Growth disturbances and malnutrition are frequent consequences of chronic neurological disorders in children. Relation of body mass to height age is a good method of nutritional assessment. The choice of access to digestive tract requires assessment of motorfunction. Nutritional support, with the use of special formula delivered by tube or nutritional stoma, is recommended in case of on- going or possible nutritionalor deficiencies. Total energy needs should be based on resting (basal) energy expenditure for height age, particularly in case of anatomical malformations. Total daily energy needs are 120–140% resting energy expenditure. In case of obesity administration of energy is equal to resting energy expenditure. In the course of treatment periodic assessment of body mass and length is necessary. Change of energy administration is mandatory if too high or too low body mass change is observed in the periods of 3–6 months.

The aim of this study was to present Scientific Opinion of the European Food Safety Authority (EFSA) for fats, fatty acids and cholesterol as a basis for national recommendations.

Polyunsaturated fatty acids (PUFA) are the essential nutrients for human growth and development. Omega-3 and omega-6 fatty acids cannot be synthesized denovo in human body hence they have to be delivered with food. Dietary intake of long-chain polyunsaturated fatty acids is associated with decreased risk of atherosclerosis and cardiovascular disease. Docosahexaenoicacid (DHA) plays an important role in neurodevelopment of infants and is related to numerous beneficial effects in children e.g. lowering risk of respiratory infections. Omega-6 fatty acids are by far more common in children’s diet than omega 3. For health reasons there is a need to increase intake of omega-3 fatty acids by including omega-3 rich products in the diet (e.g. plantoils as repeseed oil). Imbalance between low supplementation of LC-PUFA and high intake of saturated fatty acids is an urgent matter of public health. The rules of proper nutrition comprising required amount of fishe and plant oils should be clearly and widely spread among healthcare specialists and patients.

Author presents general information concerning diagnosis and treatment of sepsis and septic shock. The compendium of knowledge is based on the results ofthe own clinical studies and the experiences supported by the data obtained by other authors. Author emphasizes the importance of disturbances in hemostasis and fibrynolysis, which are caused by over-inflammatory response of the organism of neonate after bacteria invasion. These disturbances may lead to the microcirculation disorder and malfunction of the main organs. As a consequence of excessive coagulation, the bleeding may occur what significantly aggravates the clinical course of sepsis. Author also points out the protective role of non-selective phosphodiesterase inhibitor– pentoxifylline, a multipotential drug with antiinflammatory and antiaggregatory properties.

Rheumatic fever is a multisystemic inflammatory disease, which appears in children between 6–15 years old. It is characterized by arthritis, myocarditis, chorea, subcutaneous nodules and erythema marginatum.The permanent consequence of rheumatic feveris acquired heart defect. It is one of the common reason of acquired heart defects in children and youth. In this article we present the principles of diagnosis, treatment and prophylaxis of rheumatic fever.

Ursodeoxycholic acid (UDCA) is hydrophilic, there fore, nontoxic bile acid with cytoprotective, choleretic, antiapoptotic and immunomodulatory activities. The paper discusses the experiences accumulated so far in the field of application of UDCA in disorders of the liver and biliary ducts in pediatric population. In the discussed diseases long-term administration of UDCA is safe, reducesthe clinical symptoms, improves quality of lifeand the biochemical parameters, and even the morphology of the liver. The application of UDCA in the majority of diseases in children is “off label use”.

Turner syndrome is one of the causes of short stature in girls. It results from total or partial absence of one of the X chromosomes. The clinical picture includes also typical phenotype features, gonadal dysgenesis and other medical abnormalities. Treatment with recombinant human growth hormone is a standard therapy in this group of patients.

Background.

International clinical trials have been conducted in accordance with ICH-GCP standards, nonetheless still there have been many findings observed about the process of informed consenting of the patients. These findings result from lack of investigators’ knowledge and understanding of the nature and seriousness of this process. Hence it is very important to present this topic in details especially in the perspective of expected increase in the number of pediatric clinical studies resulting from implementation of EU Pediatric Regulation 1901/2006.

Aim.
The purpose of this article is to describe the process of obtaining informed consent for patient’s participation in clinical trial, to present international and Polish regulations regarding this topic and to summarize obligations of investigators who are responsible for obtaining informed consent form.

Discussion.

Several European and Polish regulations specify conditions of informed consenting in clinicaltrials. Based on these regulations we can define three types of informed consent: in person consent (provideddirectly by the patient), substitute consent (expressedby another legally authorized person in case that the patient is not able to provide legally valid consent) and parallel consent (which is obtained in case that patient is at the age of 16 years or more or patient is legally incapacitated but is able to express his opinion about participation in clinical trial). Obtaining written informed consent form signed and dated by the patientis the basic condition to participate in clinical study andthe key responsibility of the investigator. In case of minor participants it is still a controversial area whether both parents should signed informed consent form.

Conclusions.

Safety of clinical trials’ participants dependson combined efforts of all people involved in planning, conducting and monitoring clinical studies. Only correct process of obtaining informed consentguarantees high ethical standards of the trial and patient’srights. Careful obeying of applicable regulationsand rules regarding informed consenting is mandatoryto protect investigator against potential claims from the patient.

New born’s and small baby’s skin requires the specific treatment. It is thin, immature and prone to irritations. The use of inappropriate cosmetics may cause the dysfunction of skin lipids, what leads to low immunity to bacteria, viruses and fungi. The bad treatment disturbs the immature epidermal skin barrier. The information about choosing appropriate cosmetics and the way ofusing them should be given by GP.

Hospitalization in the neonatal intensive care unit of premature or ill newborn means that the child is separated from the mother. Provision of appropriate organizational, educational and technical conditions and ensuring that the child receives maternal milk is a crucial success factor for the child’s treatment. Based on extensive review of the literature we propose an algorithm for maternal milk extraction and storage for feeding the child. Presented algorithm has been implemented asstandard procedure in 3 level perinatal center.

Epidemiologic studies strongly support the notion,that breastfeeding prevents infantile infections, particularly those affecting the gastrointestinal and respiratory tracts. Clinical and experimental observations also suggest, that human milk not only provides passive protection, but also can directly modulate the immunological development of the recipient infant. This bioactive substances are hormones, growth factors, cytokines and chemokines. They operate in networks and orchestrate the development and functions of immune system. Several different cytokines and chemokines have been discovered in human milk in the past years, and the list is growing very rapidly.

The paper presents data regarding the structure of sudden and unexpected infant deaths. A review of literature regarding causes of these deaths has been conducted. In about 1/3 of deaths the cause of death can be explained and usually the causes are: infection, developmental anomalies and injuries. In 1/3 of cases the cause of death cannot be explained. In order to reduce the number of SUID it is crucial to identify risk factors in pregnancy and provide adequate medical care. Parents should be mad aware of risk factors in infants (supine sleeping position and smoking cigarettes in infant’s environment) and behave accordingly.Detailed analysis of the circumstances of death andmedical history are crucial elements in investigation of the cause of death. Autopsies should be performed according to a detailed protocol in reference pathology centre. The pathologist should have substantial experience in investigating cause of death in infants.

Due to a constantly rising percentage of infants delivered by cesarean section (non-obstetric indications included), it is important to unify guidelines of treatment for healthy infants from operative delivery. The clinical practices should encourage the restoration of natural adaptation mechanisms, such as the development of lactation and the bond between the mother and the child- hampered by such operations. The proposed rules of procedure have been introduced as invented procedure at the Holly Family Obstetrics and Gynaecology Hospital in Warsaw. The introduction to infants’breast-feeding, that had gone through caesarean section, as well as its wide spread implementation have been the major achievements of the hospital.

Intellectual development (IQ) and nutritional statu s(based on anthropological measurements) were assessed in 46 children aged 1,4–7,6 years on vegan and vegetarian diets. Normal intellectual development, with IQ higher than population reference data, and normal nutritional status with the tendency towards lower BMI index were found.

The aim of this study was to update the data on the share of human milk in feeding children to the second year of life in Poland on the example of Kuyavian‑Pomeranian Voivodeship.

Material and methods.

We used a survey addressed to the mothers of infants within these age groups: newborns (n = 176), infants and small children inthe total number of 795 at the age of the study to4 months, 5 and 6 months, 7 and 8 months, from 12 to 15 months, and 15 months to completion of twoyears of age.

Results.

High percentage of mothers start to breastfeed (99,4%) but only 65% of exclusive breastfeedingin hospital. Variety of practices such bottle-feeding and milk substitution by 5% glucose and insufficient equipment for mothers were observed in hospitals. Much fewer than recommended children are breastfed in the first six months of year (rates of exclusive BF is 22,4%).The majority of infants older than six months are artificially fed only (57%). Long and effective breastfeeding of children to the second year, as recommended, is very rare in Poland (5%). 

Conclusions.

Share of breast milk in the diets of children 0–2 years old in the Kuyavian-Pomeranian Voivodeshiphas been significantly reduced recently. To improvecurrent situation there is a need to monitor breastfeedin grates in the whole country and introduction of systematic solution to education and to establish the best practice of breastfeeding (lactation support freeof charge and reactivation of human milk bank may bean example).