Chronic neutropenia is more frequent in children than it has been thought before. Currently approximately 30 different causes of prolonged neutropenia are known; among them starvation, infections, drugs, chemical compounds, radiation and genetic defects. Both, the review of the literature and authors’own experience suggest that autoimmune neutropenia of infancy (AIN) has been more often diagnosed lately. AIN seems to be the most frequent causeof chronic neutropenia in children below 5 years of age. It is characterized by severe neutropenia, usually mild clinical course and spontaneous remission. The diagnosis of AIN, confirmed by detection of antigranulocytic antibodies, is important for differential diagnostics and helps to exclude more seriousdiseases such as severe congenital neutropenia, connected with increased risk of severe infections and acute myeloblastic leukemia. The authors present the proposal of diagnostic and therapeutic algorithm for children afflicted with chronic neutropenia, with special concern of AIN.

Atopic dermatitis is a chronic, inflammatory disorder of multifactorial etiology, with characteristic morphology and distribution of skin lesions and pruritus which has significant impact on the patient’s quality of life. Due to chronic and recurrent course , atopic dermatitis requires particular prophylactic and therapeutic management. In the present review paper we present four main components of atopic patients’ management, i.e. prevention, proper skincare, topical and systemic treatment as well as psychological support and patient education.

Iron deficiency is the most common nutritional deficiency in the developed world. Although iron supplementation corrects iron levels and evidence of anemia in iron deficiency anemia, recent information indicates that the consequences of iron deficiency in infancy seem to be much more long lasting and profound than previously thought. Although iron is present in many food items, our understanding of iron metabolism has increased tremendously. Despite good bioavailability of iron present in breast milk, breastfed infants require iron supplementation after 6 months of age. So does the formula fedinfant after formula is discontinued. Although iron is present in many food items, its bioavailability is not good. However, once that iron enters the body,there is no way for it to be excreted. Therefore, in the absence of iron loss through bleeding, iron homeostasis depends on absorption that is regulated byhepcidin. Iron excess can also lead to problems, particularly in developing countries. In inflammatory stages serum iron may be low but body stores maybe appropriate. Whenever iron supplements are needed, several aspects need to be considered but mainly, bioavailability and side effects. Side effects such as coloration of teeth, abdominal discomfort, dark stools are a common reason why people discontinue iron therapy. An appropriate form of iron supplementation with good bioavailability and at the same time being well tolerated by the gastrointestinal tract is ideal.

Cystic fibrosis is genetically determined lethal hereditary disease. Among Caucasians is the most common reason of death in group of diseases with autosomal recessive inheritance. The main goal of therapy is to improve the quality and increase the length of life. The most important problems of patients are complications of respiratory and gastrointestinal tract. Because of that people with cystic fibrosis are in the higher risk of malnutrition. Forthis reason, one of the key part of treatment is early implementation of appropriate nutritional therapy, which not only helps to improve the nutritional status but also increases respiratory capacity, improves overall health and therefore significantly increases the patient’s chances to fight the disease.

Families with young children more often travel to the tropics and developing countries. Stay in those countries substantially increases a risk of acquiring of an infectious disease. The risk depends on a region, a length and character of visit. More and more frequently parents ask doctor for advice and planning of proper prophylaxis. Proper prophylaxis, including vaccinations, can decrease a risk of infectious diseases.

In the article, electrophysiological maturation of sleep features is presented. The differences between term and preterm newborns are stressed. Prognostic value of the active and quiet sleep is discussed. The benign sleep myoclonus and central hypoventilation syndrome as the selected sleep disturbances are particularly important problems. Benign sleep myoclonus should be considered in the differential diagnosis of the neonatal seizures. Impact of drugs,chronobiotic factors and different diseases on the neonatal sleep are presented.

Parasites of the intestinal tract have been known from years, but they are still a diagnostic-therapeutic problem. There are many controversial opinions and convictions related to frequency of occurrence in polish children population: lifecycle of parasites, possibility of infection, diagnosis and treatment. In the article the most frequent in Poland parasitoses of digestive tract are discussed. For example: pinworm infection, ascariasis, tapeworm infection, giardiasis, strongyloidosis, amebiasis.

Mother-to-child transmission is one of the main routes of HCV infection in children. It is estimated that there are 4000-8000 infants delivered by HCVinfected women in Poland every year. In European multi-centre study the rate of HCV infection in infants born to HCV infected mothers is approximately 6,2%. High viral load is the main risk factor of HCV mother-to-child transmission. HCV infected women ought to be treated before pregnancy to achieveHCV clearance or decrease HCV replication. There is no evidence of protective role of elective cesarean section- further prospective studies are required. Breast-feeding is not contraindicated.

Langerhans Cell Histiocytosis is a rare disease, which is characterized by uncontrolled proliferation of pathological Langerhans cells and accumulation of inflammatory cells in almost every tissue. The etiology of the disease remains unclear; recently the role of inflammatory cytokines and regulatoryT cells has been discussed. Prognosis depends on ,,risk organs” involvement and response to the treatment. The disease management varies from longterm observation, to intensive chemotherapy and bone marrow transplantation.

Hepatic encephalopathy is a complex syndrome of neurological and neuropsychiatric symptoms including depressed level of consciousness, intellectual impairment, personality and behavior changes and neuromuscular abnormalities. In this paper authors present current classification of hepaticencephalopathy and clinical scales for grading hepatic encephalopathy.

The paper reviews guidelines and position statements on DHA supplementation in critical life periods- in infancy, early childhood, breastfeeding and pregnant women. Consistency of major statements was presented. The paper summarized major conclusions for clinical practice.

Stevens-Johnson Syndrome (Stevens-Johnson Syndrome - SJS), a milder form of toxic epidermis necrolysis (Toxic Epidermal Necrolysis - TEN), can beinduced by drugs as well as microbial infections. We present three patients who developed the SJS in the course of Mycoplasma pneumoniae infection with pulmonary manifestation. The clinical manifestations involve extensive lesions in the mucosa of the oral cavity, throat, tonsils, conjunctiva as wellas scrotum and penis skin with single changes on trunk skin.

Background:
Nonalcoholic fatty liver disease in children is associated with obesity, but the distribution of body fat has not been analyzed so far.
Aim:
The aim of this study was to assess the distribution of body fat using magnetic resonance imaging (RM) and lipid metabolism markers in children with NAFLD.
Methods:
We included 45 obese children with NAFLD and 25 obese children without NAFLD. All patients underwent body fat distribution measurements using magnetic resonance and laboratory tests including serum lipid profile. All patients completed dietetic record for main nutrients.
Results:
The comparison of body composition and adipose tissue distribution parameters using statistical analysis (Mann-Whitney test) revealed nosignificant differences between the groups except for significantly higher visceral/subcutaneous adipose tissue ratio in children with NAFLD. Therewere also no significant differences in the lipid parameters with the exception for markedly higher cholesterol levels in children with NAFLD. The studygroups did not differ in terms of consumption of key nutrients.
Conclusion:
Increased visceral/subcutaneous adipose tissue ratio is a risk factor for the development of liver steatosis in obese children.

Objectives:
The aim of this study is the preliminary analysis of impact of the milk bank on the organizational and financial aspects, clinical effects inneonatal intensive care unit (NICU) and the attitude of the medical staff and parents to the availability of milk from the milk bank.
Material and methods:
Working of the milk bank from April to September 2012 was analyzed. An assessment of the financial and organizational aspects included the characteristics of the donor milk, pasteurization procedures and a comparison of costs. 172 patients hospitalized in NICU, ofwhich 54 were feeding with the milk from the milk bank (2012) and 118 newborns in 2011 and 2012, feeding only with breast milk or breast milk substitutes were included in the study. Analysis of clinical results was based on a comparison of the duration of parenteral nutrition, the start ofa minimal enteral feeding, late onset sepsis, necrotizing enterocolitis and type of colonization of the gastrointestinal tract. Attitudes of medical staffand parents to the milk bank was based on a questionnaire.
Results:
Analysis revealed: 34 donors of milk, 134 human breast milk pasteurization procedures, obtainment of 166 liters of human milk and median cost of 100 ml of milk as 32 PLN. In patients feeding with the milk from the milk bank, a strong trend of early introduction of minimum nutritionaltrophic as well as reducing the incidence of necrotizing enterocolitis were noticed. A questionnaire showed that three quarters of women admitted that information about the existence of a milk bank is an important criterion for choosing a hospital to give birth. Almost all would benefit from the proposals of milk from the bank, if there is such a need in their child, and the ideaof milk banks should be extended.
Conclusions:
Preliminary observations indicate very good effect supply only breast milk for the gastrointestinal tract function, resulting in a very early introduction of enteral nutrition and a reduction in the occurrence necrotizing enterocolitis. We observe very acceptable attitude of medical staff’s to human milk bank and using it for feeding neonates. The pro-lactation’s behaviours of nurses and parents have reinforced. The reception of the human milk bank is very optimistic especially among parents.

Recurrent respiratory tract infections are common problem in infant and small children. In this article, we present current knowledge about recurrent respiratory tract infections prevention in paediatric patients.