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The aim: to study the etiological structure of acute respiratory infections in children aged 3 to 12 hospitalized in the early stages of the disease in the department of respiratory infections of the children’s hospital, and to reveal the features of their clinical course and the timing of DNA / RNA elimination of respiratory viruses from nasal secretions, depending on the method of therapy. Materials and methods: 100 children with acute respiratory infections aged 3 to 12 years were monitored. The nasal secrets on the DNA / RNA of respiratory viruses were studied by PCR. Depending on the method of therapy, patients were divided into 2 groups: patients of group 1 (comparison) received basic treatment (without the use of antiviral drugs), in patients of the 2nd group (main), along with basal therapy, the drug was used umifenovir in a 5-day course at the ageappropriate dosage. Results: In the etiologic structure of ARVI in children from 3 to 12 years, the leading place was taken by rhinovirus, influenza and metapneumovirus infections (isolated – 18%, 19% and 20% respectively, in the form of a mixed infection – 11%). The main syndromic diagnosis at the height of the disease was rhinopharyngitis. Complications were observed in 42% of cases, as often as possible with flu – 53% of cases. Features of metapneumovirus infection in children of this age group were: predominance of non-severe forms of the disease in the form of acute fever with symptoms of rhinopharyngitis, as well as a small incidence of lower respiratory tract infections. The use of the drug umiphenovir in children with acute respiratory viral infections of various etiologies contributed to significantly faster elimination of viral DNA / RNA from the nasal secretion, which was accompanied by a ecrease in the duration of the main clinical and hematological symptoms of the disease, a decrease in the incidence of complications, and reduced the duration of stay in hospital. Conclusion: application of modern molecular genetic methods of diagnostics made it possible to identify the leading role of influenza, metapneumovirus and rhinovirus infections in the etiology of acute respiratory viral infection in patients aged 3 to 12 years, and to determine a number of clinical features characteristic of this age group. The results of the study testify to the effectiveness of umiphenovir in the treatment of children with acute respiratory viral infections of various etiologies and allow us to recommend this drug as an effective and safe etiotropic agent.

1 ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, Саратов; 2 ГУЗ «Клинический перинатальный центр Саратовской области», Саратов; 3 ГАУЗ «Энгельсский перинатальный центр», Энгельс В работе освещены основные этиопатогенетические факторы риска рождения глубоконедоношенных детей (ГНД), присущие им патологические состояния. Обозначены критерии живорождения, принятые в РФ в 2011 г. согласно ре-комендациям ВОЗ. Приведены статистические данные выживаемости ГНД, а также показатели смертности и других неблагоприятных исходов. Представлены данные литературы, посвященные международному опыту выхаживания таких детей и прогнозирования жизнеспособности новорожденных в зоне предела жизнеспособности (ЗПЖ). Отра-жены основные патологические состояния, характерные для детей, рожденных с очень низкой массой тела (ОНМТ) и экстремально низкой массой тела (ЭНМТ), и способные привести к инвалидизации (поражение нервной, дыхатель-ной систем, анализаторного аппарата и др.). Показаны значимость внутриутробных инфекций (ВУИ) в формировании инфекционно-воспалительных заболеваний (ИВЗ), место и особенности врожденного иммунитета в осуществлении противоинфекционной защиты и способы ее коррекции при тяжелых формах ИВЗ. Обоснована необходимость разра-ботки дифференцированных программ лечебно-профилактических мероприятий, направленных на коррекцию кри-тических состояний и облегчение течения развившихся болезней.Ключевые слова: глубоконедоношенные дети; выхаживание; зона предела жизнеспособности; инвалидизация; внутриутробные инфекции; врожденный иммунитет. The article deals with basic ethiopathogenetic factors of birth of extremely premature infants, their malconditions, disease incidence. The authors give live birth criteria adopted in Russia in 2011 according to WHO recommendations. The article presents basic ethiologic factors of prematurely born and the role of intrauterine infection (IUI) in the pathogenesis of this condition, also survival rate, mortality and adverse outcomes. These literatures devoted to the international experience of nursing of such children and forecasting of viability of newborns in the viability limit zone (VLZ) are provided. Reflects the basic malconditions typical of children with very low (VLBW) and extremely low birth weight (ELBW) and leading to disability (damage to the nervous, respiratory system, analysis unit, etc). It is shown significance of IUI in the formation of infectious and inflammatory diseases (IID), the place and especially the innate immune system in the implementation of antiinfectious protection and ways of its correction in severe forms of EWI. Need of development of the differentiated programs of the treatment-and-prophylactic actions directed to correction of critical conditions and simplification of a course of the developed diseases is proved. NURSING AND REHABILITATION OF VERY PRETERM INFANTS: CURRENT STATE OF THE PROBLEM

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Modern ideas about the most severe variant of hereditary tyrosinemia are reflected -- its first type related to orphan diseases (the population frequency of occurrence is 1: 100,000-120,000 live newborns). The latest data on etiology is highlighted (mutations in the gene for the enzyme fumarylacetoacetase (FAA), leading to a deficiency of fumarylacetohydrolase (FAH), the last enzyme in tyrosine catabоlism; the genetic mutation is localized on human chromosome 15q23-q25 and consists of 14 exons) and the mechanisms of development of the disease ( the bypass abnormal pathway of tyrosine metabolism with the formation of highly toxic and carcinogenic metabolites -- succinyl acetoacetate (SAA) and succinylacetone (SA), others; substrate accumulation mainly in FAH-deficient hepatocytes and proximal renal tubule cells; violation of the processes of gluconeogenesis, ammonia detoxification and hepatic protein synthesis), which determine different clinical variants and symptom polymorphism. A modern classification of type I tyrosinemia and a detailed protocol for diagnostic examination of the patient, including instrumental methods, laboratory monitoring of highly toxic derivatives of the tyrosine metabolic pathway and molecular genetic studies, are presented. Denotes a range of diseases that should be carried out a differential diagnosis of tyrosinemia. The modern concept of treatment of this orphan disease (protein-free diet, specialized amino acid mixtures, hepatoprotectors, vitamin D and others) is laid out with an emphasis on enzyme replacement therapy with nitisinone, an enzyme inhibitor (4-hydroxyphenylpyruvate dioxygenase) of the first phase of tyrosine degradation. A description of a clinical case and a 15-year-old teenager with a hereditary tyrosinemia type I who received a low protein diet, the amino acid mixture «XPHEN TYR Tyrosidone» (Nutricia) and nitisinone (Orfadin®).