ʻAʻole anei e hana pono nā puʻupaʻa o kāu pēpē? E makaʻala kākou i kēia Potter Syndrome!

Inā he makuahine hānau ʻoe, hopohopo nui paha ʻoe no ke olakino o kāu pēpē, ʻeā? He mea maʻamau ke noʻonoʻo inā e ulu maikaʻi ana kāu pēpē i loko o ka ʻōpū a inā e holo pono ana nā mea āpau. I kēia lā e kamaʻilio mākou e pili ana i kahi maʻi kakaikahi loa e hiki ke hoʻopilikia i nā pēpē. Ua kapa ʻia ʻo Potter Syndrome. E hopohopo paha ʻoe ke lohe ʻoe i kēia, akā he mea nui loa ia e makaʻala.

I ka ʻōlelo maʻalahi, he aha ka Potter Syndrome?

ʻAe, e wehewehe kākou. ʻO ka maʻi Potter, i kapa ʻia i kekahi manawa ʻo ka Potter sequence , he maʻi kakaikahi ia e hoʻopilikia ai i ka ulu ʻana o ka pēpē i ko lākou wā i loko o ka ʻōpū. ʻO ke kumu nui o kēia, ʻaʻole i ulu pono nā puʻupaʻa o ka pēpē a i ʻole ua pilikia kā lākou hana . Ua ʻike anei ʻoe i ka wā e noho ana kahi pēpē i loko o ka ʻōpū, nui ka wai amniotic a puni lākou. He kuleana nui nā puʻupaʻa i ka mālama ʻana i ka nui o kēia wai amniotic. No laila, i ka wā e hana pono ʻole ai nā puʻupaʻa, emi ka nui o kēia wai amniotic. ʻO kēia ka mea a nā kauka e kapa nei he oligohydramnios.

ʻO ka mea kaumaha, i kekahi manawa hānau ʻia kahi pēpē me ka ʻole o nā puʻupaʻa ʻelua, kahi kūlana i kapa ʻia ʻo "Bilateral Renal Agenesis", hiki ke make. Eia nō naʻe, hiki i kekahi mau pēpē ke ola inā he akahai ko lākou mau hōʻailona a inā ʻaʻole koʻikoʻi ka nalowale ʻana o ka wai. Eia nō naʻe, hiki i kēia mau pēpē ke loaʻa i nā maʻi mau o ka māmā a me nā puʻupaʻa i ko lākou wā ʻelemakule.

ʻO wai ka mea i ʻoi aku ka pilikia o kēia kūlana?

ʻOiaʻiʻo, hiki i kēia maʻi i kapa ʻia ʻo Potter syndrome ke hoʻopilikia i kekahi pēpē. No ka mea, pili pono ia i ka lawa ʻole o ka wai amniotic. Eia nō naʻe, ua ʻike kekahi mau noiʻi he ʻoi aku ka nui o ka loaʻa ʻana o kēia maʻi i nā pēpē kāne .

He maʻi hoʻoilina anei ka Potter syndrome?

He mea paʻakikī iki kēia. ʻAʻole he maʻi hoʻoilina ka Potter syndrome. Eia nō naʻe, aia kekahi mau maʻi e hiki ke hoʻoulu iā ia. E nānā kākou i ke ʻano o lākou:

• Maʻi puʻupaʻa polycystic: Hiki ke hoʻoilina ʻia kēia mai ka makuahine a i ʻole ka makuakāne (autosomal dominant) a i ʻole mai nā mākua ʻelua (autosomal recessive). ʻO kēia ke kumu o ka hana ʻana o nā cysts i loko o nā puʻupaʻa.
• ʻO Renal agenesis: ʻO kēia ka hiki ʻole o nā puʻupaʻa ke ulu. I kekahi manawa hiki ke hana ʻia kēia e nā mutations i loko o nā genes FGF20 a i ʻole GREB1L. Hiki ke hoʻoilina ʻia kēia kūlana ma ke ʻano autosomal dominant a i ʻole autosomal recessive. ʻO ke ʻano kēia, pono e hoʻoilina ka pēpē i ka mutation mai kekahi a i ʻole nā ​​mākua ʻelua.
• Nā loli genetic sporadic: I kekahi manawa, hiki i kahi loli genetic random ke hana i ka Potter syndrome, ʻoiai inā ʻaʻohe mea o ka ʻohana i loaʻa i ke ʻano ma mua.

Pehea ka maʻamau o kēia ʻano?

He maʻi laha ʻole ka Potter syndrome. Ua manaʻo ʻia e hoʻopilikia wale kēia maʻi i hoʻokahi i loko o 4,000 a 10,000 mau pēpē i hānau ʻia. No laila, mai hopohopo i ka lohe ʻana e pili ana i ia mea. Akā, he mea nui e makaʻala.

Pehea ka hopena o ka Potter syndrome i ke kino o kahi pēpē?

ʻO kēia ka mea nui loa. Hoʻopilikia ka maʻi Potter i ke ʻano o ka ulu ʻana a me ka hana ʻana o nā ʻōpū o loko o ka pēpē, ʻoiai hoʻi nā puʻupaʻa . E like me kou ʻike, he mau ʻōpū koʻikoʻi nā puʻupaʻa e wehe i nā huahana ʻōpala a me ke wai keu mai ko mākou kino. I ka wā o ka pēpē i loko o ka ʻōpū, hana nā puʻupaʻa i ka mimi. Hoʻopōʻaiapuni ʻia kēia mimi ma ke ʻano he wai amniotic.

No laila, inā ʻaʻole hana pono nā puʻupaʻa o ka pēpē, ʻaʻole lākou e hana i ka wai amniotic lawa e hoʻopuni iā ​​​​lākou. ʻO kēia wai amniotic ka mea e hoʻomalu ai i ka pēpē. Ke nalowale kēia wai, ua hoʻopilikia ʻia ke ʻano o ka ulu ʻana o nā ʻōpū a me ke kino o ka pēpē. I nā huaʻōlelo ʻē aʻe, ʻaʻole e ulu piha nā ʻōpū . A laila ʻaʻole hiki i kēlā mau ʻōpū ke hana pono i kā lākou hana. ʻO kēia ke kumu o nā hōʻailona hoʻoweliweli ola.

He aha nā hōʻailona o ka Potter syndrome?

Hiki ke ʻokoʻa nā hōʻailona o ka Potter syndrome mai kēlā pēpē a kēia pēpē, a hiki ke ʻokoʻa ke koʻikoʻi o ke ʻano. Hiki i kēia mau hōʻailona ke hoʻopilikia i kou hāpai ʻana, hiki ke alakaʻi i ka hānau mua ʻana .

Ka nele o ka wai amniotic

I ka wā hāpai, aia kahi wai melemele a moakaka e hoʻopuni ana i ka pēpē. ʻO kēia ka wai amniotic. Mālama kēia i ka pēpē a hāʻawi iā ia i kahi e ulu ai. Hana ia ma ke ʻano he pale ma waena o ka paia uterine a me ka pēpē. ʻAʻole lawa kēia wai amniotic i nā pēpē me ka Potter syndrome, no laila ke kaomi mai ka paia uterine e hoʻopilikia i ke ʻano o ka ulu ʻana o ka pēpē.

Nā hiʻohiʻona kūikawā o ka helehelena a me ke kino

Hoʻopilikia ke kaomi i hoʻokumu ʻia e ka nele o ka wai amniotic i ke ʻano o ka ulu ʻana o ke kino o ke pēpē. Hiki i kēia ke hana i nā hiʻohiʻona helehelena kikoʻī. Ua kapa ʻia kēia ʻo "Potter facies" . ʻO kēia mau hiʻohiʻona:

• ʻAʻole i ulu pono ka ʻauwae (me he mea lā ua huli ʻia i loko).
• He ʻūmiʻi ma lalo o ka lehelehe lalo.
• Ua hoʻokaʻawale ʻia nā maka i kahi mamao loa.
• Ua palahalaha ke alahaka ma Naha.
• Nā pepeiao haʻahaʻa a me ka hoʻemi ʻia o ke cartilage ma nā pepeiao.
• Peʻe ka ʻili ma nā kihi o nā maka.

Hiki i kēia kaomi ke hoʻopilikia i ka ulu ʻana o nā ʻāpana ʻē aʻe o ke kino o ka pēpē. Eia kekahi laʻana:

• Ka pōkole o nā lima a me nā wāwae.
• ʻAʻole hiki ke hoʻolōʻihi a hoʻopololei pono i nā hono, a me ke koʻikoʻi (contractures).
• He liʻiliʻi ka nui o ke pēpē i ka hoʻohālikelike ʻia me ka makahiki hāpai.

Nā ʻōpū i ulu ʻole a i ʻole nā ​​​​​​kikowaena i kūpono ʻole

ʻO nā hōʻailona e hoʻopilikia ana i nā ʻōpū ka mea hoʻoweliweli nui loa i ke ola.I loko o ka maʻi Potter, ua hoʻopilikia ʻia ka ulu ʻana o ka pēpē, no laila ʻaʻole i loaʻa i nā ʻōpū o loko nā kuhikuhi a i ʻole ka manawa e pono ai lākou e ulu pono. ʻO nā hōʻailona e hiki mai ana ma muli o kēia:

• Nā maʻi puʻuwai hānau.
• Nā maʻi o ka maka (e.g. cataracts, lens luxation).
• Nā maʻi puʻupaʻa (ka hāʻule ʻana o ka puʻupaʻa mau loa, ka agenesis puʻupaʻa, ka maʻi puʻupaʻa polycystic).
• Nā maʻi o ka māmā (ka maʻi māmā mau loa, ka pilikia o ka hanu ʻana).

Hoʻopilikia pū ka ulu ʻana o nā puʻupaʻa maʻamau i ka nui o ka mimi e hiki i kahi keiki hānau hou ke hana. He hōʻailona kēia a nā kauka e nānā ai i ka wā e ʻike ai i ka maʻi Potter.

He aha nā kumu o ka Potter syndrome?

Aia kekahi mau kumu e hiki ai ke hoʻoulu i ka Potter syndrome. ʻO lākou kēia:

• ʻAʻole ulu pono nā puʻupaʻa a i ʻole ʻaʻohe o lākou puʻupaʻa.
• Ka maʻi puʻupaʻa polycystic.
• ʻO ka maʻi ʻōpū ʻokiʻoki (ʻO ka maʻi ʻōpū ʻokiʻoki / ka maʻi Eagle-Barrett)
• Nā ālai ʻana o ke ala mimi.
• Ka liki ʻana o ka wai amniotic ma muli o ka haki ʻana o nā membrane.
• Nā kūlana olakino i kāohi ʻole ʻia ma ka makuahine, no ka laʻana, ka maʻi diabetes type 1.

ʻO kēia mau hōʻailona, ​​ʻoiai nā mea e hoʻopilikia ana i nā puʻupaʻa, hiki mai no ka mea ʻaʻole lawa ka wai amniotic i loko o ka ʻōpū e hoʻopuni ai i ka pēpē .

No ke aha e emi nei kēia wai amniotic?

E nānā kākou i kēia me nā kikoʻī hou aku. ʻO ke kumu nui ka ulu ʻana o nā puʻupaʻa ma ke ʻano kūpono ʻole .

Ua ʻike anei ʻoe i ka wā hāpai, lana kāu pēpē i loko o kahi wai moakaka a melemele i kapa ʻia ʻo ka wai amniotic. Mālama kēia wai i kāu pēpē a kōkua iā ia e ulu i kou wā hāpai? I ka hoʻomaka ʻana o kou hāpai ʻana, ua hana ʻia kēia wai amniotic me ka wai a me nā meaʻai mai kou kino. Inu kāu pēpē i kēia wai amniotic. Ma waena o nā pule 16 a me 20, hoʻomaka kāu pēpē e hāʻawi i kēia wai amniotic. Pehea ʻoe i ʻike ai? Ma ka mimi ʻana! Inu kāu pēpē i kēia wai a laila hoʻopuka iā ia ma ke ʻano he mimi. Hana ʻia kēia i loko o kahi pōʻaiapuni.

No laila, inā loaʻa i kāu pēpē ka Potter syndrome, ʻaʻole i ulu pono kāna mau ʻōkana hana mimi, ʻo ia hoʻi nā puʻupaʻa, a i ʻole ua nalowale lākou, a i ʻole ʻaʻole lākou e hana. No ka mea ʻaʻole hiki i ka pēpē ke mimi, ʻaʻole hiki iā ia ke kōkua i ka nui o ka wai amniotic e pale aku iā ia. ʻO ia ke kumu i emi ai ka wai amniotic i loko o ka ʻōpū.

Aia kekahi mau ʻano like ʻole o ka Potter syndrome?

ʻAe, hoʻokaʻawale nā ​​​​kauka i nā ʻano like ʻole o ka maʻi Potter, ma muli o nā hōʻailona e hoʻopilikia ai i nā puʻupaʻa.

• ʻO ka maʻi Potter Classic: ʻO kēia ke ʻano maʻamau. Hana ia i ka wā e hānau ʻia ai kahi pēpē me ka ʻole o nā puʻupaʻa ʻelua.
• ʻAno I o ka maʻi Potter:Hoʻokumu ʻia kēia ʻano maʻi e kahi maʻi i kapa ʻia ʻo ka maʻi puʻupaʻa polycystic, kahi i hoʻoilina ʻia mai nā mākua ʻelua a he maʻi autosomal recessive. I kēia maʻi, hana ʻia nā cysts i loko o nā puʻupaʻa.
• ʻO ka maʻi Potter type II: Hoʻokumu ʻia kēia ʻano maʻi e nā ʻano ʻē i ka ulu ʻana o ka puʻupaʻa e kū mai ana i loko o ka ʻōpū i ka wā hāpai.
• ʻO ka maʻi Potter ʻano III: Hoʻokumu ʻia kēia e ka maʻi polycystic kidney, e like me ke ʻano I. Eia nō naʻe, ua hoʻoilina ʻia mai hoʻokahi makua wale nō (Autosomal dominant).
• ʻO ka maʻi Potter ʻano IV: Hoʻokumu ʻia kēia ʻano maʻi e kahi ālai ʻia o ke ala mimi (obstructive uropathy) ma muli o ka ulu ʻana o ka pēpē i loko o ka ʻōpū.

Pehea e ʻike ʻia ai ka maʻi Potter?

Hiki ke ʻike ʻia ka maʻi Potter i ka wā hāpai ma o kahi hoʻokolohua prenatal . ʻO kahi hōʻailona e loaʻa paha iā ʻoe kēia ʻano i ka wā hāpai, ʻo ia ka nele o ka wai amniotic a puni ka pēpē. E nānā kāu kauka i kēia i ka wā o kahi scan ultrasound. E nānā pū lākou i nā hōʻailona kino e like me ka ʻoʻoleʻa o nā hono (contractures).

Inā ʻaʻole i ʻike ʻia kēia ma mua o ka hānau ʻana o ka pēpē, e hana ke kauka i kahi hoʻokolokolo kino ma hope o ka hānau ʻana o ka pēpē e nānā i nā hōʻailona. ʻO kēia mau hōʻailona:

• Haʻahaʻa loa ka hoʻopuka ʻana o ka mimi.
• Loaʻa nā hiʻohiʻona helehelena kikoʻī.
• Paʻakikī ka hanu ʻana.

He aha nā hoʻokolohua e hana ʻia e hōʻoia i kēia?

Hiki i ke kauka ke hana i kekahi mau hoʻokolohua e hōʻoia i ka maʻi:

• Hoʻāʻo koko genetic e ʻike ai i ke gene kuleana no nā hōʻailona.
• E nānā i nā māmā o kāu keiki, nā puʻupaʻa, a me ke ala mimi me nā hoʻokolohua kiʻi e like me ka X-ray, MRI, a i ʻole ultrasound .
• Nā hoʻāʻo koko a mimi paha e nānā i nā pae electrolyte a me nā enzyme.
• ʻO kahi hoʻāʻo echocardiogram e nānā i nā hōʻailona o ka maʻi puʻuwai.

He aha nā lāʻau lapaʻau no kēia?

ʻO ka lāʻau no ka Potter syndrome e pili ana i ke koʻikoʻi o nā pilikia o ka māmā a me ka puʻuwai (pulmonary hypoplasia) e hoʻopilikia ana i kāu keiki, a me nā koho i loaʻa e kākoʻo i ka hana puʻupaʻa o kāu keiki.

E noʻonoʻo e pili ana i ia mea, pono e hoʻopuni ʻia kāu pēpē e ulu ana e ka wai amniotic i ka wā hāpai e hoʻomohala pono ai i kona mau māmā. Inā piha ka umauma o ka pēpē no ka manawa lōʻihi, e nalowale paha ka nui o ka ʻiʻo māmā e ola ai ma hope o ka hānau ʻana.

Hiki ke paʻakikī loa ka mālama ʻana i kahi keiki hānau hou me ka hāʻule piha ʻana o nā puʻupaʻa. I kekahi mau hihia, ua kaupalena ʻia nā hana mālama koʻikoʻi a hoʻohana ʻia ka mālama palliative neonatal e mālama pū i ka pēpē a me nā mākua a hāʻawi i ka hōʻoluʻolu no ka pēpē.He koho paha ka mālama ʻana methodological.

Inā ola kāu pēpē ma hope o ka hānau ʻana, e kālele nui ka lāʻau lapaʻau i ka pale ʻana i nā hōʻailona hoʻoweliweli ola. Hiki i kēia mau lāʻau lapaʻau ke komo pū me:

• Ka hoʻohana ʻana i nā lako kākoʻo hanu (e.g. ventilator ).
• Nā lāʻau lapaʻau e kōkua ai i ka hana o ka māmā.
• ʻO ke ʻoki kino e hoʻoponopono ai a wehe paha i nā mea ālai i loko o ke ala mimi.
• ʻO ke ʻoki kino e hoʻomaikaʻi ai i ka hānai ʻana ma o ka lāʻau lapaʻau IV, kahi paipu nasogastric, a i ʻole kahi paipu hānai.
• ʻO ka Dialysis kahi lāʻau lapaʻau e wehe i nā mea ʻawahia e hōʻiliʻili ana i loko o ke koko ma muli o nā ʻano ʻē o nā puʻupaʻa. Inā ʻaʻole holomua ka lāʻau dialysis ma hope o kekahi mau makahiki, hiki i ke kauka ke paipai i kahi hoʻoili puʻupaʻa .

Ma muli o ka wā i ʻike ʻia ai kāu pēpē, hiki ke hoʻomaka ka lāʻau lapaʻau i ka wā hāpai. Hiki paha iā ʻoe ke kūpono no kahi lāʻau lapaʻau noiʻi, e like me ka amnioinfusion, kahi e hoʻohui ai i ka wai i kou lua amniotic e pani i ka wai a puni kāu pēpē. Hana maikaʻi kēia lāʻau lapaʻau ma mua o 22 mau pule o ka hāpai ʻana.

Hiki ke pale ʻia ka Potter syndrome?

ʻO ka mea pōʻino, ʻaʻohe ala e pale aku ai i ka Potter syndrome .

He aha kaʻu e manaʻo ai inā loaʻa i kaʻu keiki ka Potter syndrome?

ʻAʻohe lāʻau lapaʻau no ka Potter syndrome. I ka hapanui o nā hihia, inā ʻike mua ʻia ke ʻano i ka wā hāpai, hiki i kāu kauka ke hoʻolālā no ka hānau palekana a hāʻawi i ka lāʻau lapaʻau e kōkua i kāu pēpē e ola ma hope o ka hānau ʻana.

He mea hoʻoweliweli ke ola o nā hōʻailona o ka Potter syndrome. Eia nō naʻe, inā ʻaʻole i hoʻopilikia nui ʻia nā māmā a me nā puʻupaʻa o kāu pēpē e nā hōʻailona, ​​​​hiki i kāu pēpē ke loaʻa kahi prognosis maikaʻi iki aʻe.

Ma muli o ka hoʻomaka koke ʻana o ka lāʻau lapaʻau ma hope o ka hānau ʻana, ʻaʻole holomua nā lāʻau lapaʻau āpau. Pono paha lākou e hana i nā ʻoki kino he nui i ka wā ʻōpiopio o ke ola.

He aha ke kūlana o ke ola o kahi pēpē me ka Potter syndrome?

Hiki i nā pēpē i ʻike ʻia me ka maʻi Potter ke loaʻa kahi ola pōkole loa . He ʻokoʻa kēia no kēlā me kēia kanaka, a pili ia i nā hōʻailona. Inā koʻikoʻi nā hōʻailona, ​​a inā pilikia ka ulu ʻana a me ka hana o nā ʻōpū nui e like me ka puʻuwai, nā māmā, a me nā puʻupaʻa, ʻaʻole maikaʻi ka prognosis. ʻAʻole ola ka hapa nui o nā pēpē i nā lā mua o ke ola . I nā hihia palupalu, kahi i ʻole koʻikoʻi loa nā hōʻailona a ʻaʻole i pilikia nui nā ʻōpū, hiki ke lōʻihi iki ka manaʻolana ola.

E kamaʻilio kāu kauka me ʻoe e pili ana i nā pilikia o ka maʻi o kāu pēpē, a e ʻōlelo aku i nā lāʻau lapaʻau e hoʻolōʻihi i kona ola. Inā koʻikoʻi ka maʻi o kāu pēpē, ʻo ka mālama palliative paha ke ala e kōkua iā ʻoe e hoʻomanawanui i ke kaumaha o ka nalowale ʻana o kahi mea aloha.Hiki ke ʻōlelo ʻia ke aʻo ʻana no ke kaumaha a i ʻole ka make ʻana.

Āhea wau e ʻike ai i ke kauka?

Inā ʻike ʻoe i kekahi mau loli i kou wā hāpai, ʻoiai inā e pau koke ka neʻe ʻana o kāu pēpē ma hope o ka neʻe maikaʻi ʻana , e ʻike koke i kāu kauka. Hiki ke hānau mua ʻia kāu pēpē ma mua o ka mea i manaʻo ʻia. No laila, he mea nui loa ka loaʻa ʻana o nā hoʻokolohua prenatal maʻamau me kāu kauka e hoʻomākaukau ai no ka hānau ʻana o kāu pēpē.

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?

He mea maʻamau ka loaʻa ʻana o nā nīnau he nui i loko o kou manaʻo i ka manawa e like me kēia. E ho'āʻo e nīnau i kāu kauka i kēia mau nīnau:

• He aha ke kumu nui o ka maʻi o kaʻu pēpē?
• E pono anei iaʻu ke ʻoki kino ma hope o ka hānau ʻana o kaʻu pēpē?
• He aha nā hopena ʻaoʻao o nā lāʻau lapaʻau āu i ʻōlelo mai ai?
• He aha ke ala palekana e hānau ai i kaʻu pēpē me ka Potter syndrome?
• He aha kaʻu e hana ai e kōkua i kaʻu pēpē e ola?

Hiki ke lilo i mea ʻeha a paʻakikī hoʻi ka hoʻoponopono ʻana i ka lono e hiki ʻole i kāu pēpē ke ola i kahi maʻi e hoʻoweliweli ana i ke ola. E hana pū kāu kauka me ʻoe e hoʻoholo i ka maʻi o kāu pēpē. E hōʻoia lākou ua palekana kāu pēpē a loaʻa iā lākou ka lāʻau lapaʻau koke e hōʻoluʻolu i nā hōʻailona ma hope o ka hānau ʻana.

ʻO ka mea hope loa, nā mea e hoʻomanaʻo ai

He maʻi hoʻokaumaha maoli ka Potter Syndrome. Ke aʻo ʻoe e pili ana i ia mea, e kaumaha a makaʻu paha ʻoe. He mea maʻamau kēlā.

• E hoʻomanaʻo he mea laha ʻole kēia .
• ʻO ke kumu nui o kēia, ʻaʻole e ulu pono nā puʻupaʻa o ke pēpē a no laila ua emi iho ka wai amniotic .
• He mea nui ka ʻike mua ʻana i ka wā hāpai .
• Inā koʻikoʻi nā hōʻailona, ​​​​ʻaʻole e ola nā pēpē he nui . He mea paʻakikī loa ka ʻike ʻana i kēia, akā he mea nui e kamaʻilio e pili ana i ia mea me ka ʻoiaʻiʻo.
• ʻAʻole ʻoe hoʻokahi. E kākoʻo kāu hui lapaʻau, ʻohana, a me nā hoaaloha iā ʻoe i kēia manawa paʻakikī . Mai kānalua e ʻimi i ke aʻo ʻana inā pono.

Manaʻolana mākou ua kōkua kēia ʻike iā ʻoe e hoʻomaopopo i kēia maʻi laha ʻole. Inā he mau nīnau hou aku kāu, mai kānalua e kamaʻilio me kāu kauka.

ʻO ka maʻi Potter, Potter syndrome, pēpē, puʻupaʻa, wai amniotic, hāpai keiki, nā hōʻailona, ​​​​​​lāʻau lapaʻau