Ушкодження діафрагмального нерва є нечастим, проте добре відомим ускладненням пологової травми, яке спричинюється травмуванням плечового сплетіння [14,16]. Найчастіше виявляють однобічний парез правого купола діафрагми [9], а білатеральні ушкодження трапляються рідше [1,4]. Діафрагмальний нерв  – єдиний, який забезпечує рухову активність діафрагми, а його ушкодження може зумовити розвиток паралічу або парезу діафрагми, що призводить до зниження вентиляційної здатності, дихальної недостатності, а також до необхідності в тривалій штучній вентиляції легень, особливо при білатеральному ушкодженні [1,11,12]. Лікування цих немовлят передбачає тривалу респіраторну підтримку, медикаментозне лікування та хірургічну плікацію діафрагми, найчастіше в разі однобічного ураження [14,15]. Слід зазначити, що можливе і спонтанне відновлення функції діафрагми [5,7,8], проте це потребує тривалої респіраторної підтримки. Наводимо клінічний випадок першого застосування в Україні трансторакальної імплантації стимулятора діафрагмального нерва в немовляти з білатеральним паралічем діафрагми. Метою роботи було представити нову можливість у лікуванні немовлят з білатеральним паралічем діафрагми.

Nowadays, newborns that required prolonged respiratory maintenance for different reasons are more often surviving. Increase in the number of complications is observed on the background of positive clinical effects of certain component of intensive therapy. Search for the factors, which provoke appearance of recurrent bronchial obstruction syndrome, is an important component and basis of prophylaxis.

The aim of our research was to conduct analysis of factors that provoke the development of recurrent bronchial obstruction syndrome.

To build mathematical model of bronchial obstruction development in young children with respiratory disorders in neonatal period,, the method of logistic regression was used

The results of conducted analysis enabled to detect that the presence of respiratory therapy significantly determines the risk of appearance of recurrent bronchial obstruction syndrome and suggest mathematical model of individual calculation of risk factors in this pathology. Data of conduction of mathematical analysis can be used for elaboration of a complex of rehabilitation measures concerning the development of recurrent bronchial obstruction syndrome in children, who suffered respiratory disorders in neonatal period. The highest risk of recurrent bronchial obstruction syndrome development in children born before 29 gestational week with simultaneous combination of prolonged (over 700 hours) total period of respiratory therapy.

Elaborated method of individual calculation of the risk of recurrent bronchial obstruction syndrome development in young children, who experienced respiratory disorders in neonatal period, has practical significance and can be applied in everyday clinical practice. 

The development of allergic rhinitis is considered to be caused by the complex interactions between genetic predisposition and environmental factors. Polymorphisms in the interleukin (IL)-13/4/4RA pathway have previously been shown to be associated with atopic diseases. The purpose of this study was to determine the association between IL-13 R130Q, IL-4 T589C, IL4 receptor alpha (IL-4RA) I50V, or IL-4RA Q576R polymorphisms and risk of allergic rhinitis in a hospital-based Malaysian population. A case-control pilot study was undertaken and genotyping of these polymorphisms was performed using polymerase chain reaction–restriction fragment length polymorphism on 54 allergic rhinitis patients and 45 healthy individuals. Polymorphism of IL-13 R130Q showed significant difference in genotype (p 0.048) and allele (p 0.002) frequencies in allergic rhinitis when compared with healthy controls. Individuals who were GA heterozygotes (adjusted odds ratio [ORadj] 3.567; 95% CI, 1.211–10.509), and carriers of A allele genotype (ORadj 3.686; 95% CI, 1.300 –10.451) and A allele (ORadj 3.071; 95% CI, 1.514 – 6.232) had an elevated risk of developing allergic rhinitis. The genotype and allele frequencies of IL-4 T589C, IL-4RA
I50V, and IL-4RA Q576R polymorphisms were not significantly different between the allergic rhinitis patients and normal healthy individuals and did not show an associated risk with allergic rhinitis. Our findings indicate that polymorphic variant of IL-13 R130Q appears to be associated with increased risk for development of allergic rhinitis in a hospital-based Malaysian population but not IL-4 T589C, IL-4RA I50V, and IL-4RA Q576 polymorphisms. Additional studies using larger sample size are required to confirm our findings and its exact role in allergic rhinitis.

Cow's milk protein allergy is an urgent problem in young children. Early diagnostics and formation of therapeutic tactics are the basic priorities in allergy treatment among young children. Oral provocation tests, which can be performed only in medical establishments, are a golden standard for diagnosing food allergy. Active search continues for optimal scheme of diagnosing cow's milk protein allergy in children in the first year of life. The aim of our research was to create the algorithm of diagnosing cow's milk protein allergy in children younger than one year of age, which will optimize obtaining reliable data on a patient's condition and decrease a load of laboratory examinations on young children using elimination and provocation food test. To complete the set goal, a record of allergological anamnesis, examination, assessment of physical condition and determination of specific IgE to cow's milk proteins were conducted to diagnose cow's milk protein allergy. Then, based on the obtained results, elimination and provocation food test was performed in two phases - elimination phase and provocation phase. Diagnostic in vitro is needed to choose the level of medical establishment for conduction of oral provocation tests: in case a specific IgE index is over 0.7 kU/L, testing is performed in an intensive care unit, if IgE is less than 0.7 kU/L - in a specialized inpatient department. Three clinical cases involving different methods have been presented for diagnosing cow's milk protein allergy - elimination and provocation test, oral provocation test and administration of individual diet based on the obtained results. A complex diagnostic approach, in particular, study of anamnesis, record of nutrition diary, elimination diet, enables to optimize diagnostics of food allergy, and diagnostic addition of a product - to assess tolerance clinically during extension of diet. An elaborated method of diagnosing cow's milk protein allergy in children younger than one year of age can be recommended for wide use in a clinical practice.

Aim: To determine the prevalence and to estimate factors associated with food hypersensitivity in young children of the Lviv region in Ukraine.

Methods: A prospective cross-sectional survey study was conducted between 2016 and 2017 in the Lviv region of Ukraine. A specially designed questionnaire about food hypersensitivity of young children developed and validated by M. J. Flokstra-de Blok was used after translation into the Ukrainian language. The questionnaire included 34 questions, grouped into general and detailed information. Parents of children aged 0–3 years were asked to complete the questionnaire at pre-schools and medical institutions.

Results: Among 4,500 distributed questionnaires, 3,214 (71%) were completed and processed. Parents reported that 25% of their young children had food hypersensitivity. According to the survey the most common agents involved in food hypersensitivity in young children were cow's milk (34%), egg (28%), and wheat (24%). Hypersensitivity to milk occurred in 50% of children in the age group of 1–2 years. Regional differences associated with food hypersensitivity were also found. Namely, in the Carpathians, there was more hypersensitivity to fish (27%) and honey (22%) than in other regions, while hypersensitivity to soy was detected mostly in Lviv City residents (8.5%). Unknown causes of food hypersensitivity were highly reported (34%) in the Carpathians.

Conclusion: Prevalence and some distinctiveness of food hypersensitivity revealed in four geographic and climate zones as well as in Lviv City have a considerable practical use for formulation of recommendations for children with food hypersensitivity.