[The procedures of a neonatal service at a perinatal center]. / Taktika neonatal'noi sluzhby v perinatal'nom tsentre.

The authors analyze the development histories of 54 full-term newborns born in a satisfactory state, though in need of intensive care and rehabilitation at a special department for neonatal diseases. The absence of asphyxia at birth could not preclude a disease in the future. Analysis of mother's risk factors and neonatal disease permit a conclusion that babies born to mothers with a high-risk pregnancy even when born full-term should be singled out as a special group because of a high risk of disease development (intrauterine infection, cerebral disturbances, developmental defects, endocrine diseases, metabolic disorders, etc.). The most significant of mother's risk factors are reproductive function abnormalities (sterility, habitual abortions, a history of perinatal loss, etc.). Analysis of erroneous policy of neonatologists and late treatment start demonstrated that maternal risk factors should be more thoroughly assessed at childbirth.

[Cardiac rhythm in healthy newborn infants and in infants from the risk group in the early neonatal period]. / Ritm serdtsa zdorovykh novorozhdennykh i detei gruppy riska v rannem neonatal'nom periode.

Studies of heart rhythm parameters, carried out in 88 healthy newborns and in 117 risk-group babies over the course of the early neonatal period (starting from the second minute and up to the seventh day of life) helped derive the normal values of heart rhythm and determine the time characteristics of regulation mechanism establishment in the early postnatal ontogenesis: from sympathetic tonus and centralization of heart rhythm control in the first hours of life to augmenting parasympathetic tonus and autoregulation. Prenatal risk factors were found conducive to deceleration of the newborn's adaptive reactions even when no clinical symptoms of neonatal abnormalities are detectable. The feeding (sucking) process in health is associated with elevation of cholinergic activity of the autonomic nervous system; this phenomenon underlies the method for assessment of the newborn's adaptation (feeding test). The metabolic parameters are less informative in assessment of postnatal adaptation efficacy as against heart rhythm parameters.

[Clinico-biological evaluation of the status of newborn infants and the tactics in the management of the early postnatal period]. / Kliniko-biologicheskaia otsenka sostoianiia detei pri rozhdenii i taktika vedeniia rannego postnatal'nogo perioda.

Biology of the perinatal period as a basis of neonatal management is an area of conceptual controversy. Literature evidence and findings of a clinical and functional study in 175 term newborns support the concept of intrapartum and neonatal stress. This is a rationale for a strategy of maintaining the adaptive mechanisms of the fetus and newborn in a maximal range and active support of neonatal homeostasis. Narcotic depression, prolonged hypothermia++ of various origins are considered as factors endangering the postnatal adaptation.

[A period of urgent postnatal adaptation as a critical stage of human ontogenesis]. / Period ékstrennoi postnatal'noi adaptatsii kak kriticheskii étap ontogeneza cheloveka.

The infant's state immediately after delivery is characterized by critical shifts of homeostasis parameters: decompensated mixed acidosis, pathologic indices of gaseous blood condition (arterial hypoxemia and hypercapnia), spontaneous postnatal hypothermia. Qualitative change of functional systems after delivery is accompanied by expressed tense of adaptation and regulation mechanisms and by centralization of cardiac rhythm control. The use of mathematical analysis of cardiac rhythm made it possible to find out that the change of degree of adaptation tense in the process- of postnatal period obeys the exponential dependence; moreover, the duration of transitional process of healthy newborns is 1 hour, but it considerably increases in case of hypoxia. After comparison of cardiac rhythm indices of these two groups of newborns it has been pointed out that mechanisms of adaptation after delivery are equal and they are based on the growing activity of central regulation processes. The dynamics of transitional process such as the period of postnatal adaptation indicates the reserve possibilities of infant and helps to reveal pre-nosological forms of disadaptational syndrome.