1

С02 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. ,

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13. Read text II and say what the main idea of it is:

Infant Patients with Adult Pain

While doctors and nurses accept that newborn babies suffer pain as much as older children and adults, they do little to help infants who have to undergo distressing procedures. Dr Jane Tohill and Dr Olive McMorrow of the National Maternity Hospital, Dublin, sent out a detailed questionnaire to the staff of 21 neonatal intensive care units in the British Isles about their pain relief policy. Of the 17 that replied, just less than three-quarters agreed that doctors tend to under-prescribe painkillers and a third that nurses do the same.

More upsetting, the survey revealed that more than a quarter of the units give babies no pain relief before a chest drain is inserted and only 40 per cent provide relief to babies suffering from fatal conditions such as spina bifida. The researchers argue in The Lancet that units should have a written policy on when pain relief should be given; otherwise it will not be provided. Most important, traumatic procedures should be performed without pain relief only in emergencies.

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Ex.3 Make up all kinds of questions ( 5-10) to the instruction given below:

Axillary temperature

SAFETY

1. There are no age restrictions for taking an axillary temperature.

PROCEDURE

1. Select thermometer: glass or electronic. Follow agency guidelines regarding type of thermometer to use, oral or rectal.

2. Expose axillary area.

3. Make sure axillary skin is dry. Pat dry if necessary as it prevents a false low reading.

5. Prepare thermometer as in Oral Temperature.

6. Place tip of thermometer under the child’s arm, well up into the axilla. Bring the child’s arm down close to the body and hold in place. It ensures more accurate measurement, allows thermometer tip to rest against superficial blood vessels in axilla; brings skin surfaces together, thus reducing air around the tip of the thermometer that might affect temperature reading.

7. Leave in place required amount of time.

1. Glass thermometer: 6-10 minutes according to agency policy. It allows sufficient time for the thermometer to register results in a more accurate assessment of body temperature.

5. Remove thermometer and read as in Oral Temperature.

6. Clean and store thermometer as in Oral Temperature.

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.

2. 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 P02 and pH and increased PC02). A wide range of maternal, fetal, and placental conditions can lead to asphyxia in newborn. A common factor seems to be marginal exchange of 02 and C02 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 P02 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

5	available	^^ доступный," имеющиися в распоряжении; пригодный, полезный
6	concern	забота, беспокойство; отношение; участие, интерес
7	debris	инородные вещества или остатки органических веществ; зубной налет.
8	depression	вдавление; депрессия; ослабление, уменьшение, снижение действия, подавление
9	to equip	оборудовать, снаряжать
10	failure	недостаточность, отсутствие; повреждение, остановка; авария; неудача
11	hazard	риск, опасность
12	hypoventilation	понижение количества воздуха в легких
13	hypoxemia	гипоксемия (сниженная содержание кислорода в артериальной крови)
14	intensive care unit	отделение реанимации
15	intrapartum fetal monitoring	наблюдение за плодом во время беременности
16	to manage	оказывать помощь, вести больного; суметь, удаваться
17	marginal	маргинальный, краевой; предельный, критический; минимальный (напр, о реакции)
18	micrognathia	микрогнатия (аномально малая величина челюстей, особенно нижней)
19	resuscitate	оживлять; приводить в сознание
20	retrolental fibroplasia	ретролентальная фиброплазия (патологич. замещение сетчатки фиброзной тканью и кровеносными сосудами у недоношенных, находившихся в кувезе при повышенном содержании кислорода)
21	sophisticated	сложный (о приборе, машине и т.д.)
22	suction	сосание; всасывание; отсасывание, аспирация
23	supplemental = supplementary	дополнительный
24	survive	выживать, уцелеть; перенести (операцию); пройти (обследование)
25	tolerate	терпеть, выносить; быть толерантным

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