E aʻo kākou e pili ana i ka Necrotizing Enterocolitis (NEC), kahi maʻi ʻōpū koʻikoʻi e loaʻa pinepine ana i nā pēpē hānau mua.

Ua hānau mua ʻia kāu pēpē? Ua ʻike mākou i ka weliweli a me ka hopohopo o ka makuahine a i ʻole ka makuakāne ke loaʻa iā lākou kahi pēpē hānau mua. ʻOi loa aku inā aia ka pēpē i loko o ka NICU ( Neonatal Intensive Care Unit), ʻoi aku ka nui o kēlā manaʻo. Ke hele koke mai ke kauka a haʻi iā ʻoe he pilikia koʻikoʻi ko kāu pēpē, kahi maʻi i kapa ʻia ʻo NEC (Necrotizing Enterocolitis), he paʻakikī ke haʻi i nā huaʻōlelo i kona manaʻo. I kēia lā, ke kamaʻilio nei mākou e pili ana i kēia maʻi i kapa ʻia ʻo NEC, kahi a nā makuahine a me nā makuakāne e makaʻu nei, akā he mea nui loa ia e makaʻala.

I ka ʻōlelo maʻalahi, he aha kēia NEC?

He maʻi ʻōpū koʻikoʻi loa ka Necrotizing Enterocolitis (NEC) e hoʻopilikia nui ana i nā pēpē hānau mua. I kēia hihia, ua hōʻino ʻia nā ʻiʻo o ka ʻōpū o ke pēpē, pehu, a hoʻomaka e make. ʻO ke ʻano o ka huaʻōlelo "necrotizing" ʻo ia hoʻi "ka make ʻana o nā ʻiʻo." ʻO "Enterocolitis" ʻo ia hoʻi ka mumū o ka ʻōpū.

E noʻonoʻo e pili ana i ia mea, ʻaʻole wale ko kākou ʻōpū he paipu. He ʻōkana paʻakikī lākou i hana ʻia me nā ʻiʻo ola e kōkua ana i ka hoʻoheheʻe ʻana i ka meaʻai a me ka omo ʻana i nā meaola. Ma NEC, lilo ka paia o kēia ʻōpū i nāwaliwali, hōʻino ʻia, a i kekahi manawa ua puka i loko . Inā hana ʻia kēlā lua, hiki i nā germs, e like me ka bacteria, i loko o ka ʻōpū ke komo i loko o ka ʻōpū o ka pēpē a i ʻole ke koko. He kūlana weliweli loa kēia.

ʻO ka maʻamau, hiki mai ka NEC ma waena o ʻelua a me ʻeono pule ma hope o ka hānau ʻana. I kekahi mau pēpē, he palupalu loa ia a e hoʻomaikaʻi. I kekahi, hiki ke koʻikoʻi a hoʻoweliweli i ke ola.

ʻO wai ka mea i pilikia nui i ka loaʻa ʻana o kēia maʻi?

No nā pēpē he 10 i loaʻa iā NEC, he 9 nā pēpē hānau mua ʻole . He mea kākaʻikahi loa nā pēpē i hānau ʻia i ka manawa piha e loaʻa iā ia. ʻO kēia ka poʻe i loaʻa i ka pilikia nui loa:

• Nā pēpē i hānau ʻia ma mua o 37 mau pule o ka hāpai ʻana: He kiʻekiʻe loa ka pilikia no nā pēpē i hānau ʻia ma mua o 32 mau pule.
• Nā pēpē kaumaha haʻahaʻa loa i ka wā hānau: ʻO nā pēpē i kaumaha ma lalo o 2.5 kilokani (5.5 paona) i ka wā hānau he nui ko lākou pilikia. ʻO nā pēpē i kaumaha ma lalo o 1 kilokani (2.2 paona) he nui ko lākou pilikia.
• No nā pēpē i hānai ʻia ma o kahi ʻōmole (ʻai enteral): Ma muli o ka emi ʻana o ka hiki o nā pēpē hānau mua ke omo, hāʻawi ʻia ka waiū ma o kahi ʻōmole i hoʻokomo ʻia ma ka ihu i loko o ka ʻōpū.
• No nā pēpē i loaʻa nā pilikia i ka wā hānau: Eia kekahi laʻana, nā pēpē i loaʻa nā pilikia e like me ka pilikia o ka hanu ʻana a i ʻole ka maʻi puʻuwai.

Ma kahi o hoʻokahi i loko o 1,000 mau pēpē hānau mua e loaʻa iā NEC. Eia nō naʻe, loaʻa kēia ʻano ma kahi o hoʻokahi i loko o 10,000 mau pēpē hānau piha. No laila, he pololei ke ʻōlelo ʻana he maʻi nui kēia o nā pēpē hānau mua.

He aha nā ʻano nui o nā NEC?

Hoʻokaʻawale nā ​​kauka i kēia maʻi i kekahi mau ʻano, ma muli o ka manawa e hoʻomaka ai nā hōʻailona a me ke kumu o ka maʻi.

I kekahi manawa, ua loaʻa nā hōʻike e pili ana i nā pēpē he nui e ulu ana i ka NEC i ka manawa like ma ka NICU ( Neonatal Intensive Care Unit). I ia mau hihia, ʻo ke kumu paha he maʻi bacteria e like me E. Coli.

No ke aha i hana ʻia ai kēia NEC? He aha ke kumu?

ʻO kaʻoiaʻiʻo, ʻaʻole i loaʻa i nā kauka hoʻokahi kumu no NEC. Manaʻo lākou he hui pū ʻana ia o kekahi mau kumu.

ʻO nā kumu nui:

1. Nā ʻōpū ʻōpiopio: ʻAʻole i ulu piha nā ʻōpū o kahi pēpē hānau mua. He palupalu loa lākou a he nāwaliwali. No laila, he paʻakikī iā lākou ke kaʻina hana ʻai.

2. ʻŌnaehana pale kino nāwaliwali: ʻAʻole i hoʻomohala piha ʻia ka ʻōnaehana pale kino e hakakā nei i nā maʻi i nā pēpē hānau mua. No laila, hiki i ke kino ke paʻakikī ke hakakā me kahi maʻi liʻiliʻi i loko o nā ʻōpū.

3. Ka emi ʻana o ke kahe koko i nā ʻōpū: ʻO ka ʻōnaehana kahe koko o nā pēpē hānau mua e hoʻokau mua i ka hoʻouna ʻana i ke koko i nā ʻōpū koʻikoʻi e like me ka lolo a me ka puʻuwai. I nā manawa o ke kaumaha (e.g., nele i ka oxygen), hōʻemi ke kino i ka nui o ke koko e kahe ana i nā ʻōpū. Ke emi ke kahe koko, ʻaʻole loaʻa i nā ʻiʻo i loko o nā ʻōpū ka oxygen a lākou e pono ai. ʻO ka hopena, ua hōʻino ʻia kēlā mau ʻiʻo a hoʻomaka e make.

Ke hui pū ʻia kēia mau mea, lilo ka paia o ka ʻōpū i nāwaliwali, e ʻae ana i ka bacteria e ulu ma laila, e hoʻoulu ai i ka mumū a alakaʻi i ka NEC.

He aha nā hōʻailona o ka NEC?

Ke nānā mau nei nā kauka a me nā kahu maʻi i kahi pēpē ma ka NICU. No laila, inā ʻike lākou i kahi hōʻailona liʻiliʻi o NEC, hana koke lākou. Ma ke ʻano he makua, he mea nui iā ʻoe e makaʻala i kēia mau hōʻailona.

Hiki ke ʻike mālie ʻia nā hōʻailona i kekahi mau lā, a i ʻole hiki ke ʻike koke ʻia i loko o kahi pēpē i olakino.

• ʻO ka pehu ʻana o ka ʻōpū a me ka ʻeha: Paʻakikī ka ʻōpū o ka pēpē ke hoʻopā ʻia, uē ke pēpē ke kau ʻia ma luna, a ua piha ka ʻōpū.
• Ka hōʻole ʻana e inu waiū: Ua hōʻole koke kahi pēpē i inu maikaʻi i ka inu waiū, e waiho ana i nā koena o ka ʻōpū.
• Ka luaʻi ʻana: ʻO ka luaʻi ʻana, ʻoiai he ʻōmaʻomaʻo a he melemele paha, he hōʻailona paha ia o ka pale ʻana o ka ʻōpū.
• Nā loli i ka neʻe ʻana o ka ʻōpū: Nā loli i ka neʻe ʻana o ka ʻōpū, nā ʻōpala e like me ka maʻi pākī, a me ke koko i loko o ka ʻōpala .
• Ka loli ʻana o ke kūlana olakino maʻamau:
• Hoʻolohi a piʻi aʻe paha ka puʻuwai o ka pēpē.
• Hoʻololi ka wikiwiki o ka hanu ʻana, i kekahi manawa e kū ana ka hanu no kekahi manawa (apnea).
• Hāʻule ke koko.
• ʻAʻole hiki ke mālama ʻia ka mahana o ke kino.
• Ua palaualelo loa ke pēpē a me he mea lā ua make ʻo ia.

Inā ʻike ʻia kekahi a ʻoi aku paha o kēia mau hōʻailona, ​​​​e noiʻi koke nā limahana NICU.

Pehea e ʻike ai nā kauka i kēia?

ʻO ka mea mua a ke kauka o kāu pēpē e hana ai, ʻo ia ke nānā pono i kāu pēpē. E nānā lākou no ka pehu a me ka palupalu. E hana pū lākou i kekahi mau hoʻokolohua e hōʻoia i ka maʻi.

• X-ray ʻōpū:ʻO kēia ka hoʻāʻo koʻikoʻi loa. Hiki iā ia ke nānā i nā pehu kinoea i loko o ka paia o ka ʻōpū. Ua kapa ʻia kēia ʻo 'pneumatosis intestinalis'. Eia kekahi, inā ua puka ka ʻōpū, hiki iā ʻoe ke ʻike i ka ea manuahi i loko o ka lua ʻōpū.
• Nā hoʻāʻo koko: Nānā kēia i nā maʻi (bacteria) i loko o ke koko, ka helu haʻahaʻa o nā cell koko keʻokeʻo, a me nā pilikia clotting koko.
• Hoʻāʻo Fecal: Kōkua kēia hoʻāʻo i ka ʻike ʻana i ke koko i loko o ka ʻōpala i ʻike ʻole ʻia e ka maka.

He aha nā pilikia e hiki ke loaʻa mai ka NEC?

No ka mea he maʻi koʻikoʻi ʻo NEC, hiki ke loaʻa nā pilikia ma hope o ia.

• Peritonitis: Inā he lua i loko o ka ʻōpū, hiki i ka bacteria ke komo i loko o ka lua ʻōpū a hoʻoulu i kahi maʻi koʻikoʻi (peritonitis). Hiki i kēia ke alakaʻi i kahi maʻi hoʻoweliweli ola i kapa ʻia ʻo sepsis , kahi e laha ai ka bacteria ma ke kino holoʻokoʻa.
• ʻO ke koʻikoʻi o ka ʻōpū: Ma hope o ka ho'ōla ʻana o NEC, hiki i ka ʻāpana i hōʻino ʻia o ka ʻōpū ke lilo i ʻeha a wili i ka wā e ho'ōla ai. He mea paʻakikī kēia e ʻai ai. Pono paha kēia i ke ʻoki ʻana ma kahi lā ma hope.
• ʻO ka Short Bowel Syndrome: Inā make kahi ʻāpana nui o ka ʻōpū ma muli o NEC a pono e wehe ʻia ma ke ʻoki ʻana, ʻaʻole lawa ka ʻāpana i koe o ka ʻōpū e omo pono i nā meaʻai. Ua kapa ʻia kēia ʻano he short bowel (short gut) syndrome . Pono nā pēpē me kēia ʻano i ka nānā kūikawā i ka meaʻai i ko lākou ola a pau.
• Nā Lohi o ka Ulu a me ka Hoʻomohala ʻana: ʻO nā pēpē i loaʻa iā NEC, ʻoiai ka poʻe i hana ʻia i ke ʻoki kino, e ʻike paha i kekahi mau lohi i ka ulu ʻana a me ka ulu ʻana o ka lolo ma hope o ke ola. No laila, he mea nui loa ka mālama ʻana i kēia mau pēpē ma lalo o ka nānā mau ʻana o ke kauka.

Pehea e mālama ʻia ai?

Ke kānalua ʻia ʻo NEC, hoʻomaka nā kauka i ka lāʻau lapaʻau. ʻO ka pahuhopu nui ka hāʻawi ʻana i ka ʻōpū i ka hoʻomaha piha .

1. Hoʻōki i ka hānai waiū: ʻO ka mea mua e hana ai, ʻo ia ke hoʻōki loa i ka hānai ʻana i ka pēpē ma ka waha a i ʻole ka ʻōmole. E hoʻomaha kēia i nā ʻōpū a hoʻomaka e ho'ōla.

2. ʻAi IV: Hāʻawi ʻia nā meaʻai a me nā wai a pau e pono ai ka pēpē ma o ka saline (nā wai IV) i hāʻawi pololei ʻia i loko o kahi aa.

3. Ke kau ʻana o ka paipu nasogastric: Hoʻokomo ʻia kahi paipu (paipu nasogastric) ma o ka ihu i loko o ka ʻōpū, e hoʻokahe ana i ka ea a me nā wai i hōʻiliʻili ʻia i loko o ka ʻōpū. Hoʻēmi kēia i ka pehu ʻana i loko o ka ʻōpū a hoʻomaha i ke kaomi ma luna o nā ʻōpū.

4. Nā lāʻau antibiotic: No ke kaua ʻana i ka maʻi a me ka pale ʻana i ka laha ʻana o ka maʻi, hāʻawi ʻia nā lāʻau antibiotic ikaika ma o ka intravenous.

5. Ke nānā mau ʻana:Nānā pono ʻia ke pēpē. Hana mau ʻia nā hoʻāʻo koko a me nā kukuna X e ʻike ai inā e hoʻomaikaʻi ana ke kūlana a i ʻole e ʻoi aʻe ana ka ʻino.

Āhea e pono ai ke ʻoki kino?

Ma kahi o hoʻokahi o nā pēpē ʻehā e pono ai ke ʻoki kino. Hana ʻia ke ʻoki kino no:

• Inā ua hōʻoia ʻia kahi perforation i loko o ka ʻōpū.
• Inā ʻaʻole e hoʻomaikaʻi ke kūlana o ka pēpē me ka lāʻau lapaʻau.

I ka wā o ke ʻoki ʻana, wehe ke kauka ʻoki i ka ʻāpana make o ka ʻōpū a hoʻopili hou i nā ʻāpana olakino ʻelua o ka ʻōpū. I kekahi manawa, inā pehu loa ka ʻōpū, he paʻakikī ke hoʻopili hou koke iā ia. I ia mau hihia, hana ʻia kahi ʻoki i kapa ʻia he ostomy .

Inā liʻiliʻi loa ka pēpē a maʻi loa paha e hana ʻia ke ʻoki kino, hiki i ke kauka ke kau i kahi ʻōmole liʻiliʻi (drain) i loko o ka ʻōpū e hoʻokahe i ka wai a me ka ea i loaʻa i ka maʻi i hōʻiliʻili ʻia i loko o ka lua ʻōpū. E hōʻoluʻolu kēia i nā hōʻailona. Ma hope mai, ke ʻelemakule iki a olakino ka pēpē, e hana ʻia ke ʻoki kino.

He aha ka wā e hiki mai ana o kahi pēpē me NEC?

ʻOiai he maʻi weliweli ʻo NEC, hiki ke mālama ʻia. 8 o 10 mau pēpē me NEC e ola ana. ʻOiai kekahi o kēia mau pēpē e loaʻa paha nā pilikia olakino lōʻihi, ola ka hapa nui i nā ola maʻamau a piha.

Aia kekahi mau ala e pale aku ai i kēia?

ʻOiai ʻaʻole hiki ke pale loa ʻia, aia kekahi mau mea hiki iā ʻoe ke hana e hōʻemi i ka pilikia o NEC.

• Ke pale ʻana i ka hānau mua ʻana: ʻOi aku ka maikaʻi o ka mālama ʻana i ka pēpē i loko o ka ʻōpū no ka lōʻihi e like me ka hiki. No ka hana ʻana i kēia, e hahai i nā ʻōlelo aʻoaʻo lapaʻau kūpono i ka wā hāpai.
• Nā inikini Corticosteroid: Hāʻawi nā kauka i nā makuahine i pilikia i ka hānau mua ʻana i kahi inikini i kapa ʻia he corticosteroid. Kōkua kēia i ka ulu ʻana o nā māmā a me nā ʻōpū o ka pēpē.
• Ka hānai waiū: ʻO ka hānai waiū ka pale maikaʻi loa no kahi pēpē hānau mua. He mana kupaianaha ko ka waiū umauma e hōʻemi i ka pilikia o NEC. Mālama nā mea hoʻoikaika i ka pale ʻana i ka ʻōpū o ka pēpē.
• Probiotics: Ua hōʻike kekahi mau noiʻi e hiki i ka hoʻohui ʻana i nā probiotics (bacteria maikaʻi) i ka waiū umauma a i ʻole ka waiū waiū ke hōʻemi i ka pilikia o NEC. Eia nō naʻe, pono ʻoe e kamaʻilio me ke kauka o kāu pēpē ma mua o ka hana ʻana i kēia.

Hiki ke lilo i mea hoʻohoka no nā mākua ke loaʻa kahi pilikia e like me NEC ʻoiai kā lākou pēpē i loko o ka NICU. Akā e hoʻomanaʻo, ua hoʻomaʻamaʻa kūikawā ʻia nā kauka a me nā kahu maʻi ma ka NICU e ʻike a mālama koke i kēia mau kūlana. E hilinaʻi iā lākou. E kamaʻilio me lākou e pili ana i nā nīnau a hopohopo paha āu e loaʻa ai.