This paper presents the protocol of step by step elaboration of the nutritional program for the children presenting with traumatic brain disease during the period of clinical stabilization of its acute manifestations with special reference to the early rehabilitative measures. The main steps include the choice of the diet, the modes of its consumption, and dosing regimens based on the assessment of the nutritional status, energy expenditures, and the act of swallowing. Strong evidence of the beneficial effect of the nutritional support for the children in the persistent vegetative state is provided on condition that the standard mixtures for enteral nutrition are administered through a nasogastric tube or a gastrostomy tube. Indirect calorimetry has demonstrated low energy demand of the patients in the vegetative state, regardless of their age and the type of motor rehabilitation. It is concluded that active early rehabilitation is possible and necessary for the prevention of complications of hypodynamia and the maintenance of muscular mass in the children.

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В опрос адекватного питания пациентов после тяжелой травмы актуален с давних времен, но в настоящее время нет четких рекомендаций по стратегии питания для больных, перенесших позвоночно-спинномозговую травму [1]. В литературе встречаются лишь отдельные статьи по нутритивной поддержке у взрослых; вопросы питания детей, перенесших такую травму, в публикациях не освещены.Необходимый нутритивный статус и снижение риска развития алиментарно-зависимых осложне-

One of the features of traumatic spinal cord injury in children is a high probability of the isloted form of its injury (syndrome SCIWORA – spinal cord injury without radiograph abnormality). Mobility and elasticity of the spine column in childhood explains a relatively rare incidence of its injury in young children; however, we meet a high incidence of the isolated spinal trauma in this group of patients. According to various authors, SCIWORA is more common in children under the age of 5 ~ 64%; from 6 to 12 ~ 35%; over 12 – about 20%. The relevance of the present study is explained by errors in the isolated spinal cord injury diagnostics and by the lack of clear clinical and diagnostic algorithm optimizing SCIWORA verification in this category of patients. Aim. To analyze the level of SCIWORA diagnostics in children with spinal cord injury (SCI) in a specialized surgical hospital as well as to assess reasons of misdiagnostics. Material and methods. 167 children with SCI were included into the study. They were admitted to the Clinical and Research Institute of Emergency pediatric Surgery and trauma (CRIEpSt) in 2014-2020. Depending on the time of admission, patients were divided into two groups: Group I – children who were admitted to the hospital within the first month after injury; Group II – children who were admitted later. Children aged 12.2 ± 5.0 y.o., in average. All patients were examined for their neurological status by ASIA scale; they also had radial diagnostics: computed tomography (CT) and magnetic resonance imaging (MRI). Results. The isolated spinal cord injury (SCIWORA) was revealed in 6.0% of children with SCI who were admitted to CRIEpSt in 2014 – 2020. The greater number of SCIWORA (60%) occurred as a result of road accidents and was recorded in the thoracic region (50%). Isolated the soinal cord injury occured more often in the age groups under 5 y. o. and 5 – 12 y.o. (by 40% in each age group). The severity of spinal cord injury in SCIWORA depends on the very mechanism of such damage: A – 80%, B – 20% by ASIA scale. In SCIWORA, computed tomography does not allow to fully assess SCI severity. MRI is prescribed for more precise diagnostics: to clearly visualize damages to the ligamentous apparatus and intervertebral discs; in addition to clinical findings to confirm contusion, hematomyelia, partial or complete rupture of the spinal cord; to make rehabilitation prognosis using tractography. Conclusion. The reasons for errors in the isolated spinal cord injury diagnosis in children is a result of underestimated severity of child’s condition due to his/her young age or due to the combination of SCI with severe traumatic brain injury (TBI) with a reduced state of consciousness. In case of even a slight suspicion of isolated spinal cord injury, the diagnostic algorithm in little children or in patients with reduced consciousness state should include a “head-to-toe” CT scanning and MRI examination in addition to a full-fledged neurological examination.