Presented recommendations are an extended and actualized version of pediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendation and Recommendations of Children’s Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Pediatrics have been also discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born up to 33 weeks of gestational age and published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account. 

Artykuł jest tłumaczeniem pracy: Litwin M, Niemirska A, Obrycki Ł i wsp. Guidelines of the Pediatric Section of the Polish Society of Hypertension on diagnosis and treatment of arterial hypertension in children and adolescents. Arterial Hypertens 2018;22(2):45-73. DOI: 10.5603/AH.2018.0007. Należy cytować wersję pierwotną (przedruk za zgodą wydawnictwa ViaMedica).

Postbiotics is used to refer to soluble substances secreted by bacteria, by-products of their metabolism or substances released after bacterial 
 lysis, which may directly or indirectly positively affect human organism. Their mechanism of action or health effects are not entirely known, yet there is an increasing number of publications suggesting their beneficial role, such as antimicrobial, ant-inflammatory or immunomodulatory. The article summarizes the publication of Aguilar-Toalá et al. from 2018, which reviewed available data on postbiotics. 

Opracowanie na podstawie: Aguilar-Toalá JE, Garcia-Varela R, Garcia HS i wsp. Postbiotics: An evolving term within the functional foods field. Trends Food Sci Technol 2018;75:105-114.

In pathogenesis of community – acquired pneumonia in children, some atypical bacterias should be taken into consideration – Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydia trachomatis, Chlamydophila psittaci, Legionella pneumophila. In this article characteristic biological features of above mentioned bacterias, atypical clinical course of the disease, diagnostic possibilities and therapeutic indications in children are discussed. Standardy 

Differential diagnosis between the common cold or allergic rhinitis is a challenge for both pediatricians and allergists. Both diseases have similar symptoms and their seasonal peak of presence might be in similar time. The paper presents current diagnostic guidelines suggests the therapeutic approach in both diseases. 

Café-au-lait spots (CALs) are diagnostic only in a few diseases with a predominance of neurofibromatosis type 1. On the other hand, differential diagnosis in a child with multiple CALs includes almost 80 clinical entities, in which this sign is either important or marginal indicator of a particular syndrome. Moreover, in a healthy Caucasian population 1 or 2 CALs are observed with 40-60% frequency. Another complication of a diagnostic process are concomitant sign and symptoms, which warrant final diagnosis, disclose more often with age of a patient, or sometimes observed not until the next generation descents. Complicated process of clinical diagnosis, especially in young children with multiple CALs, as well as information concerning the centers assure the complex diagnosis and(or) disease management, including coordinated care, directed to pediatricians and GPs is a purpose of this article. 

The increase in allergy observed for several decades may be a consequence of early intestinal dysbiosis emerging in the first months after birth. Intestinal microbiome is formed in the first 1000 days of a child’s life and during this period is particularly sensitive to various factors: composition of mother’s microbiota, length of pregnancy, type of delivery, child’s diet, number of siblings, contact with peers, animals, antibiotic therapy. Breastfeeding and natural labor favorably affect the formation of infant intestinal microbiome and protect against the development of allergies. The intestinal microbiota of these infants is characterized by an early dominance of bifidobacteria, which can have a significant impact on the development of immune tolerance. Bifidobacterium breve is a species of the most commonly isolated from the intestines of healthy breast-fed infants, also present in human milk. The paper discusses the most important environmental factors affecting the formation of the microbiome and presents the importance of bifidobacteria, with particular emphasis on Bifidobacterium breve, in the microbiome modulation towards anti-allergic processes and the possibility of their use in allergy prevention. 

Human milk contains nutrients and bioactive factors essential for infant development and immunological protection. Unique composition of immunoglobulins, growth factors, cytokines, antimicrobial and antiviral proteins provides a perspective of using breast milk as a natural medical product. The usage of human milk in the treatment of ocular surface diseases, especially for conjunctivitis has been widely known in folk medicine for years and is still eagerly recommended among breastfeeding mothers. This paper presents information about the most common types of neonatal conjunctivitis. It also summarizes results of scientific researches concerning antimicrobial properties of breast milk and collects reported complications resulting from the application of human milk in the infected or injured eye. 

The link between acute pancreatitis (AP) and development of diabetes is still debatable. Although hyperglycemia and glucosuria are not uncommon during acute pancreatitis, permanent diabetes is extremely rare in children. Some observations suggested that patient who had an episode of AP develop glucose intolerance and risk of developing diabetes is 15% within 1 year and increased to 40% over 5 years. Studies have not shown that neither the severity of pancreatitis nor treatment modality is detrimental in developing diabetes. It was proposed that AP might not be causative but only triggering factor with other predisposing factors developing diabetes including autoimmunity, genetic susceptibility, obesity or hyperlipidemia. It was shown that endocrine pancreatic dysfunction in AP is associated with the decreased plasma insulin levels fasting and after glucose stimulation. Acute pancreatitis can occur in a bidirectional association with diabetic ketoacidosis as abdominal pain is a clinical feature common to both conditions. Obesity and android fat distribution are closely related with admission hyperglycemia and developing organ failure in patients with severe acute pancreatitis. Diabetes occurred when exocrine pancreas activity was reduced as much as by 90% and lifelong risk of developing diabetes mellitus in the setting of chronic pancreatitis is estimated at 25-75%. Carbohydrates homeostasis early in the disease course is regulated by multiple factors including: impaired early insulin response to oral and intravenous secretagogues, insulin resistance, glucagon and incretin responses. 

High flow nasal cannula therapy (HFNC) has become increasingly popular modality of respiratory support for neonates. The most important information regarding HFNC was summarized in the article. The mechanism of action and most common applications were discussed. 

Ingrown toenail is one of the most common disease of the nail in children and adolescents. It may significantly affect routine physical activity, leading to discomfort, pain and limitation of movement.

Aim: A retrospective analysis of clinical aspects of ingrown toenail in children and adolescents and an attempt to evaluate the efficacy of standard surgical methods of treatment.

Material and methods: Medical files of consecutive 120 children aged up to 18 years treated on for ingrown toenail in the Department of Pediatric Surgery and Urology in Wroclaw between 2010-2014 were analysed with a special emphasis on clinical aspects and surgical treatment. Moreover, a questionnaire with questions regarding clinical course of the disease, its impact on daily activity, nail care and the final assesement of applied treatment was sent to all patients and their caregivers.

Results: The mean age of reviewed patients was 13 years and 3 months. There were 68,3% of boys. Left toenail was affected in 53,7% of patients. In 10,9% of patients both nail were found ingrown. Lateral nail fold was involved in 61,5% of children. Both folds were found affected in 38,7% of patients. All children were subjected to Emmert procedure. Mean score of esthetic result of the procedure was 3,87 ( score 1-5). Follow-up review revealed a recurrence of the disease in 54% of patients.

Conclusions: Ingrown toenail remains a serious medical problem affecting routine physical activity of young patients, but is often neglected by clinicians. Classical surgical procedure may alleviate the acute problems, but very high rate of recurrence prompts the parents for seeking the alternative methods of treatments. 

Infantile hemangiomas (IHs) are benign vascular lesions classified in 1996 by ISSVA as vascular tumors. They are characterized by a very rich cellular weaving with high metabolic activity. ). Hemangiomas of early childhood occur in 10% - 12% infants. The effect of this non-selective beta-blocker on early childhood hemangiomas was first described by doctors Christine Léauté-Labrèze of Bordeaux Children’s Hospital in 2008. Effectiveness of propranolol in treatment of IH was confirmed in many papers.

Objectives: The general aim of the study was evaluation of the results of propranolol treatment of infantile haemangiomas.

Material and methods: We analyzed the results of treatment with propranolol of patients hospitalized due to the occurrence of vascular tumors of childhood hemangiomas at the Department of Surgery and Traumatology who underwent several months of observation at the Polyclinic of University Children’s Hospital in Lublin in 2011-2015. The study group consisted of 84 patients, 17 (20.24%) boys and 67 (79.76%) girls. The control group consisted of 28 patients with infantile hemangiomas observed in the Clinic of Pediatric Surgery, who did not meet the criterion of eligibility for treatment with propranolol. The dose was adjusted to the weight of the child (2,5-3 mg / kg m.c. in 3 doses). Patients photographic documentation were taken during visits to ambulatory, and analysis of the appearance of a hemangioma in terms of color and size were made. Lesions have been reported (based on a visual analogue scale  - VAS) ranging from +1 to -10. On a scale of 0 is represented by a picture of AVM before treatment. Regression of these tumors in color and size is from 0 to -10 and the progression of 0 to + 1. The lesion was assessed after one and sixt months of treatment. Surveys used Microsoft Office Excel 2007 and Statistica 7.0

Results: In the analyzed group of 84 patients the size of the hemangioma reduction was observed in 80 (95.23%) cases. In 4 (4.76%) there was no change in size of the hemangioma on both the 1 and 6 months of treatment. During treatment, a gradual regression of the size was observed as for VAS assessment. Treatment with propranolol had a significant impact on changing the size of hemangiomas between 1 and 6 months of treatment. Fading hemangioma occurred in 78 (92.86%) patients after 1 month of treatment. In 6 (7.14%) patients did not have the impact at the time of propranolol treatment as for the color change. In 70 (83.33%) patients after 1 month of treatment there occurred fading of hemangioma containing the VAS score between -1 and -5. During 6 months of therapy, further regressions progressed. In 10 (11.90%) patients had complete regression. Comparing the results of treatment depending on location, both the size and color of hemangioma, there were no statistically significant differences (p = 0.23). In the study 84 patients side effects requiring discontinuation were observed in 1 (1.19%) patient.

Conclusions:

1. The use of propranolol causes rapid regression of hemangiomas in children.

2. The use of propranolol is burdened with an insignificant number of complications, and only in individual cases it should be withdrawn from treatment.

3. Inclusion of propranolol significantly affects the regression of lesions as compared to untreated patients in the evaluation of VAS. 

Leukaemia is the most common cancer in children and accounts for approximately 26% of all childhood malignancies. Acute lymphoblastic leukemia (ALL) is the most common diagnosed type of leukaemia and accounts for 80% of pediatric acute leukaemia. Acute myeloid leukaemia (AML) accounts for approximately 15-20% of childhood leukaemias and is much less common in the pediatric population. Early signs and symptoms of leukaemia are non-specific and often present in other childhood diseases, so they could be marginalized. Because of that, the diagnosis of acute leukaemia could be delayed, which can lead to worse treatment outcomes. Those non-specific symptoms include: fever of unknown origin, weakness, loss of appetite and bones as well as joints pain. Survival rates in AML are worse than in ALL and overall survival rate is approximately 50%. Resistance to chemotherapy leads to worse treatment results. In the article, we present a case of 8-year-old boy who was diagnosed with drug-resistance AML. The leukaemia occurred with symptoms similar to infectious disease. 

Teething is one of the indicators of child’s development and health condition. Teething disturbances may indicate the existence of a systemic disease or local pathology in the oral cavity. Signs and symptoms associated with primary tooth eruption concern parents and encourage them to use different, not always safe, methods and therapeutic agents. The paper presents basic information on factors interfering with tooth eruption, symptoms associated with teething and recommended methods of treatment.