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Objective. To study the morphometric characteristics and splenic immune cell response in patients with COVID-19.Material and methods. A prospective observational study included 70 patients. Of these, 45 patients admitted to the infectious diseases hospital with Coronavirus infection caused by the SARS-CoV-2 virus diagnosis were included in the COVID-19 group, and 25 patients were included in the acute respiratory viral infection (ARVI) comparison group. Spleen linear dimensions, including length, width, and thickness were assessed using ultrasound imaging, and calculations of the spleen weight and spleen weight coefficient (SWC) were obtained. Additionally leukocyte count and formula, erythrocyte sedimentation rate (ESR) were estimated, and the leukocyte index (LI) and neutrophil-to-lymphocyte ratio (NLR) were calculated.Results. Microsplenia was common in the acute period of COVID-19 with mean SWC value 1.6±0.2. In 17 (37.8%) patients the SWC varied from 1.0 to 1.5, and in 9 (20%) microsplenia was critical with SWC

The purpose of this study was to assess acquired knowledge and practical skills in foreign medical students (FMS) after theoretical and practical training in cardiopulmonary resuscitation.Material and methods. We conducted a prospective randomized trial «Simulation-based CPR training among international medical students: perspectives for medical education» envolving students undergoing training in the 31.05.01 specialty — General Medicine in English. Sealed envelope randomization was used to assign the participants (N=71) to 3 groups. European Resuscitation Council (ECR) educational Guidelines for Resuscitation was studied by students of all 3 groups. Group 1 (N=21) students did not receive additional training materials and practices. Group 2 (N=25) students were additionally provided with a link to a video lesson on CPR on the ECR Youtube channel. Students from Group 3 (N=25) were additionally involved in developing 3 mind maps: on the anatomy and physiology of the heart and CPR algorithm. All participants underwent theoretical training at the 1st stage, and «Basic Cardiopulmonary Resuscitation and Automated External Defibrillation (AED)» simulation training at the second stage. At the end of the course, students’ practical skill in performing continuous chest compressions were examined.Results. The majority of examinees passed the ECR platform test on the first or second attempt. The participants of the simulation course demonstrated high learning efficiency: there were no statistically significant differences between the groups in the number and average frequency of compressions performed. Almost all participants correctly performed hand placement in the center of the chest for chest compression. Decompression phase efficiency reached 71–77% (P=0.811) in all groups. The majority of examinees performed chest compressions to the required depth and with the recommended frequency (P=0.62).Conclusion. The educational project initiated by foreign students yielded positive results: acquired knowledge of CPR algorithm, gained essential techniques of performing chest compressions and giving rescue breaths, retained skills in using automated external defibrillator, as well as teamwork skills.

Aim of the study: to develop an additional professional competence «Emergency care in cardiac arrest» and to evaluate a set of tools for its development among the graduating students majoring in general medicine (code 31.05.01).Material and methods. The study was done in two stages. During the first stage, within the framework of PC (professional competence)-11 «Readiness to participate in providing first medical aid in conditions requiring urgent medical intervention» an additional professional competence «Emergency care in cardiac arrest» was developed with the definition of performance assessment. During the second one, the scientific research was conducted at the medical institute of the Immanuel Kant Baltic Federal University during the study of Anesthesiology, resuscitation, and intensive care, which has been included in the block 1 discipline (module) list, being a basic part of the General Medicine curriculum (code 31.05.01). The study involved 140 six-year students majoring in general medicine (code 31.05.01). The students were divided into two groups. The main group included 80 students who studied in 2021 (average age 25±1.5 years), while the control group comprised 60 participants who studied in 2019 (average age 25.9±1.6 years, retrospective analysis).Results. An additional professional competence «Emergency care in cardiac arrest» and its stratified structure have been developed. Specific elements were elaborated for each component stratum. Based on the developed elements, which were mastered by the student in the process of training, the necessary competence was developed. The novel pedagogical technologies in the curriculum contributed to more effective learning and development of the competence. The levels of development of additional professional competence «Emergency care in cardiac arrest» differed between the groups. Most students in the control group had a threshold level of competence. The basic and advanced levels of competence were significantly higher among the students in the main group compared with the control group (P

The aim is to study the current aspects of resident training in anesthesiology and intensive care. The article focuses on the theoretical training of residents, the importance of a thorough knowledge of pathophysiology, and the formation of clinical thinking. Opportunities for the use of innovative educational computer technologies in residency training are shown. A consistent interdisciplinary pedagogical interaction makes it possible to improve the outcomes of residency training by achieving the main goal of developing a physician who has acquired universal, general and specific professional competences and is capable of providing high-quality medical care.

The spleen is a secondary immune and the largest organ of the reticuloendothelial system, actively involved during infectious mononucleosis. Clinically, assessing a degree of organ involvement in the pathological process seems unlikely. As a rule, only palpation and percussion are used to determine the size of the spleen, which represents a late and subjective sign of potential splenomegaly. Ultrasound examination provides ample opportunities to estimate the spleen size during infectious mononucleosis. Our study was aimed at identifying morphometric and Doppler ultrasound changes in the spleen in patients with infectious mononucleosis. Materials and methods. There were enrolled 24 patients with infectious mononucleosis to be compared with 30 healthy medical institute students in control group. All participants underwent splenic ultrasound examination. Spleen echotexture and contour clarity together with measuring linear dimensions: length, width, and thickness were analyzed. Splenic artery and vein velocity parameters were measured at the gates of the spleen. Elastographic window for fibroelastometry was positioned within the window for standard grayscale examination. Measurements were performed at 5 or more points of the spleen parenchyma at least 4—5 mm away from the capsular zone and the zone of large vessels. Based on the morphometric measurements obtained, the mass, spleen mass coefficient (SMC), as well as the spleen mass/body height ratio and spleen mass/body surface area ratio were calculated. Results. We found that patients with infectious mononucleosis had the length, thickness and weight of the spleen significantly greater than those observed in control group. However, the mass of the spleen varies widely and justified to calculate the CMS as an objective criterion to assess the size of the spleen. It was revealed that infectious mononucleosis may proceed in one of the three variants of the splenic response: decreased size, CMR < 1.5; normal size, CMR ranged from 1.5 to 4; splenomegaly, CMR > 4. Splenomegaly is associated with increased organ stiffness, peak blood flow velocity and pressure in v. lienalis, as well as periportal lymphadenopathy. Identified changes are characteristics of young patients. Conclusion. Ultrasound examination of the spleen is of high diagnostic value for patients with infectious mononucleosis allowing highly accurate assessment state of the immune organs in the acute disease period. At the preclinical stage, gradation of splenomegaly is possible depending on its intensity, assessed hemodynamics and organ stiffness.

Diagnostic morphometric criteria for splenomegaly in children with infectious mononucleosis are established using ultrasound. The study included 29 children with infectious mononucleosis. The average age is 11.7 ± 3.5 years. A morphometric measurement of the length, width and thickness of the spleen, elastometry (EM), and lymph nodes were evaluated. The spleen mass was determined by method of O.V. Vozgoment, coefficients: the ratio of spleen mass to body mass (KMS, Km), body length (KI), body surface area (Ks). The average CCM value was 6,47 ± 2,8, the absolute value of the indicator varied from 1,9 to 14,2. According to the CCM, patients are divided into 3 groups: group A – 6 (20,7%), group B – 11 (38%), group C – 12 (41,3%). The average mass of the spleen was 332,5 ± 119.6 g, the CMS – from 7,7 to 14,2, the average value of the indicator – 8,6 ± 1,9. In group B the mass of the spleen, compared with group C is 1,2 times less. In group C the spleen mass is statistically significantly greater compared with groups A and B. In group C, spleen rigidity was increased in 42,9% of cases. The average EM value is 15,8 ± 4,8 kPa. A negative correlation between the average strength between EM and age (r = – 0,65, p = 0,01) was revealed. A direct relationship was found between the mass of the spleen and the CMS, and lymphadenopathy of various localization, often periportal lymph nodes.

The aim of the study is to provide a rationale for the morphological diagnostic criteria of respiratory distress syndrome (RDS) and acute respiratory distress syndrome of the newborn (ARDSN) in extremely preterm newborn infants.Materials and methods. Autopsy protocols of 31 newborns were studied. The average gestational age of children was 28.9±5.3 weeks, body weight at birth was 1404±945 grams. Fifty eight percent of newborns in the sample had extremely low body weight (ELBW). At birth, all newborns were found to have severe asphyxia, and the median score on the Apgar scale at the 1st minute of life was 3 [2; 5] points. In all cases there was an unfavorable course of the disease. The median life span was 72 [22; 181] hours.The results of the study. The study revealed two variants of hyaline membrane formation in preterm newborns with acute respiratory failure. Hyaline membranes in the lungs were found in 93.5% of newborns, in 51.6% of cases there was ARDSN due to the primary surfactant deficiency, in 41.9% of children ARDS was due to immature lung being exposed to various direct and indirect damaging factors. In all cases a distinct morphological pattern in newborns with the hyaline membranes was identified: immaturity and antenatal damage to air-blood barrier, pneumonia, microaspiration, ischemia of the lungs.Conclusion. Acute respiratory distress syndrome is typical for 41.9% of extremely preterm infants, its development is favored by exposure of immature lungs to direct (congenital pneumonia, amniotic fluid aspiration) and indirect (severe perinatal hypoxia with ischemia, shock, hemorrhagic syndrome) damaging factors. Morphological signs of ARDS were most often found in newborns with congenital pneumonia, asphyxia, neonatal aspiration of amniotic fluid.

Pain management is a foreground task of physicians specializing in various disciplines. Special attention is paid to the issues of early comprehensive rehabilitation of post-stroke patients and prophylaxis of probable long-term complications related to injuries of different brain structures.Post-stroke thalamic syndrome is the most frequent multiform complication that requires multidisciplinary efforts. Understanding of the morbid physiology of pain thalamic syndrome is the cornerstone of successful management providing higher quality of patients’ life. Currently, profound changes have taken place in the prophylaxis, diagnosis, and management of post-stroke thalamic syndrome. This review highlights the most common types of pain experienced by patients after thalamic stroke, presents morbid physiological mechanisms of pain development depending on the location of ischemic brain injury, and discusses the issues of up-to-date management and rehabilitation of post-stroke thalamic syndrome patients.

The purpose of the study is to determine early non-invasive (ultrasound) diagnostic criteria of splenomegaly in neonates with a high risk of congenital or postnatal infection.Materials and methods. In the prospective study, 163 newborn infants of the first week of live were included. All neonates included in the study were classified as possessing a high risk of an intra-uterine infection (IUI). Depending on the birth weight, the infants were split into two groups: group «А» — 80 full-term newborns with normal birth weight, and group «В» — 83 full-term newborns with fetal growth restriction (FGR). A comprehensive examination of newborns including spleen ultrasound was carried out.Results. An increased spleen weight coefficient (Km) was found in newborns with high risk of infection development that included congenital oromaxillofacial and gastrointestinal defects, perinatal contacts with various microorganism. The increased spleen weight and Km reflected conditions of the immune system organ of the newborn in response to an adverse exposure including infection.Conclusion. Ultrasound examination of morphometrical characteristics of the spleen in newborns with various medical conditions represents a convenient and simple method of early diagnosis of splenomegaly. The most sensitive index is the spleen weight coefficient (Km), which reflects the immune system organ response to an adverse perinatal exposure including contact with an infectious agent. The mean spleen weight coefficient is within the range of 1.1 to 3.0. When the index exceeds 4, the risk of development of an infectious disease increases. This method can be used as a screening approach for newborns of different gestation age who have been included in the high-risk group based on a congenital or early postnatal infection.

The purpose of the study is a comprehensive assessment of morphological changes in the placenta and lungs to detect early signs of congenital pneumonia in extremely premature infants.Materials and methods. Protocols of post-mortem examinations of 23 preterm newborns died from severe respiratory failure were analyzed. The average gestational age of the newborns was 26.4±2.7 weeks and the body weight at birth was 972.4±355.8 grams. In the sample, 78.3% of infants had an extremely low birth weight (ELBW). At birth, all newborns presented severe asphyxia. Newborn underwent several types of respiratory therapy since birth: Mechanical ventilation was performed in 65.2% of newborns since their birth, non-invasive ventilation was performed in 26.1% of cases, and 8.7% of patients underwent oxygenotherapy through a facial mask. In all cases, there was an unfavorable course of the neonatal period, a progressive deterioration of newborns' condition, and a lethal outcome. A comprehensive histological examination of the placenta and the lungs of deceased premature newborn infants was performed.Results. Congenital infections of different localizations remain the leading cause of death.Congenital pneumonia and generalized infections are clinically manifested at birth by severe perinatal hypoxia and respiratory failure. In the case of congenital pneumonia, the morphological patterns are polymorphic and characterize the severity of lung damage. For some newborns, these patterns include accumulation of exudates and fibrin, segmented leukocytes, fragments of basophilic coccal microflora, and a large number of colony forming bacilli, and desquamated alveolocytes with a deformed nucleus are visualized in the deformed lumen of the alveoli and bronchi. Diffuse lymphoid-leukocyte infiltration in the septa and respiratory parts of the lungs are typical for other infants. Histological examination find lumpy or lamellar eosinophilic hyaline membranes in alveoli in specimens from these newborns. Diffuse, focal or confluent segmentonuclear infiltration in various lung structures is commonly combined with hyaline membranes of various localizations and sizes. Hyaline membranes were detected in 93.5% of cases.Conclusion. Very early preterm delivery is associated with intrauterine pneumonia and systemic infection in extremely premature infants. Early clinical and laboratory signs of intrauterine infectious lung include severe perinatal hypoxia, very low Apgar score and laboratory test findings (hypoxaemia and decompensated metabolic lactate acidosis) that are resistant to standard resuscitation measures. Hypoxemia and decompensated metabolic acidosis persisting during the first hours of postnatal life indicate the severity of intrauterine lung damage and require a rapid change of treatment aimed at normalization of lung function, prevention of complications in the respiratory system, hemostasis and central nervous system. Clinicians should be better informed about the features of early postnatal adaptation of extremely premature infants with congenital pneumonia to provide appropriate treatment.

For many decades, the world community’s efforts have been aimed at reducing the neonatal and infant mortality from intrauterine infections. In 1990, the United Nations and the World Health Organization set out the priority of decreasing children mortality by 2015 году. In spite of impressive success in newborn treatment, mortality due to sepsis decreases slowly; when survive, postnatal children develop central nervous system impairments of different level of severity. In the recent decade, new data have emerged concerning the methods of intrauterine infections prophylaxis, diagnosis, and treatment. The purpose of the review is to present data concerning specifics of pregnancy course when infections develop, contemporary diagnostic methods including studies of interleukins, placenta morphology, allelic genes, and to reflect the current approach to the treatment of intrauterine infections in newborns.

The purpose of the study. To study parameters of the lipid metabolism in newborn infants to identify general patterns depending on the gestational age.Materials and methods. The course of pregnancy and its outcome was analyzed in 286 women who gave birth to 323 infants; 89 of them were born in multiple pregnancies. The infants were divided into 4 groups depending on the gestational age. Levels of cholesterol (C), triglycerides (TG), low-density lipoproteins (LDL) and high-density lipoproteins (HDL) were tested in the central venous blood immediately after birth and on the 5th day of life.Results. Hypotriglyceridemia below 0.2 mmol/l was typical for 31.3% of the newborns; a TG level within the range of 0.21—0.5 mmol/l was found in 43.3% of infants, i.e. the perinatal production of TG was decreased in 76.6% of infants. The perinatal TG production depended on the infant's gestational age: the smaller it was, the lower TG blood level was in infants at birth. At the gestational age of 25—33 weeks, the perinatal TG production was low in most newborns. The perinatal production of the lipid metabolism parameter was increased with the increase of the gestational age. The TG blood level increased rapidly at the gestational age of 37 weeks. The postnatal TG production in the blood of newborn babies had no dependence on the gestational age strating from the gestational age of 31 weeks and more. Hypercholesterolemia and lower both LDL and HDL levels were found in newborns of all groups at birth; no significant intergroup differences in concentration of C, HDL or LDL were observed (P>0.01).Conclusion. The state of the lipid metabolism in the newborns in the perinatal period depends on the gestational age and the birth weight. Low TG production is typical for small premature infants with a low and extremely low birth weight due to physiological immaturity of organs and systems. The peculiarities of the prenatal morphogenesis make an adequate lipid metabolism possible by the full-term gestational age only. An abnormal course of pregnancy impairs normal triglyceride, C, LDL and HDL production. The greatest changes of the tested parameters are typical for small immature infants with a gestational age of 25—31 weeks. This age is associated with a high incidence of the respiratory distress syndrome. Deficiency of buffer bases affects the TG production at birth; the pH value and blood oxygen tension at birth affect the C level. The production of lipid metabolism parameters increases with the increase of the gestational age. There are certain individual characteristics in newborns who may have perinatal disorders of the lipid metabolism at the full-term gestational age.

Aim. To study the red blood cell (RBC) morphology in newborn infants with a history of perinatal hypoxia using the atomic-force microscopy. Material and methods. The state of RBC membranes of 10 newborns with a history of perinatal hypoxia was studied. All infants were born with low Apgar scoring; the following resuscitative measures were carried out at birth: tracheal intubation, mechanical ventilation (MV). The study group newborns were transferred from the delivery room to the ICU, where MV was started. To obtain images of normal red blood cells in the field of the atomic force microscope (AFM), 14 full-term newborns delivered after a favorable course of pregnancy and normal term labor were enrolled in a reference group. Results. Discocytes and planocytes comprised 36% of the total red blood cell count in the residual umbilical cord blood of newborns with a history of perinatal hypoxia; there was a decreased amount of normal RBC forms, thus demonstrating an unfavorable effect of hypoxia on newborn's RBC membrane. Poikilocytosis was typical for infants exposed to perinatal hypoxia; transitional forms of RBCs (stomatocytes and echynocytes) were visualized. Stomatocytosis and echynocytosis were typical for 80% of newborns. Stomatocytosis persisted in full-term newborns exposed to hypoxia complicated with aspiration of neonatal meconium. The analysis of RBC membrane nanostructure demonstrated that the first-order height (h1) experienced the greatest alterations at birth in newborns with perinatal hypoxia; it was 4.2 times as much as the similar parameter in healthy newborns. Estimations of second-order height (h2) parameter values demonstrated a two-fold increase showing that the spectrin matrix also changed under the effect of hypoxia. The third order value (h3) was significantly higher in newborns with perinatal hypoxia, than that in healthy infants. Therefore, perinatal hypoxia causes antenatal complete damage of nanostructures of RBC membranes. Conclusion. Perinatal hypoxia alters RBC morphology and impairs the nanostructure of membranes. These changes confirmed the effect of the hypoxia degree on all nanostructures of RBC membranes: phospholipid bilayer, protein elements of the membrane, spectrin matrix. Changes in heights and spatial periods of the red blood cell membrane surfaces h1 and h3 associated with hypoxia apparently are aimed at a compensatory increase in the red blood cell membrane surface contributing to the increase of the gas exchange area. These changes may represent adaptive responses to hypoxia aimed to preserve the functional capabilities of red blood cells. The course of an early adaptation period (post-hypoxic period) is characterized by the instability of all nanostructures of red blood cell membranes and a greater variability of morphological forms. Effects of perinatal hypoxia on the red blood cell membrane persist for some time and go beyond the early neonatal period.

The purpose of the study is to evaluate morphological changes in lung vessels of preterm infants with the infant respiratory distress syndrome (IRDS).Material and Methods. Case history records and postmortem examination protocols of 70 preterm infants who died because of severe respiratory compromise as a result of IRDS were analyzed. All newborns were divided into three groups: the IRDS group included 25 (35.7%) infants who died due to IRDS (no surfactant); the Curosurf group was composed of 26 (37.2%) infants who received an exogenous surfactant Curosurf as a part of a complex therapy; the Surfactant BL group included 19 (27.1%) infants receiving Surfactant BL. Histological and morphometric examinations of lung vessels were performed. The Kernogan index calculated as the ratio between the lumen diameter and the wall thickness was determined.Results. The arterial bed of newborns in the IRDS and Curosurf groups was composed of vessels having up to several μm in diameter. Larger arteries (51—100 μm in diameter) and arteries of more than 100 μm in diameter are distributed uniformly and comprise 1/3 of the total number of visualized vessels. The invert correlation of the arterial vascular bed was typical for the infants in the Surfactant BL group: arteries of 50 μm in diameter comprise 30% of all vessels, and arteries of more than 100 μm in diameter prevail. The venous bed of newborns consisted mainly of vessels having less than 50 μm in diameter. The greatest changes in the arterial wall thickness (ТСА) are typical for vessels with a total diameter of more than 51 μm. In babies of the IRDS group, the greatest (ТСА) changes were typical for arteries of 51—100 μm in diameter. Changes in arterial walls (>101 μm) were typical for the Surfactant BL group. Unlike other groups, in the Curosurf group, no significant changes in the parameters under the test were found (P>0.05). In this group (as compared to IRDS and Surfactant BL groups), there were minimal changes in vein characteristics and the minimal venous wall thickness (ТСv) (>100 μm in diameter). The Kernogan index for veins with small diameter was minimal.Conclusion. Evaluation of the microcirculatory bed of lungs in IRDS patients is an urgent problem because the pulmonary gas exchange impairment in preterm infants is primarily caused by circulatory and microcirculatory disorders of various degrees of severity that result from anatomic and functional immaturity of the lung micro circulatory bed. In cases of unfavorable outcomes, dilation of arterial and venous lumen and vascular wall thickening might be considered as principal signs of microcirculatory disorders. Surfactants affect changes in the diameter of lumen of lung vessels, especially those with a diameter more than 50 μm, presumably improving the blood supply of the lungs. Minimal changes of tested parameters were typical for newborns on Curosurf versus IRDS and Surfactant BL groups of infants.

Objective: to demonstrate the course of early period of postnatal adaptation of a premature newborn born from a mother with type 1 diabetes mellitus (T1DM), characterized by abnormal glucose and lipid metabolism. Adverse factors included complications during pregnancy.Conclusion. Medical examination of the newborn born from a mother T1DM included the assessment of glycemic profile and a full evaluation of metabolism, including lipid metabolism. Respiratory therapy was selected based on clinical and laboratory data. The aim of care was normalize the metabolism and eliminate hypoxia and its consequences as soon as possible. The highfrequency oscillatory ventilation was the possible priority in the selection of mechanical ventilation mode, which allowed to quickly eliminate hypoxia. This strategy resulted in reconstitution of spontaneous breathing, the normalization of metabolism and stabilization of the newborn's condition by the end of the early neonatal period.

Objective. Investigate the impact of the course of pregnancy and labor on some lipid metabolic disturbances in newborn infants.Subjects and methods. The anamnestic data of the course of pregnancy, which were used to identify a high risk for intranatal hypoxia and the birth of a critically ill baby, were analyzed in 217 pregnant women. In addition to assessment of a baby's status at birth, the newborn infants underwent measurements of cholesterol and triglyc-erides in their central venous blood just after birth and on day 5 of life Results. The low levels of triglycerides and cholesterol are an inherent feature in the newborns born via an emergency cesarean section due to bleeding-complicated placental presentation or abruption and other obstetric causes. The most critical plasma level of triglycerides in extremely premature infants born at 22—29 weeks' gestation and in those having extremely low birth weight was no more than 0.01—0.2 mmol/l. Gestational age and birth weight have an impact on the production of triglycerides. Acute intranatal hypoxia affects the perinatal concen-tration of cholesterol in the newborns; the severer is hypoxia, the lower are blood cholesterol levels.Conclusion. Varying perinatal triglyceride and cholesterol metabolic disturbances are specific in newborn infants with respiratory failure who were born via an emergency cesarean section due to placental abruption or discoordinated labor activity. The low blood levels of the test substances are detectable in babies at birth. Gestational age and birth weight are another factors that influence blood triglyceride concentrations. The lowest triglyceride levels are a characteristic feature in newborn infants at 22—29 weeks' gestation and in those having extremely low birth weight.

The review considers mechanisms for the development of respiratory failure caused by lipid metabolic disturbances. It gives data on the lung surfactant composition and lipid imbalance in severe concomitant injury, sepsis, and gestosis. Information on the prenatal and postnatal synthesis of triglycerides and cholesterol is detailed.

Objective: to conduct an atomic force microscopy (AFM) study of the red blood cell nanostructure in neonatal infants with ABO and rhesus (Rh) isoimmunization. Subjects and methods. The investigation included 27 neonates, including 13 infants with Rh sensitization and 14 with ABO isoimmunization. The course of pregnancy complicated by Rh sensitization was characterized by the emergence of the blood titers of Rh D antibodies and immunoglobulin G (IgG) subclasses: IgG1, IgG2, and IgG3. IgG production increased at 34 weeks' gestation when all the subclasses were detectable in different titers. There was either Rh or ABO incompatibility between the newborns and their mothers. Differential diagnosis of isoimmunization was made in the pair of an O (I) Rh-negative mother and an A (II) Rh-positive baby. Complete blood count and blood biochemical indicators were estimated; Rh D and IgG antibody titers were determined; red blood cells from 11 neonatal infants were examined using an AFM. The investigation was performed with residual umbilical cord blood and central venous blood during neonatal treatment. Results. Combination therapy for neonatal Rh or ABO isoimmunization terminates a cascade of immunological responses and erythrocyte hemolysis, lowers bilirubin levels, but fails to influence the morphological composition and macrostructure of red blood cell membranes. The consequences of the perinatal effects on the red blood cell membrane persist for a certain time and are outside the early neonatal period.

Objective: to master and practically execute cardiopulmonary resuscitation (CPR) procedural techniques, to acquire skills to use state-of-art equipment, and to teach work in the team. Subjects and methods. Forty-six interns and residents took a simulation course of training in basic CPR and automatic external defibrillation. Three-four days before the course, its participants received the certified translation of the European Resuscitation Council (ERC) information material and studied it. The course education program encompasses lectures, lessons on a medical care algorithm in sudden cardiac arrest, and practical works using models, including chest compression, ventilation, and automatic external defibrillator (AED) training. The duration of the course is 6—7 hours. Results. All the interns and residents were motivated to learn: to acquire first aid skills to manage sudden cardiac arrest. The ERC algorithm and a 4-stepped model to have practical skills were used. The taken course met expectations in 100% of the participants; all the interns and residents adequately acquired practical CPR skills and successfully completed their training. A questionnaire survey at the end of the course showed the high efficiency of the course. The training enhanced motivation in 29 interns and residents; they obtained an ERC provider degree; 10 interns and residents continue to take a course of training as an ERC instructor.

Objective: to study the nanostructure of red blood cell membranes and erythrocyte index in preterm neonatal infants.Subjects and methods. The trial enrolled 47 neonatal infants, including 33 preterm infants who were included in a study group and 14 fullterm infants who formed a comparative group. The gestational age of the preterm infants was 33.3±1.9 weeks and the birth weight was 2065.4±304.8 g. Red blood cell counts, hemoglobin, and erythrocyte indices were estimat ed and the red blood cells were examined using an atomicforce microscope.Results. At birth, the preterm infants showed macrocytosis, intrauterine poikylocytosis, and the impaired nanostructure of red blood cell membranes. Intrauterine hypoxia affects the red blood cell membrane nanostructures: a phospholipid bilayer and a spectrin matrix, without damaging the membrane protein component. The detected changes are reversible and directed to maintaining the functional ability of red blood cells in a critical situation. At birth, gestational age, a baby's weight, hemoglobin, and blood cholesterol and standard bicarbonate levels influence the parameters of a red blood cell component. The early neonatal period was characterized by an active process on the red blood cell membranes and a change of morphological forms, suggesting the continuing postnatal rearrangement of erythropoiesis and a preterm infant's adaptation to new environmental conditions.

Objective: to evaluate the efficiency of inhaled surfactant therapy in neonatal infants with respiratory failure.Subjects and methods. The trial enrolled 13 premature neonatal infants; their mean gestational age was 31.8±2.8 weeks and the birth weight was 1825±600.9 g. They had a oneminute Apgar score of 4.3±1.4. All the neonates needed mechanical ventilation (MV) atbirth because the leading clinical sign was respiratory failure caused by acute intranatal hypoxia, neonatal amniotic fluid aspiration, respiratory distress syndrome (RDS), and cerebral ischemia. Curosurf was injected in a dose of 174.7±21 mg/kg in the infants with neonatal RDS at 35 minutes of life. All the babies included in the study were noted to have severe disease and prolonged MV. After stabilization of their status, the neonates received combination therapy involving surfactantBL inhalation to reduce the duration of MV. The dose of the agent was 75 mg. Results. After surfactantBL inhalation, effective spontaneous respiration occurred in 69.2% of the newborn infants; successful extubation was carried out. The median duration ofMV after surfactant BL inhalation was 22 hours (4—68 hours). There were no reintubated cases after inhalation therapy. Following surfactantBL inhalation, 4 (30.8%) patients remained to be on MV as a control regimen; 3 of them had highfre quency MV. SurfactantBL inhalation made it possible to change the respiratory support regimen and to reduce MV parame ters in these babies.

Objective: to evaluate the efficacy of alveofact in neonatal infants with respiratory distress syndrome (RDS). Subjects and methods. The trial enrolled 5 premature neonatal infants. Their mean gestational age was 30.2±2.3 weeks; the birth weight was 1422±604 g. All the premature neonates needed mechanical ventilation (MV) because the leading clinical sign was severe respiratory failure. The surfactant alveofact was injected endotracheally in all the neonates at 3—5 minutes of life, by taking into account their gestational age and birth MV. The mean dose of the agent was 50 mg/kg).Results. The pilot study indicated the efficacy of alveofact. There was normalization of lung gasexchange function parameters after alveofactinjection within the first 24 hours of life. Alveofact administration allows MV with the parameters close to physiological ones.

Objective: to substantiate the efficacy of bipolar impulses of different shapes and duration.Method. The investigation used the dynamic model II of the mammalian ventricular cardiomyocyte membrane in the guinea-pig, proposed by Luo and Rudy (1994—2000). The cardiomyocyte membrane was acted by substituting the current density of the impulse under study. The threshold impulse energy ratio considered as an integral index of the threshold action (a measure of efficiency) of an impulse measured in μA2 ms/cm4 was then calculated. A comparison was made between a classical quasi

The paper proposes a scheme for fuzzy-regulation of reactive power and voltage in electrical power network where static thyristor-controlled compensators are used as a source of reactive power. Description of formalized procedure pertaining to fuzzy regulator in the form of fuzzy relations between controlled (voltage) and controllable parameters of the network (current and reactive power of a condensator). An algorithm efficiency proposed for a fuzzy-logic regulator and used for regulation of static condensators has been shown on the basis of calculative experiments and an electric power network taken as an exemple

За более чем 100-летнюю историю своего существования Российское научное медицинское общество терапевтов переживало разные времена. К счастью, последние годы ознаменовались значительным подъемом активности деятельности Общества, как и всей отечественной терапии в целом. Поэтому, с одной стороны, закономерно, а с другой — весьма символично, что журнал «Архивъ внутренней медицины» начал издаваться именно сейчас. О прошлом, настоящем и о перспективах журнала, которого так долго ждали все терапевты нашей страны, рассказывает человек, внесший огромный вклад в развитие Общества терапевтов и создание «Архива внутренней медицины» — Андрей Александрович Спасский, врач высшей категории, доктор медицинских наук, генеральный секретарь Общероссийской общественной организации «Российское научное медицинское общество терапевтов».

The paper presents the results of a study of blood gas composition and acid-base balance (ABB) in the use of the Russian drug Surfactant BL in preterm neonatal infants with respiratory distress syndrome (RDS). The surfactant was given to 57 preterm neonates. A control group consisted of 52 children with RDS who had received a course of treatment before the use of the drug in the hospital. Statistical analysis indicated the virtual similarity of the study and control groups. The study demonstrated that that in Surfactant BL-treated patients, blood oxygenation (pO2, %SO2c, A-a DO2, respiratory coefficient) improved much more rapidly and the mean values of these parameters remained statistically significantly better from the end of 24 hours of treatment than in the control neonates up to the end of therapy in the intensive care unit of the maternity hospital. Studies of blood ABB showed that the neonates of both groups had moderate metabolic acidosis at the initiation of therapy. With the therapy performed, the parameters of ABB generally reached normal values within the first 24 hours of therapy. There were no obvious differences in the changes of blood ABB parameters in the neonatal infants of both groups. Analysis of the results of treatment in neonates with ABB showed a statistically significant advantage in terms of positive outcomes of treatment in the group of Surfactant BL-treated patients.

Objective: to study the nanostructure of red blood cell membranes in premature babies with neonatal respiratory distress syndrome (NRDS), by applying atomic force microscopy. Subjects and methods. The investigation included 27 newborn infants, of them 13 premature babies with NRDS formed a study group. The mean gestational age was 33.1±2.3 weeks; their birth weight was 1800±299.3 g. A comparison group consisted of 14 full-term babies with favorable pregnancy and term labor. The mean gestational age of the babies was 39.4±0.5 weeks; their birth weight was 3131.7±588.8 g; the infants had a one minute Apgar score of 8±0.4. Their red blood cells were examined using an atomic force microscope. The objects to be examined were residual umbilical cord blood (RUCB) from the premature infants; central venous blood after 7 hours of birth and neonatal venous blood taken on day 7 of life. Results. RUCB from full-term babies contained planocytes that were a major morphological type of red blood cells. In physiological pregnancy and acute fetal hypoxia, the morphological composition of red blood cells in premature neonates with NRDS was close to that in full-term babies. The planocytes are also a major morphological type of red blood cells in the premature infants; the frequency of their occurrence varies. Stomatocytes are typical of all the neonates in the NRDS group; their frequency levels vary greatly: from 8 to 65% of the total number of erythrocytes. The examination revealed that the premature infants of 31—36 weeks gestation were characterized by abnormal erythrocyte shapes that showed a high variability. At birth, the premature babies were found to have changes in the nanostructure of red blood cell membranes, which were influenced by intrauterine hypoxia. The first-order value reflecting flickering in the red blood cell membrane varies to the most extent. Conclusion. Atomic force microscopy showed that the greatest changes in the structure of red blood cell membranes were found in RUCB. The premature babies with NRDS had intrauterine poikilocytosis caused by unfavorable factors, as confirmed by the presence of multiple correlations. Analysis of the nanostructure of red blood cell membranes revealed that the first-order value reflecting flickering in the red blood cell membrane was most sensitive; this indicator showed a slow normalization. Correspondence to: Key words: red blood cell membrane, nanostructure, planocytes, stomatocytes, premature newborn infants, respiratory distress syndrome.

Objective: to study the causes of acute intranatal hypoxia and reveal a relationship of placental changes to respiratory failure (RF) in newborn infants. Subjects and methods. The investigation included 252 neonates with the complicated course of an early neonatal period. Their gestational age was 26 weeks to 40 weeks, birth weight varied from 850 g to 4100 g. 95.3% of the newborn infants were born with a low Apgar score and RF, which required mechanical ventilation immediately after birth. The neonatal status was clinically evaluated; the values of blood gas composition and acid-base balance were recorded; the pathogen was discharged from the tracheobronchial tree; chest X-ray survey and placental morphological examination were performed. Results. The main cause of neonatal respiratory failure is chronic intrauterine hypoxia caused by placental inflammatory changes and fetal-placental blood circulatory disorders, which gives rise to preterm delivery, cerebral hemodynamic disorders, and neonatal amniotic fluid aspiration. Bacteriological examination of tracheobronchial aspirations showed that no microflora growth occured in the majority of the newborns acute intranatal hypoxia. Enterococcus faecalis and Staphylococcus epidermidis were isolated in 12.3% and 8.7%, respectively. Growth of в-hemolytic streptococcus was observed in 2.8% of cases. The rate of microbial association specific only for rate premature infants with neonatal respiratory distress syndrome (NRDS) was 4.8%. Conclusion. Placental changes causing fetal-placental circulatory disorders were ascertained to be responsible for acute intranatal and postnatal neonatal hypoxia. Placental inflammatory changes occurred in the majority of cases, as confirmed by bacteriological examinations of neonatal infants. Isolation of the varying microbial flora in infants with RF to a greater extent is, indicative of the infectious process occurring in the maternal body. Key words: acute intranatal hypoxia, neonatal amniotic fluid aspiration, intrauterine infection.

to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS), by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods. The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1) 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group); 2) 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3) 90 premature newborn infants who had died from NRDS at its different stages. Results. The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric hemorrhages decreased from 28.8 to 9%), the stay length of the neonates in an intensive care unit, and early neonatal mortality rates from 9.3 to 0.9‰ and in improving demographic indicators.

Objective: to reveal a relationship of placental inflammatory changes to bacterial infection in premature neonates with respiratory failure. Material and methods. Bronchoalveolar aspirate was bacteriologically studied in 157 premature neonates with respiratory distress syndrome (NRDS); the total and differential leukocyte counts were measured in their peripheral blood. The levels of the cytokines IL-1^3, IL-4, IL-6, and TNF-a were studied in different biological fluids of mothers and their babies; the placentas were also morphologically examined. Results. An analysis of bacterial cultures from the tracheobronchial tree revealed no growth of bacterial microflora in 61.8% of cases, Enterococcus faecalis and Staphylococcus epidermidis were isolated in 6.4 and 8.3% of the infants, respectively; Staphylococcus haemolyticus, Staphylococcus capitis, Enterobacter agglomerans, and hemolytic group A Streptococcus were seen in 1.9% each; moreover, 1.3% of the newborn infants were found to have Bacillus spp., Staphylococcus aureus, Escherichia coli, Acinetobacter spp., and Serratia marcescens. Other microorganisms and a microbial association were encountered in 8.9% of cases. Placental morphological examination revealed different inflammatory changes concurrent with chronic and acute placental insufficiency. The investigation demonstrated that the maternal peripheral plasma levels of IL-1^, IL-4, IL-6, and TNF-a were within the physiological range at the end of the first period of delivery. The amniotic fluid displayed elevated IL-6 and TNF-a concentrations and normal IL-4 and IL-1e levels, suggesting that there was an intrauterine inflammatory process. Conclusion. Premature birth is associated with various placental inflammatory changes, which causes intrauterine stimulation of macrophages in the chorionic villi. Specific immune defense mechanisms that prevent the development of a fetal infectious process, i.e. the maternal infectious process, may induce preterm birth, but fail to lead to fetal and neonatal diseases. The investigation has shown that NRDS is a major disease in premature neonatal infants. Key words: intrauterine infection, premature neonates, cytokines, neonatal res piratory distress syndrome.

The present paper gives information on cytokines during pregnancy, their role in its physiological course and development of adaptation in premature neonates in the postnatal period. Key words: cytokines, preterm labor, innate immunity, premature neonate, respiratory distress syndrome.

Objective: to study lung X-ray changes in premature neonates born from multiple pregnancy respiratory failure. Subjects and methods. Forty-six premature neonates born from multiple pregnancy who had RF were followed up; of them 9 (39.1%) and 14 (60.9%) were monochorial-diamniotic and diochorial-diamniotic twins, respectively. Lung X-ray films were analyzed in 39 infants with RF. By taking into account the babies’ gestational age and the clinical picture of RF, the newborn infants were given the exogenous surfactant Curosurf. Clinical evaluation of their status and plain lung X-ray films were made. If a fatal outcome occurred, the lung was investigated morphologically. Results. There were different lung X-ray patterns: no abnormal changes; the following X-ray signs were most characteristic: a less clear lung field transparency and an increased lung pattern in the middle internal areas of both lungs; a false aspiration pneumonia pattern caused by the Curosurf remnants being present in the airways; hyaline membrane disease and congenital pneumonia were detected in 5.1% of cases. Atelectases were found with the late administration of Curosurf. Conclusion. The prophylactic administration of Curosurf causes lung X-ray changes in the premature neonates with RF. Abnormal lung changes were absent most frequently in the first 24 hours of mechanical ventilation (MV). Atelectases and intrapulmonary hemodynamic disorders were found with the later, the so-called medical Curosurf administration. The emergence of new treatments for RF, such as early transition to MV and administration of exogenous surfactants, in premature neonates alters not only the clinical, but also X-ray pattern of respiratory distress syndrome. Key words: respiratory failure, atelectases, respiratory distress syndrome, premature neonates, multiple pregnancy, lung X-ray film.

Objective: to reveal the factors that are responsible for the development of respiratory distress syndrome (RDS) and the specific features of its course in preterm twin neonates. Subjects and methods. Twenty-three patients who had had twin pregnancy, including 9 (39.1%) and 14 (60%) with monochorial and bichorial biamniotic twin pregnancies, respectively, were examined. Their mean age was 28.5±5.4 years. Obstetric and gynecologic histories, conditions at conception, the course of pregnancy, the type of pla-centation, and fetal presentation were considered. The placentas were morphologically examined. In all the patients, pregnancy ended in birth of 46 premature neonates, of them there were 19 (41.3%) boys and 27 (58.7%) girls. The gestational age of the neonates averaged 31.7±2.3 weeks. The evaluation of the efficiency of performed therapy used clinical assessment of the status of the premature neonates; measurement of partial oxygen tension (pO2) and calculation of alveolar-arterial oxygen gradient (A-a DO2), respiratory index (RI), and oxygenation index (OI); death rates were analyzed. Results. The main cause of respiratory failure (RF) was RDS in premature twins. Neonatal blood aspiration-caused pneumonia occurred in one case. The course of RDS was variable. Most neonatal infants needed exogenous surfactant replacement therapy and mechanical ventilation (MV). No signs of RF were present in 7 (15.2%) premature neonates. Conclusion. Premature twins are a high RDS risk group. The unfavorable factors that contribute to the development of the disease are multiple pregnancy, a past maternal obstetric history, in-vitro fertilization-induced pregnancy, severe gestosis in the second half of pregnancy, and preterm delivery. The type of placentation affects the fetal status after birth. Fatal outcome occurred in infants from the monochorial bioamniotic twins. In multiple pregnancies, there are pathological changes in the placenta, its membranes, and umbilical cord, which induces fetal circulatory disorders and creates unfavorable conditions for untrauterine development of the fetal lung. In premature twins, MV considerably varies in duration: from short-term to long-term, which is suggestive of the severe course of RDS in a number of cases despite the administration of a surfactant. Hgh neonata! RSD death rates recorded in the twins. Key words: premature neonates, respiratory distress syndrome, surfactant, mechanical ventilation, multiple pregnancy, type of placentation.

This paper gives information on intrauterine lung development in health and under poor conditions influencing the prenatal morphogenesis of lung tissue: threatening miscarriage, gestosis in the first and second halves of pregnancy, and placental insufficiency. It considers the development of the lung depending on fetal gender and a season. Key words: premature delivery, prenatal lung morphogenesis, premature neonates, surfactant, respiratory distress syndrome.

Objective: to perform an early neonatal ultrasound study of intracardiac hemodynamics in premature neonates with respiratory distress syndrome (RDS) during mechanical ventilation. Subjects and methods. The paper presents the results of ultrasound study of intracardiac hemodynamics in 51 premature neonates. Two patient groups were identified. Group 1 comprised 34 infants with severe RDS who received the exogenous surfactant Curosurf and Group 2 consisted of 17 apparently healthy premature newborn infants. Results. Functional tension of the cardiovascular system was characterized for premature neonates with RDS. There were signs of left ventricular systolic dysfunction within the first 24 hours of life and those of right ventricular dysfunction by day 5 of postnatal age. Within 5 days of life, there were echocardiographic signs of pump dysfunction of both ventricles: stroke volume, cardiac index, and blood minute volume. Analysis of changes in peak blood flow velocity and peak pressure gradient across the atrioventricular valves of the right and left ventricles indicated that 17.6% of the children showed increases in peak blood flow velocity and tricuspid valve pressure gradient in the systolic phase. The greatest peak blood flow velocity changes were recorded in the pulmonary artery trunk. By day 5 of life, signs of pulmonary hypertension concurrent with hydropericardium remained in 29.4% of cases. RDS – was shown to be accompanied by higher Qp/Qs ratio in premature neonates. The lower index was attended by the alleviated signs of respiratory failure. In RDS, mainly left-to-right blood shunt was accomplished through the open oval window, but the shunt intensity decreased when the pathological process was resolved in the lung. The functioning patent ductus arteriosus was hemodynami-cally significant in none case. Conclusion. The premature neonates with RDS were found to have intracardiac hemo-dynamic changes. By day 5 of postnatal age, there was no normalization of major intracardiac hemodynamic parameters although respiratory failure resolved in most neonates. Key words: premature neonates, respiratory distress syndrome, mechanical ventilation, intracardiac hemodynamics, echocardiography.

Objective: to choose an artificial ventilation (AV) mode in premature neonates with respiratory distress syndrome (RDS) after administration of exogenous surfactants and to compare the duration of AV and the development of complications in relation to the type of an exogenous surfactant. Subjects and methods. The paper presents the results of choosing an AV mode in 122 premature neonates with severe RDS. The choice of an AV mode, the duration of respiratory therapy, and the development of complications after administration of exogenous surfactants were studied. The neonatal infants were divided into 2 groups: 1) 55 neonates who were given Surfactant BL in the complex therapy of RDS; 2) 67 neonates who received Curosurf. Results. The study has demonstrated that the initial mode of ventilation (completely controlled assisted or positive end expiratory pressure) may be chosen after administration of Curosurf depending on the clinical picture of remaining respiratory failure. This policy makes it possible to preserve spontaneous breath in 29.3% of cases and to considerably reduce the duration of respiratory therapy. When Surfactant BL is used, only one initial AV mode (completely controlled ventilation) may be chosen according to the manufacturer’s guidelines as drug-induced cessation of spontaneous breathing is required. Nevertheless, the administration of Surfactant BL also facilitates recovery of effective spontaneous breathing in most neonates with RDS. Conclusion. The use of the exogenous surfactants enables the AV modes with preserved spontaneous breathing to be employed, which reduces the duration of AV and the number of complications. Key words: respiratory distress syndrome, premature neonates, Curosurf, Surfactant BL, artificial ventilation modes.

Objective: to evaluate the efficiency of artificial ventilation (AV) after administration of the exogenous surfactants Curosurf and Surfactant BL in premature neonates with respiratory distress syndrome (RSD). Subjects and methods. The paper presents the results of evaluation of the efficiency of therapy with exogenous surfactants, by examining the blood gas composition and AV parameters. The study included 122 premature neonates with severe RSD. According to the type of a used surfactant, two groups of neonates were identified: Group 1 comprised 67 neonates who were given Curosurf and Group 2 consisted of 55 neonates who had Surfactant BL. Results. The study has revealed some differences between the drugs. Four hours after administration of Curosurf, the neonates with RSD showed heterodirectional changes in partial blood oxygen tension; no abnormal changes in this index were found in most neonates; however, hyperoxia or hypoxia appeared in some newborn infants. After administration of Surfactant BL, no hyperoxia was virtually detected. Hyperoxia did not depend on the baseline oxygen fraction in the inspired gas mixture in most cases. The found changes were transient. To choose ventilation parameters was based on an attempt to bring partial blood oxygen tension closer to the normal values. The main task of the treatment was achieved: this was to carry out sparing AV in premature neonates, allowing no mechanical injury to the immature lung or ventilation complications. Conclusion. pO2 variability after administration of exogenous surfactants calls for a considerate attitude to the choice of AV parameters and an individual approach to a patient. The specific features of the pharmacological action of exogenous surfactants should be taken into account when they are used. In this connection, blood gas composition should be frequently investigated – particularly within the first 24 hours after administration of the agents in order to timely modify AV parameters.

Objective: to study a role of proinflammatory and anti-inflammatory cytokines in the pathogenesis of acute respiratory distress syndrome (ARDS) in preterm neonates. Subjects and methods. The examination program included the determination of production of IL-1/J, IL-4, IL-6, and TNF-a in various biological fluids of mothers and their preterm neonates. Blood cytokines were measured in 57 preterm neonates. The study comprised infants at 27 to 36 weeks postconception who had birth weights of 1040 to 2980 g. Results. The study has revealed the specific features of postnatal immune adaptation in premature neonates. The most changes are characteristic of proinflammatory IL-6. Expression of this cytokine in biological fluids is variable and it depends on the factors that influence the intrauterine fetal status: threats of pregnancy interruption, maternal somatic diseases, and development of severe gestosis. Conclusion. The findings support that premature neonates have a balance between proinflammatory and anti-inflammatory interleukins, and a rather mature immune system that prevents the development of an inflammatory process in the presence of ARDS during artificial ventilation. In ARDS, there was no suppressed function of the monocyte-macrophageal cells that produced proinflammatory cytokines. The changes in proinflammatory and anti-inflammatory interleukins promoted postnatal adaptation of the immune system in a premature neonate. The performed treatment ensured anti-infectious defense and the maintenance of homeostatis and vital functions in preterm newborn infants. Key words: preterm neonates, acute respiratory distress syndrome, proinflammatory and anti-inflammatory cytokines.

Objective: to study the production of surfactant apoprotein D in preterm neonates with acute respiratory distress syndrome (ARDS) during artificial ventilation (AV). Subjects and methods. The paper presents the results of studying the production of surfactant protein D (SP-D) in various biological fluids in 44 preterm neonates. Two groups of newborn infants were identified according to the clinical manifestations of ARDS. The study group comprised 25 infants with the severe course of the disease, in this connection the preventive administration of the exogenous surfactant Curosurf and AV were made in all the neonates at birth. The control group included 19 preterm babies without signs of ARDS. Results. The study has demonstrated that in parturients and preterm neonatal infants, surfactant apoprotein D is detectable in various biological fluids: amniotic fluid, the gastric aspirate obtained just after birth, residual umbilical cord blood, serum following 8 hours of birth, and bronchoalveolar fluid. Despite the low gestational age of the neonates, the lung surfactant system is able to produce SP-D, as evidenced by its high content in the amniotic fluid and residual umbilical cord blood of preterm neonates. The production of apoprotein D in preterm neonates considerably reduces in the next few hours after birth. Conclusion. The findings suggest that fetal tissues generate SP-D, which improves pulmonary gas exchange in preterm neonates in the first hours after birth and that alveolar-capillary membrane dysfunctions are transient in the neonates on AV. Key words: preterm neonates, acute respiratory distress syndrome, surfactant, surfactant apoprotein D.

Objective: to reveal lung morphological changes in preterm neonatal infants with hyaline membrane disease (HMD) in the use of exogenous surfactants and artificial ventilation. Materials and methods. Case histories and autopsy protocols were analyzed in 90 preterm neonates who had died from severe respiratory failure. All the neonates were divided into 4 groups: 1) 20 (22.2%) infants who had received the exogenous surfactant Curosurf in the combined therapy of HMD; 2) 19 (21.1%) babies with HMD who had taken Surfactant BL; 3) 25 (27.8%) surfactant-untreated infants who had died from HMD; 4) 26 (28.9%) very preterm neonates with extremely low birth weight who had died within the first hour of life. The lungs were histologically and morphometrically examined. Results. The study demonstrated the specific course of HMD when exogenous surfactants and artificial ventilation were used. The contributors to the development of the disease are intranatal amniotic fluid aspiration and intranatal fetal hypoxia. Conclusion. Artificial ventilation and the use of exogenous surfactants do not block the generation of hyaline membranes. The latter differ in formation time, form, and location. The differences in a cell response to hyaline membranes were found in the neonatal infants receiving exogenous surfactants. The characteristic morphological signs of the disease for all the neonates enrolled in the study are alveolar and bronchial epithelial damages and microcirculatory disorders. Key words: preterm neonatal infants, hyaline membrane disease, exogenous surfactants, artificial ventilation, histology, morphometry.

Objective: to optimize radiodiagnosis of neonatal lung diseases. Subjects and methods. The results of examinations were analyzed in 7 patients treated at a Kaliningrad regional children’s hospital. Along with physical examination and routine chest X-ray study, lung spiral computed tomography (CT) was made in all the babies on a Somatom Emotion spiral tomographic scanner (Siemens). The dose of irradiation was 4.1 mZV. The study was performed in the craniocaudal direction. The standard lung window mode was as follows: scanning time, 14.75 sec; scanning width, 3 mm; section width, 5 mm; 110 kV; 45 mA/sec. Results. CT established the pattern of a pathological process in the lung. It clarified the nature of the disease in all the cases. Conclusion. CT can provide an accurate topical diagnosis of a pathological process in the lung. This particularly applies to neonatal infants exposed to artificial ventilation. CT reveals the pattern and degree of evolved pulmonary complications and it is of high informative value. Key words: computed tomography, neonatal infants, lung.

Objective: to determine the causes of preterm labor and the factors contributing to the development of acute respiratory distress syndrome (ARDS) in the newborn. Subjects and methods. The paper presents the results of analyzing case histories and autopsy protocols of preterm neonates who died from ARDS. The study group comprised 20 (36.6%) very low-weight neonatal infants. Twelve (21.8%) neonates out of all the infants received the exogenous surfactants Curosurf and Surfactant BL. Lungs and placentas were histologically studied. Results. The study has demonstrated that various placen-tal abnormalities are one of the risk factors of preterm labor and ARDS. Intranatal amniotic fluid aspiration is a poor predictor. Conclusion. The efficiency of therapy with the exogenous surfactants depends on the quality of care delivered to a baby at birth, the time of switching the patient to artificial ventilation and the time of administration of a surfactant. Exogenous surfactants should be administered only in obstetric facilities that have all conveniences at their disposal to render a specialized aid to preterm infants. Key words: preterm neonate infants, acute respiratory distress syndrome, exogenous surfactants, primary atelectases, hyaline membranes.

Objective: to study the effects of the surfactants Surfactant-BL and Curosurf on pulmonary oxygenizing properties in preterm neonatal infants with respiratory distress syndrome (RDS). The studies were performed in 81 preterm neonates with severe RDS. For the therapy of RDS, the exogenous surfactants Surfactant-BL and Curosurf were used in 52 and 29 children with RDS, respectively. The similarity of infants from both groups was statistically confirmed. Blood gas composition and artificial ventilation parameters were examined. Results. The administration of the exogenous surfactants Surfactant-BL and Curosurf normalized blood gas composition, enhanced alveolar ventilation, and improved pulmonary ventilation-perfusion relationships. The exogenous surfactants permit the performance of artificial ventilation when the values are close to the physiological ones. There were no significant differences in the effects on the surfactants on gas exchange parameters. Key words: respiratory distress syndrome, surfactant, artificial ventilation, mean airway pressure, blood gas composition.