Frequently ill children: A new vision of the old problem

The article is devoted to an urgent medical and social problem of recurrent respiratory infections in children. In domestic pediatric practice, there are currently no unified approaches to diagnosis, prophylactic medical examination and rehabilitation of a group of sickly children. This article presents an adapted version of the Inter-society Consensus developed by the Italian Medical Associations in the field of pediatrics, pediatric infectious diseases, allergology, immunology, and otorhinolaryngology. The consensus includes an algorithm of a differentiated approach to determining the risk of recurrent respiratory pathology in children in different age groups, markers for additional examination to exclude genetic pathology and chronic diseases. The low effectiveness of prevention of recurrent acute respiratory infections in children creates prerequisites for the search of methods to improve the rehabilitation potential of patients. Over the past few years, the study of the human gut microbiome as a separate extracorporeal organ that affects all body systems is promising. In the case of propensity to frequent respiratory diseases, the most important attention is paid to the “intestine-lung” axis, since this axis is bidirectional and represents the cross-relationships of the respiratory and digestive systems. The presence of this axis is due to the structural homology of the intestine and lungs from the point of view of histology and embryology and confirmed by experimental and clinical studies. The article presents the results of domestic and foreign studies devoted to find the changes in a gut microbiome and microbiome of upper respiratory tract. There is a numberof systematic reviews and meta-analyses demonstrating the presence of interrelated and interdependent changes in the gut microbiome duringrecurrent respiratory infection process, which allows to consider the prospect of using probiotics in sickly children.