The progression of perinatal care and advanced methods of intensive therapy lead to constant improvement of morbidity as well as mortality rates of immature neonates. However, development and growth in these patients still remain unsatisfactory. The majority of very immature infants leave hospital exhibiting signs of compromised nutritional status and growth retardation. These problems increase inversely proportionally to gestational age and birthbody weight. Taking into account the long-term adverse effect of growth retardation in this critical development period, different interventions are taken inorder to correct nutritional status of infants. Feeding practices during this period include human milk, preterm formula, term formula, and finally, nutrientenriched post discharge formula. The first advantageous effect of feeding infants with nutrient-enriched formula after hospital discharge was revealed almost 20 years ago. In the following years the positive effect of PDF formula was confirmed not only on anthropometric parameters but also on cognitive development. The assessment of the specific nutritional needs of an individual patient is enabled by regular monitoring of the growth process based onregular measurements of weight, length and head circumference. We should avoid the situations which lead to malnutrition, as well as too “aggressive early nutrition” which initially results in excessive weight gains while long-term observations have shown an increased incidence of cardiovascular diseases, diabetes and obesity.

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Percutaneous endoscopic gastrostomy (PEG) is a widely used method for long-term nutritional treatment in children. The presented article is an attempt to describe studies evaluating the correlation between gastrostomy and gastroesophageal reflux (GER) in pediatric patients. Unfortunately high-quality evidence does not currently exist to provide evidence that PEG insertion quantitatively or qualitatively influence the gastroesophageal reflux in children.

The aim of my study was to characterize fish oils and to present the safety aspects of fish oils and fish liver oils which are the main source of the eicosapentaenoic and docosahexaenoic acid in diet.

Clinical dysmorphology is a medical specialty investigating disturbances of embriogenesis with special insight into rare syndromic forms of congenital anomalies or other distinct anatomical features (dysmorphism). A dysmorphic feature at a given body region (face, cranium, neck, trunk, limbs, hands, feet, fingers/toes or genitals) is a notable physical symptom, that is different from typical anatomy of that region (appearance) seen in other sameage representatives of the geographically and ethnically defined population. The feature is not noted in the parents or other members of the family. Dysmorphic features are uniformly present at birth, although some only appear with patient’s age (e.g. in mucopolysaccharidoses). Frequently, the symptoms are one the wane with age. Dysmorphic syndromes define a unique, pathogenetically linked set of symptoms/anomalies embracing differences in anatomy and appearance, often times accompanied by developmental delay and/or congenital anomalies. Currently, several thousand dysmorphic syndromes are known. Their recognition at the clinical level, and thus knowledge of natural history, is of utmost importance for optimisation of care (prevention of possible complications, establishing prognosis and initiating most suitable treatment), reliable genetic counselling in the families as well as for scientific purposes of uncovering causes and mechanisms of congenital dysmorphic syndromes. The aim of this article is dissemination of the role of dysmorphology in pediatrics as well as assessing significance of this medical specialty in an uneasy diagnostic process of recognizing dysmorphic syndromes in children.

Allergic rhinitis is the most common chronic disease in children, affecting up to 24% of children at the age of 6 years old in Poland. Allergic rhinitis isa symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. Symptoms of allergic rhinitis include rhinorrhoea, nasal obstruction, nasal itching and sneezing. The diagnosis of allergic rhinitis is often quite easy, but in youngchildren may cause problems and many children are still under-diagnosed. Intranasal glucocorticosteroids are the most effective drugs for thetreatment. Allergic rhinitis has a major impact on quality of life, sleep and school performance. It should be considered as a strong risk factor for asthma development and a risk factor for the control of asthma. Patients with persistent allergic rhinitis should be evaluated for asthma and patients with asthma should be evaluated for rhinitis.

Microbial theory of allergy assumes that an increase in the incidence of allergic diseases observed in recent decades is related to the change incomposition of microbiota colonizing the intestinal tract. Probiotics modulate intestinal microbiota and activate the immune system in the directionof anti-allergic processes. This paper presents the mechanism of action of probiotics and a review of clinical trials assessing the efficacy of probiotic supplementation in the prevention and treatment of allergies.

Breastfeeding is the optimal standard for infant nutrition due to its health benefits for the infant and the mother. Exclusive breastfeeding for six months and continuation of breastfeeding during introducing solid foods, as long as desired by mother and baby, is recommended. Supplementation of breastfed infants with formula is a widespread practice. Sometimes is given by a mother, sometimes recommended by a doctor, usually is not necessary. Unjustified supplementation disturbs the process of lactation and shortens the duration of breastfeeding. It should be limited to medically justified reasons and conducted in the manner, that helps to continue the breastfeeding in as big dose as possible. There have been described the rules of supplementation of bf infants in the paper. The assessment of breastfeeding and correction of all aspects as needed should be the first step, to make the infant get the maximum amount of milk during sucking the breast. When that intervention is ineffective mother should start to express her milk. The only reason to give formula is too low supply of mother’s milk.

Acne vulgaris is one of the most common skin diseases, affecting especially adolescents. Pediatric acne is the term used to describe the presentation ofthis disease from birth through 11 years of age. Within the entity of pediatric acne, four subgroups were distinguished: neonatal acne, infantile acne, midchildhood acne, and preadolescent acne. This classification is important because of slightly different etiology, clinical presentation and treatment in the various age groups. In this paper we have also taken into consideration pediatric diseases with skin lesions similar to acne lesions, as well as endocrine disorders associated with pediatric acne.

The last years development of perinatology have resulted in increased survival of newborns and premature infants. Biological immaturity of premature became the risk damage of psychoneurological development. These infants are subjected to intensive and often long-term aggressive therapy. They are supported and monitored with the most modern equipment due t possible complications of both iatrogenic prematurity and the same as retinopathy of prematurity (retinopathy of prematirity - ROP), bleeding into ventricules and brain tissue (intraventricular haemorrhagia - IVH) or periventricular necrosis (perivetricular leukomalatia - PVL), nectroticans enterocolitis (NEC), bronchopulmonary dysplasia (BPD) or a consequence of persistent ductusarteriosus (patient ductus arteriosus - PDA). One method of improving treatment outcomes and reduction in their severity as well as improving the quality of life of premature babies is physiotherapy. It is used in preterm infants and includes proper positioning in order to maximize the effect ofventilation and psychomotor stimulation. Shantala massage, which also involves parents, establishes communication and emotional bond between theinfant and his parents. In kangaroo, where skin-to-skin contact is more intimate, child can again maintain the relationship with the parent and vice versa. Physiotherapist is also involved in stimulation of breathing, sucking and swallowing of a child. The introduction of physical therapy in the treatment of a child may have a positive impact on ventilation and thus shorten the time spent on ventilation replacement and can reduce the adverse effects1. Physiotherapist working with newborns must maintain all safety rules. The child should be monitored through out the process of physiotherapy, but alsothe procedure for the qualification or exemption and the activities of physiotherapy in order to assess the quality of care. The introduction of standard physical therapy can significantly improve of child’s vital signs. Physiotherapy should be done in collaboration with the physician and neonatology midwife for the correct interpretation of monitored functions and behavior of the child’s safety during manual therapy. Early initiation of manualtherapy in the department of pathology and neonatal intensive care can improve development of the premature.

Protein is regarded to be the basic nutrient. The basic requirement for protein is relatively low – in adults it is precisely calculated from the nitrogen balance. Still, it increases in the periods of rapid growth - that is why it is significantly higher in infants (up to about 1.3 g/kg body weight/day) and decreases in small children to about 1 g/kg body weight/day. Preterm infants are a very specific group of children in whom requirements are very high exceeding even 4 g/kgbody weigth/ day. The best source of protein in infancy is human milk. Recently it was shown that high protein diet in infancy increases risk of obesity andthe present recommendations define upper limits of protein in milk formulas as well as the quality of protein for which the golden standard is human milk.The diet of children >1y of age is high in protein and deficiency hardly occurs in Europe, still the upper limits are not precisely described and are defined around 3 g/kg body weight/day.

Prophylaxis against infections is one of the most important elements of the complex, interdisciplinary approach to the management of children with inflammatory bowel diseases (IBD). On one hand, it is motivated by the fact that acute infectious disease may lead to the flare-up of the underlying disease. On the other hand, patients with IBD frequently receive immunosupresive drugs which may change the natural course of infectious diseases and deteriorate their treatment. In this manuscript, we raised the problem of immunization in IBD and presented recommendations on vaccination in Crohn’s disease (CD) and ulcerative colitis (UC).

Since 1996 the initation of routine immunisation of infants significantly decrease the frequency of hepatitis B infections, up to 4,11 per 100 000 inhabitants in 2011. Avaiable data now extending to follow-up for nearly 30 years after full primary has been demonstrated that in spite of subsequent decline andultimate loss of detectable serum anti-HBs, a full primary course of hepatitis B vaccine confers protection against acute clinical disease and chronic hepatitis B infection for long periods of time. People worldwide do not present protective levels of anti – HBs (< 10 mIU/ml), even in 50%, despite of it there are protected. The proper response of the immune system to a booster dose of HBV reveals that immunological memory is good after primary vaccination. Long-term follow-up of vaccinated children has confirmed that universal HBV vaccination in infancy has produced adequate protection formore than 20 years, the most important is, that no increase of HBV infection has been observed. A booster dose of HBV vaccine is now not recommended in any National Immunization Programs.

<p>Since 2007, the main priority of changes postulated by Pediatric Group of Experts on Immunization Programme is an introduction universal pneumococcal vaccination for children under 2 years of age. In the current year it was again not included in the PSO announced by the Ministry of Health. The only change that PSO introduced in 2013 is the replacement of the DTP vaccine by the DTaP and addition of the 4th dose of vaccine against hepatit is B virus to childrenwho were born prematurely. What would make implementation of vaccines in 2013 difficult, is the introduction of PCV10 vaccine as mandatory vaccination for so-called healthy preterm infants and PCV13 vaccine (the only one registered in medical risk groups) dedicated to this group of infants (for the diseaseslisted in paragraph a) and b) B. Mandatory Vaccination of persons at risk of infections. According to the Summary of Product Characteristics vaccination healthy preterm infants may be vaccinated with PCV13 or PCV10 (point c). Pentavalent vaccines has not appeared as mandatory for children up to 2 years of age, as well as the dTaP vaccine does not replace dT in adolescents at 14 years of age. It could reduce the number of cases of pertussis to a large extent. Given the risks of a number of influenza, its severe course and especially cases of death of risk patients, Pediatric Group of Experts on Immunization Programme calls for changes in the Immunization Programme for 2014, recommending the restoration of influenza vaccination for children from 6 months of age to 18 years of age and the introduction of compulsory vaccination in selected chronic diseases and in immunocom promised patients.</p>

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Changes of Polish Immunization Programme for 2013 are little - they bring acellular pertussis vaccine (DTPa) for children born before 37 weeks of gestational age and for newborns with weight below 2500g. A few changes have also been provided in so-called advised vaccinations; they include theuse of acellular pertussis vaccine in teenagers and adults; they also precisely define risk groups of invasive pneumococcal disease and include indications for PPV 23 and PCV 13.