The article presents the current recommendations of the Working Group on Probiotics and Prebiotics of the ESPGHAN concerning the use
of probiotics for the prevention of antibiotic-associated diarrhea (AAD). Based on the available data, when the use of probiotics for the prevention
of AAD is considered, the Working Group recommends using Lactobacillus rhamnosus GG or Saccharomyces boulardii. When the use of probiotics
for the prevention of Clostridium difficile-associated diarrhea is considered, the Working Group suggests using Saccharomyces boulardii.

The paper presents the summary of current clinical guidelines for the management of respiratory distress syndrome in preterm neonates.

„European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update”

The article presents the results of a systematic review conducted by Rutayisire et al. and published in 2016 in BMC Gastroenterology regarding the influence
of delivery mode on infants’ gut microbiota. The results of 7 studies, which met the inclusion criteria, indicate a presence of a significant correlation
between the mode of delivery and the diversity and colonization patterns of gut microbiota in the first 3 months of life. The studies also show
that there is no significant difference between gut microbiota in 6 months old infants delivered vaginally and of those delivered by cesarean section.

Pneumonia is defined as an acute disease of alveolar region of the respiratory tract. The disease is described as community acquired pneumonia, when the
symptoms appear in a previously healthy child, staying at home, or after less than 48 hours of hospitalization. The diagnosis of pneumonia should be established
on the basis of anamnesis and clinical symptoms – further diagnostics should be performed in severe cases or when there is no improvement after the
proper first line therapy. The most important part of the treatment of pneumonia in children should be an age-dependent empiric antimicrobial therapy, or
when the viral etiology is suspected – the proper symptomatic and/or antiviral treatment.

Syncope is a frequent clinical problem in pediatrics. Although in most cases it is innocent, it remains a diagnostic challenge for pediatricians and
general practitioners. A properly obtained medical history is the most important element of differential diagnosis of syncope. Together with physical
examination and basic ECG analysis it is usually sufficient to make a diagnosis and reduce the number of unnecessary specialist consultations and
hospitalizations. The objective of this article is to present the definition, epidemiology, patophysiological classification, diagnostic procedures and
treatment of syncope in children

Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic disease in children. It develops in genetically susceptible individuals, with the participation
of environmental factors. The essence of the disease is a deficiency of insulin, generated as a consequence of self-destruction of pancreatic β
cells. Early diagnosis of diabetes gives a chance for remission. The basic elements of treatment in diabetes include insulin therapy, proper diet, physical
activity, therapeutic education. A child with T1DM should stay under care of both out-patient clinic and hospital ward where professional Diabetes Care
Team is present. The goal of T1DM treatment is the normal development of the child and prevention of acute and chronic complications of diabetes. All
patients should be regularly screened for: nephropathy, retinopathy, neuropathy, lipid disorders and diabetes-associated conditions.

Skin lesions are observed in people of all ages. Its occurrence in children often worries the parents. We would like to present conditions which are met on
daily basis in clinical practice - vascular anomalies and pigmented nevus. We will concentrate on those symptoms that should encourage further diagnostics
and possibly treatment. Although, usually these changes are not life threatening, an appropriate treatment procedure will often avoid future complications.
Additionally, we would like to point out to the skin symptoms which could suggest the development of malignant neoplasm, or those suggesting the
development of a malignant neoplasm disease in the background of a benign lesion, keeping in mind that early diagnosis is one of the major prognostic
factors which impacts outcome and patient’s quality of life after treatment completion.

Urticaria is a skin disorder that may be often observed in adults (25%) and children (from 2.1% to 6.7%), which could result in a significant reduction in
quality of life. It may be acute or chronic (lasting more than 6 weeks), intermittent or persistent . Urticaria is defined as the sudden appearance of wheals
with central swelling and surrounding erythema, which are typically pruritic, sometimes burning.
Pruritus (itch) can be defined as a poorly localized, nonadapting, usually distressing and unpleasant sensation that causes an intense desire to scratch.
It may determine the quality of life and functioning of patients, and causes frustrations, irritations, sometimes depression, interferes with daily activities
and sleep. Pruritus is regularly reported in the general population (lifetime prevalence, 22%). The pathological mechanism of itch in urticaria is different
than in other skin diseases. The main role is plying by histamine and its effects through receptors H1 and H4. This pathomechanism determines the
different treatment. A crucial step in controlling the symptoms of urticaria, and mostly annoying itching, is to use systemic antihistamines, such as H1-
receptor antagonists. We have to use second-generation H1 antihistamines in standard doses. First-generation antihistamines should not be used due to
their multiple confirmed side effects.
Presently, we have a new drug − rupatadine, which showed high efficacy in pruritus and urticaria. It is well investigated, the modern second-generation
antihistamine with additional, synergistic action of anti-PAF. Rupatadine is effective, and well tolerated dosing every 24 hours. It has a very good safety
profile and can be used in itching in urticaria from 2 years old.

This article summarizes current data on food introduction to the diet of infants at risk of developing allergy.

Chronic cholestasis, mainly biliary atresia and progressive familial intrahepatic cholestasis, leads to malnutrition and require additional energy supply
as well as macro and micronutrient supplementation. The major issue is lipid soluble vitamin supplementation − which should be based on monitoring
of concentrations or makers of deficits and appropriate increased dosage. There are also special preparations to supplement cholestatic children
− like water soluble vitamin E (TPGS).

Glycogen storage diseases (GSDs) belong to inborn errors of carbohydrate metabolism, which are classified into exclusively hepatic types and mixed
– hepato-muscular forms, whereas according to the order of deficient enzyme discovery into following types: I, III, IV, VI, IX, XI and 0 (glycogen synthetase
deficiency). Main symptoms, common for all types, are hypoglycemia and hepatomegaly (except for type 0). Since a lot has changes in terms
of diagnosis and clinical management in GSD, the aim of this paper is to discuss these novel approach according to current guidelines of American
College of Medical Genetics and Genomics (ACMG) and GSD Program of Florida University.

This paper briefly summarizes issues with research papers. Knowledge on tracking down the best evidence and critical appraisal is essential not only for
scientists, who are actively involved in research, but for all clinicians and health care professionals.

Introduction: Hepatocerebral mitochondrial depletion syndrome (MDS) is characterized by severe, progressive liver failure associated with neurological
dysfunction. The results of the routine laboratory tests are highly unspecific. MDS recognition is based on the presence of mtDNA depletion in the liver tissue
and identification of causative mutations in one of responsible genes (DGUOK, MPV17, POLG, C10orf2, SUCLG1).

The aim of this work was to present results of the study concerning hepatocerebral depletion syndrome in children and to propose recommendations of
proceeding in suspected cases.

Material and methods: Fragments of the liver tissues (biopsies, autopsy slices, explants) obtained from 297 affected children with unknown disease etiology
were enrolled in this study. We evaluated histopathological picture of the collected samples and performed molecular analyses consisted of the
mtDNA depletion (mtDNA/nDNA ratio) assessment and causative mutations identification. The material was divided into three groups, including
the tested one, the control group (with no features of liver damage) and the reference group (molecularly confirmed MDS). According to the
literature data mtDNA/nDNA ratio below 30% of control values was considered to be pathological.

Results: In the study group mtDNA/nDNA ratio below 30% of control values in the liver was found in 8 out of 243 patients. In all 8 patients MDS
diagnosis was excluded on the basis of comprehensive analysis of the course of disease, histological and molecular studies. The cause of mtDNA depletion
in the liver of the particular cases remains unexplained. In the whole group negative correlation between mtDNA/nNA value and the presence of histological
features of the liver damage, including fibrosis, inflammation, necrosis and age was found.

Conclusions:
1. Hepatocerebral MDS constitutes an extremely rare cause of hepatopathy and acute liver failure in children.
2. The possibility of mtDNA depletion of an acquired (not genetically determined) character and unexplained pathomechanism, reduces the value of this
parameter in the differential diagnosis of MDS.

Autoimmune encephalitis (AE) is a heterogeneous group of diseases characterized by a wide range of neurological and psychiatric symptoms, in
which anti-neuronal antibodies are present. There are also specific forms of AE that are related to cell-mediated immune response. AE incidence is not
precisely known, but it is estimated that it could be higher than 20% of all the encephalitis.

The aim of the study was to determine the type of antineuronal antibodies in children with suspected autoimmune disease and its clinical
characteristics.

Material and methods: The study retrospectively analyzed the clinical symptoms, and outcomes in pediatric patients with suspected autoimmune
encephalitis and unclear autoimmune disease in children hospitalized in the Department of Pediatrics, Nutrition and Metabolic Diseases at the
Children’s Memorial Health Institute. It was screening of antibodies in serum against myelin (anty-MOG, anty-MBP, anty-MAG), anti-neuronal antibodies
(anty-NMDAR, anty-VGKC, anty-GABA, anty-AMPA) and anti-GAD (intracellular antigen).

Results: Among the 13 cases enrolled in this study, 8 patients were positive for the antibodies against myelin. In nobody was detected anti-neuronal antibodies
(anty-NMDAR, anty-VGKC, anty-GABA, anty-AMPA, anty-GAD). The most common diagnosis in this children was encephalitis (4 patients), the other
patients were diagnosed: posterior reversible encephalopathy syndrome (PRES), hemophagocytic limphohistiocytosis (HLH), DOPA-responsive dystonia,
alopecia areata with hyperreactivity symptoms.

Conclusion: The presence of antibodies anti-neuronal may indirectly indicate autoimmune mechanism of the disease and provide very important for clinicians
to help in establishing the diagnosis in the pediatric population. It could be helpful in the application of appropriate immunosuppressive treatment.
There is a need to test a larger group of patients with encephalitis that would allow separation of the characteristics of the clinical, biochemical and
radiological symptoms in the central nervous system, targeting diagnosis and determine optimal therapy.

Aim: The breastfeeding course in the first year of life was analyzed in the study in mothers with and without breastfeeding problems. The time
of the introduction of fluids, complementary foods and formula was assessed and also the influence of the above practices on breastfeeding
duration.

Material and methods: The study was carried out in Warsaw between 2010 and 2014. There were 281 mothers of children in the age of 13 to 36
months included in the study after completing the questionnaire consisting of 34 questions. Mothers were assigned to three groups A, B and K:
the groups A and B consisted of women with breastfeeding problems, the control group K was made of mothers without breastfeeding problems.

Results: The median time of excusive breastfeeding duration was 5 months, the median total breastfeeding duration was 12 months. In the age of
4 months and earlier 26% of infants received fluids, 17% received complementary foods. Formula was introduced on permanent basis in the median
age of 5 months, but 45% of infants have never received formula during breastfeeding. The decision to give formula was most often made
by mother (odds ratio OR = 9), pediatrician (OR = 5.4), neonatologist (OR = 4.5). Mothers with breastfeeding problems in comparison to mothers
without problems more frequently gave supplementation (63.2 and 52 vs 38%), on average 2 months earlier introduced formula on permanent
basis and were giving bigger amounts (117 and 92 vs 72 ml/24 hours).
Earlier introducing of fluids, complementary feeding, supplementing with formula shortened total breastfeeding duration (hazard ratio HR = 0.8;
95% CI:0.71-0.9, p = 0.0004, HR = 0.65; 95% CI:0.52-0.82, p = 0.0004 and HR = 0.9; 95% CI: 0.79-1.02, p = 0.04 respectively).

Conclusions: Feeding practices such as introducing fluids, complementary foods and formula shorten total breastfeeding duration, so they should not be started earlier than it is justified by medical reasons or recommendations. Some mothers introduce fluids and solids too early.
Lactation problems are connected with more frequent supplementation. Giving formula to an infant is most often mother’s decision.

Objectives: To present families’ concerns and economic limitations regarding caring of child with cerebral palsy.

Materials and methods: Study was carried out between 2013 and 2014 among 190 parents of children with cerebral palsy (CP) and among 111 parents
of healthy children. The diagnostic survey with the use of an author’s questionnaire concerned socio-demographic data, economic status and
functioning of families. In addition, parents of children with CP were also questioned about caring and rehabilitation process. Statistical analysis was
performed with the use of chi-square test and Spearman’s rank correlation coefficient.

Results: Mean value of age was above 40 yrs old. The questionnaire was more often completed by mothers in both study groups (73% vs 87%). Both
parents worked to provide caring to their child in respectively 23% and 61% of families. In as many as 64% of families with a child with CP one of the
parents had to resign from professional work. Financial status was described as poor and parents answered that they missed money for the basis expenditures
in 50% of families with a child with CP and in 7% of families with healthy children. The major problem with rehabilitation of the child regarded
lack of financial sources and a long distance to the rehabilitation center. As many as 48% of parents with a child with CP were provided with
poor and very poor rehabilitation equipment.

Conclusions: Worse financial status is observed among families with CP child and is related to the number of working parents. Financial status has
a major impact on the rehabilitation process of a CP child.

Cardiac tamponade is a rare complication of vascular catheterization of the newborn, still it is associated with high mortality. We analyzed three cases of patients
who developed this complication both as a result of peripherally inserted central catheter (PICC) − cannulation of central venous through peripheral
vessels with ECC (Nutriline, Premicath) and a technique of Seldinger (internal jugular vein and femoral vein catheterization).
In most cases pericardial effusion was primarily diagnosed by echocardiography, further x-rays provided information about the mechanism of complication.
In all cases pericardial drainage was required.
Undoubtedly important part among reasons for cardiac tamponade were abnormal vascular catheter tip location, usually deep in RA (right atrium) in close
contact with myocardium, the use of hyperosmolar fluids of parenteral nutrition and high doses of catecholamines at critically ill child with severe cardiorespiratory
failure.

Fever usually becomes an essential challenge for physicians. Diagnostics is frequently difficult and permanent, as numerous reasons for fever have to be excluded.
Based on case reports, the authors intended to emphasize the necessity of a detailed dental examination, as a routine diagnostic procedure for children
suffering from fever of unknown origin, because carries might pose its main reason.

There are more and more complaints regarding infringements on the part of physicians. The mentioned trend is accompanied also by legal changes,
which aim at an efficient settlement of cases resulting from inappropriately provided healthcare benefits. Activities incompliant with due diligence requirements,
that is medical malpractice, very often constitute a reason to hold physicians to account. What are the types of malpractices committed by
physicians and what can be done to avoid them?