The purpose - to analyze bacteriological cultures from the abdominal cavity in various forms of appendicitis, to recommend a rational scheme of antibiotic prophylaxis and empirical therapy in children diagnosed with acute appendicitis. Materials and methods. The study based on bacteriological cultures of the abdominal cavity contents of operated children (laparotomy and laparoscope) with acute appendicitis. Patients were treated in the surgical department of the Zhytomyr Regional Children’s Clinical Hospital in 1997-2020. Results. We analyze 4255 (2334 children; 54.9% - positive) abdominal content cultures of children with acute appendicitis and its complications who were treated in the period 1997-2020. A total of 4965 children were treated, of which 31.3% of children underwent laparoscopic surgery. If we analyze by years, the number of laparoscopic appendectomies compared to 2001 increased by 57.34%. In the microbiological aspect of simple appendicitis, the five leaders are: E. coli - sown in 57.97% of all positive results, Ent. faecalis - 13.36%, S. aureus - 7.6%, Klebsiella spp. - 5.76%, Str. spp - 5.63%. Whereas in destructive forms of appendicitis: E. coli - 57.83%, E. faecalis - 13.58%, Ps. aeruginosa - 8.95%, S. aureus - 8.68%, Str. spp - 3, 38%. The structure of the isolated microflora in complicated appendicitis includes: S. aureus (8.03%), E. coli (48.7%), Ent. faecalis (28.3%), Ps. aeruginosa (7.8%), other pathogens - 7.17%. Cases of mixed infection in the focus of inflammation do not exceed 10.0%. The percentage of susceptibility of pathogens, which are most often sown from the abdominal cavity, to antibiotics in different periods of observation is different. It is important to remember that adequate antibacterial therapy should cover the anaerobic spectrum in destructive forms treatment. The widest range is protected by beta-lactams, carbapenems and chloramphenicol, but the use of the latter two groups is limited in pediatric practice, especially chloramphenicol due to its toxicity. You can create beneficial combinations of metronidazole, to which aerobes are not sensitive, together with cephalosporins, which in turn do not have clinically significant antianaerobic activity. Conclusions. After analyzing the microbiological structure of simple and destructive appendicitis, it is advisable in each surgical hospital to study its own bacterial mirror. It is rational to attribute acute phlegmonous appendicitis without peritonitis to a simple (uncomplicated) form, and in the presence of peritonitis - to a destructive form of appendicitis. Simple and destructive forms of appendicitis have different microbiological picture. In the presence of postoperative complications in the microbiological picture, four pathogens are in the lead: E. coli, Ent. faecalis, S. aureus, Ps. aeruginosa. It is efficient to change treatment tactics, avoid monotherapy as such, in particular, cephalosporins, use more combinations, as well as use other groups of antibiotics, such as protected penicillins. Thus, we will be able to inhibit the growth of antibiotic resistance, reduce the frequency and intensity of postoperative complications, reduce the length of stay of the patient in the hospital. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent was obtained from parents (or guardians). No conflict of interests was declared by the authors.

Despite advances in the diagnosis and treatment of necrotizing enterocolitis (NEC), the associated morbidity and mortality rates remain high. Purpose - to establish risk factors for mortality of necrotizing enterocolitis in preterm born infants, as well as to analyze histological changes of the intestinal lining. Materials and methods. The course of NEC in 21 preterm neonates who died of this disease (group 1, n=21) over a period of 3 years was analyzed. To establish risk factors for mortality rate health indicators of children in group 1 were compared with the course of NEC in children who survived with similar stages of the disease (group 2, n=43). The following research methods were used: general clinical, laboratory, instrumental, histological and statistical. Results. Our data show that the main causes of severe stages of NEC in preterm infants is infection, often in combination with severe asphyxia. The identified risk factors for mortality allowed to establish that the risk of death for children with NEC was associated with: male sex (OR=4.675; χ2=7.679; p=0.006) - increases the risk for mortality by 4 time; inflammatory changes in the placenta (OR=6.139; χ2=10.501; p=0.002) - increases the risk by 6 times; red blood cell transfusion in children (OR=8.262; χ2=8.557; p=0.004) - increases the risk by 8 times; thrombocytopenia (OR=4.320; χ2=4.866; p=0.028) - increases the risk by 4 time; the developmen of multiple organ system failure (OR=12.364; χ2=17.578; p<0.001) and DIC syndrome (OR=10.725; χ2=14.592; p<0.001) - increases the risk by 12 and 11 times, respectively; the positive symptoms - oedema of the anterior abdominal wall (OR=14.025; χ2=19.258; p<0.001) and vasodilation of the anterior abdominal l wall (OR=5.333; χ2=5.444; p=0.02) - increases the risk by 14 and 5 times, respectively; the intestinal pneumatosis on abdominal when x-ray detected (OR=6.840; χ2=6.867; p=0.009) and the peritoneal effusion detected by abdominal ultrasound (OR=8.750; χ2=14.448; p<0.001) - increases the risk of mortality by 7 and 9 times, respectively. During histological examination of the intestinal wall with NEC lymphohistiocytic infiltration of submucosa indicates perinatal hypoxia and its crucial role in the thanatogenesis of the disease, while polymorphonuclear segmental neutrophil infiltration is associated with perinatal infection. In 15 children (71.4%) changes of both types were noted, which indicates mixed etiology of intestinal lesions. Conclusions. Study results confirmed that necrotizing enterocolitis is a serious disease of newborns with a high mortality rate. The severe forms of NEC occur against the background of infection in combination with hypoxia. The obtained risk factors for the mortality rate of NEC allow to improve the prognosis of the course of this disease, will provide an opportunity to identify children who need increased attention of doctors to the treatment and further management of these patients with the use of preventive technologies that can prevent catastrophic consequences. The presence of congenital intestinal defects in combination with premature birth contribute to the development and aggravate the course of NEC, up to the development of stage III and a negative prognosis of the disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the parents of patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: necrotizing enterocolitis, preterm neonates, risk factors for mortality, histological changes.

Introduction. Pain is a signal to any aggression that leads to cellular damage and requires a defensive response. Uncontrolled acute perioperative visceral pain can lead to the development of pain chronicity. By studying the characteristics of chronic pain, some scientists have identified relationships with single-nucleotide polymorphisms of the beta2-adrenergic receptor (ADRB2) gene. Purpose - to study the dependence of pain expression in the postoperative period in children on the polymorphism of the molecular structure of the ADRB2 receptor. Materials and methods. The study involved 42 children (20 boys and 22 girls) aged 7 to 18 years who were treated in the surgical department in 2020-2022 for acute appendicitis and peritonitis. Results. Based on the results of examining all the subjects under study, 13 children had the Arg16Gly polymorphism, 15 children had the Arg16Gly polymorphic variant, and 14 children were diagnosed with the homomorphic Gly16Gly polymorphism in the ADRB2. The data obtained confirmed the trend of the preliminary analysis and proved better body response to pain relief and reduced pain intensity in individuals with the Arg16Arg variant of the ADRB2. Analysis of the dependence between the polymorphism of the ADRB2 molecular structure and Visual Analogue Scale (VAS) scores in children in the postoperative period proved that the presence of Arg in the receptor phenotype had a strong negative correlation with the VAS score on discharge day (r=-0.822, p<0.001), while the presence of Gly in the receptor phenotype had a strong positive correlation with the Visual Analogue Scale score on discharge day (r=0.814, p<0.001). In regression analysis, the presence of Gly in the receptor phenotype was associated with a 1.917-fold increase in the VAS score at hospital discharge (OR: 1.917; 95% CI: 1.448-2.385; р<0.001). Conclusions. The presence of the homomorphic Arg16Arg variant of the ADRB2 in children who underwent anterior abdominal wall surgery was accompanied by rapid response to analgesics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.