The enteral nutrition is one of the basic problems of care of the newborn. The article presents management of enteral nutrition in newborns based on the
recommendations of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).

This paper presents summary of results of assesment of efficasy of induction therapy with biosimilar infliximab in polish paediatric patients with Crohn
disease. Results of this study was published this year in Journal of Pediatric Gastroenterology and Nutrition.

The author discussed reports on liver disorders in children discussed at the 50th Annual Meeting of European Society for Paediatric Gastroenterology,
Hepatology and Nutrition, 10-13 May 2017 in Prague.

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Cow’s milk proteins are the most common cause of food allergy in children. Cow’s milk allergy (CMA) starts usually in the first year of life and last several
years. The clinical manifestations of CMA are very variable. CMA may lead to failure to thrive and may be life-threatening. Early and proper diagnosis is extremely
important to initiate the appropriate diet that allows normal growth and development. The natural history of CMA, symptoms and diagnostic rules
including value and safety of oral food challenge and interpretation of diagnostic tests are described.

The management of cow’s milk allergy comprises the avoidance of cow’s milk and cow’s milk products and dietary substitution with extensively hydrolysed
formula or amino-acid formula. The choice of the formula should take into account the age of the child, the severity of clinical symptoms and appropriate
nutritional composition of the formula providing energy, protein, calcium, iron and vitamins. Nutritionally incomplete formulas can lead to faltering growth
and nutritional deficiencies. Amino-acid formulas are suitable first line formulas for severe cow’s milk allergy and are available for use in children over 1 year
old when allergic child require additional energy, calcium and iron.

Varicella (chickenpox) belongs to the category of classic childhood rash diseases (affecting mainly children who are 5 to 9 years old). It is a highly contagious
disease, caused by the varicella zoster virus (VZV). A characteristic symptom of the disease is polymorphic rash1.
Management of varicella is dependent on patient’s age, comorbidities, the extent and location of the skin lesions. The standard approach is geared to prevention
and the prevention of complications and consists of a symptomatic treatment and proper care.
Symptomatic treatment is usually sufficient for patients under 12 years of age, immunocompetent and with a mild course of varicella1. With a growing
age of the patient, the disease becomes more severe, the risk of complications increases, it is then necessary to include causal treatment. The inclusion of
such treatment is also recommended in the cases of primary and secondary immune disorders of the patient2.
The most common complications of varicella can be divided into 3 groups: secondary bacterial superinfection and dehydratation, pneumonia and neurological
complications2. Shingles (oka herpes zoster) occurs with the reactivation of the virus in patients who have undergone primary infection.
The primary method of prevention is immunization.

The present paper, based on the literature review of recent years, provides recommendations for the standards of CDI management in children. In view
of the increasing number of CDI incidence proper classification of patients for diagnostic tests, which are still inappropriate, seems of great significance.
Moreover, indication of various therapeutic possibilities is also crucial. In the pediatric population, approximately 20% of infections are associated with increased
virulence (NAP1/BI/027), which in turn cause higher incidence of serious complications.

Parental feeding practices and nutritional behavior of children, especially in infancy, when children are completely dependent on their parents, are
closely related and affect on nutrition status in later years. Shaping eating habits already begins during pregnancy. The amniotic fluid which surrounds
the fetus is rich in sensory impressions, and the chemicals contained in it stimulate the fetal receptors so that the unborn child can experience
the flavors of the food from mother’s diet. Another important developmental stage is the way parents feed their infants in the first 6 months of
life, which can affect the intake of food in many different ways. Caregivers also shape their child’s eating habits by appropriately expanding their
diet and selecting complementary products, feeding practices, and their own eating behavior as role models.

Rotavirus diarrhea is a leading global cause of mortality and morbidity in children under 5 years of age. By March 2017, rotavirus vaccination had been implemented
in national vaccination programs in 92 countries worldwide. After implementation of rotavirus vaccination in childhood immunization programs,
there has been a significant reduction in rotavirus-associated hospitalizations in industrialized countries and a significant reduction in rotavirus-
associated deaths in developing countries. Additionally, a reduction in nosocomial infections and seizures in children has been observed. This review
summarizes the history of rotavirus vaccines and perspectives for the future as well as current knowledge regarding rotavirus vaccine effectiveness and adverse
events. Medical subject headings and free-language terms were used to search MEDLINE (up to July 2017) for relevant studies.

Calcium is an important macroelement for human body and for oral cavity. Appropriate calcium intake during pregnancy and childhood is a condition
of proper development and mineralization of teeth and maxillofacial bones. It influences their function during whole life.
This paper discusses the role of calcium in odontogenesis and its impact on the function of oral cavity tissues. It presents the effects of hypocalcemia
and hypercalcemia in dentition and paradontium. It highlights the relation between low calcium level in plasma in developmental period and
enamel and teeth defects, delayed teething and caries. It also discusses the role of calcium present in saliva in caries prophylaxis and dental calculus
formation.

Drug hypersensitivity is a complex diagnostic problem and has therapeutic implications. Despite the relatively common symptoms reported by parents after
antibiotics treatment, including most commonly beta-lactam, the incidence of actual hypersensitivity to drugs after a full allergy workup is lower. One
reason is that viral infections can cause rashes while taking antibiotics at the same time. Diagnosis of antibiotics hypersensitivity is time-consuming and
performed usually on allergology departments. It is important to select a safe antibiotic for the patient. Commercial diagnostic tests are difficult to access,
so parenteral drugs are used instead. This requires repetition at appropriate intervals with increasing concentrations of the drug. Testing of specific immunoglobulins
is safe, but available only for selected antibiotics, and has a relatively low sensitivity and specificity. Other in vitro tests are expensive and require
collaboration with an experienced laboratory. The oral challenge is a gold standard for diagnosing, but requires usually hospitalisation and adequate
patient precaution. The possibility of severe drug-related adverse events, such as anaphylactic shock, Stevens-Johnson syndrome (SJS) and toxic epidermal
necrolysis syndrome (Lyell’s syndrome), requires extreme caution. Desensitisation protocols have been developed that can be used in selected patients
when the drug is needed for further treatment.

Respiratory tract infections especially in children, are common reason for visiting primary care physicians. Although viruses are the most common cause of
infections, bacteria are important agents in acute pharyngitis, otitis media, sinusitis and pneumonia. The first choice treatment are β-lactam antibiotics. The
article focuses on use of amoxicillin with clavulanic acid and cefuroxime according to updated Recommendation for treatment in community-acquired respiratory
tract infections developed by National Antibiotic Protection Program 2016.

Pain assessment and management remain a great challenge in neonatal care. Morphine is the most commonly used opioid in neonatology. The aim of this
paper is to review the current knowledge about morphine’s efficacy and safety in the treatment of pain in neonates.

The composition and functions of maternal milk are exceptional and are the golden standard for the development of new formulas providing the most
adequate substitution for infants who, for various reasons, cannot be breastfed.
Both the complexity and the physiological variability of the composition of mother’s milk does not allow for its precise reproduction, also because of the
presence of numerous biologically active ingredients. Fats not only remain the main source of energy in the child’s diet, but also play additional roles in
the body.
The authors focus on several lipid fractions: long-chain polyunsaturated fatty acids, medium chain fatty acids, β-palmitate and complex lipids present in the
milk fat globule membranes naturally occurring in human milk. Based on current reports, we know about the potentialy positive biological effects of these
new ingredients added to infant formula. However, further studies are needed to confirm these observations also in the long run.

Administration of exogenous surfactant to preterm infants who develop respiratory distress is the treatment of choice. Surfactant replacement therapy
has proven effective in reducing mortality and pulmonary morbidity, and has been a mainstay of therapy in preterm infants intubated soon after birth.
Randomized, controlled trials confirmed that initiation of continuous positive airway pressure (CPAP) from birth has been at least as effective as routine intubation
for stabilization and prophylactic surfactant treatment. In order to avoid potentially traumatic intubation, new methods of surfactant administration
are being developed. It was confirmed that less invasive surfactant administration at spontaneously breathing preterm infants reduced mortality and
incidence of bronchopulmonary dysplasia (BPD), decreased the need and time of mechanical ventilation and lowered the risk of intraventricular hemorrhage
(IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC). Recent publications concerning LISA/MIST and new European Consensus
Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update, specially surfactant therapy were presented.

The license to produce original (innovative) drugs usually expires after 20 years and at that moment the generic formulations appear on the market. The
registration process of generic drugs is different than that of the original products and is mainly related to the result of bioavailability test, performed in the
group of adult healthy volunteers. The evidence of similar blood concentration (over time) of generic drug versus original drug is the basic rule. The generic
drugs are delivered for the same indications as the original ones, however they do not undergo clinical investigations in adults (nor children) with certain
diseases and comorbidities. Therefore the real safety of generic formulations is not always clear, especially in cases of sequential changes of the formulas
in the same patient, in cases of multidrug protocols with pharmacologic interactions between the drugs and with the use of drugs in patients of highly
variable age (from infants to adolescents and to aged persons). Organ transplantation demands specific pharmacotherapy with very strict primary endpoints
of efficacy and safety: – acute rejection; graft and patient survival and specific drug-related toxicity. Low price is the major advantage of generic drugs
however they may induce adverse clinical consequences, therefore introducing generic formulations in pediatric transplantation must be very careful.

Generic drugs are discussed as a specific category of medicinal products. Circumstances surrounding the rise of generic legislation in the USA are reminded,
followed by discussion of drug quality, examined from the point of view of chemical purity, as well as pharmaceutical and biological equivalence. Finally
controversies around therapeutic equivalence of brand name drugs and generics are addressed, in view of clinical expert opinions regarding various
categories of pharmaceutical products.

The article considers the question of personal development as an outcome of traumatic experiences. Based on analysis of literature and research the
authors present process of posttraumatic growth, its conditions and correlates.

Aim: Exclusively breastfed infants may be at risk of iron deficiency (ID) and iron deficiency anemia (IDA), which may potentially impair development. The
aim of this review was to summarize current knowledge on health effects of iron supplementation in breastfed infants.
Methods: MEDLINE, EMBASE and Cochrane Library medical databases were searched for relevant articles up to July 2017. Randomized trials (RCTs) comparing prophylactic iron supplementation to placebo or no intervention in healthy breastfed infants were eligible for inclusion.
Results: Six articles reporting the results of 5 RCTs (N = 599) were included. Prophylactic dose of iron (≈1 mg/kg body mass/day) halved the risk for ID/IDA
during the 1st year of life [pooled results from 5 RCTs (N = 599), relative risk 0.45; 95% CI: 0.3-0.68]. Iron supplementation moderately increased hemoglobin
and ferritin concentrations, and mean corpuscular volume within the 1st year of life. One RCT (N = 75) reported better motor but not mental performance
in the supplemented group at 13 months of age: psychomotor developmental index, PDI (Bayley scale), was 100 +/- 12 in iron group, and 93 +/- 8.8 in the
placebo group (p < 0.05). Infections rates and weight gain did not differ between the groups. In one RCT (N = 263) linear growth and head circumference
were negatively affected by supplementation.
Conclusions: Iron supplementation (≈1 mg/kg body weight/day) halved the risk of ID/IDA in healthy breastfed infants. The potentially beneficial effect on
development and the risk of slower growth need to be addressed in further trials.

Objectives: Assessment of current metabolic state and energy expenditure seems to be important in the dietary treatment of children with severe malnutrition.
The aim of the study was to assess the rest energy expenditure (REE) in girls with anorexia nervosa (AN) compared to healthy peers.
Material and methods: In total 24 girls aged 14-18 years (mean 15,6 years) were studied. Among them were 14 girls with AN in the acute phase of the disease
(BMI 14,96 kg/m2, Z-score mean -2,574). As the control group, we studied 10 healthy girls with BMI within normal values for age and gender. We performed
breath test assessing energy expenditure using 13C-sodium bicarbonate and IRIS device (Wagner GmbH).
Results: REE was respectively 1056,9 ± 169,2 kcal in children with AN and1465,4 ± 228,1 kcal in the control group (p < 0.001). Both Harris-Benedict as well
as Mifflin equation overestimated REE in children with AN. There was no correlation of REE measured by 13C-sodium bicarbonate breath test with BMI and
hormones serum level. REE correlated significantly with the weight of children with AN, but not in control group.
Conclusion: REE assessment by 13C-sodium bicarbonate breath test may be useful in the clinical practice in the treatment of AN.

Hepatitis A is a common disease all over the world. Higher occurence of the virus is registered in Asia, Africa and South and Central America. Poland is classified
as the area of low HAV endemicity. The majority of population is not immune against hepatitis A virus and this increases a risk of local infections and
compensatory epidemics. There was a family presented, where in the parents and the youngest child hepatitis A with a variant of cholestatic liver disease
was recognized. The active immunoprophylaxis applied to other two children protected them from hepatitis A. Propagation of vaccinations against hepatitis
A virus seems to be justified in postexposure prophylaxis.

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