Vegan/vegetarian diet and human milk donation: An EMBA survey across European milk banks.

The nutritional adequacy of human milk (HM) from vegan/vegetarian mothers has been a matter of debate, and a variety of recommendations regarding the eligibility of these mothers as human milk donors exists. According to the latest evidence, HM from vegans/vegetarians is similar in its composition to that from omnivores, however, some differences may be observed regarding vitamin B12 and omega-3 fatty acids concentrations. Maternal supplementation of these compounds has been proven effective in increasing their HM concentration. With this survey, we aimed to explore the practices currently in use in European human milk banks (HMBs) regarding potential donors following vegan/vegetarian diets. The online survey was distributed to European HMBs between January and July 2022. A total of 188 HMBs were contacted, and 118 replied (response rate 63%). Vegan and vegetarian mothers were recommended supplements of vitamin B12 to be accepted as donors in 27% and 26% of HMBs, respectively. Additional omega-3 fatty acid supplementation was required in 8% HMBs. In the remaining HMBs, these mothers were either systematically excluded or included regardless of supplementation. The dosage of the recommended supplements was extremely variable. Fifty-one percent of HMBs were following recommendations to guide their practice, national or local recommendations mainly. Great variability in European HMBs practices towards potential donors following vegan/vegetarian diets exists. Some of these practices can result in loss of donors and/or in potential nutritional deficiencies. Standardised evidence-based recommendations on this issue and their implementation in daily HMB practice are needed.

Pneumocystis jirovecii Colonization in Preterm Newborns With Respiratory Distress Syndrome.

We describe the prevalence of Pneumocystis jirovecii in mother-infant pairs of very low birth weight newborns <32 weeks gestation. Molecular and microscopic methods were used for detection of P. jirovecii in patients' specimens. Pneumocystis DNA was detected in 8 nasopharyngeal aspirates (14%) of 56 newborns and in 7 oral washes (21%) of 34 mothers. Pneumocystis detection immediately after birth suggests the possibility of its transplacental transmission. Compared to noncolonized infants, more frequent occurrence of bronchopulmonary dysplasia was seen in colonized infants (P = .02), suggesting a potential clinical importance of this pathogen in abnormal lung development.

A Randomized, Controlled Trial to Investigate the Efficacy of Nebulized Poractant Alfa in Premature Babies with Respiratory Distress Syndrome.

OBJECTIVE: To investigate the efficacy and safety of nebulized poractant alfa (at 200 and 400 mg/kg doses) delivered in combination with nasal continuous positive airway pressure compared with nasal continuous positive airway pressure alone in premature infants with diagnosed respiratory distress syndrome. STUDY DESIGN: This randomized, controlled, multinational study was conducted in infants at 280/7 to 326/7 weeks of gestation. The primary outcome was the incidence of respiratory failure in the first 72 hours of life, defined as needing endotracheal surfactant and/or mechanical ventilation owing to prespecified criteria. Secondary outcomes included the time to respiratory failure in the first 72 hours, duration of ventilation, mortality, incidence of bronchopulmonary dysplasia, and major associated neonatal comorbidities. In addition, the safety and tolerability of the treatments were assessed reporting the number and percentage of infants with treatment-emergent adverse events and adverse drug reactions during nebulization. RESULTS: In total, 129 infants were randomized. No significant differences were observed for the primary outcome: 24 (57%), 20 (49%), and 25 (58%) infants received endotracheal surfactant and/or mechanical ventilation within 72 hours in the poractant alfa 200 mg/kg, poractant alfa 400 mg/kg, and nasal continuous positive airway pressure groups, respectively. Similarly, secondary respiratory outcomes did not differ among groups. Enrollment was halted early owing to a change in the benefit-risk balance of the intervention. Nebulized poractant alfa was well-tolerated and safe, and no serious adverse events were related to the study treatment. CONCLUSIONS: The intervention did not decrease the likelihood of respiratory failure within the first 72 hours of life. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03235986.

Antibodies in the breastmilk of COVID-19 recovered women.

OBJECTIVE: Human milk contains antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which may serve as a protective factor through passive immunization in infants. The objective of this study was to measure the levels of anti-SARS-CoV-2 IgG and IgA in human milk and serum after a SARS-CoV-2 infection. DESIGN: Breast milk and serum samples from 72 lactating mothers with confirmed SARS-CoV-2 asymptomatic or symptomatic infection were collected 1-229 days after the onset of clinical symptoms related to COVID-19. Seventeen mothers with no history of COVID-19 served as a control group. Enzyme-Linked ImmunoSorbent Assay was performed to analyze antibodies against SARS-CoV-2. RESULTS: SARS-CoV-2-IgA human milk antibodies were detected in mothers and their concentrations were consistently higher than SARS-CoV-2-IgG antibodies. The serum and breastmilk samples of women with COVID-19 was characterized by a higher concentration of anti-RBD IgA and IgG than the serum from the control group without COVID-19. No statistically significant difference was observed between the antibody levels in the serum samples obtained from symptomatic and asymptomatic women exposed to SARS-CoV-2 and between the antibody level and the time from a positive SARS-CoV-2 test result over the period studied. CONCLUSION: Our results confirm the presence of SARS-CoV-2 IgA and IgG antibodies in the breastmilk of COVID-19 recovered women and the possibility of these antibodies in providing specific immunologic benefits to breastfeeding infants such as protection against the virus transmission and severity of the acquired COVID-19 disease.

Vegan or vegetarian diet and breast milk composition - a systematic review.

It is known that nutritional composition of breast milk is, to a certain extent, related to maternal diet. The question of nutritional adequacy of mothers' milk is often raised whenever a vegetarian or vegan diet during the lactation process is concerned. For this reason, in some countries, the recruitment of vegan lactating women as milk donors is excluded by milk banks. The purpose of this systematic review is to summarize existing knowledge on variability of specific nutrients in breastmilk of mothers adhering to a plant-based diet. The databases, including MEDLINE (Pubmed) and Scopus, were used to identify relevant publications. Data extraction and analysis were conducted following a PRISMA protocol. Thirteen publications concerning the impact of dietary pattern and levels of animal-origin food intake on breast milk composition were included. The systematic review has shown that all non-vegetarian, vegetarian and vegan mothers produce breast milk of comparable nutritional value. Several differences are primarily attributed to fatty acids and some micro-components, primarily vitamin B12. Regardless of dietary choices, nourishment and adequate nutrition have a significant impact on human milk composition - on the basis of the current evidence, vegetarian and vegan mothers are capable of producing nutritionally valuable milk for their infants, as far as the appropriate supplementation compensating for breastfeeding mother's nutritional requirements is provided. Dietary choices should not be a permanent exclusion criterion for donor candidates in human milk banks.

Homozygous mutation in the Neurofascin gene affecting the glial isoform of Neurofascin causes severe neurodevelopment disorder with hypotonia, amimia and areflexia.

The Neurofascins (NFASCs) are a family of proteins encoded by alternative transcripts of NFASC that cooperate in the assembly of the node of Ranvier in myelinated nerves. Differential expression of NFASC in neurons and glia presents a remarkable example of cell-type specific expression of protein isoforms with a common overall function. In mice there are three NFASC isoforms: Nfasc186 and Nfasc140, located in the axonal membrane at the node of Ranvier, and Nfasc155, a glial component of the paranodal axoglial junction. Nfasc186 and Nfasc155 are the major isoforms at mature nodes and paranodes, respectively. Conditional deletion of the glial isoform Nfasc155 in mice causes severe motor coordination defects and death at 16-17 days after birth. We describe a proband with severe congenital hypotonia, contractures of fingers and toes, and no reaction to touch or pain. Whole exome sequencing revealed a homozygous NFASC variant chr1:204953187-C>T (rs755160624). The variant creates a premature stop codon in 3 out of four NFASC human transcripts and is predicted to specifically eliminate Nfasc155 leaving neuronal Neurofascin intact. The selective absence of Nfasc155 and disruption of the paranodal junction was confirmed by an immunofluorescent study of skin biopsies from the patient versus control. We propose that the disease in our proband is the first reported example of genetic deficiency of glial Neurofascin isoforms in humans and that the severity of the condition reflects the importance of the Nfasc155 in forming paranodal axoglial junctions and in determining the structure and function of the node of Ranvier.

[Recurrent respiratory tract infections in children]. / Nawracajace zakazenia dróg oddechowych u dzieci.

Respiratory diseases are among the most common disorders found in the clinical practice of every pediatrician. It is estimated that a total of 10-15% of children experience recurrent respiratory tract infections (RRTI). Unfortunately, there is no universal consensus on the definition of recurrent respiratory tract infections in children. In addition, the number of episodes taken into account to define the recurrent nature of infections varies depending on the disease (location of the ongoing infection) and its severity. The most commonly accepted definition is the occurrence of eight or more documented respiratory tract infections per year in preschool children (up to three years old) and six or more in children older than three years, in the absence of any pathological condition underlying recurrent infections. It is very important to select in the group of children suffering from RRTI those who may have primary immunodeficiency. The detailed medical history plays an important role. In cases of positive medical history for immunodeficiency, it is mandatory to conduct a detailed examination of the immune system.

Letter to the editor: clarifying some aspects and the terminology of individualized human milk fortification.

This letter has been written by the components of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification in response to a recent paper published by Mathes et al. (BMC Pediatr. 2018 May 8;18(1):154) with the aim of drawing attention to the importance of the use of a metabolic marker to adapt protein intake in preterm infants. EMBA Working Group on Human Milk Fortification clarifies further the terminology and some specific aspects regarding individualized human milk fortification. There are two types of individualized human milk fortification: Adjustable human milk fortification and Targeted human milk fortification. Advantages and disadvantages of these methods are summarized.

Lectin-Based Method for Deciphering Human Milk IgG Sialylation.

In light of the immunoprotective function of human milk and the incontestable impact of IgG glycosylation on its immune functions, characterization of the sialylation profile of human milk IgG is needed. Lectins as a molecular probe were applied in lectin-IgG-ELISA to analyze the sialylation and galactosylation pattern of skim milk IgG of mothers who delivered at term and prematurely. Well-defined biotinylated lectins were used: Maackia amurensis II (MAA II), Sambucus nigra (SNA), Ricinus communis I (RCA I), and Griffonia simplicifolia II (GSL II) specific to α2,3-Neu5Ac, α2,6-Neu5Ac, Gal(ß1,4)GlcNAc, and agalactosylated glycans, respectively. The sialylation pattern of milk IgG differs qualitatively and quantitatively from maternal plasma IgG and is related to lactation stage and perinatal risk factors. Expression of MAA-, SNA-, and GSL-reactive glycotopes on term milk IgG showed a positive correlation with milk maturation from days 1 to 55. Preterm birth was associated with an increase of MAA-reactive and a decrease of RCA-reactive IgG glycotopes. Moreover, higher SNA- and GSL-reactive and lower RCA-reactive glycoform levels of milk IgG were associated with infection of lactating mothers. Application of a specific and simple method, lectin-IgG-ELISA, reveals the sialylation pattern of milk IgG over milk maturation. However, further investigations are needed in this area.

[Vegetarian diet in pregnancy and lactation - safety and rules of balancing meal plan in the aspect of optimal fetal and infant development]. / Dieta wegetarianska w ciazy i okresie laktacji ­ bezpieczenstwo i zasady bilansowania jadlospisu w aspekcie optymalnego rozwoju plodu i noworodka.

Pregnancy is a period of intense fetal development, as well as maternal physiological adaptation. During this period a varied diet is particularly important, as intake of macronutrients and micronutrients directly affects pregnancy outcome and the quality of breast milk. The dietary recommendations for pregnant women are indeed very similar to those for other adults, but with a few remarkable exceptions. Therefore, it is important to evaluate, monitor, and, when appropriate, make changes to improve maternal nutrition both before and during pregnancy and lactation, while respecting patients' choices. Growing interest of vegetarian diets needs to be included, as pregnant women may present with unique nutrient deficiencies. However, evidencebased reviews showed that "vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes". This statements is supported by worldwide nutrition specialists, though, the risk and consequences of nutrient deficiencies is emphasized. The nutritional adequacy of a vegetarian diet must be judged individually, not on the basis of what it is called, but on the type, amount, variety and bioavaliability of nutrients that are consumed. Special consideration is required for proteins, calcium, iron, zinc, vitamin B12 and omega-3 fatty acids. Moreover, following advices regarding micronutrients supplementation is essential. This article provides guidelines for counseling vegetarian patients in prenatal and postnatal care.

[Congenital Cytomegalovirus infection - still a relevant problem (based on own experience and literature)].

As far as infectious factors are concerned, Cytomegalovirus is considered one of the most common causes of progressive hearing impairment and neurological disorders among children. The increasing number of CMV infections creates the necessity of quick diagnosis and treatment that may reduce the consequences or even completely resolve the condition. It is essential that the diagnostic team consists of not only neonatologists but also obstetricians/perinatologists. In many countries, including Poland, screening is not being carried out among pregnant women, which delays the diagnosis and the begining of antiviral treatment or might even indispose the therapy.

Colostrum Lactoferrin Following Active and Recovered SARS-CoV-2 Infections during Pregnancy.

Lactoferrin (Lf), which is particularly abundant in human breast milk during the early stages of lactation, provides protection against a variety of infections, including viral infections, and has demonstrated activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this study was to measure the concentrations of Lf in the colostrum of mothers with active coronavirus disease 2019 (COVID-19) infections during delivery, in mothers with a history of COVID-19 during pregnancy, and in non-infected controls. In this cross-sectional study, colostrum samples from 41 lactating mothers with a confirmed history of SARS-CoV-2 infection (asymptomatic or symptomatic) (both active and past infections) were collected. Twenty-eight colostrum samples collected during the pre-pandemic period served as a control group. An enzyme-linked immunosorbent assay was performed to analyze the Lf concentrations. Concentrations of Lf in the colostrum samples were closely related to virus infection. Colostrum samples from mothers with confirmed SARS-CoV-2 infections contained higher concentrations of lactoferrin compared with samples from mothers from the control group. The highest concentrations of Lf were found in the colostrum samples of mothers with active SARS-CoV-2 infection during delivery when compared with the post-infection and control samples. This observed increase in lactoferrin suggests that it may be an important protective factor for breastfed infants, a finding which was particularly relevant during the pandemic period and remains relevant whenever a breastfeeding mother is infected.

Lactoferrin supplementation during pregnancy - a review of the literature and current recommendations.

Pregnancy is a period which requires special care and attention. Maintaining health during pregnancy helps to avoid birth related complications and is the best way of promoting a healthy birth. Besides a daily intake of folic acid, iron, iodine, vitamin D3 and A, calcium and polyunsaturated fatty-acids, as recommended by health agencies, supplementation of lactoferrin - a protein of multidirectional biological activity and proven safety of use - seems to be beneficial. A wide range of lactoferrin biological roles (including regulation of iron balance, modulation of immune responses, antimicrobial, antiviral, antioxidant, and anti-inflammatory activity) may contribute to better pregnancy and birth related outcomes.

Impact of gestational diabetes and other maternal factors on neonatal body composition in the first week of life: a case-control study.

OBJECTIVES: Newborns of diabetic mothers are at increased risk of abnormal nutritional status at birth, thus developing metabolic disorders. The aim of this study was to evaluate the anthropometric measurements and body composition of newborns born to mothers with gestational diabetes in comparison to newborns born to mothers with normal glucose tolerance in pregnancy, in the first week of their life. Maternal factors affecting the gestational period were also evaluated. MATERIAL AND METHODS: The study included 70 participants: neonates born to mothers with gestational diabetes (GDM) and neonates born to healthy mothers (non-GDM). A set of statistical methods (e.g., ANOVA, Kruskal-Wallis test, Chi-square test, regression, cluster analysis) was used to compare data between the study groups and to find their association with maternal factors. RESULTS: Our approach resulted in statistically significant classification (p < 0.05) by maternal history of hypothyroidism, weight gain during pregnancy and diagnosis of GDM. Newborns of mothers diagnosed with both GDM and hypothyroidism had lower birth weight and fat mass than newborns of mothers without GDM nor hypothyroidism (p < 0.05), however this finding might be associated with high incidence of excessive gestational weight gain among healthy mothers. No differences in body composition were found between the study groups on account of maternal GDM only (p > 0.05). CONCLUSIONS: Thus, well-controlled gestational diabetes mellitus as an individual factor does not significantly affect neonatal anthropometric measurements and body composition.

COVID-19 in pregnancy, management and outcomes among pregnant women and neonates - results from tertiary care center in Wroclaw.

OBJECTIVES: A novel coronavirus - SARS CoV-2 - outbreak has, for sure, been the greatest medical challenge in recent years. The maternal and neonatal consequences of the infection are still largely unknown. MATERIAL AND METHODS: This prospective study aims to describe the perinatal care and outcomes of SARS-CoV-2 positive pregnant women and their newborn infants during the third wave of the pandemic, in a large tertiary university center in Wroclaw/Poland from 15 February to 1 May 2021. RESULTS: The paper describes a group of 83 women with confirmed SARS-CoV-2 infection during delivery, as well as their newborn infants (n = 84). The course of COVID-19 disease in pregnant patients was mostly asymptomatic (56%) but 31% women manifested mild to moderate symptoms and 14% had severe infection. The median gestational age at the delivery was 38 weeks. On average, 16.7% of mothers were separated from their newborns at birth, 83.3% practiced skin-to-skin, and roomed in with their babies, and 84.5% of the infants received any mother'smilk. Preterm infants were more often borne by mothers with symptomatic course of COVID-19 infection. Need for neonatal treatment was only due to prematurity. Neonates with acquired infection (after 14th day of life) had to be treated symptomatically with fever and loose stools, only 28.5% had symptoms of respiratory failure. CONCLUSIONS: Despite the confirmed SARS-CoV-2 infection, the majority of mother- infant dyads were in a good health condition. The data on perinatal care reported in the paper could be helpful contribution supporting childbirth physiology protection during the COVID-19 pandemic.

Effects of Early versus Standard Central Line Removal on the Growth of Preterm Infants with Very Low Birth Weight: A Non-Inferiority, Randomized Clinical Trial.

Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study's primary outcome was weight at 36 weeks' postmenstrual age, with a non-inferiority margin of -210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks' postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, -68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants.

SARS-CoV-2 Infection and Pregnancy: Maternal and Neonatal Outcomes and Placental Pathology Correlations.

There is accumulating evidence on the perinatal aspects of COVID-19, but available data are still insufficient. The reports on perinatal aspects of COVID-19 have been published on a small group of patients. Vertical transmission has been noted. The SARS-CoV-2 genome can be detected in umbilical cord blood and at-term placenta, and the infants demonstrate elevated SARS-CoV-2-specific IgG and IgM antibody levels. In this work, the analysis of clinical characteristics of RT-PCR SARS-CoV-2-positive pregnant women and their infants, along with the placental pathology correlation results, including villous trophoblast immunoexpression status for SARS-CoV-2 antibody, is presented. RT-PCR SARS-CoV-2 amniotic fluid testing was performed. Neonatal surveillance of infection status comprised RT-PCR testing of a nasopharyngeal swab and the measuring of levels of anti-SARS-CoV-2 in blood serum. In the initial study group were 161 pregnant women with positive test results. From that group, women who delivered during the hospital stay were selected for further analysis. Clinical data, laboratory results, placental histomorphology results, and neonatal outcomes were compared in women with immunohistochemistry (IHC)-con SARS-CoV-2-positive and IHC SARS-CoV-2-negative placentas (26 cases). A positive placental immunoprofile was noted in 8% of cases (n = 2), whereas 92% of cases were negative (n = 24). Women with placental infection proven by IHC had significantly different pathological findings from those without. One infected neonate was noted (n = 1; 4%). Infection was confirmed in perinatal autopsy, as there was the intrauterine fetal demise. The potential course of the infection with the risk of vertical transmission and implications for fetal-neonatal condition is critical for proper clinical management, which will involve comprehensive, multidisciplinary perinatal care for SARS-CoV-2-positive patients.

Relationship between AB0 blood groups and selected pregnancy conditions and neonatal diseases.

The influence of the blood group on the occurrence and severity of diseases has aroused the curiosity of scientists for many years. The AB0 group system is the best known and described blood group system. It is also the only system whose antibodies are constantly present in the blood serum. The most common blood type in Poland, according to data provided by Honorary blood donation and blood therapy, is group A Rh+ (plus), while the least common is group AB Rh- (minus). In studies of pregnant women scientists discovered the influence of blood type in the development of preeclampsia, gestational diabetes, the risk of preterm labor, and even COVID-19 infection. The impact of the mothers' blood group also affects the birth weight of newborns, as well as the development of hemolytic disease of the newborn due to the heterospecificity of AB0. The influence of the blood group on the increased risk of developing certain diseases and complications of the neonatal period has also been proven. Therefore, it seems important to study blood groups of pregnant women and newborns of different nationalities, correlate the results with available reports and use this knowledge in everyday clinical practice. This will help to increase the speed of detection of diseases in pregnancy and neonatal period. It will also facilitate the management of the patient depending on their blood group.

The link between knowledge of the maternal diet and breastfeeding practices in mothers and health workers in Poland.

BACKGROUND: There are multiple misconceptions concerning the breastfeeding mother's diet and its adverse impact on breast milk composition and the breastfed child's health, which might lead to breastfeeding cessation. Although prophylactic maternal dietary restrictions are not recommended, mothers all over the world are often recommended to avoid certain foods, due to cultural beliefs, social pressure and even outdated or ambiguous medical recommendations. In Poland, there is no systematic approach to breastfeeding education in the form of nationwide educational programs for particular social groups. It was estimated that in 2017 only 3-4% of Polish infants were exclusively breastfed at 6 months of age. The aim of this study was to recognize the scale of common dietary misconceptions among lactating mothers in Poland and to compare knowledge and opinions between medical staff and mothers who have ever breastfed a child. In addition, the paper is an attempt to identify factors contributing to the still current practice of recommending prophylactic dietary restrictions to breastfeeding mothers by medical staff. METHODS: The study was conducted in Poland, in January - February 2019. The study used a diagnostic poll method and was conducted mainly in an electronic form. A total of 1159 completed questionnaires data were analyzed: 35.1% completed by medical staff and 64.9% by mothers in non-medical professions. Statistical calculations were conducted with Chi-square test, logistic regression and U Mann Whitney test (level of significance set at 0.05). RESULTS: The respondents presented a good level of knowledge and predominantly assessed the questioned statements correctly. Duration of breastfeeding was found to be the main factor determining respondents' knowledge (p <  0.05). Concerning medical staff, the parity (p <  0.001) and applying an elimination diet when themselves breastfeeding (p <  0.001) had a significant impact on recommendation of prophylactic dietetic restrictions to the lactating women. CONCLUSIONS: Regardless of a resonably good level of knowledge on maternal nutrition in the lactation period, both breastfeeding mothers and medical staff are still convinced of the beneficial effect of preventive dietary restrictions, which affects further lactational counselling and lactational performance.

Impact of refusal to vaccine in the neonatal period on the implementation of the vaccination calendar in the first year of life.

INTRODUCTION: The level of vaccination coverage with obligatory preparations in Poland reaches 98%. This is facilitated by the introduction of the Individual Vaccination Calendar (IVC) compliant with medical contraindications to vaccination. AIM: The aim of the study was to assess whether the refusal of vaccinations after birth has an impact on the proper implementation of the vaccination calendar in the first year of life. METHODS: The study involved healthy, term newborns who were born in the Department of Neonatology in 2011-2015. There were 156 patients enrolled to the study. Among them, 133 were in the control group - vaccinated after birth, and 23 constituted the study group - not vaccinated after birth. RESULTS: Not all healthy newborns are vaccinated after birth, statistical significance was obtained between the study and control group (p < 0,00001).Only 48% of patients not vaccinated after birth received TB-vaccine during the first year (p < 0,00053).Parents of 26% of infants in the study and of 2% of infants in the control group declared using the IVC (p < 0,001). CONCLUSIONS: Proper implementation of the vaccination schedule in the first year of life results from the initiation of vaccinations after birth.Unreasonable introduction of the IVC promotes incorrect timing of mandatory vaccinations.