Ke pilikia nei kāu pēpē hānau hou i ka hanu ʻana? E aʻo kākou e pili ana i ka PPHN (Persistent Pulmonary Hypertension of the Newborn)!

ʻO kahi pēpē hānau hou kekahi o nā hauʻoli nui loa o ke ola, ʻeā? Akā he mea maʻamau nō hoʻi ke manaʻo iki i ka makaʻu a me ka hopohopo, ʻoiai e pili ana i ke olakino o ka pēpē. I kekahi manawa, hiki i nā pēpē hānau hou ke loaʻa i kekahi mau pilikia hanu. He kūlana koʻikoʻi kēlā, akā hiki iā kākou āpau ke hoʻokele maikaʻi inā ʻike kākou a pau. E kamaʻilio wale kākou e pili ana i kēia lā.

He aha ka PPHN? He aha maoli ia?

I ka ʻōlelo maʻalahi, he pilikia hanu koʻikoʻi ka PPHN i loaʻa i nā pēpē hānau hou. Hana ia i ka wā e puka mai ai kāu pēpē mai kou ʻōpū a hoʻomaka e hanu i ke kaiapuni waho, a ʻaʻole kūpono kā lākou ʻōnaehana hoʻopuni koko.

E noʻonoʻo i kēia ʻano. I ka wā e noho ana kāu pēpē i loko o kou ʻōpū, loaʻa iā ia ka oxygen ma o ke kaula umbilical, ma o ka placenta. I kēlā manawa, ʻaʻole nui ke koko e hele i kona mau māmā. ʻO kēia no ka mea ua paʻa pinepine ʻia a ua haiki ʻia nā kīʻaha koko i loko o nā māmā (nā aʻa pulmonary). Holo kekahi koko i nā māmā a hele pololei i ke koena o ke kino. Ua like ia me ka lawe ʻana i kahi ala ʻokoʻa ke paʻa ke alanui.

Eia nō naʻe, pono e hana ʻia kahi loli nui i ka wā e hānau ai ke pēpē a hanu mua . A laila, pono e wehe ʻia nā kīʻaha koko i loko o nā māmā i pani ʻia (`(dilate)`). ʻO ia ka manawa e komo ai ka oxygen i loko o nā māmā me ka ea. A laila, hele ke koko i nā māmā ma o kēia mau kīʻaha koko i wehe ʻia, lawe i ka oxygen, a hāʻawi i kēlā koko i piha i ka oxygen i ke kino holoʻokoʻa, ʻoi aku hoʻi i ka lolo, ka puʻuwai, a me nā puʻupaʻa.

I loko o ke kūlana i kapa ʻia ʻo PPHN, ʻaʻole e wehe pono nā kīʻaha koko i loko o nā māmā o ka pēpē, a ʻaʻole lawa paha. He aha ka mea e hana ai? Hoʻomaka ke koko kiʻekiʻe i loko o nā māmā (pulmonary hypertension). Hoʻopaʻa kēia i ka nui o ka oxygen e hiki aku i ka lolo o ka pēpē a me nā ʻōpū koʻikoʻi ʻē aʻe. He pilikia olakino hoʻoweliweli kēia a pono e hoʻomaka koke ʻia ka lāʻau.

Pehea ka maʻamau o kēia ʻano i kapa ʻia ʻo PPHN?

Loaʻa ka PPHN ma kahi o 2 o kēlā me kēia 1,000 hānau ola. ʻO ia ka mea maʻamau i nā pēpē i hānau ʻia i ka manawa kūpono (ma waena o 37 a me 42 mau pule) a i nā pēpē i hānau ʻia ma hope o ka lā hānau (ma hope o 42 mau pule). Eia nō naʻe, ʻaʻole hiki ke loaʻa pinepine i nā pēpē manawa piha.

He aha nā hōʻailona o ka PPHN? Pehea mākou e ʻike ai?

Inā loaʻa i kāu pēpē ka PPHN, hiki iā lākou ke hōʻike i nā hōʻailona e like me:

• Nā pilikia hanu: ka hanu wikiwiki loa a lohi loa paha, ke kani ʻana o ka wheezing i ka wā e hanu ana, a me ka manaʻo e piholo ana kou umauma i loko (`(retractions)`).
• Piʻi ka helu o ka puʻuwai ("(Rapid heart rate)`).
• Hiki ke ʻike ʻia ka ʻili o kahi pēpē he polū (cyanosis), ʻoiai ma nā wahi e like me nā lehelehe, ke alelo, a me nā manamana lima.
• Ke koko haʻahaʻa (hypotension).
• I loko o ke kokoNā pae oxygen koko haʻahaʻa .
• Ke lohe nei i nā leo keu a i ʻole nā ​​leo ʻē aʻe (`(heart murmur)`) i ka wā e hoʻolohe ana i ka puʻuwai.

Inā ʻike ʻoe i hoʻokahi a ʻoi aku paha o kēia mau hōʻailona ma hope koke iho o ka hānau ʻana o ka pēpē, a i ʻole i loko o kekahi mau hola, he mea nui loa ia e hoʻomaopopo koke i nā kauka.

He aha nā kumu e kōkua ai i ka ulu ʻana o PPHN?

ʻAʻole maopopo i nā kānaka noiʻi ke kumu maoli o ka PPHN, akā ua manaʻo ʻia ua hana ʻia e ka ulu pono ʻole ʻana o nā māmā o ka pēpē a i ʻole ʻaʻole hiki ke hoʻololi (wehe) i ke kaiapuni o waho ma hope o ko lākou haʻalele ʻana i ka ʻōpū.

He aha nā mea e hoʻonui ai i ka pilikia o ka PPHN?

ʻOiai ʻaʻole ʻike ʻia ke kumu kikoʻī, hiki i kekahi mau kumu ke hoʻonui i ka pilikia o ka loaʻa ʻana o ka PPHN i kahi pēpē. E nānā kākou i ko lākou ʻano:

• ʻO ka ʻume ʻana o ka meconium: ʻO kēia ka manawa e komo ai ka ʻōpala mua o ka pēpē (kapa mākou iā ia he `(Meconium)`, he mānoanoa iki a pipili) i loko o kona ʻōnaehana hanu ʻoiai ʻo ia i loko o ka ʻōpū.
• Nā maʻi: Nā maʻi o ka māmā, e like me ka maʻi pneumonia, a i ʻole nā ​​maʻi koko.
• ʻO ka maʻi pilikia hanu (RDS): ʻIke pinepine ʻia kēia i nā pēpē hānau mua ʻole ʻia nona nā māmā i hoʻomohala piha ʻole ʻia.
• ʻO ka asphyxia hānau: ʻAʻole i loaʻa i kahi pēpē ka oxygen lawa ma mua a i ka wā hānau paha.
• ʻO ka hernia diaphragmatic: Hana ʻia kēia ke hana ʻia kahi lua i loko o ke ʻiʻo e hoʻokaʻawale ana i ka umauma a me ka ʻōpū o ke pēpē (i kapa ʻia ʻo diaphragm). ʻAe kēia i kekahi o nā ʻōpū o ka ʻōpū e paʻi ma waena o ka lua i loko o ka umauma.
• ʻO nā mea ʻē aʻe i loko o ka puʻuwai hānau a i ʻole ka māmā: No ka laʻana, he māmā liʻiliʻi a i ʻole kahi valve puʻuwai i ālai ʻia.
• Ka hoʻohana ʻana i kekahi mau lāʻau lapaʻau i ka wā hāpai: Ua manaʻo ʻia e pili pū ana paha ka hoʻohana ʻana i nā lāʻau lapaʻau i kapa ʻia ʻo "NSAIDs" (nā lāʻau anti-inflammatory nonsteroidal) a me "SSRIs" (nā mea hoʻopale serotonin reuptake), ʻoiai i ka wā hāpai hope. No laila, inā ʻoe e lawe ana i kekahi lāʻau lapaʻau i ka wā hāpai, he mea nui loa ia e kamaʻilio me kāu kauka e pili ana i ia mea.

He aha nā hopena lōʻihi o ka PPHN?

Ma kahi o hoʻokahi i loko o ʻehā (1 i loko o 4) mau pēpē i ola i ka PPHN e loaʻa i kekahi kekelē o ke kīnā ma muli o ka nele o ka oxygen i ka lolo. ʻO kēia mau pilikia:

• Nā lohi o ka hoʻomohala ʻana .
• Hiki ke loaʻa nā pilikia lohe, i kekahi manawa kuli.
• Nā kīnā aʻo .
• Ka emi ʻana o ka hiki ke hana i nā hana kino .

No laila, he mea nui loa e hoʻomau i ka mālama ʻana i nā pēpē i hoʻōla ʻia mai ka PPHN ma lalo o ka mākaʻikaʻi lapaʻau a e nānā i ko lākou ulu ʻana.

Pehea e ʻike ʻia ai ka PPHN?

Hiki i ke kauka o kāu pēpē ke hana i nā ʻano hoʻokolohua like ʻole e hoʻoholo ai inā loaʻa i kāu pēpē ka PPHN. ʻO kekahi o kēia mau mea:

• Helu koko piha (CBC): Ke ana kēia i ka helu o nā hunaola koko keʻokeʻo, nā hunaola koko ʻulaʻula, a me nā platelet i loko o ke koko o ke pēpē.
• ʻO ka pulse oximetry (pulse ox): He ʻano maʻalahi kēia, ʻaʻole invasive no ke ana ʻana i ka pae oxygen i loko o ke koko o ke pēpē.
• ʻO ke kinoea koko arterial (ABG): Ke ana kēia i ka maikaʻi o ka loaʻa ʻana o ka oxygen i ke kino o ke pēpē a me ka maikaʻi o ka wehe ʻana i ke kalapona dioxide.
• X-ray o ka umauma: Kōkua kēia e ʻike inā ua hoʻonui ʻia ka puʻuwai o ke pēpē a inā paha he mau maʻi māmā.
• Echocardiogram (echo): He ultrasound kikoʻī kēia o ka puʻuwai o ke pēpē. Loiloi ia i ke kahe ʻana o ke koko i ka puʻuwai a me nā māmā.
• ʻO ke ultrasound poʻo: Kōkua kēia i ka nānā ʻana i kekahi kahe koko i loko o ka lolo o ke pēpē.
• Nā hoʻāʻo electrolyte serum: Hoʻohana ʻia kēia mau hoʻāʻo e nānā i ke kaulike o nā minelala i ke koko o ke pēpē.
• ʻUku lumbar (spinal tap): Hiki ke hana ʻia kēia hoʻāʻo i kekahi manawa e nānā inā loaʻa i ka pēpē kekahi mau maʻi.

ʻAʻole pono e hana i kēia mau hoʻokolohua a pau; na nā kauka e hoʻoholo i nā hoʻokolohua e hana ai ma muli o ke kūlana o ka pēpē.

Pehea e mālama ʻia ai ka PPHN?

ʻO ka pahuhopu nui o ka mālama ʻana i ka PPHN ʻo ia ka hoʻonui ʻana i ke kahe ʻana o ka oxygen i nā ʻōpū o ka pēpē a pale i nā pilikia koʻikoʻi. Aia nā ʻano lapaʻau like ʻole no kēia:

• Oxygen: Hiki ke hāʻawi ʻia i ka pēpē i ka 100% oxygen ma o ka cannula nasal, nā prongs nasal, a i ʻole kahi mask.
• Hoʻoulu ea mīkini: Hoʻokomo ke kauka i kahi ʻōmole i loko o ka ʻōpū makani o ka pēpē (trachea) a hoʻohana i kahi ventilator e kōkua i ka pēpē e hanu.
• Ke kāohi ʻana i ke koko: Hiki ke hāʻawi ʻia i ka pēpē i ka lāʻau lapaʻau e kāohi i ke koko ma o kahi aʻa koko (`(IV)`).
• ʻO ka nitric oxide: ʻO ka nitric oxide kahi kinoea e kōkua ai i ka wehe (hoʻonui) i nā kīʻaha koko i loko o nā māmā o kāu pēpē, e hoʻomaikaʻi ana i ke kahe koko i nā māmā.
• Hoʻoulu ea oscillatory alapine kiʻekiʻe: He ʻano hoʻoulu ea kūikawā nō hoʻi kēia. Hiki iā ia ke kōkua i ka hoʻomaikaʻi ʻana i nā pae oxygen i loko o ke koko o ka pēpē.
• ʻO ka oxygenation membrane extracorporeal (ECMO): Hoʻohana ʻia kēia mīkini i ka wā e nāwaliwali loa ai ka puʻuwai a i ʻole nā ​​māmā o ka pēpē e hiki ʻole ke kāohi ʻia e nā lāʻau ʻē aʻe. Lawe ia i ke koko mai ke kino o ka pēpē no kekahi manawa, hoʻohui i ka oxygen iā ia, a hoʻihoʻi iā ia i ke kino, e hāʻawi ana i ka oxygen i ka lolo a me nā ʻāpana ʻē aʻe o ke kino. Hana ia e like me ka māmā hana.

Hiki iā mākou ke pale aku i ka PPHN?

E like me kā mākou i kūkākūkā ai ma mua, ʻaʻohe ala e pale loa ai i ka PPHN no ka mea ʻaʻole mākou i ʻike pono i ke kumu . Eia nō naʻe, ʻo ka pale ʻana i kekahi mau lāʻau lapaʻau i ka wā hāpai e hiki ke kōkua i ka hōʻemi ʻana i kou pilikia. No laila, inā hāpai ʻoe, e kamaʻilio me kāu kauka ma mua o ka lawe ʻana i kekahi lāʻau lapaʻau e hōʻoia i ka palekana e lawe i ka wā hāpai.

ʻEhia ka lōʻihi e ho'ōla ai mai ka PPHN?

Hoʻōla ka hapa nui o nā pēpē mai ka PPHN i loko o hoʻokahi a ʻelua paha pule . Eia nō naʻe, hiki i kekahi mau pēpē ke lōʻihi, i kekahi manawa he mau mahina, e hoʻōla piha ai. ʻOiai ma hope o ka hoʻōla ʻana o kāu pēpē, he mea nui e pale iā lākou mai ke anu, ka maʻi palū, a me nā maʻi viral ʻē aʻe. Hiki ke hana i kēia ma ka holoi pinepine ʻana i kou mau lima, ka palena ʻana i ka ʻike ʻana o kāu pēpē i nā lehulehu, a me ka mālama ʻana i kāu pēpē mai ka poʻe maʻi. He manaʻo maikaʻi nō hoʻi no nā mea a pau o kou hale e loaʻa i ka lāʻau pale maʻi palū i kēlā me kēia makahiki.

ʻO ka mea nui, he mea nui e lawe i kāu pēpē no nā hoʻokolohua lapaʻau maʻamau a me nā kipa kūikawā e hōʻoia i ka holomua pono ʻana o ko lākou ulu ʻana.

He aha ka nui o ke ola a me ka nānā ʻana no ka PPHN?

He maʻi koʻikoʻi ka PPHN, a ʻo ka mea pōʻino, ma waena o 7% a me 10% o nā pēpē me ke ʻano e make ana mai nā pilikia. No nā pēpē e ola ana, ma kahi o 25%, a i ʻole hoʻokahi i loko o ʻehā, hiki ke loaʻa nā hopena lōʻihi (e like me ka lohi o ka ulu ʻana, nā pilikia aʻo, a me ka nalowale o ka lohe) i hoʻokumu ʻia e ka nele o ka oxygen i ka lolo.

I ka manawa hea e pono ai ʻoe e lawe i kāu pēpē i ke kauka?

Ma hope o ka ho'ōla ʻana o kāu pēpē mai ka PPHN, e hōʻoia e lawe i kāu pēpē i nā manawa hoʻokolokolo āpau . E kōkua kēia i kāu kauka e hoʻomau i ka nānā ʻana i kāu pēpē. I kēia manawa, e ʻimi koke i ke kōkua lapaʻau inā hōʻike kāu pēpē i kekahi o kēia mau hōʻailona:

• Inā loaʻa iā ʻoe ke kuni.
• Inā ʻoe e hōʻemi i kāu lawe ʻana i ka waiū, a inā ʻaʻole ʻoe e inu iki i ka waiū.
• Inā e piholo ana kou umauma i loko i kou hanu ʻana, a inā paha ʻoe e hanu me kou mau puka ihu e hāmama ana.
• Inā ʻoe e hana i kahi leo hū a ʻūhū paha i ka wā e hanu ana.
• Inā hoʻomaka ka ʻili e lilo i polū a hina paha.

Ke ʻike ʻoe ua loaʻa i kāu pēpē hānau hou kahi maʻi e like me PPHN, he mea maʻamau ke manaʻo i ka hui pū ʻana o ke kaumaha, ka makaʻu, ka huhū, a me ka huikau. He mea maoli kēlā. E aʻo i ka mea hiki iā ʻoe e pili ana i ka PPHN mai nā kauka a me nā kahu maʻi e mālama nei i kāu pēpē. E haʻi lākou iā ʻoe i nā mea āpau e hiki ai iā ʻoe e pili ana i ke kūlana o kāu pēpē, a pehea e hiki ai iā ʻoe ke hōʻoluʻolu a kōkua iā lākou. I ka manawa kūpono, e lilo ʻoe i loea i ke kūlana o kāu pēpē, a e loaʻa iā ʻoe ka hilinaʻi e hana i nā mea āpau e hiki ai iā ʻoe no kāu pēpē.

Nā mea nui e hoʻomanaʻo (Leka Lawe-Home)

• He pilikia hanu koʻikoʻi ka PPHN i nā pēpē hānau hou. I kēia kūlana, ʻaʻole e wehe pono nā kīʻaha koko i loko o nā māmā, e pale ana i ke kino mai ka loaʻa ʻana o ka oxygen lawa.
• ʻOiai ʻaʻole ʻike ʻia ke kumu kikoʻī o kēia , aia kekahi mau mea pilikia e like me ka makemake ʻana i ka meconium, ka maʻi, RDS, a me ka emi ʻana o ka oxygenation i ka wā hānau.
• Inā ʻike ʻoe i nā hōʻailona e like me ka paʻakikī o ka hanu ʻana, ka ʻili polū, a i ʻole ka puʻuwai wikiwiki, e ʻimi koke i ke kōkua lapaʻau.
• ʻO nā lāʻau lapaʻau e komo pū ana me ka oxygen, ke kākoʻo ventilator, ka nitric oxide, a me ka ECMO.
• ʻOiai he mea hiki ʻole ke pale loa ʻia , he mea nui e lawe wale i nā lāʻau lapaʻau palekana i ka wā hāpai e like me ke kuhikuhi a ke kauka.
• He mea nui ka nānā ʻana i ke olakino no ka manawa lōʻihi a me ka nānā ʻana i ka ulu ʻana ma hope o ka hoʻōla ʻana.
• ʻAʻole ʻoe hoʻokahi i kēia manawa. E kiʻi i ke kākoʻo mai nā kauka a me ka ʻohana. Nui nā mea hiki iā ʻoe ke hana no kāu pēpē.

ʻO ka PPHN, keiki hānau hou, pilikia hanu, ke koko kiʻekiʻe o ka pulmonary, oxygen, mālama keiki hānau hou, cyanosis