Ke pilikia nei kāu pēpē ma waena o kona umauma a me ka ʻōpū? E kamaʻilio kākou e pili ana i ka (Congenital Diaphragmatic Hernia - CDH)!

Inā he makuahine hānau ʻoe a i ʻole e manaʻo ana i kahi lālā hou e hui pū me kou ʻohana, he mea nui loa kēia moʻolelo iā ʻoe. I kekahi manawa hiki i kā mākou poʻe liʻiliʻi ke komo mai i kēia ao me nā kīnā hānau i lohe ʻole ʻia e mākou. ʻO ia kekahi o kēlā mau kūlana a mākou e kamaʻilio ai i kēia lā, he paʻakikī iki, akā he mea pono ke makaʻala.

He aha ka CDH? E hoʻomaopopo maʻalahi kākou.

ʻAe, e nānā kākou i kēia ʻano `(Congenital Diaphragmatic Hernia)` a i ʻole `(CDH)` no ka pōkole. I ka ʻōlelo maʻalahi, he ʻano kēia e kū mai ana i ka wā hānau. Hana ʻia kēia i ka wā e noho ana ke pēpē i loko o ka ʻōpū. Aia kahi ʻiʻo e hoʻokaʻawale ana i ko kākou umauma a me ka ʻōpū, a mākou e kapa aku nei ʻo `Diaphragm` . Ua like ia me ka paia e hoʻokaʻawale ana i ʻelua lumi. Inā ʻaʻole ikaika kēia diaphragm, a inā he lua i loko, hiki i nā ʻōpū i loko o ka ʻōpū - ʻo ia hoʻi, ka ʻōpū, nā ʻōpū, ke akepaʻa, a pēlā aku - ke komo i loko o ka lua umauma. ʻO ia ka mea a mākou e kapa aku nei he `(Hernia)`, a i ʻole hernia.

I kēia manawa, e noʻonoʻo i ka mea e hiki mai ana inā hana ʻia kekahi mea e like me kēia i ka wā e ulu ana ka pēpē i loko o ka ʻōpū. Ke neʻe nā ʻōpū o ka ʻōpū i loko o ka umauma, ʻaʻole lawa ka lumi ma laila, ʻeā? ʻO ka pilikia nui, ʻaʻole lawa ka lumi o nā māmā e ulu pono ai. Ke liʻiliʻi nā māmā, ʻo ia hoʻi, ke loaʻa kahi kūlana i kapa ʻia ʻo `(Pulmonary Hypoplasia)`, paʻakikī ka pēpē i ka hanu ʻana ma hope o ka hānau ʻana, a ʻaʻole lawa ka oxygen i ke koko. ʻAʻole wale ia, akā hiki ke piʻi aʻe ke koko i loko o nā māmā. Hoʻokomo pū kēia i ke kaomi nui ma ka puʻuwai. No laila, pono ka pēpē me `(CDH)` i ka lāʻau lapaʻau kūikawā ma hope koke o ka hānau ʻana.

He aha nā hōʻailona o kahi pēpē me CDH?

Inā pilikia nui kāu pēpē i ka hanu ʻana ma hope koke o ka hānau ʻana, he hōʻailona nui paha ia o ke kūlana (CDH). Eia kekahi, e ʻike paha ʻoe i nā mea e like me:

• Ka puʻuwai wikiwiki loa (Tachycardia).
• ʻO Cyanosis kahi ʻano poni ʻulaʻula o ka ʻili ma muli o ka nele o ka oxygen.
• Nā leo hanu haʻahaʻa loa (ʻoi aku hoʻi ma kekahi ʻaoʻao).
• Ke lohe ʻana i ke kani o nā ʻōpū ke kau ʻoe i kou pepeiao i ka umauma.
• Ua ʻōpuʻu ka umauma a ua like me ka barela, ʻoiai ʻo ka ʻōpū me he mea lā e piholo ana i loko.

Inā loaʻa i kāu pēpē kekahi a ʻoi aku paha o kēia mau hōʻailona, ​​​​ʻoi aku ka maikaʻi o ka ʻike koke ʻana i ke kauka.

No ke aha e ulu ai kēia CDH? He aha nā kumu?

He mea paʻakikī i nā kauka ke haʻi pololei i ke kumu pololei o kēia kūlana "(CDH)". Eia nō naʻe, ua ʻike ʻia e ka noiʻi e pili ana paha kēia mau mea:

• Nā kumu hoʻoilina: ʻO ia hoʻi, kekahi mau mea i hoʻoili ʻia ma o nā hanauna.
• Ka ʻike ʻia ʻana i nā mea ʻino i ka wā hāpai: Nā mea e like me kekahi mau kemika a me nā cigarette.
• ʻAʻole lawa ka meaʻai no ka pēpē i loko o ka ʻōpū: Loaʻa i ka pēpē kāna meaʻai mai ka meaʻai a ka makuahine e ʻai ai.

ʻO kēia nā kumu o kēia manawa, akā ke hana ʻia nei nā noiʻi hou aʻe ma kēia.

He aha nā pilikia e hiki ke hana ma muli o ka CDH?

E like me kā mākou i kūkākūkā ai ma mua, he nui nā pēpē me CDH he mau māmā i ulu pono ʻole (Pulmonary Hypoplasia). Hiki i kēia ke hana i nā pilikia like ʻole:

• Haʻahaʻa ka pae oxygen i loko o ke koko (Hypoxemia): Hoʻopilikia kēia i nā ʻōpū āpau o ke pēpē, ʻoiai ka lolo a me ka puʻuwai. Inā koʻikoʻi a mau paha kēia kūlana, hiki iā ia ke hōʻeha i ka wā lōʻihi.
• Ke koko kiʻekiʻe i loko o nā aʻa o nā māmā (Pulmonary Hypertension): Hoʻokau kēia i ka nui o ke kaumaha ma ka ʻaoʻao ʻākau o ka puʻuwai a hiki ke hoʻoulu i ka hāʻule ʻana o ka puʻuwai.
• Nā Maʻi ʻAkemāmā: Hiki i nā māmā i ulu pono ʻole ke loaʻa maʻalahi nā maʻi e like me ka niumonia. ʻOiai ma hope o ka hoʻoponopono ʻia ʻana o kahi hernia me ke ʻoki ʻana, hiki i ka pilikia o kēia mau maʻi ke hoʻomau i ke ola holoʻokoʻa.

Ma waho aʻe o kēia, ʻo nā pēpē me `(CDH)` e loaʻa paha nā pilikia ʻē aʻe:

• Nā pilikia hānai: Hiki ke kumu o ke kaomi ʻana ma luna o nā ʻōpū o ka ʻōpū a i ʻole ma muli o nā hana lapaʻau he nui i ka wā hānau. Pono paha kekahi mau pēpē e hānai ʻia me ka tube no ka manawa lōʻihi, a hiki nō hoʻi ke ʻike i ka ulu ʻana o ka pēpē.
• Nā Lohi o ka Hoʻomohala ʻana: Pono paha kekahi mau pēpē i ka hoʻōla kino, ka ʻōlelo a i ʻole ka hana no kekahi manawa ma muli o ka nele o ka oxygen.
• Poho Lohe Sensorineural: Ua nalowale mālie kekahi mau pēpē me CDH i ko lākou lohe. ʻAʻole maopopo i nā kānaka ʻepekema inā paha ke kumu o kēia maʻi ponoʻī, ka lāʻau lapaʻau, a i ʻole nā ​​mea ʻelua.

E noʻonoʻo i ka nui o ke kaumaha o kahi makuahine a makuakāne paha ke lohe i kahi mea e like me kēia. Akā e hoʻomanaʻo, ua holomua loa ka ʻepekema lapaʻau i kēia manawa.

Pehea e ʻike ai nā kauka i ka CDH?

I ka hapa nui o ka manawa, hiki i nā kauka ke ʻike i kēia kūlana i ka wā o ka ultrasound prenatal maʻamau i kou wā hāpai. Ke ʻike ʻia, e hana lākou i nā hoʻokolohua hou aʻe. No ka laʻana, e hana lākou i kahi MRI fetal e nānā pono i ka hernia. E hana pū lākou i kahi echocardiogram fetal e ʻike inā ua hoʻopilikia ʻia ka puʻuwai o ka fetus.

I kekahi manawa, ʻaʻole paha e ʻike nā kauka i ka CDH a hiki i ka hānau ʻana o ka pēpē. Ma hope o ka hānau ʻana o ka pēpē, kānalua paha ka hui lapaʻau inā ʻike lākou i nā mea e like me ka paʻakikī o ka hanu ʻana, kahi septum deviated, a i ʻole ka umauma puʻupuʻu. A laila e hana lākou i kahi X-ray umauma a me kahi echocardiogram . Hiki iā lākou ke lawe i kahi hāpana koko e nānā i nā pae oxygen koko o ka pēpē a e nānā i nā ʻano ʻē aʻe o ka genetic .

He mea kākaʻikahi loa, ʻaʻole paha e hōʻike nā pēpē me CDH i kekahi mau hōʻailona nui i ka wā hānau. Inā liʻiliʻi loa ka hernia, ʻaʻole paha e ʻike ʻia i ka wā kamaliʻi, a i ka wā makua paha.

He aha nā lāʻau lapaʻau no ka CDH?

Hoʻomaka ka lāʻau no kēia maʻi, ʻo ia hoʻi ka "Congenital Diaphragmatic Hernia", i ka wā e ʻike ʻia ai. E makaʻu paha ʻoe ke lohe ʻoe e pili ana i kēia lāʻau, akā e hoʻomanaʻo e hana ana nā kauka i nā mea āpau e pale aku i kāu pēpē.

Lapaʻau ma mua o ka hānau ʻana

Inā ua ʻike ʻia ʻoe me CDH i kou wā hāpai, e nānā pono kāu kauka iā ʻoe. E nānā lākou i nā pilikia me nā ʻōnaehana kino ʻē aʻe, no ka mea, i kekahi manawa hiki ke lilo i ʻāpana o kahi kūlana paʻakikī. E nānā pū lākou e ʻike inā e hānau mua ʻia kāu pēpē (hanau mua), a inā pēlā, e hoʻoholo lākou inā e hoʻoulu i ka hana (hoʻoulu i ka hana) e kōkua i ke olakino o ka pēpē.

I kekahi mau hihia kūikawā, hiki i ke kime lapaʻau ke mālama i ka ʻōpū ma mua o ka hānau ʻana o ka pēpē. ʻO "Fetoscopic Tracheal Occlusion (FETO)" kekahi o ia ʻano hana ʻoki ʻōpū. Kōkua ia i ka hoʻomaikaʻi ʻana i ka nui a me ka hana o nā māmā o ka ʻōpū i ka wā e ulu ana ka pēpē i loko o ka ʻōpū. Hana ʻia kēia me ka hoʻohana ʻana i kahi kāmela liʻiliʻi i kapa ʻia ʻo "Fetoscopy", ma o nā ʻoki liʻiliʻi i hana ʻia ma kou ʻili i loko o kou ʻōpū.

Ma kēia kaʻina hana `(FETO)`, hoʻokomo ke kauka i kahi pōpō liʻiliʻi i loko o ka `(Trachea)` o ka ʻōpū. A laila, ʻo ka `(Amniotic Fluid)` a ke pēpē e moni ai e hōʻiliʻili ma hope o ka pōpō a i loko o nā māmā, e hoʻoulu ai i nā māmā e pehu. Hoʻomaikaʻi kēia pehu ʻana i ka ulu ʻana a me ka hana o nā māmā, a kōkua i ka hoʻoponopono ʻana i kekahi o nā pōʻino i hana ʻia e `(CDH)`.

Ka mālama ʻana i ka hānau keiki ʻana

ʻO ka maʻamau, pono nā pēpē i hānau ʻia me ka CDH i ka mālama koʻikoʻi mai kahi hui loea ma hope koke o ka hānau ʻana. Inā ʻaʻole i hoʻomohala piha ʻia nā māmā o ka pēpē (Pulmonary Hypoplasia), e hāʻawi mua ʻia lākou i ke kākoʻo oxygen. No kekahi mau pēpē, he ʻōmole hanu paha kēia i hoʻopili ʻia i kahi mīkini hanu .

Pono paha kekahi mau pēpē i ke kākoʻo ola ikaika aʻe. Ua kapa ʻia kēia ʻo Extracorporeal Membrane Oxygenation (ECMO) . Pili kēia i ka pale ʻana i nā māmā ʻōpiopio o ka pēpē a i kekahi manawa i ka puʻuwai, a me ka hoʻohana ʻana i kahi mīkini e hoʻohui i ka oxygen i ke koko a hoʻihoʻi i ke kino o ka pēpē.

ʻO ka mea aʻe, pono ke ʻoki ʻana i ka pēpē. E mālama ʻia ke pēpē ma ka Neonatal Intensive Care Unit (NICU) a hiki i ka wā e kūpaʻa ai ke pēpē no ke ʻoki ʻana. ʻO ke ʻano maʻamau kēia a hiki i ka wā e emi ai ke koko kiʻekiʻe i loko o nā māmā (pulmonary hypertension) a ʻaʻole pono hou ka extracorporeal membrane oxygenation (ECMO).

No ke ʻoki ʻana, e hoʻomoe ke kauka anesthesiologist i ka pēpē ma lalo o ka anesthesia . A laila e hana ke kauka lapaʻau pediatric i ke ʻoki ʻana.ʻO ke ʻoki kino e pili ana i ka hoʻoneʻe ʻana i nā ʻōpū i hoʻoneʻe ʻia mai ka umauma i loko o ka ʻōpū a me ka hoʻoponopono ʻana i ke kīnā ma ka diaphragm. I ka hapanui o nā hihia, ʻo ia hoʻi ka hapalua o nā ʻoki kino āpau, hiki i nā kauka ke hana i kahi ʻoki kino minimally invasive (MIS) e pili ana i ka hana ʻana i nā ʻoki liʻiliʻi ma kahi o 3 millimeters ma kahi o kahi ʻoki nui .

Pehea ke ʻano o ka manawa hoʻōla?

I ka hoʻōla ʻana o kāu pēpē mai ke ʻoki ʻana, e hoʻemi mālie ʻia ʻoe mai ka oxygen. E hoʻomau ʻia ka hānai ʻia ʻana iā ʻoe ma o kahi paipu a hiki i ka wehe ʻia ʻana o ka paipu hanu. Ma hope o kēlā, e kōkua nā mea lapaʻau ʻōlelo a me nā loea lactation iā ʻoe a me kāu pēpē e hoʻomaka i ka hānai ʻana ma ka waha. ʻOi aku ka lōʻihi o ka hoʻemi ʻana o kekahi mau pēpē i ka oxygen a me ka hānai ʻana i ka paipu ma mua o nā mea ʻē aʻe. E kākoʻo kāu hui lapaʻau iā ʻoe no ka lōʻihi e pono ai.

He aha ka wā e hiki mai ana o nā pēpē me CDH?

ʻO ka nūhou maikaʻi, ua hoʻomaikaʻi nui ʻia ka nui o ke ola ʻana o nā pēpē i hānau ʻia me CDH. Ma waena o 7 a me 9 o 10 mau pēpē e ola ana. ʻOiai ua hānau ʻia kēia mau pēpē me nā kūlana koʻikoʻi loa, inā e hala lākou i nā lā mua, ʻoi aku ka maikaʻi o ko lākou manawa e ola ai. Loaʻa paha i kekahi mau keiki nā pilikia lōʻihi, akā hiki iā lākou ke ola lōʻihi a piha. Me ka holomua o ka ʻepekema lapaʻau, ke hoʻomaikaʻi nei nā helu ola pōkole a me nā hopena olakino lōʻihi i kēlā me kēia lā.

ʻO ka wānana lōʻihi e pili ana i kekahi mau kumu:

• Ua hānau mua ʻia anei ke pēpē?
• Auē ke ʻino o ke kūlana o ka pēpē i ka wā i hānau ʻia ai.
• Ka nui o ka hernia.
• He aha ke kino i komo i loko o ka umauma?
• Aia kekahi mau pilikia olakino ʻē aʻe?

ʻOi aku ka nui o ka pilikia o nā pēpē e pono ai ke kōkua hanu a hānai paha no ka manawa lōʻihi i ka loaʻa ʻana o nā pilikia e like me ka maʻi māmā mau loa, ka hāʻule ʻana o ka ulu ʻana, ka nalowale o ka lohe, a me ka lohi o ka ulu ʻana. E nānā pono ke kauka o kāu keiki iā lākou i ko lākou mau makahiki ʻōpio.

Hiki ke hopohopo a hoʻoluhi nui ka ʻike ʻana ua loaʻa i kāu pēpē kahi hernia diaphragmatic congenital. E lawe ʻia kāu pēpē i ka ʻāpana mālama koʻikoʻi (ICU) ma hope koke o ka hānau ʻana, a pono paha e noho i ka haukapila no ka manawa lōʻihi. Akā me ka holomua o ka ʻepekema lapaʻau, ʻoi aku ka maikaʻi o ka nānā ʻana no ke kūlana ma mua o ka wā ma mua. ʻOiai he manawa paʻakikī kēia, aia kahi hui o nā kauka a me nā kahu maʻi ma aneʻi e kōkua iā ʻoe a me kāu keiki hānau hou. E kākoʻo lākou iā ʻoe mai ka manawa o ka hōʻoia ʻana, a hiki i ke ola mua o kāu pēpē.

Nā mea e pono ai mākou e hoʻomanaʻo

ʻOiai he ʻano koʻikoʻi kēia ʻano i kapa ʻia ʻo `(Congenital Diaphragmatic Hernia - CDH)`, inā ʻike ʻoe iā ia ma mua, hiki iā ʻoe ke kū i mua me ka hopohopo ʻole.

• ʻO CDH kahi maʻi e kū mai ana i ka wā hānau a ke kumu o ka neʻe ʻana o nā ʻōpū o ka ʻōpū i loko o ka umauma ma muli o kahi kīnā i ka diaphragm.
• ʻO ka hopena nui kēia i ka ulu ʻana o nā māmā.
• Hiki ke ʻike ʻia kēia ma o nā scan i ka wā hāpai.
• Pono lākou i ka lāʻau lapaʻau kūikawā a me ke ʻoki kino ma hope koke iho o ka hānau ʻana.
• Me ka holomua o ka ʻepekema lapaʻau, hiki i ka hapa nui o kēia mau pēpē ke ola i nā ola maikaʻi.

Inā he mau nīnau a hopohopo paha kāu e pili ana i kēia, e kamaʻilio me kāu kauka a kahu maʻi paha. Hiki iā lākou ke hāʻawi iā ʻoe i ka ʻike hou aku a kōkua iā ʻoe e lawe i ke kaumaha mai kou manaʻo. E hoʻomanaʻo, ʻaʻole ʻoe hoʻokahi.

ʻO CDH, Hernia Diaphragmatic Congenital, Hernia Diaphragmatic, Nā kīnā hānau, Ka ulu ʻana o ka māmā, Ola kino o ka pēpē, ʻoki kino