Introduction. Motor colon dysfunction is seen in most patients after surgical intervention for Hirschsprung’s disease regardless of the pull-through technique and absence of technical errors during surgery. The main cause of motor colon dysfunction are developed dystrophic disorders in the wall of dilated colon which can be manifested as episodes of both fecal incontinence and constipation. Cholinesterase inhibitors are pathogenetic preparations which are prescribed for hypo- and atonic colon conditions. The authors present a clinical case of successful treatment of 1.5 month-old child with Hirschsprung’s disease who was prescribed postoperative cholinesterase inhibitor Ipidacrine.Clinical case. A boy, aged one month and one day, was operated on for Hirschsprung’s disease of the recto-sigmoid form. Agangliosis sized 13 cm. Colon hypotonic dysfunction persisted in the postoperative period. Rehabilitation for 19 days did not give any positive results. So, it was decided to prescribe Ipidacrine (after approval of the Expert Commission because of age restrictions for the given preparation). Ipidacrine effective dose was 2 mg per kg twice a day per os. Therapy lasted for 7 days after which the colon function was normalized. No adverse cholinergic effects were recorded.Conclusion. The authors consider that after sufficient accumulation of clinical data Ipidacrine can be prescribed as pathogenetic preparation in functional hypotonic colon disorders in children including those with Hirschsprung’s disease at their postoperative period.

In world pediatric practice, protracted bacterial bronchitis is the leading cause of chronic cough in preschool-age children. However, in Russia this nosology is not often diagnosed, and in real clinical practice children are observed for doubtful and ambiguous diagnoses. In 2021, the Russian Ministry of Health updated the clinical guidelines “Bronchitis” for pediatric age category with inclusion of protracted bacterial bronchitis in the list of bronchitis variants with designation of disease criteria: wet cough lasting at least 4 weeks, auscultatory symptoms of bronchitis in the absence of signs of chronic lung and bronchial pathology, cough relief after 2 weeks of therapy with an antibacterial drug active against H. influenzae, S. pneumoniae, M. catarrhalis. The article presents a review of the literature on protracted bacterial bronchitis in the historical aspect, and also reflects the criteria of the disease, epidemiology, etiology, pathogenesis, clinical presentation, methods of examination. Particular attention is paid to the treatment and debatable scientific and practical issues in the study of protracted bacterial bronchitis in the light of the clinical guidelines of the Ministry of Health of the Russian Federation. It is emphasized that the etiotropic treatment of protracted bacterial bronchitis is antibacterial therapy. The effectiveness of antibiotics for this disease has been proven in systematic reviews. Therapy is prescribed empirically. The first-line drugs of choice is oral amoxicillin/clavulanic acid. Preference is given to drugs in the form of dispersible tablets. The duration of therapy remains a subject of scientific debate. According to the clinical guidelines of the Russian Federation Ministry of Health, the course of treatment should not exceed 2 weeks, in case of ineffectiveness and/or relapse of protracted bacterial bronchitis, the course of antibiotic therapy may be prolonged to 4–6 weeks.

Vitamin B12 deficiency affects not only the bone marrow, but also the nervous system. Usually, B12 hypovitaminosis develops slowly during several years, although infants may also have this disorder. Patients and methods. We performed a retrospective analysis of clinical symptoms and results of routine laboratory testing in patients with vitamin B12 deficiency anemia. Our sample included 19 children of 3–24 month age (Group 1) and 9 adolescents (Group 2). All patients were treated in Krasnoyarsk Regional Clinical Center for Maternal and Child Health in 2012–2019. All participants had serum levels of vitamin B12 below 83 pg/mL. Results. All patients from Group 1 were found to have nervous system disorders, including muscular hypotonia (100%), hypo- or adynamia and retardation of motor skills (63%), and hyporeflexia (42%). More than two-thirds of adolescents (67%) had pancytopenia. One-third of children of 3–24 month age (32%) developed involuntary movements during treatment with cyanocobalamin. Conclusion. Vitamin B12 deficiency in infants may manifest itself with neurological disorders that do not correlate with the severity of anemia. Children with muscular hypotonia and delayed psychomotor development should be tested for their serum level of vitamin B12 if all other potential causes of these disorders have been excluded. It is also important to perform differential diagnosis with paroxysmal conditions, including those induced by cobalamin therapy. Key words: anemia, vitamin B12, involuntary movements, hypodynamia, hyporeflexia, hypotonia, pancytopenia, cyanocobalamin

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