At the forefront of pediatrics: from historical traditions to an innovative future

We present to your attention a special issue of the journal "Patient-Oriented Medicine and Pharmacy," dedicated to a significant milestone—the 55th anniversary of the Pediatric Faculty of Yaroslavl State Medical University (YSMU), which in 2025 was reorganized into the Institute of Pediatrics and Reproductive Health.

For over half a century of service to children's healthcare is not just a temporal milestone; it is a history of continuous development of national science and education. Over these years, the Pediatric Faculty of YSMU has become a recognized center for training highly qualified pediatricians, making an invaluable contribution to the development of Russian pediatrics and related disciplines.

This issue reflects the current state and future prospects of children's healthcare, demonstrating the breadth of scientific interests and the depth of research of the national pediatric school. Particular attention is paid to current trends in modern medicine, from innovative targeted technologies to the digitalization of drug supply for children with rare diseases.

We would also like to note the high scientific level of the research presented in this issue, their practical significance, and their compliance with modern international standards.

In the journal's section on new drugs and technologies, a relevant review by T.I. Pushkin and L.G. Emelichev covers new monoclonal antibodies not yet registered in the Russian Federation, which are in late-stage clinical trials or were approved by the FDA (USA) in 2024–2025. The review discusses drugs targeting new pathways (IL-31, IL-33/ST2, OX40/OX40L), expanding treatment options. Of particular note are ultra-long-acting drugs, such as depemokimab for asthma, administered once every 6 months, which may improve treatment adherence. Data on the efficacy of dupilumab for chronic spontaneous urticaria and omalizumab as monotherapy for multiple food allergies are presented. Drugs effective in patients with atopic dermatitis who did not respond to dupilumab, and for patients with asthma without eosinophilia, are also described. It is noted that some drugs demonstrate a sustained effect even after treatment discontinuation. The emergence of new targets will allow for more precise therapy selection based on the patient's disease phenotype and endotype, expanding the therapeutic arsenal for refractory cases and diseases where treatment options were extremely limited. Drugs with extended dosing intervals will improve treatment adherence and quality of life. The necessity for further research into long-term safety and addressing issues of registration and ensuring the availability of these innovative drugs in the Russian Federation is emphasized.

In the journal's pediatrics section, a study by N.M. Bogdanov and A.V. Kalashnik on the influence of pregnancy and childbirth characteristics on the intensity and frequency of regurgitation in infants was published. A statistically significant association was found between regurgitation syndrome and even mild, compensated forms of preeclampsia and gestational diabetes in the mother. It was discovered that infants from mothers with preeclampsia in the third trimester and gestational diabetes mellitus more frequently had regurgitation of minimal intensity, which may be associated with the compensated, non-severe course of these conditions. A strong association was established between rapid labor and the development of high-intensity regurgitation. In this sample, no significant association was confirmed between regurgitation and other studied factors: anemia, mode of delivery, edema, or maternal hypertension. The results allow for more accurate identification of the risk group for developing intense regurgitation already at the stage of pregnancy and childbirth, enabling personalized preventive measures from the child's birth.

The article by K.V. Dashichev et al. on early predictors of postnatal developmental disorders in prematurely born children demonstrates that the dynamics of insulin-like growth factor-1 (IGF-1) levels in the neonatal period are more informative than its static level. Two opposite dynamic patterns were identified: a high initial level with a subsequent decrease, and a low initial level with a subsequent increase. It was established that the second group is a risk group—these children had significantly more frequent deviations in physical development by 12 months. A connection was shown between the IGF-1 dynamic pattern and maternal pregnancy pathology. Dynamic assessment of IGF-1 levels could become a new early biochemical marker for identifying preterm infants at high risk, allowing for timely nutritional correction and prevention of both underweight and obesity.

The review article by T.A. Karginova et al. on the features of physical development in preterm children systematizes modern understanding of the problem, detailing the interrelationship of anatomical and physiological characteristics, nutritional status, motor development, and the influence of bronchopulmonary dysplasia. The importance of pre-conception preparation as the primary method for preventing prematurity is emphasized. The article serves as a relevant guide for pediatricians and neonatologists, helping to more accurately identify children at greatest risk of delay and underscoring the need for an interdisciplinary approach.

The article by E.A. Kupriyanova et al. on the management of children with intestinal stomas at different locations in the neonatal period summarizes clinical experience and details all stages of management—from intensive preoperative preparation to postoperative care, nutritional support, and stoma care. It is shown how the level of stoma placement determines the specifics of metabolic disorders and the risk of complications. The stages of nutritional support are described in detail. The article can serve as a practical guide for neonatologists and surgeons, promoting standardization and improvement of care quality, early complication prevention, and enhancing the role of breast milk.

The study by L.I. Mozzhukhina et al. on gastrointestinal manifestations of food allergy in young children confirms and details that different forms manifest in strictly defined age periods: FPIAP (proctocolitis) at 2–6 weeks of life, FPIES (enterocolitis) up to 3 months, FPE (enteropathy) after 4 months. Characteristic symptoms, coprogram data, fecal calprotectin levels, and specific morphological changes in the intestinal mucosa are described for each form. The high efficacy of a specific highly hydrolyzed formula for rapid symptom relief, mucosal restoration, and tolerance formation is confirmed. The timing of tolerance formation is specified: for FPIAP and FPIES by 3 years, for FPE in most cases by 5 years. Knowledge of the typical age of manifestation and clinical picture of each form will allow doctors to suspect a specific type of allergy more quickly, prescribe targeted examination, optimize treatment, and improve prognosis.

The study by V.V. Bekezina et al., dedicated to the study of the microcirculatory-tissue system as a marker of pre-nosological disorders of cardiovascular health in schoolchildren, proposes specific, quantitatively measurable markers for adolescents with overweight and obesity. It was established that the main screening marker is a state of "increased activity" of the functional state of the microcirculatory-tissue system, determined by the indicator of oxidative metabolism. This state is accompanied by a high fluxmotion index, indicating increased sympathetic influences on microvessels. The laser Doppler flowmetry method can be integrated into preventive examination programs for pre-nosological screening, allowing for the identification of children with high cardiovascular risk before the appearance of obvious symptoms.

The article by I.A. Leontev et al. on the features of body composition in children with cerebral palsy (CP) demonstrates that even children with normal height and weight indicators can have serious hidden body composition disorders: reduced muscle and fat mass and phase angle. Key markers of nutritional risk were identified: decreased active cell mass, phase angle, and skeletal muscle mass. Dynamic observation over a year shows that these disorders are progressive. Bioimpedance analysis should become a routine examination method for all children with CP to identify hidden disorders and initiate early nutritional support.

In the journal's otorhinolaryngology section, a study by V.V. Shilenkova et al., dedicated to the study of childhood dysphonias, confirms that the two main reasons for seeking care are mutation (49.5%) and vocal fold nodules (38.1%), with the majority of patients being boys. Clinical cases of pathologies rare in children—contact granuloma and chronic edematous laryngitis developing against a background of untreated gastroesophageal reflux disease—are described. It was found that parents often do not notice voice problems in their child, and the initiators of seeking care are usually teachers or other doctors. It is shown that dysphonia has the greatest negative impact on the child's physical state. Low treatment adherence was identified in patients with vocal fold nodules. The observation results emphasize the need for active identification of voice problems in children by pediatricians, school medical staff, and teachers.

M.N. Kuzmina et al. conducted a study on modern infectious mononucleosis in children, which revealed a shift in incidence to two key groups: children aged 4–6 years (31%) and adolescents aged 11–17 years (26.3%). Atypical mononuclear cells were detected in only 52.2% of patients, questioning the reliability of relying solely on a complete blood count for diagnosis and mandating serological confirmation. In primary infection, Epstein-Barr virus dominates, both as a mono-infection and in combination with cytomegalovirus (CMV). Reactivation of the process was overwhelmingly caused by CMV. A low level of C-reactive protein in most patients with tonsillar exudates indicates the viral nature of tonsillitis. The high frequency of ampicillin rash was confirmed. A revision of the diagnostic algorithm with mandatory serological testing and more judicious antibiotic prescribing is necessary.

In the journal's epidemiology section (I.K. Rapoport), an analysis of trends in the morbidity of children and adolescents in Russia during the digital renewal of schools was conducted for the first time, broken down into four stages of digital renewal (1995–2023). It was established that a negative trend of increasing morbidity was observed in the first two stages; growth stopped or reversed in the third stage; and a new increase was noted in the fourth stage. Primary morbidity in children increased by 55.9%, and in adolescents by more than twofold. The problem of disease chronicity is emphasized. A proposal was formulated to include specific nosologies in official statistics for better monitoring of school-related pathology. We hope that pediatricians and school doctors will more carefully assess the risks associated with digital load.

The study by M.S. Ivanov et al. on the assessment of body weight formation in schoolchildren aged 7–17 years across 40 subjects of the Russian Federation provides current data covering all federal districts. The main conclusion is that, despite the vast geographical and ethno-cultural diversity of the regions, the basic patterns of physical development remain unchanged everywhere. The study provides an extensive dataset that can serve as a basis for refining regional norms and standards of physical development, allowing for a more accurate assessment of a child's body weight compliance with sex-age norms specific to their region of residence.

In the journal's section on pharmaceutical organization, an analysis by O.V. Sokolova on the digitalization of drug supply for children with rare diseases, using the Yaroslavl Region as an example, identified a key problem: business processes for registered medicinal products (MPs) are fully digitalized, while for unregistered MPs they are conducted manually. Standardization of the list of unregistered medicinal products based on digital information from their packaging is proposed for integration into existing digital accounting systems. The importance of the mechanism for transitioning patients from the care of the "Krug Dobra" Foundation to the regional preferential supply system in adulthood is emphasized. Implementing the proposed standards will accelerate and simplify the process of supplying unregistered medicinal products, reduce the risk of errors, and improve the timeliness of therapy.

E.S. Uglov et al., in a historical article dedicated to the 55th anniversary of the Pediatric Faculty of YSMU, describe the stages of its transformation into the Institute of Pediatrics and Reproductive Health (from 2025). The expansion of the structure to 11 specialized departments, the increase in the number of students, the introduction of modern educational technologies, and the strengthening of ties with practical healthcare are described. The reorganization aims to systemically improve pediatric training and enhance the role of YSMU in the development of children's healthcare and reproductive medicine in Russia.

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Congratulating the Pediatric Faculty of YSMU on its 55th anniversary, I express confidence that the traditions laid down by its founders will be worthily continued by the new generation of scientists and physicians. May the coming decades be a period of new discoveries, innovative solutions, and significant achievements for the benefit of the health of Russia's children.