Objectives:
Evaluation of the efficacy of heparin flush administered 3 times a week as a prophylaxis of thrombotic complications in children receiving parenteral nutrition as well as the assessment of the influence of such treatment on catheter related blood stream infections.

Material and methods:
33 patients age 4 months to 17 year (median 16 months), receiving Home Parenteral Nutrition 5-7 times a week, were included in the study and divided in two groups according to the treatment approach. 18 patients were exposed to heparin flush (3 times a week) and 15 patients (control group) received normal saline flush. A number of thrombotic and infectious complications in both groups were analysed.

Results:
The median time of observation was 15 months (range 4 – 24 months). In each group, thrombotic complication occurred - once during the study. In case of 8 patients from heparin flush group catheter related sepsis occurred (9 episodes) versus 5 patients from normal saline flush group (8 episodes). The difference was not statistically significant.

Conclusions:
It seems that heparin flush of central vein catheter 3 times a week does not prevent neither thrombotic nor infectious complications of longterm parenteral nutrition in paediatric patients.

This paper is a practical summary of Q&A raised by parents regarding proper preparation to the summer holiday to be spent with children. It recallsthe rules of conduct in the life-threatening conditions ( loss of consciousness, cardiac arrest and breathing, the anaphylactic shock, bites by insects,strangling), as well as provides advice how to help in less dangerous situations, like: minor injuries of the face, eye, nose, in fractures, bleeding, bites through insects, vipers, bruises, chafes, solar burns or cuts. The means of prevention of solar burns, bites and stinging by insects, travel-sickness andfood poisonings were described as well as principles of proper dressing of children and safe applying of the air-conditioning. The need of vaccination was pointed out. In addition some hints were added regarding the content of a travel first aid kit.

LCHAD deficiency is the inborn error of metabolism due to disturbed mitochondrial burning of long chain triglycerides, resulting in such symptoms as: hepatopathy, cardiomyopathy, myopathy, peripheral polineuropathy and retinal pigmentary degeneration, together with nonketotic hypoglycaemia. The treatment is mainly based on the special diet, and general therapeutic aim is reduction of intramitochondrial oxidation of long chain fattyacids through avoiding prolonged fasting and decreasing of LCT consumption to 7-10% of daily energy requirement. Medium chain triglycerides are supplementary source of fat and should provide from 10 to 20% of daily energy requirement. In infantile period, intervals between feedings during day should not be longer than 4 hours, and during night – not longer than 6 - 8 hours. At older children, adolescent and adults, safe night break shouldnot last longer than 10-12 hours. Preventive hospitalizations, with using of concentrated glucose infusions, during reduced appetite and/or vomiting (frequently in the course of infection) are to prevent from metabolic decompensations.

Cholestatic liver disease in childhood frequently results in growth retardation. The pathophysiology is usually multifactoral including reduced calorie intake, abnormal protein and carbohydrate metabolism, fat and fat soluble vitamin malabsorption, increased energy expenditure, pancreaticin sufficiency, accompanying infections and genetic disposition. Authors present up-to-date opinions on growth retardation in particular cholestatic syndromes and the influence of different methods of treatment. After liver transplantation growth improves in the majority of children with good liverfunction. However some children, with Alagille syndrome and PFIC and late operation do not grow normally. In individual cases therapy with growth hormone should be considered.

Recurrent meningitis is a complex therapeutic and diagnostic problem. Anatomical defects, trauma, immune deficiencies, and chronic infections aremain risk factors. Considering differential diagnosis, despite of infectious agents, autoimmune diseases should be taken into account. The authors pointed out the diagnostic and therapeutic difficulties which appears in case of recurrent meningitis not responding completely to antimicrobial treatment. An important role in the diagnosis of these diseases play immunoas says (eg to detect antibodies in both serum and cerebrospinal fluid) and imaging studies. In some cases, which despite of extensive diagnostic remain unresolved, brain or meninges biopsy should be considered. Immunotherapy is crucial in the aseptic central nervous system vasculitis treatment.

Along with the observed increase of an index of autism spectrum disorders incidence of the number and variety of different therapies which are supposed to help children with ASD to adapt better in every aspect of their lives improves. There is also an evident change in psycho-pedagogical treatment as the biomedical therapies are being included more and more often. One of the most popular, although not proven yet, therapy is gluten-free and casein-freediet. There is a huge amount of data indicating the benefits of GFCF diet in self-help books for parents of individuals with ASD. However, results of empirical studies are still inconsistent. Thus, this article attempts to compare scientific data and popular science books for individuals with ASD and their families.

Diaper dermatitis is one of the most prevalent cutaneous diseases in infants. Humidity, increased local temperature under the diaper as well as maceration of the stratum corneum increase the susceptibility of the skin to friction and irritation from the contact with urine, faeces and chemicals. Frequent diaper changes and application of thick barrier creams are helpful in both the prophylaxis and treatment. However, while making a differential diagnosis, many diseases affecting the diaper area should also be considered, including psoriasis, acrodermatitis entheropatica, seborrhoeic dermatitis and others.

This article summarizes current data on the use and safety of elemental formulas (amino acid-based products). To identify relevant data, the MEDLINE and the Cochrane Library were searched in March 2013. Additionally, current recommendations from scientific societies or experts groups are presented.

In 2008, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases developed guidelines for the management of acute gastroenteritis in children. This article summarizes these guidelines and reviews data published in2008-2013, with special emphasis on the interventions available in Poland. To identify relevant data, MEDLINE and the Cochrane Library were searchedin April 2013. Since the introduction of rotavirus vaccines, norovirus is the main cause of medically attended acute gastroenteritis in some parts of theworld. Rehydration and normal feeding that should be continued no later than 4 to 6 hours after the on set of rehydration remain the key treatments. Probiotics with documented efficacy (currently, these are Lactobacillus GG and Saccharomyces boulardii), racecadotril (an antisecretory drug), andsmectite (an adsorbent) are all effective adjunctive therapies to oral rehydration, and any of these therapies may be considered in the management ofacute gastroenteritis. Only rarely is antibiotic treatment needed.

Asthma is a chronic inflammatory disease of the airways associated with variable airflow obstruction and bronchial hyperresponsiveness. Asthma ispresenting with recurrent episodes of wheeze, cough, chest tightness, difficulty in breathing. There is no diagnostic tests available for children younger than 5 years of age. Diagnosis of asthma in young children can often be made based of clinical symptoms, family history of asthma and atopy, therapeutictrial with short-acting bronchodilatators and inhaled glucocorticosteroides for 8-12 weeks. Differential diagnosis is very important because asthma symptoms are not pathognomonic and may occur as a result of several diagnosis conditions.

Iron deficiency is defined as the decrease of the total content of iron in the body. Laboratory tests for investigating iron deficiency (ID) fall into two categories: measurements providing evidence of iron depletion in the body, and the measurements reflecting iron-deficient red cell production. Irondeficiency is usually diagnosed using conventional laboratory test of iron status, such as serum ferritin and transferrin saturation. Unfortunately, diagnosis of iron deficiency with currently available laboratory parameters is more complex and nonspecific when concomitant inflammatory conditions are present. Standard test of iron status used in differential diagnosis are affected by inflammation, hindering clinical interpretation. Findings demonstratea significant advantage in the simultaneous determination of ferritin, sTfR and sTfR index.

Iron is an essential nutrient for humans, and has important metabolic functions as a cofactor for several enzymes and a major component of oxygen transporter in body. Under physiological conditions, there is a balance between iron absorption, iron transport and storage in human body. Anemia of chronic disease (ACD) and iron deficiency (IDA) anemia are the most prevalent forms of anemia. Proinflammatory stimuli contribute to ACD directly by inhibition of erythropoies is and indirectly by decreasing the iron available for hem synthesis. The letter may be attributed to increased levelof iron regulatory peptide hepcidine. The functional iron deficiency present in patients with anemia of chronic diseases (ACD) can be complicated by true iron deficiency resulting from chronic blood loss. It is important to distinguish between ACD and ACD/IDA to appropriately guide therapeutic regiments especially in respect to iron repletion strategies.

Paracetamol – widely used as an analgesic and an antipyretic drug, if overdose is hepatotoxic. Due to easy access it is a main cause of acute liver failure in many western countries. Authors present treatment algorithm in patients with paracetamol overdose.

Proper nutrition is a key factor affecting human health. Lactation is a stage of life in which the demand for nutrients and possible supplementation of macro- and micronutrients changes. The diet of lactating mothers should be optimal during the course of lactation. The imbalanced diet can leadto increased risk of malnutrition in breast-feeding women. Breast milk of high quality can be produced by women of different nutritional status because milk production takes precedence over other metabolic needs of the mother. Unfavourable conditions of nutrition and hydration may reduce the amount of milk produced with no significant changes in the quality. Proper nutrition is particularly important in such condition as multiple pregnancy, premature birth, cesarean section, insufficient maternal milk production and the risk of allergies - in this cases, the optimal diet can the success of breast-feeding. A special group of products which are popular among the mothers are galactagogues – the substances that stimulate the maternal milk production. Their use should never replace the lactation advice and the safety and side effects for the child should always be considered– especially for herbal plants. However, the long tradition of the use of certain products containing such ingredients (eg. barley malt) is confirmed by the current knowledge on the regulation of lactation and is an inspiration to explore new formulations promoting lactation, which can be taken by breastfeeding women in the interests of the proper development of the child.