Early-onset neonatal sepsis (EONS) continued to rise over the past 30 years and remains the leading cause of morbidity, and mortality among newborns. Diagnostics need to determine the generalization of the infection process as accurately as possible and lead to the study of the significant biomarkers of the systemic inflammatory response. Their kinetics and reference values are specific to newborns. Routinely used biomarkers are C-reactive protein and procalcitonin. Presepsin (PSP) is a soluble form of the CD14 glycoprotein (sCD14-ST) and has been actively studied in the last decade. It reflects the participation of the first line of protection against pathogens and expresses on granulocytes and macrophages hPSP. Studies focused on the diagnostic accuracy of PSP show variable results. The main object of research in neonatology was term and late preterm babies. Studies devoted to the assessment of the clinical informativeness of various combinations of biomarkers in EONS deserve special attention.

Objective. Assessment of the diagnostic accuracy of levels of PSP at the age of 2 and 12±4 h of life, procalcitonin (PCT) and C-reactive protein (CRP) at the age of 48–72 h of life, and their combination in blood in newborns with EONS.

Material and methods. A single-center prospective study was conducted, which included newborns of gestational age 23/4–41 weeks who were admitted to the NICU after the birth in a serious condition due to the development of respiratory and/or cardiovascular disorders, and who had at least two clinical signs of EONS in the first hours of life. On the 1st day of life, the examination included blood culture, complete blood count (CBC), PSP level, at 48–72 h of life, a repeat of the CBC, levels of CRP and PCT were performed. PSP concentration determined at 2 time points: during the first 2 h after birth (T₂), and at the age of 12±4 h of life (T₁₂). Newborns were divided into 2 groups depending on the presence of EONS: the main group – newborns with EONS (n=145), and the control group – newborns without an infectious disease (n=127). Statistical analysis of the data conducted using SPSS V.26 software.

Results. The analysis showed the highest diagnostic accuracy of PSP level at the age of 12±4 h of life with an AUC of 0.759±0.031 (95% CI 0.697–0.782) (p<0.0001) with a cut-off value for predicting EONS of 383.0 pg/ml with Se 70.1% and Sp 68.7%, NPV 68%, PPV 70,4% compared with the measurement at the age of 2 h of life; the median of PSP at the age of 12±4 h in newborns with EONS was 468.5 (361.5–684.5) pg/ml. Analysis of the dynamics of PSP at points T₂ and T₁₂ showed a significant increase in PSP level over time in the main group by 12 h of life (p=0.0003), in contrast to the control group, where PSP level did not increase (p=0.32). The diagnostic accuracy of PCT at 48–72 h of life demonstrated Se 72.6% and Sp 97.3% with an AUC of 0.857±0.027 (95% CI 0.803–0.911; p<0.00001) with a cut-off value of 2.64 ng /ml, NPV 96%, PPV 72%, in contrast to CRP, in which AUC was 0.685±0.039 with low sensitivity and specificity, and a cut-off value was chosen corresponding to 99% specificity – 4.88 mg/l. The total diagnostic accuracy of PSP at 12±4 h of life, PCT, and CRP at the age of 48–72 h was 87.5%, with Se 86.3% and Sp 89.7%, with a total AUC of 0.928±0.019 (p<0.00001).

Conclusion. The highest diagnostic accuracy of presepsin as a marker of early neonatal sepsis was determined at the age of 12±4 h of life. The cut-off value for PSP level at the age of 12±4 h of life for predicting EONS was 383.0 pg/ml (Se 70.1% and Sp 68.7%). The use of a combination of systemic inflammatory response markers: PSP level at 12±4 h of life, followed by a study of PCT and CRP levels in the interval of 48–72 h, increases the efficiency of diagnosing EONS (Se 86.3% and Sp 89.7%).

Hypovitaminosis D currently represents a public health problem. Worldwide, 54% of pregnant women and 75% of newborns are vitamin D deficient. A severe deficiency was diagnosed in 18 and 29% of cases, respectively.

Objective: to assess the level of vitamin D supply of newborns and their mothers with the physiological course of the perinatal period living in the Khabarovsk Region.

Material and methods. Study design: observational, analytical, cross-sectional. The study included 54 mother–newborn pairs by random sampling: full-term newborns (group 1, n=54) with a conclusion at birth of Z38.0 according to ICD‑10 and mothers of these children (group 2, n=54). During pregnancy, women were divided into age subgroups: early (15–25 years, n=21), middle (26–35 years, n=22) and late (36 years and older, n=11) reproductive period. Quantitative determination of the level of 25-hydroxyvitamin D (25(OH)D) in the serum of umbilical cord (newborns) or venous (mothers) blood was performed by enzyme immunoassay.

Results. When analyzing the concentrations of 25(OH)D in the blood serum of newborns and mothers, it was found that the average value of the calcidiol in the body of newborns was almost 2 times higher than the maternal one (49.8 vs 25.9 ng/ml, respectively, p=0.000). In the group of mothers, the prevalence of vitamin D deficiency and insufficiency was diagnosed in 35.2 and 40.7% of cases, while these rates in newborns were 3.7 and 7.4%, respectively, p<0.001). Low vitamin D status was recorded in 95.2% of young mothers (subgroup 1 of the study), slightly less in the pregnant women of the second subgroup (77.3%), the lowest prevalence of vitamin D deficiency and insufficiency was determined in the group of mothers of the late reproductive period (36.4%) (p=0.003).

Conclusion. Our study revealed a high prevalence of low vitamin D status in the mother group. A moderately positive relationship has been established between the levels of vitamin D in the bodies of newborns and their mothers, which demonstrates the need for adequate vitamin D supply for women during pregnancy.

To present a modern view on the metabolism of folate and folic acid in the human body and their role in the development of the child. The rationale for the use of an active form of folate (metafolin) for providing folate to babies, including its use as part of infant formula for artificial feeding of newborns and infants.

Hepcidin is an antimicrobial peptide and one of the main regulators of iron metabolism. The review presents literature data on the features of formation, metabolism, and pathogenic aspects of the action of hepcidin, as well as the possibility of its practical application in neonatology. Hepcidin synthesis increases with iron overload and the development of a systemic inflammatory reaction, with a decreasing activation of erythropoiesis against the background of hypoxia and anemia. In premature newborns, separate indicators of iron metabolism and systemic inflammatory response correlate with changes in the concentration of hepcidin in the blood and urine. It seems promising to study hepcidin in preterm infants as a biomarker used to assess iron homeostasis and as an inflammatory biomarker.

The gut microbiota in children is considered one of the vital exogenous «organs» that determines a person’s health both as a child and as an adult. In the first few years of life, the gut microbiota undergoes drastic changes. These changes are caused by a number of factors. In children, they include gastrointestinal tract (GIT) diseases and various non-infectious pathologies inside and outside the GIT. The most significant gut microbiota changes are the reduced normal microbiota diversity or reduced number of key microbial species from phylometabolic core, as well as the presense of opportunistic microorganisms and toxicity/invasiveness genes. The laboratory assessment of the gut microbiota in children requires modern, accurate, reproducible, and accessible approaches that are grounded in fundamental scientific achievements and validated especially for children.

One of the methods widely used by specialists for the diagnosis and treatment of severe bronchopulmonary pathology in newborns and infants is bronchoalveolar lavage (BAL). The use of the BAL for diagnostic purposes is currently beyond doubt. Its therapeutic value in the literature is represented by isolated reports. It should also be noted that despite the widespread use of the therapeutic BAL in clinical practice in newborns and infants, the indications and contraindications for this procedure have not only not been regulated yet but have not even been fully defined.

Purpose of the study. Based on the analysis of literature data, to determine the indications and contraindications for therapeutic BAL in newborns, premature infants, and infants, and also to establish its possible classification features.

Results. Based on the analysis of available literature data, indications and contraindications for therapeutic BAL were systematized for neonatal patients and infants; the classification features of therapeutic BAL were identified in order to unify the design of standard operating procedures within a single conceptual field. The manifestations and causes of the development of complications and adverse reactions that occur during therapeutic BAL were determined and systematized. It was found that, despite the large number of available scientific publications and the usage of BAL for therapeutic purposes in clinical practice in newborns and infants, a number of issues, such as indications, contraindications, and methods for conducting procedures. Nevertheless, they remain poorly studied. The fact that the issues related to the conduct of BAL are interdisciplinary in nature and the junction of the competencies of doctors of various specialties: anesthesiology, neonatology, pediatric pulmonology, and specialists in endoscopy.

The procedures for therapeutic BAL in neonatology in relation to the preventive and therapeutic use of surfactant preparations are regulated and presented in the form of standard operating procedures. All other options are currently under development.

Conclusion. To solve existing problems, it is necessary to conduct systematic research in this direction with the involvement of all interested specialists and the definition of roles.

The article devoted to the new rules for the provision of paid medical services, put into effect from September 01, 2023. They imply important changes in the procedure for concluding contracts for the provision of paid medical services and informing of patients. The question of the timing has been clarified. Response to the claims of patients (customers, consumers) regarding the provision of paid medical services reveal more clear. For the first time, a remote method of concluding this type of contract has legislated.

The article is devoted to the peculiarities of communication with the parents of a palliative child who are in the stage of adoption. Special attention is paid to the features of the stage of accepting anger, depending on the type of personality of the parent.