Text I. Resuscitation of the newborn

A. The concern of medicine is life – helping to create it, preserving it whenever possible, easing its pains, making its ending as painless as possible. The first concern is birth, and since the beginning of history, lawmakers have placed it at the top of their agender because no society can survive without healthy generation.

Nowadays of seriously ill newborn babies has significantly improved by advances in medical technology. Infants who would have died had they been born in the 1950s or early 1960s can nowoften survive for long periods with the help of the sophisticated, though costly, medical treatment available in the neonatal intensive care units (NICUs) found in some 600 hospitals across the USA. As of 1989, these units had treated 200,000 newborn babies each year at an estimated annual cost of $ 1.5 billion.

As for Russia, neonatal intensive care units help to survive thousands of infants. The part played by the pediatrician in the marternity service has become very important, as it is clear now that beneficial results of adequate neonatal care or its lack extend through entire life span. During the immediate neonatal period the pediatrician must concern himself with three major aspects. Firstly, some babies require special care because of prematurity, low birth weight, congenital malformations, birth trauma, or other disabilities. Secondly, all normal full-term babies should be under pediatric management and receive specialized evaluation and supervision. Thirdly, it is important for all newborn infants to be thoroughly examined shortly after birth and before discharge, to exclude developmental defects and deviations from normal. Many neonatal problems may arise after the second day of life in apparently well babies: the adjustment of correct breast feeding, detection of some congenital malformations and such conditions as hyperbilirubinemia, post-natal infection and tetany.

B. Some babies may require emergency procedures which are helpful in their resuscitation. Cardirespiratory depression (heart rate less than 100 beats per minute, hytension, hypoventilation, or apnea) may occur to some degree in 10% to 15% of newborn infants. Prompt therapy may be lifesaving and is necessary to minimize permanent CNS disability. Resuscitation techniques may be the following: thermal protection. Pharengeal suctioning, airway suctioning, external cardiac massage.

One frequently considered cause of cardiorespiratory depression is asphyxia (decreased PO2 and pH and increased PCO2). A wide range of maternal, fetal, and placental conditions can lead to asphyxia in newborn. A common factor seems to be marginal exchange of O2 and CO2 across the placenta which becomes further compromised during labor.

The hallmark of the newborn intensive care unit is the ability to manage long-term assisted ventilation of sick infants. Styles of ventilation (rapid vs. slow, long vs. short inspiratory times, etc.) may differ among institutions. Various styles have proven effective. A uniform team approach (physician, nurse, respiratory therapist, radiologist, and clinical laboratory) is essencial. The brand of equipment used is not critical. Success is determoned by how well you use the equipment you have and by your patient evaluation. Respiratory failure may occur in infants with a wide range of disorders, including lung disease, heart disease, intrathorasic anomalies, CNS depression by drugs or disease, and in premature infants with severe apneic spells. When respiratory failure is severe and other methods for treating pulmonary insufficiency have failed, mechanical ventilation is indicated.

Ventilation by bag and mask is easily learned and is usually an effective means of establishing lung expansion. Its success rate is usually only limited by the availability of an appropriate size mask and the experience of the operator and less often by the severity of lung disease. Ventilation assistance is indicated in resuscitation and for managing infants for short periods of time while preparing for intubation.

Supplemental oxygen is an important form of therapy for many infants with cardiopulmonary disorders. It should be recognized that its use may be associated with the occurrence of retrolental fibroplasia and chronic lung disease and that criteria have not been established that insure minimal hazard to the patient. Therefore, it is presently recommended oxygen administration to be regulated to maintain the arterial PO2 within the range for normal newborns, 50 to 100 torr. Oxygen therapy is indicated in hypoxemia, resuscitation, cyanosis.

The purpose of percussion, vibration, and suctioning (PVS) therapy is to improve the clearance of mucous and debris from the airways. These techniques are often fatiguing to the infant and time consuming for nursery personnel and therefore need to be used judiciously. The use of PVS is indicated in patients with excess or thickened pulmonary secretions and prophylactically in patients with chronic lung disease and impaired respiratory movement (e.g., paralyzed infants). Frequency depends on productivity of secretions, therapeutic goals, and tolerance. PVS orders must be individualized, not ritualized, and frequently reassessed. Personell providing PVS therapy are often the best judges of effectiveness and patient tolerance. If an infant fights PVS, blood gases may deteriorate for the subsequent 30 minutes or even longer. Tolerance of PVS therapy should be evaluated initially and periodically using a transcutaneous CO2 monitor and pulse oximetry. Infants who have cardiorespiratory instability are the most likely to deteriorate during PVS.

Safety of babies with severe labor complications and inhereted diseases depends on highly qualified medical personnel and well-equipped neonatal intensive care units. Thanks to the achievements of medical science it has become possible to treat and to prevent many fatal neonatal disirders and to recognize at early stage defects which may cause chronic diseases. Acute observation and intensive care have improved survival statistics for newborns with developmental anomalies.

9. Answer the questions using the text:

1.What is the concern of medcine?

2. Why can no society survive without healthy new generation?

3. Are advances in medical technology helpful in treatment of seriously ill infants or not?

4. Why may some babies require special care during the immediate neonatal period?

5. What is asphyxia?

6. What can lead to asphyxia?

7. What may detect those infants who cannot tolerate labor?

8. When is mechanical ventilation indicated?

9. What infants may respiratory failure occure in?

10. In what cases is oxygen therapy indicated?

11. When may prompt therapy be lifesaving?

12. What is the purpose of PVS therapy?

13. When is PVS therapy indicated?

14. Thanks to what has it become possible to prevent and to treat many fatal neonatal disorders?

10. Give the English equivalents to the word combinations in brackets. Translate the sentences:

1. The concern of medicine is (сохранить жизнь) whenever possible. 2. Treatment of seriously ill infants becomes possible due to (достижениям в медицинских технологиях). 3. A wide range of maternal, fetal and placental condotions (могут привести к асфиксии) in the newborn. 4. (Многие неонатальные проблемы) may arise after the second day of life in apparently well babies. 5. When (остановка дыхания) is severe mechanical ventilation (показана). 6. (Значительная гипоксия у новорожденного) is usually defined as PaO2 less than 50 torr. 7. Some practitioners (рекомендуют ограничение) of FiO2 to 0.80 (для оживления новорожденного) in the delivery room. 8. It is common practice (назначать кислород) in a concentration just sufficient (чтобы облегчить цианоз), while awaiting the results of blood gas maesurements. 9. The goal of therapy is to maintain PaO2 in the range of 50 to 100 torr and preferably 60 to 80 torr in small prematures (чтобы избежать гипоксии или гипероксии). 10. Thanks to the constantly improving (родовспомогательная служба) and child care there has been a large decrease in infant (смертность) in our country.

11. Choose the definitions corresponding to the following terms:

asphyxia, hydrocephaly, premature, amniotic, rubella, perinatal, trimester, microcephaly, hyperbilirubinemia

one third Ithree month) of the period of pregnancy; excess of the bilirubin in the blood; pathological smallness of the head due to defective development of the brain; congenital dropsy of the brain due to its defective development; an acute exanthematous contagious febrile disease caused by virus; occurring at the time of birth; pertainingto the amnion, fetal membrane forming bag of waters; born or interrupted before the stage of maturity; decreased PO2 and pH2 and increased PCO2.