Objectives:
Evaluation of an efficacy of 20% SmofLipid with an addition of fish oil based lipid emulsion (10% Omegaven) in treatment of cholestasis and/or parenteral nutrition-related liver disease in children on long term parenteral nutrition.

Material and methods:
15 patients aged 2 months to 17 years (median 40 months) on home parenteral nutrition with deteriorating liver function (elevated bilirubin and/or liver enzymes) were included in the study. Pure fish oil was added to parenteral mixtures with fat emulsion containing soybean oil, medium-chain triglycerides, olive oil and fish oil to obtain the total dose of fish oil exceeding 0.5g/kg/day (median 0.725g/kg/day). Datafrom control visits was analysed retrospectively by the Wilcoxon test.

Results:
The median time of therapy was 89 days (range 47-332d). A median of total and conjugated bilirubin concentration decreased from 1.65to 0.75mg/dl (p<0.015) and 1.01 to 0.46mg/dl (p<0.026), respectively. Also decrease of liver enzymes median concentration was observed: alanine transaminase (ALT) from 106 to 62U/l (p<0.013) and asparagine transaminase (AST) from 138 to 63U/l (p<0.004). In 4 patients the bilirubin and/or ALTand AST concentration increased or did not change. The patients who did not respond to therapy were significantly longer parenterally fed before the study (82.5 vs. 29 months).

Conclusions:
The mixture of an intravenous fat emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil with pure fish oilemulsion may is helpful in the treatment of cholestasis and/or parenteral nutrition-related liver disease in children on long-term parenteral nutrition.

Neonatal care after repair of congenital heart disease is challanging for medical personel due to specific problems of neonatal period pathophysiology of circulation and heart anatomy (e.g. univentricular hert) and complications after surgery, especially after cardiopulmonary by-pass. Most of standards used in post-operative therapy in different cardiac centers are founded on medical knowledge and experience because clinical research in this group ofage is very rare.In this paper we discuss standards of post-operative therapy for neonates after cardiac surgery used in Postoperative Intensive Care Unit (OIT2) of Children’s Memorial Health Institute in Warsaw.

Pediatric pain is still undertreated. The purpose of this article is to present modern concepts of analgesia in acute pediatric pain. The first part isfocused on nociception, factors influencing pain perception, basic analgesia concepts and pain service organization.

The article presents the recommendations for the nutritional therapy in children, selection of the type of access to the gastrointestinal tract, indications and contraindications for feeding by nasogastric tube and PEG. Principles of hospital enteral nutrition, including the tasks of nutrition team, and home enteral nutrition are discussed. Enteral nutrition regardless of the route of administration and diet should begin in hospital (assessment of nutrition,selection of the route of supply, selection and method of administration of diet), and then, if necessary, continued in the patient’s home, after training of caregivers.

Shwachman-Diamond syndrome (SDS) is a multi-systemic condition, characterized by abnormal haematopoiesis, exocrine pancreatic dysfunction, abnormalities of skeleton, recurrent infections and short stature. It is estimated that SDS occurs in 1 out of every 100 000-200 000 live births. SDS isthe most common cause of pancreatic insufficiency in children after cystic fibrosis. Hematologic aberrations include depression of 1 or more of the hematopoietic cell lines, cytogenetic abnormalities, aplastic anemia and hematologic malignancies, particularly acute myelogenous leukemia. Most patients present with persistent or intermittent neutropenia. In addition, the liver, kidneys, brain and teeth may be affected. Currently the diagnosis ismade basing on the clinical criteria and molecular testing of SBDS gene.

Child development refers to the biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence. Assessment of the standards in child development is a difficult task for doctors because these developmental changes may be strongly influenced bygenetic factors and events during child`s postnatal life. There is considerable variation in the achievement of milestones, even between children with developmental trajectories within the normal range. That is why it is easy to overlook the beginning of pathological process. The same difficulties are present when child`s speech is evaluated. The aim of the study was to present main reasons leading to abnormal speech development and to answer the question: what should the doctor do if the child’s speech / language appears to be delayed? A checklist of milestones for the normal development of speech and language skills in children from birth to 6/7 years of age is included on the following pages. These milestones help doctors if a child may need extra help and requires professional attention. The main causes of speech development were mentioned such as hearing loss, neurological diseases, anatomical anomaly including speech organs. The role of the specialist consultations were underlined.

Allergic rhinitis (AR) is the most common chronic disease in children. ANN effect on cognitive function, sleep, academic and school performance, the child’s behavior and quality of life. AR symptoms are nasal obstruction, nasal discharge (also sag on the back of the throat), sneezing, itching that lasts for at least one hour a day for at least 2 consecutive days. According to ARIA AR divided into intermittent and persistent, which can be mild or moderate/ severe exacerbation. Persistent AR is recognized when symptoms are present > 4 days a week for > 4 weeks. In Poland persistent AR occurs in 13% of6-7 year olds and 16.7% of 13-14 year olds. Diagnosis is based on a detailed medical history and physical examination. Phenotype of AR can be dividedin terms of duration of symptoms, severity, predominant symptoms. Treatment of child with persistent AR should consist of four steps: precise diagnosis, recommendation for prevention, medical treatment (based on the drugs that block the histamine H1 receptor, and intranasal corticosteroids), specific immunotherapy. In recent years, a new quality and hope for more effective treatment in children with persistent AR is a new drug - Rupatadine. It combines two parallel and synergistic mechanisms of anti-inflammatory action (anti-H1 and anti-PAF), which results in a more complete blocking of allergic reactioncascade. It has proven to be effective in removing nasal blockage in persistent AR and greatly improve the quality of life in children. Rupatadine is theonly drug with proven, RCT studies, efficacy in children aged 6-11 years with persistent AR. It is an innovative, highly effective and safe therapeutic option.

The article offers a comprehensive review of problems related to preterm newborns, epidemiology of prematurity in Poland and maternal- and fetal-specific causes of preterm labor, including medical and socioeconomic factors. The most common clinical problems such as infant respiratory distress syndrome (IRDS), intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BDP), together with their pathomechanisms, ways of treatment and prevention, are presented. The article also includes dietary recommendations for neonates with small and extremely small birth weight, guidelines on management of neonatal anemia, iron and DHA supplementation, as well as prevention of respiratory syncytial (RS) virus and early stimulation of the development. The Main Sanitary Inspectorate (MIS) in the 2013 Vaccination Program recommended administration of pneumococcal vaccine, as well as acellular DTPa vaccine against diphtheria, tetanus, pertussis, to all prematurely born children. Infants who received acellular DTPa insteadof whole-cell DTP vaccine in the first year of their life ought to be vaccinated with the fourth dose of DTP between 16-18 months of life.