Human cytomegalovirus (CMV) is the most frequent cause of congenital infections in neonates and a most common cause of non-genetic sensorineural
hearing loss (SNHL) in children; it also often leads to neurodevelopmental disabilities. Among children with congenital CMV infection (cCMV) only 10-15%
present symptoms at birth, other asymptomatic infants stay undiagnosed. Because of serious delayed sequelae of cCMV and lack of screening programs
it is important to disseminate knowledge about preventive strategies and advances in diagnostics techniques and treatment in neonates. In the paper
authors present current recommendations of diagnostics and treatment of CMV in neonates.

The article summarizes the position of the ESPGHAN (European Society for Paediatric Gastroenterology Hepatology and Nutrition) Committee on Nutrition
on the consumption of sugars by infants, children and adolescents. The publication presents the classification of sugars, data on sugar consumption among
children and adolescents in Europe, current recommendations on sugar intake and information on the impact of sugar consumption on health.

The paper presents the results of the Israeli study, which analyzed a group of more than 1.5 million adolescents in middle-aged 17.7 (16-25 years),
potential recruits. In all participants of the study, medical screening was performed, followed by specialist examinations to determine the diagnosis
of a specific kidney disease. The observation leaves patients with impaired renal function diagnosed in the past, regardless of its cause. The aim
of the study was to assess the risk of developing end-stage renal disease (ESRD) in patients with renal disease diagnosed in childhood, with their
normal function at 18 year of age. Evaluation of participants in the study for the occurrence of ESRD was made using the Israeli database of patients
undergoing renal replacement therapy (RRT). Over 30 years of follow-up, ESRD was developed by 2490 study participants (26 of 3198 (0.2%)
who were diagnosed with congenital anomalies of the kidney and urinary tract (CAKUT) in the past, 73 of 7231 (1.0%) participants with a history of
pyelonephritis and 42 of 8611 (0.5%) of patients with glomerulopathy diagnosed in childhood .The detailed analysis also determined the impact
on the risk of developing ESRD coexistence with haematuria, the time of inclusion in the study or the length of the observation period of patients.

The article presents available data on the relation between observed environmental changes, including climate change and increasing air pollution,
and allergic diseases. The impact of changes in the intestinal microbiota on the risk of those diseases is also described.

The Ministry of Health has ensured unlimited access to PCV13 vaccine for at-risk children under the 2018 mandatory immunisation programme.
The availability of the vaccine will be guaranteed and the fact that a child belongs to a risk group will no longer have to be proven to Sanitary and
Epidemiological Stations. At present, the rate of non-vaccinated children is too high. In the referenced publications, many authors emphasize
that a child’s disease is not a contraindication for vaccination. On the contrary, PCV13 should be administered as soon as possible to such a child
in order to protect them from disability or death due to pneumococcal infection. Children who receive immunosuppression for many months
may be safely and effectively vaccinated even if their immune response to vaccination is unsatisfactory, as it should be remembered that immunological
memory post PCV13 vaccination may result in a milder course of pneumococcal infection as compared to a child who has not been
vaccinated. The situation is due to concerns about potential lack of efficacy or safety of vaccination. It is important to offer children an opportunity
for prevention against IPD by using a vaccine with the broadest coverage of Streptococccus pneumoniae serotypes which are responsible for
IPD. PCV13, due to its increased immunogenicity, induces a reduction in carriage in a vaccinated child.
Currently, according to the vaccination schedule, access to PCV13 is guaranteed only to preterm infants born before pregnancy week 27. Recent genetic
studies demonstrated that all preterm infants born before pregnancy week 37 are at a risk of developing infections as defective innate immunity results
not only in the failure to inhibit inflammation, but also in increased susceptibility to bacterial infections. In such a situation the whole population of children
born before pregnancy week 37 should be vaccinated with PCV13.

Diagnosis and treatment of phenylketonuria in Poland is based on the newborn screening system and on early (up to the 10th day of life) initiation of
the therapeutic low-phenylalanine diet. Continuous dietary treatment including natural low-protein food and amino acid supplements allows normal
development of an affected child. Blood phenylalanine concentrations should not exceed 6 mg/dl (0.36 mmol/l) in children up to 12 years of age and in
pregnant women, and 10 mg/dl (0.6 mmol/l) in patients aged 12 years and above. Blood phenylalanine concentration should be measured at least once
a week in the first year of life, fortnightly in patients aged 1-12 years and once a month in older patients. Low treatment adherence is a serious problem,
especially in teenagers and adults. It can result in cognitive decline and development of neurological and psychiatric sequelae. Only rigorous hyperphenylalaninemia control in pregnant patients allows preventing development of irreversible brain damage in their children.

The article deals with psychological factors supporting well-functioning while experiencing chronic stress and life difficulties, such as long-term illness.
It presents concept of resilience and positive adaptation associated with it in two aspects: 1) as a personal feature – its ability to flexibly mobilize and restore
balance in negative circumstances, and 2) as a development process, enabling using individual’s potential and psycho-social resources to confront
life’s hardships.

Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases, with only colonic involvement (UC) or involvement of other parts of the
gastrointestinal tract. Most frequently cited statistical data show that prevalence of extraintestinal manifestations is 21-41%. In this review we discussed
dermatological, ophthalmological, mucosal, musculoskeletal, hepatobiliary, renal, cardiac and haematological manifestations. Some manifestations are
consequences of intestinal malabsorption and malnutrition, while other are due to hypersensibility to medications (sulphasalasine, tiopurins, anty-TNF
therapy).
We underlined, that these manifestations are less frequent in children than in adults, but due to decreasing age at the onset of the disease its heavier course
and we may expect that the prevalence of extraintestinal manifestations will increase. As some symptoms may be related to medication, this may require
earlier modification of therapy.

In this paper the information about the most frequent in clinic, drug-induced diabetes were discussed, with guidelines based on studies and own, longterm
clinical practice in the health institute, also with transplantation clinics. Unfortunately there is no epidemiologic data about frequency of the different
acquired diabetes in children. In the assumption the most frequent is glucocorticoids-induced diabetes, however more aggravated with additive therapy
with tacrolimus.

Rotaviral infections are the most common causes of acute gastroenteritis, and the most severe course of the disease usually affects infants under 6 months
of age. High level of infectiousness and resistance to disinfectants are factors facilitating transmission of rotaviral infections, hence the only effective form of
prevention are universal vaccinations. WHO, ESPID and ESPGHAN recommend incorporation of rotavirus vaccination into national immunization programs.
The experience of other countries and comparison of the costs of vaccination with avoidable costs of hospitalization due to rotaviral diarrhoea clearly justify
the need for introducing refunded universal rotaviral vaccination in Poland.

Juvenile idiopathic arthritis (JIA) is the most common, chronic rheumatic disease in children which is an important cause of short- and long-term disability.
This broad term comprises a heterogeneous group of arthritides of unknown etiology beginning before the age of 16 years and lasting more than 6 weeks.
According to the International League of Associations for Rheumatology (ILAR) JIA encompasses 7 subtypes defined by clinical signs present during the
first 6 months of illness. These include systemic form, oligoarthritis, polyarthritis rheumatoid factor (RF) negative and polyarthritis RF-positive, juvenile psoriatic
arthritis, enthesitis related arthritis and (ERA) and undifferentiated arthritis. In the past two decades our physiopathological knowledge were essentially
improved, new diagnostics tools were introduced and new therapeutic options, including biologic drugs become available, what in turn have led to
revolution in the management of JIA patients and to improve their outcome. It is very important to early diagnose the disease and to introduce aggressive
therapy in order to avoid short- and long-term consequences of the disease.

There are longtime observations and studies on possible modifications of time and amount of gluten introduced into infants diet in order to reduce the
risk of development of coeliac disease. According to updated recommendations of The European Society for Paediatric Gastroenterology, Hepatology and
Nutrition (ESPGHAN) and Polish recommendations on infants feeding, gluten may be introduced into infant’s diet anytime between 4 and 12 completed
months of age. Consumption of large quantities of gluten should be avoided during the first weeks after first introduction.

Taste is the main determinant of food choices. Unfortunately, diet low in salt, simple sugars and fat, recommended by experts, is less tasty then “junk food”.
We present a biologic background of taste preference, its genetic determinants, sensory mechanism and neurological regulation of behaviours. Taste preference
is discussed regarding diet-dependent diseases, such as certain types of cancers, obesity and metabolic syndrome features, among others: hypertension,
disturbances of carbohydrate metabolism and non-alcoholic fatty liver diseases. The causes of development of these diseases are largely the increase
in the consumption of sweetened beverages, sweets, snacks and fast food and inadequate consumption of vegetables and fruits. Understanding the
innate determinants of the paradox of nutritional preferences is a key aspect in developing strategies for promoting healthy eating and weight reduction.
The role of agriculture and food industry is important, as there is a need for designing new varieties of vegetables and recipes of food products.

Wirus Epsteina-Barr (ang. Epstein-Barr virus, EBV), należący do wirusów Herpes, jest wszędobylskim drobnoustrojem wywołującym zakażenia we wszystkich
grupach wiekowych, najczęściej u małych dzieci, nastolatków i młodych dorosłych. Ostre objawowe zakażenie przebiega pod postacią mononukleozy zakaźnej
(MZ) cechującej się triadą objawów: gorączką, zapaleniem gardła i silnym odczynem węzłowym. EBV ma również udowodniony związek z chorobami
rozrostowymi (m.in. chłoniakami B-komórkowymi, chorobą Hodgkina, zespołami limfoproliferacyjnymi, zespołem aktywacji makrofaga, nowotworami
nosogardła), szczególnie u chorych w immunosupresji po przeszczepieniach narządów i tkanek. W diagnostyce mononukleozy pomocne są podstawowe
badania laboratoryjne: morfologia krwi obwodowej z rozmazem i aktywność aminotransferaz, natomiast potwierdzenie pierwotnego zakażenia EBV wymaga
oznaczenia swoistych przeciwciał.

Iron requirement in children is relatively high. Iron deficiency affects 20% of young children in Europe and leads to anemia in half of the cases. The main
rationale for prophylaxis is to avoid the risk of impaired development following iron deficiency anemia early in life. Current position paper of European
Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommends delayed cord clamping, introduction of iron-rich complementary foods
(including meat products and/or iron-fortified foods) from the age of 6 months, and avoiding unmodified cow’s milk as the main milk drink before the age
of 12 months (intake should be limited to < 500 mL/day in toddlers). Formula-fed infants should receive iron-fortified formulae (4-8 mg/L in Europe; 10-12
mg/L according to American Academy of Pediatrics, AAP). Additional iron supplementation is recommended in risk groups i.e. infants born preterm and/
or with low birth weight. Additionally, AAP recommends extra iron in all breastfed infants beginning at 4 months of age until appropriate iron-containing
complementary foods are introduced in the diet. World Health Organization (WHO) recommends that all children age 6 to 24 months in the regions of the
world where prevalence of anemia exceeds 40%, receive iron supplements daily under 3 consecutive months of a year. There is a discussion in literature on
early iron overexposure in developed countries due to universal baby-foods fortification. The article summarizes current knowledge on epidemiology of
iron deficiency, supplementation in risk groups, and the controversies linked to potential risk of overexposure in early life.

Every year around 13 million newborns are born before the 37th week of pregnancy around the world. This is a growing problem, especially in developing
countries. Preterm delivery is the most common cause of prenatal mortality. Due to the abnormalities in the build structure and functioning of the various
systems of premature infant, it is necessary to plan adequate nutrition properly. It is important to supply the body of preterm infant wish all nutrients and
vitamins, paying particular attention to their amounts. Considering its composition breast milk is the best choice, but in some cases the use of breast milk
fortifier (BMF) or special milk replacers for premature babies is justified.

Fecal microflora transplants (FMT) is the administration of a solution of intestinal contents from the donor’s to the recipient’s digestive tract. The aim of the
treatment is to change the composition of the recipient intestinal bacteria which is expected to have a beneficial effect. However, the first descriptions of
the treatment of variety conditions including diarrhea with intestinal microbiota transplants come from around 4th century from China. This method of
treatment seems to be rediscovered in the last years. The primary and confirmed indication for the fecal microbiota transplantation is the treatment of recurrent
Clostridium difficile infection (CDI). In 2013 the first RCT study on recurrent CDI was published with extremely high efficacy. Also in 2013 for the first
time in Poland, a microbiota transfer was performed successfully in a patient with a recurrent Clostridium difficile infection. It seems that the spectrum of
diseases, the course of which can be modified through the transfer of microbiota is greater and not only affects the digestive tract.

Acute liver failure is a rare but life-threating emergency and in about 50% the etiology remains unknown. Recently, biallelic mutations in the Neuroblastoma
Amplified Sequence NBAS gene have been identified in patients presenting with recurrent acute liver failure.
Authors present up-to-day overview on pathogenesis, clinical, biochemical and molecular phenotype of NBAS deficiency.

Measurement of serum immunoglobulin levels (IgG, IgA and IgM) is one of the basic methods in the diagnosis of primary and secondary immunodeficiencies.
In particular clinical circumstances more detailed analysis of IgG subclasses (IgG1-IgG4) is recommended. Determination of the age-related reference range for
immunoglobulins is essential for correct interpretation of individual results. Thus, it is recommended that normal values should be established locally for their
own population considering the influence of environmental and socioeconomic conditions on the immunological status, particularly in children. The aim of
the study was to define the actual reference ranges for IgG subclasses in healthy children and adults, inhabitants of Mazovia district. In total, IgG subclass levels were determined in 304 healthy inhabitants of Mazovia district, including 249 children, 35 adults and 20 samples of cord blood. The geometric mean of concentrations accompanied by 5 and 95 percentiles were calculated for each IgG subclass in 11 age-related groups. The results of IgG subclass concentrations reflect the physiological changes that occur during maturation of the immune system. In clinical practice examination of IgG subclasses is useful in the diagnosis of primary and secondary immunodeficiencies, where insufficient synthesis of individual antibodies is frequently observed. On the other hand, elevated levels of IgG subclasses may be present in infectious, allergic, autoimmune and hematological diseases as well as in some immunodeficiencies. Early identification of selective lgG-subclass deficiencies may allow clinicians to implement early and suitable medical intervention in patients with recurrent and/or severe infections.

Congenital Toxoplasma gondii infection can cause serious damage that can be diagnosed in utero or at birth, although most infants are asymptomatic at
birth. Prenatal diagnosis of congenital toxoplasmosis considerably improves the prognosis and outcome for infected infants.
Based on five case reports authors present most common mistakes in prenatal diagnosis and maternal-neonatal care failure that led to severe toxoplasmosis
in infancy.

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The aim was to systematically evaluate the effectiveness and safety of Saccharomyces boulardii in children. The MEDLINE and the Cochrane Library (both up
to March 2018) were searched for randomized controlled trials or their meta-analyses relevant to S. boulardii. In line with current recommendations, the administration of S. boulardii may be considered for the management of acute gastroenteritis and preventing antibiotic-associated diarrhea treated with antibiotics
for any reason, including Clostridium difficile infection.