Perinatal care in Lithuania.

The Preventive Program of Perinatal, Neonatal and Congenital Abnormalities in Lithuania was launched in 1992. That was the beginning of the reorganization of the Soviet maternal and child health care system. The first stage of the Program provided for the years 1992 through 1996 and aimed to create a system of maternal and neonatal care; to create a system of diagnosis and prevention of congenital abnormalities; to collect, process, and analyze maternal and neonatal data (to establish a new database); to evaluate, distribute, and use available resources efficiently; to plan financial and human resources for a perinatal care infrastructure; and to train medical personnel and control the level and quality of their knowledge. The reorganization was based on a three-tiered maternal and neonatal care system. By the end of 1996 the major goal of the Program was achieved successfully (i.e., perinatal, neonatal, and infant mortality rates decreased significantly. During the next 5 years the Program will focus mainly on qualitative aspects of perinatal care.

Trigger delay in infant ventilators.

In an experimental study we determined the response trigger delay time of three infant ventilators with a capacity to detect and support spontaneous breathing. We measured this in anaesthetized cats as the time between the start of phrenic nerve activity and the increase in airway pressure caused by the subsequent inflation. Two modes of ventilatory support were used, namely Assist/Control (A/C) and synchronised intermittent mandatory ventilation (SIMV). We found that ventilators equipped with flow sensors close to the free end of the endotracheal tube had a shorter trigger delay than a ventilator which detected breathing with an abdominal sensor. Further, the trigger delay was shorter in SIMV mode than in A/C mode of operation. A higher set sensitivity reduced the response time. We conclude that triggered ventilation may be used in infants, at least when the spontaneous breathing rate is below 60 breaths per minute. This mode of ventilation could be useful when infants are to be weaned off the ventilator.