Caffeine is the gold standard for the treatment of apnea of prematurity mostly in VLBW and ELBW newborns. This drug in the form of caffeine citrate is
usually used from the first days of newborn’s life and until post menstrual age of 34-35 weeks. Biotransformation of caffeine is almost complete in the
liver but 86% of the drug excreted unchanged by the kidney. In newborns with significant immaturity, the metabolism of caffeine is accelerated. The
therapeutic concentration is in the range of 5-25 μg/ml. Routine monitoring of serum levels is not currently recommended because side effects are observed sporadically and the most common ones are cardiac acceleration. The primary indication for the use of caffeine citrate is apnea of prematurity but additionally, caffeine has been shown to have a beneficial effect on shortening time of mechanical ventilation and improving psychomotor development. The best effects of caffeine have been demonstrated with early application, even from day 1 of life or first hours.

This paper presents summary of current recommendations from the Expert Committee on NAFLD (ECON) and the North American Society for Pediatric
Gastroenterology, Hepatology and Nutrition (NASPGHAN) for nonalcoholic fatty liver disease approach in paediatric patients.

Meningitis is a severe febrile, life-threatening illness most often affecting young children. Lumbar puncture is necessary to confirm the diagnosis and
should not be delayed since late diagnosis increases the risk of sequelae. The infection spreads through the bloodstream, less often from the middle
ear or paranasal sinuses. Etiology depends on the age of patient, the route of infection, individual risk factors and local epidemiology. The majority of
cases are caused by capsular bacteria: pneumococci, meningococci and Haemophilus influenzae b. These infections can be effectively prevented by
immunization. A systematic diagnostic approach using algorithms makes it easy for physicians to follow the current medical knowledge.

The reported incidence of tick-borne diseases has increased in Poland in recent years. Therefore, the issue of Lyme disease and tick-borne encephalitis is
currently often faced by both paediatricians and general practitioners. The paper presents standards for the diagnosis and treatment of these conditions,
based on the current recommendations of European, US and Polish experts. The practical issues related to the affected regions, risk factors and the methods
for tick removal are also raised.

In Poland, rotavirus (RV) remains the main cause of acute gastroenteritis. Typical signs and symptoms of RV infection include vomiting, watery diarrhea,
and fever. RV infection is usually a self-limiting condition. However, complications may occur. The common clinical consequences include dehydration and
electrolyte disturbances. In rare cases, this may result in hypovolemic shock and death. This review summarizes both typical and unusual complications of
RV infection. Medical subject headings and free-language terms were used to search MEDLINE (up to April 2017) for relevant studies.

Mood disorders are some of the most common disorders in children and adolescents. They may precede later emotional difficulties and disabilities.
An understanding of the disorders’ presentation, common contributing factors and methods of intervention will enable pediatricians and family doctors
to provide optimal support to these children and their families. The present paper briefly reviews the classification, epidemiology, etiology, symptoms
and treatment of mood disorders in children and adolescents.

Protein is a basic structural element of our body. Most of bioactive compounds in an organism are proteins. Studies conducted to identify minimum and
maximum protein requirements for infants and young children are mainly observational. Very few randomized controlled trails, such as EU Childhood
Obesity Project demonstrate long term effects of different early protein intakes. Based on existing evidence the maximum recommended level of protein
concentration in a cow’s milk based infant and follow on formula was recently limited to 2.5 g/100 kcal. Young children, aged 1-3 years should not exceed
daily intake of 15% of energy from protein, and their consumption of cow’s milk should be limited to 1-2 cups per day (200-400 ml). The young child formula
(for children > 12 months of age) composition should be adapted according to existing recommendations.
Preterm infants have very high protein requirements, compared to other children, especially in the first weeks of life, that can be achieved by daily enteral
protein intake of about 4.0 g/kg of body weight (4.0-4.5 g/kg in infants less than 1000 g). Adequate amount of energy should be provided together with
protein to achieve an optimal protein nitrogen accretion.

This article described the etiology and characteristic clinical syndromes of Streptococcal A pharyngitis in children. It should be noted that correct
diagnosis of disease is based on detection of Streptococcal antigen A by use of rapid antigen test. Positive results of the rapid test with sensitivity
above 90% for the diagnosis of disease in children allow the clinicians to use of antibiotic in the therapy. Empiric antibiotic therapy of pharyngitis
based on clinical picture is the main source of overuse of antimicrobial agents in out-patient clinics and selection of resistant strains.

Idiopathic infantile hypercalcemia (IIH) is caused by hypersensitivity to vitamin D3 and associated with disturbances of its metabolism leading to high serum
concentrations of active metabolites of vitamin D3 and hypercalcemia. The molecular basis underlying IIH are mutations of CYP24A1 or SLC34A1 gene. This
leads to disturbed catabolism (CYP24A1 defect) or excessive generation of 1,25(OH)2D3 (SLC34A1 defect). The clinical signs and symptoms secondary to hypercalcemia are non-specific and include anorexia, vomiting, polyuria, dehydration, constipation, growth retardation, generalized hypotonia, arterial hypertension, and unexplained fever and abnormalities secondary to hypercalciuria suggesting urinary tract infection (leucocyturia and erythrocyturia). The symptoms subside after normalization of serum calcium levels, however cases of both acute and chronic renal failure in the course of IIH have been described. Late complications of IIH are unknown, but our own observations indicate on a significant risk of nephrocalcinosis and end-stage renal failure. The clinical significance of disturbances of vitamin D3 metabolism is due to the prevalence of disturbed metabolism of vitamin D3 in general population and population exposure to excessive levels of vitamin D3 and calcium in the era of widespread vitamin D3 prophylaxis.

A child born small for gestational age (SGA), according to Endocrinological Societies, is defined by birth weight and/or length below -2SD from the
mean. In this group there are constitutionally small children as well as individuals with intrauterine growth restriction (IUGR). It is estimated that approximately
10% of SGA children do not catch-up growth in comparison to their peers in the first 4 years of life. This group can be treated with growth
hormone. On contrary, rapid weight gain in infancy and early childhood may lead to obesity and metabolic consequences later in life. Regular auxologic
and metabolic assessment of SGA children is recommended.

A bezoar is a foreign body in the gastrointestinal tract that increase in size by continuous accumulation of indigestible material. Clinical manifestation of
bezoars involves typically abdominal pain, nausea and vomiting, but also can be presented with abdominal obstruction. Treatment depends on type and
size of bezoar, including enzymatic dissolution, endoscopic fragmentation or surgery.

Non-compliance is a common problem among adolescents with chronic diseases. The incidence of non-compliance increases with age and complexity
of the treatment (including multiple-drug therapies, not attractive diet, frequent visits and hospitalizations). Non-compliance may be accidental
(non-intentional) or decisive (intentional). More intensive monitoring of the therapy and reassuring the patient about profits and risks coming from
maintaining or abandoning therapy are the solutions in the first case. The professional assistance of psychologist or psychiatrist is required in the
second situation (decisive withholding of the treatment). The mental health professionals should identify the real background of non-compliance in
particular patient. Non-compliance is underestimated in common practice and is one of the most relevant causes of the treatment failures.

Choline is an essential nutrient that plays an important and complex role in fetal programming. It is a precursor of acetylcholine, an important neurotransmitter,
as well as of phosphatidylcholine, which is a main component of cell membranes and it is a methyl donor indirectly involved in methylation of DNA
and histone proteins.
Numerous scientific studies suggest that an optimal intake of choline during pregnancy leads to a series of positive physiological changes in the offspring.
Although, most of the experiments were performed on animal models, there were also studies conducted in pregnant women.
Current expert opinion of the European Food Safety Authority suggests that adequate intake of choline for women during lactation and pregnancy is respectively 480 and 520 mg / day. Research carried out in European Union countries showed that we consume insufficient amounts of this ingredient in our diet. The following article explains the mechanism of action and functions of choline in fetal development and presents current expert opinions of the European
Food Safety Authority on the adequate intake of choline. 

Biotinidase deficiency (BD) and holocarboxylase synthetase deficiency (HCS) are inborn errors of biotin metabolism, which are characterized by seizures,
hypotonia, skin rash, alopecia, hearing loss, delayed development. Both lead to deficiency of all biotin dependent carboxylases to multiple carboxylase deficiency
MCD. Oral biotin treatment is needed and improves symptoms or prevents symptoms in asymptomatic patients.
Biotin-thiamine-responsive basal ganglia disease (BTBGD) is characterized by recurrent subacute encephalopathy with seizures, ataxia, dystonia. Defective
cerebral transport of thiamine via the biotin – sensitive transporter is a reason of this disease. The treatment of BTBGD includes both high doses of biotin
and thiamine.

Histamine is the most important and best-known mediator of an allergic reaction. Its function is a result of its interaction with H1 receptor.
As a result of antigen-antibody reaction, histamine is released from mastocytes and stimulates H1 receptors. This reaction largely determines
symptoms of allergic rhinitis, urticaria, food allergy, asthma and atopic dermatitis. Due to the key role of histamine in the development
of allergic reactions, H1 blockers (antihistamines) are the primary medications for the treatment of allergic diseases. The mechanism
of action of antihistamines is based on their competitive and reversible association with H1 receptors, which reduces the action of histamine
as an inflammatory mediator.
One of the better known and tested second generation antihistamines is desloratadine. This is an oral, long-acting, tricyclic, non-invasive,
inverse H1 agonist. It is one of the strongest antihistamines due to its outstanding specificity and affinity for human H1 receptors.
Studies show that desloratadine exhibits anti-inflammatory properties, inhibiting various mediators associated with early and late allergic
reactions.
Desloratadine shows a similar safety profile (measured by the number of side effects) as placebo, and most of the side effects are mild or
moderate. It is safe in all age groups, regardless of gender or ethnicity. Desloratadine is the second-generation antihistamine drug with the
lowest registration age − after the first year of life.
Desloratadine as an effective and safe second generation antihistamine is recommended and registered for the treatment of allergic rhinitis
and urticaria. In both of these diseases is a first-line drug. In addition, in urticaria in the absence of improvement after about 2-4 weeks,
it is recommended to increase the dose up to four times.

Preliminary clinical observations signalize favourable action of cannabinoids (“medical” marihuana) in certain neurological diseases. Particularly the
results of treatment using cannabidiol, CBD, are promising in patients (also children) with severe forms of therapy-resistant epilepsy, which cannot
be controlled with standard therapy. No appropriate evidence based scientific and clinical studies were published, which would confirm efficacy and
safety of cannabinoid application. Also neither the range of effective therapeutic dose nor the optimal proportions of the active compouds in complex
preparations (CBD/THC) are know, Pharmacotherapy in patients in developmental age always carries the risk of adverse effects and of their consequences
(distant effects), which should be first identified and well defined. For this reason, medical scientific associations in USA (AAP, AES) and in
Poland (PTN, PTE) currently do not see justified reasons for a rapid legalization of cannabinoid use as standard therapeutic preparations. Resolution
of the dilemma and actual evaluation of cannabinoid therapeutic value may be based only on multi centre scientific and clinical studies, preferably
in an international investigative programme.

Objectives: The purpose of study was to analyze causes of death in children in the years 2003-2013 conducted a single center in Poznan.

Material and methods: The study group consisted of 154 children patients whose death occurred in the period from January 1, 2003 to December 31,
2013. The retrospective study included: gender and age of the patients, initial cause of death and the month and time of the event.

Results: There were 51.95% of boys and 48.05% of girls in the study group. The average age was 78 months. The largest group of children were schoolaged
patients (45.45%) and infants (29.87%). The most common cause of death in boys and girls was injury (29.22%). Other causes of death were the
following: nervous system disorders (15.58%), infectious and parasitic diseases (12.34%) and congenital malformations (10.39%). Among infants the
most common cause of death were congenital malformations (19.57%) and respiratory disease (13.04%), while infants and infants with pre-school and
infectious diseases – infectious and parasitic diseases and injuries. In turn, among the school-aged patients, the most common cause of death was injury
(45.71%) and neurological disease (24.29%). The highest number of deaths was recorded in March (11.69%) and February and August (9.74%),
with the most common occurring between 12 and 15 hours (16.23%) and 21 and midnight (15.58%).

Conclusions: Infant and school children were the largest group of deaths and the most common cause was traumatic brain injury. In infants, the
most common cause of death was congenital developmental defects and school-age injuries. The highest number of deaths was recorded in March,
February and August.

The chromosome X-linked agammaglobulinemia (XLA, Bruton’s disease) belongs to primary deficiencies in humoral immunity. The disease is caused by a
gene point mutation located on the long arm X chromosome encoding tyrosine kinase enzyme (Btk). This enzyme is responsible for the maturation of limphocyte
B.
The typical clinical symptoms includ recurrent bacterial otitis, pneumonia, bacterial and severe viral meningitis and sepsis, usually associated with pathogens
like Staphylococci, Streptococci, Neisseria meningitidis and Heamophilus infuenzae. The diagnosis is based on mentioned above clinical symptoms and
laboratory data (lack of lymphocytes CD 19+, severe hypogammaglobulinaemia) and confirmed by molecular diagnostics. Therapeutic management includes
life-long intravenous or subcutaneous substitution of immunoglobulins. Patients with XLA might develope serious complications such as bronchiectases,
chronic sinusitis and VAPP after oral vaccine against polio.