollen (Bet v 1). Polyvalent sensitisation was revealed in 4% and 6% of cases, respectively. Conclusion. Infants have much wider range of allergens to which they are sensitive than it is commonly believed. Beside obligate food allergens, sensitisation can be caused by airborne allergens: house dust mites, epidermal, birch pollen; crossreactive component — tropomyosin.

Background. Pyoderma is the most common skin infectious disease of early age, it is a group of dermatoses characterized by purulent-inflammatory damage to the skin, dermal appendages, and subcutaneous fat. The diagnosis is based on medical history and physical examination. The main treatment methods are antibacterial therapy (local or systemic) and antiseptic skin toilet. Some forms of deep pyoderma require surgical interventions.Clinical case description. Girl A., 14 days of life, was admitted to the neonatal department of infectious disease with complaints of the mass in the left shoulder joint area. Historical information: 27 years old mother was not observed in any maternity welfare centre; chorioamnionitis was revealed at admission to the obstetric hospital. She received broad-spectrum antibacterial therapy perinatally. A girl from spontaneous vaginal delivery born on the 39th week with body weight of 2700 g, body length of 50 cm, and APGAR score of 8/9, she was breastfed. The condition on admission was severe. There were multiple indurated rash elements (pustules with turbid fluid) on the skin of the chest, limbs, and back. Skin desquamation was noted. There was hyperemia area up to 3.5 × 1.5 cm in the left shoulder joint area, with soft-elastic consistency, fluctuation symptom was positive. Complete blood count has shown: leukocytosis and neutrophilosis. Methicillin-resistant Staphylococcus aureus (MRSA) was revealed in blood via PCR method, in hemoculture, and in throat and nose cultures. C-reactive protein level was increased. Abscess culture — MRSA. Screening by immunological assay was performed to exclude primary immunodeficiency. Abscess incision and drainage were performed; 5 mL of thick yellow-green pus was obtained. Combination therapy with broad-spectrum antibiotic was carried out.Conclusion. There was positive dynamics on the administered therapy: the child condition was satisfactory, skin cleared of infectious rash, abscess was sanitized, laboratory parameters normalized, the child had no fever.

This review provides data on the use of yogurts in infants’ nutrition. The properties of these fermented milk products and associated urgent and delayed sanogenetic effects are described. The experience of yogurts (enriched with pre- and probiotics) implementation in the nutrition therapy of children who have undergone infectious diseases is shown. The yogurt usage for intestinal microbiota disorders correction in children with functional digestive disorders and chronic somatic pathology is discussed.

The organized infant’s sleep schedule is the crucial part of normal individual development. On the contrary, restless sleep, nocturnal awakening, long wakefulness can lead to deviations in physical, psychomotor, and cognitive development. Feeding schedule organized according to the time of a day and circadian rhythms (chrono-nutrition concept) can be useful for prevention and correction of such disorders. You are aware of the effect of such factors as feeding before night's sleep, nutrition at dark time of a day, diet enriched with triptophane and nucleotides, on the maturation and consolidation of infants sleep. The correlation between intestinal microbiota and factors affecting the circadian and metabolic activity of the body are presented: day-night cycles, sleep and wake, diet and nutrition. Targeted regulation of the intestinal microbiota through products enriched with functional components (prebiotics) can lead to the development of healthy sleep in infants via axis “brain – intestine – microbiota”.

The article contains the analysis of optimal patterns of supplemental feeding in infants from the point of view of the concept of the First 1000 days and the possibility of fat metabolism disorders prevention. The correlation between the early supplemental feeding (before 4 months of age) with the risk of obesity is noted mainly in socially deprived families with premature termination of breastfeeding. If supplemental feeding was sustained until 5–6 months of age as well as breastfeeding, the risk of metabolic disorder development was minimal. The time and procedure for implementation of supplemental feeding according to the formula «nutrition under the control of the child» is discussed. Specific attention was paid to the excess sugar content in nutritional support for infants as the factor associated with the development of obesity in children and adolescents.

The current development of medicine and the results of recent large-scale academic research in pediatrics provide the convincing conclusions that the formation of human health begins in the antenatal period of ontogenesis and continues throughout the infancy. The ideas and subsequent academic research on the influence of nutrition during the first thousand days of life on the programming of metabolism and the development of some chronic somatic diseases such as obesity, hypertension, coronary heart disease have become widespread. In addition, at the same period of life immune abnormalities with a predominance of one of the subpopulations, Th1 or Th2, can possibly form in children at risk of developing allergies when immune response is developing. The predominance of the Th2 cytokine profile (hyperproduction of interleukins 4, 5, 13, etc.) suggests the possibility of stable formation of the atopic status in a child afterwards. Consequently, the application of academic knowledge on the health status programming by nutrition during early ontogenesis is an important tool in preventive pediatric practice.

The article presents an overview of modern Russian and foreign scientific literature, which summarizes data on the value of normal intestinal microflora formation, and on the formation of normal microbiocenosis in ontogeny features. The causes of microbiota formation lesions and their impact on child health are described. Relevant data on the effectiveness of pre- and probiotics in the prophylaxis of noninfectious diseases is given.

Background: Children with burdened allergological history and/or having preliminary allergy manifestations need the effective prevention of allergy from the first months of life. Objective: Our aim was to assess the tolerability, safety, and efficacy of monocomponent complementary food products in the diet of infants with high risk for allergic diseases. Methods: Tolerability, safety, and efficacy of monocomponent complementary food products (vegetable puree, fruit juices, and after 6 months — meat sauce) were studied in a singlecentre, prospective, comparative study. The symptoms of indigestion, skin allergy symptoms were registered, the results of coprological research and immunogenicity of complementary food products were assessed. Results: The study included 200 children in the age from 5 months from the risk group of allergy developing. Children were divided into 4 groups of 50 people. It was found that complementary food products were well tolerated and assimilated by children, did not cause skin and gastrointestinal allergic reactions in healthy children with risk of allergy developing. Food antigens of complementary food components (pumpkin, rabbit meat, turkey meat, apples, pears, plums) were characterized by low immunogenicity: the level of specific IgE to the specified products did not change in blood serum and remained at a low level at the beginning and at the end of the study (ranging from 0.01 to 0.03 kE/l). Conclusion: Studied complementary food products (vegetable-, fruit- and meat-based) can be used in the diet of children with high risk for allergy.

Background: Premature infants with extremely low and very low birth weight with a severe overlapping perinatal pathology often feature slower growth rate within the first year of life and require special nutritional support.Objective: Our aim was to study physical development of infants with protein-calorie deficiency in the setting of using a specialized protein- and calorie-rich pediatric milk product for enteral feeding.Methods: We analyzed tolerability and efficacy of clinical nutrition within the framework of a prospective two-month-long case series. We assessed actual children’s diets and the chemical composition thereof. We determined body weight and length, body mass index (BMI), adipodermal flap thickness over the triceps. Anabolic effect of clinical nutrition was assessed on the basis of transthyretin concentration dynamics.Results: The study involved 30 infants with protein-calorie deficiency (7 term infants and 23 premature infants) with a severe perinatal pathology. High tolerability of the formula under analysis was registered in most patients. Termination of functional gastrointestinal tract disorders (posseting, colics, flatulence, constipations) was observed in 23 (87%) patients. In most cases, the use of a protein- and calorie-rich formula as a part of a therapeutic diet helped to satisfy children’s protein demand and improve their weight/length parameters: BMI increased in 19 (72%) children, body weight — in 16 (63%), body length — in 24 (92%), adipodermal flap thickness over the triceps — in all the children (100%). We observed transthyretin concentration increase from 162 (157; 171) in the beginning of the study to 187 (170; 208) mg/l in the end thereof (p = 0.028).Conclusion: A specialized protein- and calorie-rich product for enteral feeding may be used for feeding infants with protein-calorie deficiency born with a severe a perinatal pathology, including premature infants.

The literature review is dedicated to the preventive role of breastfeeding in preserving long-term health of individuals and the population in whole. The issue is urgent due to high prevalence of multifactor metabolic diseases (obesity, pancreatic diabetes, hypertonic disease etc.) in adolescents and adults; these socially significant have started to set on in younger persons in the recent years. The article presents results of the studies dedicated to the association between the nature of the infant's feeding and risk of metabolic pathology conducted in the recent decades in various countries. Most works put premature infants in the high risk group, as the diets involving special formulas contributing to "catching-up" growth of neonates with low birth weight are statistically significantly associated with high risk of long-term cardiovascular diseases. According to numerous studies, artificial feeding significantly increases the risk of excess weight and obesity, hypertonic disease and atherogenic dyslipidemia. Possible mechanisms of realization of hereditary susceptibility to metabolic disorders in the setting of artificial feeding are enhanced insulin burst paired with further development of insulin resistance; preventive role of breast milk is associated with the hormones therein, which program the individual's metabolism. Along with that, breastfeeding provides metabolic and immunological programming by means of forming optimal intestinal microbiota in a child. All the studies indicate importance of prolonged breastfeeding during infancy, which is why medical administrative support provided by medical personnel of medical and preventive facilities is important for preventing hypolactasia. District pediatricians and nurses not only control, but also organize the process of breastfeeding; when necessary, they recommend special devices intended to optimize lactation (breast pumps, nipple shields); if breast latching is not feasible – feeding with extracted breast milk using bottles and pacifiers reproducing natural breast sucking mechanism.

The problem of intestinal microbiota influencing the health of early aged children has become especially relevant over the past few years. On one hand, this is due to the significant worsening of the human environment ecology, on the other — due to the high prevalence of digestive disorders in children, especially premature ones. The introduction of modern high-informative molecular-genetic research methods (PCR-amplification with gene sequenation) made it possible to reveal the primary stage of human colonization by bacteria even at the stage of fetal ontogenesis and to thoroughly decode the microbiota structure in newborns and first-year babies. It is established, that the mothers microbiota has a direct effect on the quantity and quality of the child’s microbiota. The mother’s microbiota depends not only on her possessing inflammatory, but also metabolic diseases (obesity). There is also a direct correlation between the children’s microbiota and the wway they were born (microbiota is better in cases of natural birth), and these differences are prevalent after a number of months after birth. One of the main factors affecting microbiota after birth from the very first day is nutrition. Most studies earnestly confirm the role of breastfeeding in contributing to an optimal microbiocenosis in the child. Antibacterial therapy, being received by either the mother or the child has a negative effect on the colonization of the intestines by symbiont microbes. The negative impacts on the micro flora are especially significant for premature children especially those born with a very low and extremely low body mass. The ontogenesis of these children is most severed by malicious factors (infections followed by the necessity of a massive antibacterial therapy, hypoxia, surgical birth, forced artificial feeding) in connection with a general immaturity, including not yet fully-fledged body defense systems. Directive microbiota correction in premature children is an important condition for prevention and treatment of such severe diseases as sepsis necrotizing enterocolitis. For this reason, the usage of probiotics is considered as one of the promising practices of practical neonatology. The article contains an example of studying the effectiveness of probiotic therapy in premature babies with a combined perinatal pathology.

Rapid growth of incidence of allergic diseases in the last 40 years allows us naming allergy the pandemic of the XXI century. Allergic diseases harm not only individual patients, but the society in whole in the form of progressive increase in direct and indirect costs. According to the latest estimates, more than 150 mn people suffer from allergies, whereas more than 250 mn patients in Europe are expected to suffer from allergies in the next decade. National and international documents stating rules of preventing and treating allergic diseases must become current guidelines for clinicians everywhere. The article summarizes the latest recommendations of the European Academy of Allergology and Clinical Immunology (2014) and of the National Food Allergy Guidelines. The article presents evidence-based methods of primary allergy prevention in infants. Modern primary food allergy prevention may consist of exclusively breast feeding for at least 4 6 months; if breast feeding is not feasible, prevention may be attained by means of using preventive hypoallergenic formulas with confirmed low allergenicity and not introducing supplemental feeding before the age of 4 months. Evidence-based studies do not confirm effectiveness of any dietary restrictions of pregnant and nursing women regardless of whether they belong to the risk group or not.

This article is dedicated to the issue of infant feeding. It is universally recognized that the best product for neonatal and infant feeding is breast milk. On the basis of the worldwide literature data, the authors give a detailed account of breast milk advantages from various (biological, clinical and psychological) perspectives. They convincingly demonstrate that knowledge of preventive and medical aspects of breast feeding benefits allows conducting effective educational programs regarding motivation, struggle for breast feeding and long-term maintenance among medical personnel, mothers and their families. It is especially important to provide premature infants and sick children, who are often born unable to suck adequately, with breast feeding. The authors provide results of a study conducted at the SCCH demonstrating that special medical devices (nipples, feeding bottles) developed on the basis of studies of maternal breast sucking physiology facilitate a gradual transition from tube feeding to breast feeding.

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

The article covers modern approaches to the prevention of allergic diseases in children. We discuss the most common food allergens in the early childhood, main mechanisms of food tolerance formation and opportunities of dietary preventive measures in a risk group of the allergy development. One of the important issues, in practical terms, is the question of time and peculiarities of the complementary feeding introduction in this category of children. The own experience of use of hypoallergenic complementary feeding products in children from the risk group and with mild manifestations of atopy is presented.