Aim: To analyze the content of requests for telemedicine consultations (TMC), received by the National Medical Research Center for Children's Health, and suggest possible steps to perfect it. Design: Retrospective study. Material and methods. We analyzed the content of 167 TMC requests for patients with “general pediatric profile” received in 2021 and 2022. Results. Among requests for TMC the majority (43.1%) were for “non-explainable” fever in adolescents 9–17 years of age — with clear signs of a fictitious fever. Similar number of requests were for children with a low grade fever (37,0–37,5°C) that had been vainly investigated to find out the disease causing it. Of 4 children with Kawasaki syndrome only in one it had been suspected at the late stage. Requests for respiratory disease (37.1%) were mostly for their chronic forms. Pediatricians seem not to be conversant with chronic food aspiration syndromes’ diagnosis and management, including that in patient with neurologic conditions. Rare disease and/or unusual symptoms, as well as management of problem patients with known disease were less often the subject of TMC (12 и 7.8% respectively). Conclusion. We could state that pediatric hospitals have extensive diagnostic potential — except bacteriology that has to be upgrade. At the same time there is a tendency of pediatricians to conduct in problem cases multiple non-directional analyses and investigations, incorrectly interpret their results, as well as voluntarily formulate diagnoses. There is a need to do away with excessive and non-recommended use of antibiotics, IV infusion of “desintoxication” solutions, as well as polypharmacy. For the improvement of TMC it seems important to foresee the inclusion into TMS requests data on the disease progression as well as on the dynamics of relevant clinical and paraclinical parameters; the results of analyses and instrumental investigations should be put into addendum. There should be a feedback mechanism — a response to TMC with an appraisal of its effectivity. Keywords: telemedicine, telemedicine consultations in pediatrics.

Tracheobronchomegaly is a rare developmental defect in children, which is characterized by the expansion of the trachea and large bronchi, the diagnosis and treatment of which are made more often in adult practice, when the clinical diagnostic picture acquires the obvious features of Mounier-Kuhn syndrome. In this connection, the need arises for the early detection of this pathology in children and its differentiation from other diseases and malformations of the tracheobronchial tree, which mask a recurrent inflammatory process in the lung and upper respiratory tract, and primarily with those, such as cystic fibrosis and primary ciliary dyskinesia.The paper describes a case of secondary tracheobronchomegaly in a child with obvious clinical manifestations of Mounier-Kuhn syndrome in the presence of bronchiectasis, pulmonary fibrosis, and signs of systemic connective tissue disease. It discusses the possibilities of chest computed tomography in the diagnosis of this defect in children, as well as its causes. The sizes of the trachea and main bronchi in this patient are compared with those in the groups of children of the same age and sex who have cystic fibrosis or diffuse pulmonary fibrosis to identify a more significant role of hereditary connective tissue diseases in the development of secondary tracheobronchomegaly. The authors propose to separate the concepts of tracheobronchomegaly and Mounier-Kuhn syndrome in children and to recognize the threshold for tracheal expansion in these patients having +3SD or more.

The clinical recommendations on management of children with Gitelman syndrome developed by the experts of the Union of pediatricians of Russia are presented in this article. Gitelman syndrome is a dysfunction of distal renal tubules with further development of hypomagnesemia, hypocalciuria and secondary aldosteronism which determine hypokalemia and metabolic alkalosis. Features of epidemiology, etiology and pathogenesis, disease progression, differential diagnostics and evidence-based treatment are presented.

Acute tonsillitis, as one of the most frequent reasons for seeking medical care, especially in paediatrics, is almost the leading nosology that is misinterpreted and improperly treated. It is a fact of life that only pharyngoscopic data are the course for the prescription of a system antibiotic drug, sometimes more than one, for an average of 5 to 7 days, whereas most tonsillitis cases require only symptomatic therapy. But even in case of the right choice and streptococcal aetiology of the disease, this treatment regimen is not sufficient to eradicate the infection and prevent possible serious complications. Therefore, this approach to managing patients with acute tonsillitis does not fit the category “if an antibiotic drug is prescribed, the patient either will recover himself or the antibiotic drug will help.” Acute tonsillitis requires mandatory aetiological diagnosis and the right choice of therapy treatment of clearly defined duration. The article presents the main principles of diagnostics and treatment of acute tonsillitis, and the difficulties that paediatricians have to encounter in everyday practice.

Upper respiratory tract infections are the most common diseases in childhood. Most of them have viral etiology and resolve on their own. However, there is a category of children with a complicated course of viral infection or with a bacterial infection, who require prescription of the systemic antibiotic therapy. The article discusses the main manifestations of upper respiratory tract infections, indications for antimicrobial treatment of a particular nosology, a group of antibacterial drugs, their effective doses and the duration of therapy.

The article presents the detailed key provisions of the clinical recommendations on providing medical care to children with Kawasaki syndrome/illness, developed by the professional association of pediatric specialists — the Union of Pediatricians of Russia. The current data on the prevalence of pathology is presented, the characteristic diagnostic signs of the disease are given that allow to make a diagnosis as soon as possible and immediately appoint a specific treatment. Therapeutic measures carried out in the required volume determine the further prognosis. The comprehensive approach to the management of pediatric patients with this nosology presented in the article will ensure a high level of medical care quality provided to children with Kawasaki syndrome.

Objective of the research - to evaluate macrolides efficacy during prehospital period in hospitalized children with acute otitis media (AOM) and community-acquired pneumonia (CAP). The research included observational study of children with verified diagnosis of CAP, acute middle catarrhal/suppurative otitis, receiving outpatient macrolides therapy. Treatment was considered non-effective if patients had febrile fever after full 2 days of therapy - 48 hours or more. 162 children with CAP and 225 with AOM (n=387) were hospitalized during 2008-2015. 67 of 193 children received macrolides during prehospital period, who started treatment before hospitalization: 36 (38,3%) and 31 (31,3%), respectively. Assessment of treatment effect was possible in 49 children. Clinical inefficiency in the total amount of children was found in 90% of cases (44 patients). A high percen-tage of macrolides use during prehospital period (in 34,7% of cases), and a sufficiently high frequency of clinical inefficiency (90%) allow to recommend abandoning their use in outpatient practice for patients with diseases with high role of S. pyogenes and S. pneumoniae in disease etiology.

The issue of differential diagnosis of acute appendicitis and acute intestinal infections in contemporary medicine remains relevant for clinical practice of surgeons and pediatricians. Late diagnosis of appendicitis results in development of complicated forms of vermiform appendix inflammation. This prolongs operative intervention, duration of antibacterial therapy and duration of a child’s inpatient stay. The article presents clinical observation of three children treated for perforated appendix and generalized purulent peritonitis. The described cases demonstrate the need in multidisciplinary approach and complex diagnosis of patients with such complaints as abdominal pain, fever and diarrhea.

A clinical case of meningococcal meningoencephalitis in late postoperative period after laparoscopic omentosplenopexy for spleen injury. The Neisseria meningitidis on a par with the Haemophilus influenzae and the Streptococcus pneumonia are most common causative agents of overwhelming postsplenectomy infection. This clinical case demonstrates that immunodeficiency accompanies spleen regeneration after severe injury. The value of preventive measures during the regeneration of spleen requires further study and detalization.

Background: Amoxicillin is the drug of choice for treating the majority of community-acquired respiratory tract infections in children, including pneumonia and acute otitis media according to both international and national guidelines. Nevertheless, the practice of not following these guidelines is widespread.Objective: Our aim was to study a range of antibiotics prescribed prior to hospitalization to children with community-acquired pneumonia (CAP) and acute otitis media (AOM), and to evaluate their effectiveness.Methods. Observational study of children with hospital-verified diagnosis CAP or AOM.Results. Amoxicillin was prescribed to only 4.5% of children with CAP and 1% of patients with AOM; along with parenteral cephalosporines and amoxicillin/clavulanate in adequate doses therapy was started in 34 and 25% respectively. Other children received 3d generation oral cephalosporines or macrolides, which rendered a very low effectiveness (19 and 10% respectively). In view of a flagrant inconformity of the prescribed antibiotics and their doses to the guidelines, non-effective prescriptions were made for 72% of children with CAP and 69% — with AOM. For children with atypical pneumonia macrolides were prescribed in only 19%.Conclusion. Since amoxicillin remains the main drug for treating infections caused by an ever increasing number of resistant strains of S. pneumonia and S. pyogenes, it should be prescribed to children with CAP and AOM: its doses (as well as doses of amoxicillin/clavulanate) should be not less than 45 mg/kg/d, and in risk group patients — 80–100 mg/kg/d. The pediatricians’ skills of differentiating atypical pneumonia should be improved.

The etiology of respiratory diseases (RD) is represented by viral and bacterial pathogens [1]. Obviously, viral infections cause most of respiratory diseases in children, while antibiotic treatment is at least useless and often considered inefficient due to a multitude of adverse events. Antibiotics may cause allergic reactions, impair biocenosis of the respiratory tract and colonization of its mucous membranes with unwanted, often intestinal, flora. The greatest danger, however, is the development of overall antibiotic resistance of microbial flora which currently is one of the most serious public healthcare problems [2]. At the same time, bacterial infection, in case of late detection and inadequate treatment, poses a greater risk for serious complications and therefore requires reasonable prescription of systemic antibiotic therapy.

Tricho-hepato-enteric syndrome (syndromic, phenotypic diarrhea, SD/THES) is a rare inborn disease, which affects bowels. It is caused by the mutation of genes SKIV2L or TTC37. Manifestations include intrauterine hypotrophy, severe chronic diarrhea, which starts in infancy, characteristic facial features and hair growth abnormalities, immune disorders. There are data on two patients dealing with tricho-hepato-enteric syndrome with underlying Crohn’s disease. This is the first description of cases of aggravated tricho-hepatoenteric syndrome ever found in Russian medical literature.

Background: Pneumonia is one of the most frequent serious potentially life threatening childhood diseases. The criteria for diagnostics and treatment were designed long ago and are clearly articulated. Nevertheless, diagnostics and therapy happen most often during outpatient management.Objective: The aim was to compare the diagnostic criteria of CAP among children in Russian and foreign guidelines and also to compare the incidence. Another aim is to find out the aptness to the Russian guidelines for the management of CAP among children.Materials and methods: The comparative analysis of childhood pneumonia diagnostics and treatment guidelines have been recently published in a range of countries. We reviewed some recently published pneumonia recommendations. The timeliness and adequacy of hospitalization and treatment was analyzed for 167 hospitalized children with pneumonia diagnosed according to Russian and WHO recommendations. We also used the information about the quality of X-ray pneumonia diagnosis in 679 patients from hospitals in Barnaul, Ekaterinburg and Murmansk (PAPIRUS research project).Results: We found a high percentage of late (5-th day and later) hospitalization of children with pneumonia (37 percent in 2002–2007 and 47 percent in 2013–2014) as well as a late ( 5 days) start of therapy (20 and 34 percent accordingly). In three regional hospitals only 27 percent of X-ray films of children treated for pneumonia were attested as meeting the pneumonia criteria. We found a high frequency of macrolides as a starting therapy in typical pneumonia which often had been ineffective. Amoxicillin/clavulanate and oral cephalosporins were also ineffective in doses < 45 mg/kg/day. A poor knowledge of the clinical features of atypical pneumonia was noted with a corresponding high frequency of -lactams as a starting medication.Conclusion. Our data shows the importance of training paediatricians in modern pneumonia diagnosis and treatment.

The etiology of respiratory diseases (RD) is represented by viral and bacterial pathogens [1]. Obviously, viral infections cause most of respiratory diseases in children, while antibiotic treatment is at least useless and often considered inefficient due to a multitude of adverse events. Antibiotics may cause allergic reactions, impair biocenosis of the respiratory tract and colonization of its mucous membranes with unwanted, often intestinal, flora. The greatest danger, however, is the development of overall antibiotic resistance of microbial flora which currently is one of the most serious public healthcare problems [2]. At the same time, bacterial infection, in case of late detection and inadequate treatment, poses a greater risk for serious complications and therefore requires reasonable prescription of systemic antibiotic therapy.

В статье изложены основные принципы диагностики, дифференцирования острой инфекционной диареи у детей.Современные стандарты лечения острых гастроэнтеритов, гастроэнтероколитов основываются на рациональномприменении антибактериальных препаратов, а также использовании минимально необходимых лекарственныхсредств. Представлены терапевтические подходы, рекомендуемые ВОЗ и ESPGHAN.Ключевые слова: острый гастроэнтерит, энтероколит, дети, диарея, острые кишечные инфекции, диагностика, лечение, оральная регидратация, оральные регидратационные растворы, нифуроксазид.

The rare combination of intestinal lymphangiectasia with malrotation of the duodenum in a child of three months of life is described. Basing on the literature review only 3 similar cases were described in the world practice. The boy with protein-losing enteropathy was examined at Moscow Scientific Centre of Children's Health. The child had vomiting, diarrhea, loss in body weight, hypoproteinemia, lymphopenia. The infectious nature of the disease was excluded. It had been suggested the Waldman desease (primary intestinal lymphangiectasia). The prognosis for such disease is unfavorable. An examination of the child was continued against the backdrop of ongoing symptomatic therapy. Complete physical examination included monitoring laboratory blood tests, X-ray examination with contrast, CT-scan, gastroduodenoscopy with biopsy of the mucosa of the small intestine. Malrotation duodenum with the recurrent mid-gut volvulus with the development of secondary intestinal lymphangiectasia was diagnosed. Modern methods of examination and multidisciplinary approach made it possible to diagnose the case. Operation to eliminate fixation duodenum resulted in the recovery of the patient. At the present time the child grows and develops according to age and does not require treatment. The prognosis for this disease is regarded as favorable.

The article is dedicated to the problem of acute bronchitis in children. The relevance of this problem is obvious: according to conservative estimates, more than 150 million cases of bronchiolitis are registered annually. 7–13% of these cases require hospital treatment and 1–3% — hospitalization in an ICU. The most common etiologic factor is the virus — respiratory syncytial (the vast majority of cases — 90%); rhinovirus and influenza viruses A and B, parainfluenza, adenovirus, coronavirus, metapneumovirus, and human bocavirus are also important agents. A number of factors can cause the evolution of bronchiolitis in 0–2-years-old children. Premature infants, children with bronchopulmonary dysplasia, bottle-fed children, and patients with congenital malformations and immunodeficiencies undergo bronchiolitis especially hard. Specialists of the Professional Association of Pediatricians — The Union of pediatricians of Russia — have formulated and summarized fundamental criteria for the diagnosis, treatment and further management algorithms for patients with this pathology in accordance with the principles of evidence-based medicine.

Fever is a normal physiological response to illness in young children and it is often associated with a self-limiting viral infection. Fever is not a diagnosis, but a symptom of illness. A diagnosis of the underlying illness is essential to institute appropriate treatment. Although it is a normal response, that facilitates and accelerates recovery, some people, including many doctors, believe that fever should be treated to reduce temperature without determining the underlying illness causing the fever. Antipyretics should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature. This article aims to acquaint primary healthcare workers and general practitioners with last guidelines to assist the measurement of body temperature, deciding on when to refer and the appropriate use of antipyretic medication in children, efficacy and safety of paracetamol and ibuprofen in oral and rectal forms.