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Unit 7. Neonatology
neonatology
неонатология (мед. специальность,
intensive care uni t
отделение (палата) интенсивной те-
premature
недоношенный
intrauterine
внутриутробный
retardation
задержка
malformation
дефект (порок) развития
sepsis
сепсис (заражение крови)
asphyxia
асфиксия
approximately
приблизительно, около
delivery
роды
disappear
исчезать
pliable
гибкий, мягкий
gradually
постепенно
consume
потреблять
transition
переход
1. Read and translate t he words:
neonatal
изучающая патологию новорожден-
ных), неонатальный, новорожденный
рапии
рrematurity
birth asphyxia
syn. labor
недоношенность
асфиксия у новорожденных
2. Translate the word combinations with the given key-words:
neonatal: neonatal period, neona tal disorder, neonatal diseases
142
prematurе: prematurе infant, prematurе birth, prematurе delivery; рrematurity,
1) to be thor oughly examined
a) вследствие незрелости
2) shortly after birth
b) покрываться чем-либо
3) to require spec ia l car e
c) потреблять кислород
4) gap between the bones
d) быть тщательно обследованным
5) a gaseous environment
e) вскоре после рождения
6) because of immaturity
f) (частично) перекрывать во время
7) motor skills
g) требовать специальный уход
8) to be covered with smth.
h) моторика
9) to overlap durin g d eli ver y
i) газообразная среда
10) to consume oxygen
j) промежуток между костями
due to prematurity
intrauterine: intrauterine growth, intrauterine infection, intrauterine growth retardation
disappear: disappeared, disappearing, to disappear gradually, to disappear suddenly, to disappear after birth
3. Read and translate t he followin g word-combinations:
1) to practice in neonatal intensive care units, 2) special medical care, 3) congenital
malformations, 4) four weeks after delivery, 5) at birth, 6) soft and pliable, 7) rapid
and shallow respiration, 8) to make transition, 9) primitive reflexes, 10) to protect
from infections.
4. Match Russian and English equivalents:
родов
5. Translate into English the follo wing word-combinations:
1) неонатолог, 2) происходить в первый год жизни, 3) респираторная система
новорожденного, 4) внутриутробное развитие, 5) продолжительность неона-
тального периода, 6) вследствие сепсиса, 7) вес при рождении, 8) адаптиро-
143
ваться к газообразной среде, 8) требовать тщательного осмотра, 9) выписы-
ваться из больницы, 10) характеризоваться чем-либо.
6. Read and translate the given words:
1) to form, forming, formed, form, formal, formality, formation, informal, malformation; 2) to appear, appearance, apparently, disappear, disappearance; 3) short,
shortly, shortage
7. Translate the following sentenc es:
1) The baby’s size is associated with a variety of factors including parental size,
race, gender, maternal nutrition, and overall maternal health. 2) Male newborns
tend to be slightly longer and heavier than their female counterparts. 3) The neonate may make peculiar wheezing and coughing sounds because the entire respiratory system is underdeveloped and inexperienc ed with the demands of the extrauterine environment. 4) Neonates can see best at a distance of about 19 cm (71/2 in).
5) The neonate also maintains physiological reactivity to sound intensity, as indicated by increased heart rate and motor activity. 6) According to the study, four
communicable diseases account for 54% of all deaths globally: pneumonia – 19%,
diarrhea – 17%, malaria – 8%, and neonatal sepsis – 10%. 7) Th e research ers believe recurrent apnea in neonates to be one of the factors resulting in the development of attention deficit hyperactivity disorder (ADHD).
8. Read and translate t he text. Make the plan of the text using key-words:
NEONATAL PERIOD
Neonatology is a hospital-based specialty usually practiced in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn
infants who are ill or requiring special medical care due to prematurity, low birth
weight, intrauterine growth retardation, congenital malformations, sepsis, or birth
asphyxias.
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Neonatal period lasts approximately the first four weeks after delivery. It is
1. about
4. labour
2. because of
5. defect
3. as a result
6. allow
considered as the time of the greatest risk for the infant because about 65 % of all
deaths that occur in the first year of life happen during this 4-week period. So it is
important for all newborn infants to be thoroughly examined shortly after birth and
before discha r ge.
At birth the skin of the newborn is often pale and thin. It also may be covered with lanugo
12
– a light, fuzzy body hair, or vernix caseosa13, an oily flui d that
protects the baby from infections. Both these substances disappear shortly after
birth.
The skeleton system of the neonate is not totally developed, and consequently many of the bones are soft and pliable. For example, the fontanelles are the gaps
between the bones of the skull that permit them to overlap during the birth process.
The posterior fontanelle gradually closes up through the third month of life, whereas the anterio r fo nta ne l le is cl ose d by 18 months of age.
The respiratory system of the newborn must adapt to a gaseous environment.
Although the newborn consumes about twice the amount of oxygen as an adult
does, respiration tends to be rapid, shallow, and unsynchronized, with the abdomen
doing more work than the chest.
The digestive and circulatory systems also must make transition to independent functioning. The visual system is incomplete because of immaturity of the retina and optic nerve. M oto r skill s of the neonate are mainly characterized by primitive reflexes and random gross motor activity.
9. Find the synonyms for the following words in t he texts:
12
lanugo – лануго (тонкие, мягкие безоболочные волосы плода или эмбриона)
13
vernix caseosa – сыровидная смазка (жировая субстанция, покрывающая ко-
жу плода)
145
10. Fill in the blanks with suitable preposition s. Translate the senten ces:
1) Many neonatal problems may arise … the second day of life … apparently well
babies. 2) The low birth weight babies may need an environmental temperature …
35. 3) Some babies will require special care because … prematurity, low birth
weight, congenital malformation, birth trauma, or other disabilities. 4) The factors
which predispose … infection are maternal infection, premature birth, prolonged
rupture … amniotic membranes and prolonged labor. 5) The mother’s mental and
physical health … pregnancy are … great importance to her unborn child. 6) Constant supervision and care during the prenatal period may help … detecting and
preventing possible complications … pregnancy, difficulties in labor, neonatal
morbidity and mortality. 7) Maternal infection rubella virus … the first trimester of
pregnancy may cause … the infant deafness, cataract, cardiac defects, and sometimes brain dam a ge.
11. Ask w h-questions to the text to make its plan. Retell the text according to
your plan.
12. Read and translate the text:
JAUNDICE
Neonatal jaundice is jaundice that begins within the first few days after birth
(jaundice that is present at birth suggests a more serious condition). In fact, bilirubin levels in the blood become elevated in almost all infants and jaundice occurs in
more than half. Usually this condition represents a normal physiological phenomenon and does not cause pr oblems.
The cause of normal, physiological jaundice is well studi ed. During the embryonic life, the red blood cells of the fetus contain a type of hemoglobin different
from one that is present after birth. When the infant is born, his body begins to destroy the red blood cells containing the fetal-type hemoglobin and replaces them
with the red blood cells with adult-type hemoglobin. The liver of the newborn in-
146
fant is not mature, and its ability to process and eliminate bilirubin is limited. As a
result bilirubin accumulates in the blood. Within two or three weeks, the destruction of red blood cells completes, the liver matures, and the bilirubin levels return
to normal.
There is another uncommon syndrome associated with neonatal jaundice, referred as breast milk or breast-feeding jaundice. In this syndrome, jaundice appears
to be caused by breast feedi ng. Although the cause of this type is unknown the re is
a hyp othesis that breast milk has some substances that reduce the ability of the liver to process and eliminate bilirubin. In breast milk jaundice, the bilirubin levels
rise and reach its peak approximately in two weeks, remain elevated for a week or
so, and then decrease to normal within several weeks or months. If there is no serious cause of this condition, for example such as biliary atresia, breast milk jaundice itself does no t cause pr ob lems for the infant.
However prolonged elevation of bilirubin levels can cause neurological
damage to the infant and therefore requires treatment. Therapy usually consists of
phototherapy with artificial or natural sunlight and, in more severe cases exchange
transfusion is administered.
The benign nature of physiologic and breast milk jaundice should be differentiated from he molytic disease of the newborn. This disease is a much more serious, sometimes life-threatening cause of jaundice in newborns due to blood grou p
incompatibilities between mother and fetus, i.e. Rh incompatibility. This incompatibility results in hemolysis. Fortunately thanks to modern management of pregnancy this type of jaundice is rare.
13. Answer the questions:
1. How many types of neonatal jaundi ce do you know?
2. When does phy sio lo gic a l j au ndic e us ua lly occur?
3. What is the cause of physiologic al jaundice?
4. Why does biliru bi n le vel be c ome elevated ?
5. How long does physiological jaundice last?
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6. What’s the cause of breast milk jaundice?
7. How long does it last?
8. What treatment is usually administered in prolonged elevation of bilirubin
levels?
9. What is hemolytic disease of the new b or n?
10. What does it result in?
14. Give the Ru ssian equivalents:
1) bilirubin level, 2) the embr yonic life, 3) the fetal-type hemoglobin, 4) to process
and eliminate bilirubin, 5) destruction of red blood cells, 6) uncommon syndrome,
7) biliary atresia, 8) neurological damage, 9) life-threatening cause of jaundice, 10)
modern management of pregnancy.
15. Give the English equivalents:
1) не вызывать проблем, 2) физиологическая желтуха, 3) накапливаться в
крови, 4) длительное повышение уровня билирубина, 5) искусственный и ес-
тественный солнечный свет, 6) обменное переливание крови, 7) гемолитиче-
ская болезнь новорожденных, 8) несовпадение резус-факторов, 9) приводить
к гемолизу, 10) оставаться повышенным.
16. Give the English equivalents to the word combinations in brackets. Translate the sentences:
1. (Желтуха) occurs very frequently in the newborn, and its termination is favourable, it is so-ca lled (физиологическая желтуха). 2. Ex cessive ( разрушение крас-
ных кровяных клеток) cause accumulation of large amounts of (билирубин) in
the fetal blood which results in the appearance of jaundice. 3. In severe cases Rh
affected babies require treatment with blood transfusion of a special type, i.e. (об-
менное переливание крови). 4. Newborn infants are sometimes infected by a severe form of jaundice caused by (несовместимостью) of maternal and infant’s
148
blood. 5. An infant that is born earlier than 280 days after conception is considered
to be (недоношенный) or preterm infant. 6) The main characteristic features of
rematurity are (вес при рождении) less than 2,500 g, unproportionally large head,
open (задний и боковые роднички), skin covered with lanugo. 7) Observation
has shown that, even when the course of birth is normal intracranial hemorrhage
may sometimes occur in (новорожденных детей).
17. Translate the sentences with “modal verb + Perfect Infinitive” constructions which are rendered by:
can (could) + Perfect Infinitive – (вероятно) мог, (не) может быть, чтобы
may (might) + Perfect Infinitive – может быть, возможно, вероятно
must + Perfect Infinitive – должно быть
should + Perfect In fi nit i ve – следовало бы (нужно было бы)
1. The hyperbilirubinemia could have been due to bacterial sepsis, prematurity, or
both. 2. Maternal hepatomegaly may have resulted in failure to metabolize the fetal
bilirubin. 3. Late respiratory depression should have been expected and the personnel could have prepared the adequate equipment. 4. In both cases there were some
additional factors which might have caused or contribute to death. 5. These complications might have been avoided by a more limited surgical procedure during
the neonatal period. 6. The changes in the CNS must have been caused by the severe hypertensive state. 7. The normal mental development in our patient at the age
of four months suggests that severe neurological impairment may not have an inevitable consequence of uremia in the newborn period. 8. Large doses of immune
globulin were administered to the infant at birth because it might have prevented
disseminat io n of vir us.
18. Read and translate t he text. M ake a summary:
EXAMINATION OF THE NEWBORN
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The initial examination should be performed as soon as possible after delivery to detect abnormalities and to establish a baseline for subsequent examination.
This examination should take place in the delivery room. A second and more detailed examination is performed within 24 hours after birth. No infant should be
discharged from the hospital without final examination. Pulse, respiratory rate,
temperature, weight, length, head circumference and any visible or palpable structural abnormality should be recorded.
Examining the newborn requires patience, gentleness, and procedural flex-
ibility. If the baby is quiet and relaxed at the beginning of the examination, palpation of the abdomen or auscultation of the heart should be performed first before
the more disturbing manipulation are done.
General appearance: pallor, jaundice or cyanosis. Features of syndromes like
Down’s syndrome, Turner’s syndrome, etc. Is the baby appropriate for the period
of gestation: small or large, lan ugo or evidence of postmaturity?
Skin: birth marks, miconium staining, cyanosis, subcutane ous bleeding etc.
Head: size, tension of fontanelles, cephalhacmaloma or depressed fractures,
head circumference, sternoasto id swelling.
Face: fades, jaws, hare lip, ptosis or cataract, subconjunctival he morrhage.
Arms and hands: proportions of arms or fingers, number of fingers, normal
movements, Erb’s palsy, palmar creases, edema.
Chest: distortion, recession, distress, respiratory rate, air entry, additional
sounds, etc.
Cardiovascular syste m: apex, precordial impulse, pulse, heart murmurs.
Legs and feet: proportions of legs and feet, club foot, femoral pulse, test for
congenital dislocation of the hip by Ortoloni’s test.
19. Read the text and give its annot ation:
NEONATAL RICKETS
150
Premature infants can, during the first 3-4 m onths of life, have hy pocalcemia
associated with bone hypomineralization or frank rickets. Often there is a history
of severe BDP and chronic diuretic therapy. Phosphate deficiency may predominate.
Evaluation
1. Monitor s erum calcium and phosphorus biweekly in infants at risk.
2. Alkaline phosphatase cannot be used as sole measurement due to pooor
correlation with other biochemical and X-ray findings.
3. Evaluation of bone mineralization is necessary when biochemical abnor-
malities are noted. Routine X-ray screening at 6-9 weeks can be justified to identify severe osteopenia.
4. Complete evaluation requires a serum PTH measurement.
5. Severe demineralization occurs most frequently when a phosphorus defi-
ciency is superimposed on 25-OHD deficiency. Human milk and infant formulas
often do not meet the needs of the very small premature infant, leading to classical
phosphate-deficiency rickets.
6. With severe vitamin D deficiency, osteopenia, low normal calcium, low
phosphorus, high alkaline phosphatase, and an elevated PTH or generalized aminoaciduria are seen.
Therapy
1. Infants with rickets or severe osteopenia have been successfully treated
with oral vitamin D at dose of 4000 IU\day. Vitamin D deficiency rickets has been
treated with oral 1.25-dihydroxy-vitamin D in doses of 0.04 – 0.08 µg/kg /day 9up
to maximum of 1-2 µg/day).
2. Improved mineralization may be seen on a high calcium-high phosphorus
formula with a calcium-phosphorus rat io b elow 2: 1.
20. Read the text. Describe d ifferent genetic disorders:
BIRTH DEFECTS AND GENETIC DISORDERS