Omwana wo omuwere alina obuzibu mu kussa? Ka tuyige ku PPHN (Persistent Pulmonary Hypertension of the Newborn)!

Omwana eyaakazaalibwa kye kimu ku bintu ebisinga okusanyusa mu bulamu, si bwe kiri? Naye era kyabulijjo okuwulira ng’otya katono n’okweraliikirira naddala ku bulamu bw’omwana. Oluusi, abalongo abaakazaalibwa bayinza okuba n’obuzibu mu kussa. Eyo mbeera ya maanyi, naye ffenna gye tusobola okuddukanya obulungi singa ffenna tugimanyi. Ka twogere ku nsonga eno mu ngeri ennyangu leero.

PPHN kye ki? Ddala kye ki?

Mu ngeri ennyangu, PPHN kizibu kya maanyi mu kussa ekibaawo mu baana abaakazaalibwa. Kibaawo ng’omwana avudde mu lubuto lwo n’atandika okussa mu mbeera ey’ebweru, era enkola ye ey’okutambula kw’omusaayi tekwatagana bulungi.

Kilowoozeeko bw’otyo. Omwana wo bw’aba mu lubuto lwo, omukka gwe agufuna ng’ayita mu nnabaana, ng’ayita mu nnabaana. Mu kiseera ekyo, omusaayi mungi tegugenda mu mawuggwe ge. Kino kiri bwe kityo kubanga emisuwa gy’omusaayi mu mawuggwe (emisuwa gy’amawuggwe) gitera okuzibikira n’okufunda. Omusaayi ogumu guyita mu mawuggwe ne gugenda butereevu mu mubiri gwonna. Kiba ng’okukwata ekkubo ery’enjawulo ng’oluguudo luzibiddwa.

Kyokka enkyukakyuka ennene erina okubaawo amangu ddala ng’omwana amaze okuzaalibwa n’assa omukka gwe ogusooka . Olwo, emisuwa mu mawuggwe egyali giggaddwa gyetaaga okugguka (`(dilate)`). Wano omukka gwa oxygen w’ayingira mu mawuggwe wamu n’empewo. Oluvannyuma, omusaayi gugenda mu mawuggwe nga guyita mu misuwa gino egyaggule, ne gusitula omukka gwa oxygen, ne gubunyisa omusaayi ogwo ogujjudde omukka gwa oxygen mu mubiri gwonna, naddala mu bwongo, omutima, n’ensigo.

Mu mbeera eyitibwa PPHN, emisuwa mu mawuggwe g’omwana tegigguka bulungi, oba tegimala. Kiki ekibaawo olwo? Puleesa mu mawuggwe (pulmonary hypertension) ekula. Kino kikendeeza ku bungi bwa oxygen atuuka mu bwongo bw’omwana n’ebitundu ebirala ebikulu. Eno mbeera ya mangu ey’obujjanjabi etta obulamu era obujjanjabi bwetaaga okutandika mu bwangu.

Embeera eno eyitibwa PPHN ya bulijjo etya?

PPHN ebeerawo mu baana nga 2 ku buli 1,000 abazaalibwa nga balamu. Businga kubeera mu baana abazaalibwa mu kiseera ky’okuzaala (wakati wa wiiki 37 ne 42) ne mu baana abazaalibwa oluvannyuma lw’olunaku lw’okuzaala (oluvannyuma lwa wiiki 42). Kyokka tekitera kubaawo mu baana abazaalibwa mu bujjuvu.

Bubonero ki obwa PPHN? Tukitegeera tutya?

Singa omwana wo alina PPHN, ayinza okulaga obubonero nga:

• Obuzibu mu kussa: okussa amangu oba okussa mpola ennyo, okukola eddoboozi ery’okuwunya ng’ossa, n’okuwulira ng’ekifuba kyo kibbira mu (`(retractions)`).
• Okweyongera kw’okukuba kw’omutima (`(Omutima okukuba amangu)`).
• Olususu lw’omwana luyinza okulabika nga lwa bbululu (cyanosis) naddala mu bitundu ng’emimwa, olulimi n’engalo.
• Puleesa ekka (hypotension).
• Mu musaayiOmukka gwa oxygen omutono mu musaayi .
• Okuwulira amaloboozi ag’enjawulo oba agatali ga bulijjo (`(heart murmur)`) nga owuliriza omutima.

Bw’olaba obubonero buno obumu oba obusingawo amangu ddala ng’omwana amaze okuzaalibwa, oba mu ssaawa ntono, kikulu nnyo okutegeeza abasawo mu bwangu.

Biki ebiyamba okukulaakulanya PPHN?

Abanoonyereza n’okutuusa kati tebakakasa kiki ddala ekivaako PPHN, naye kirowoozebwa nti kiva ku mawuggwe g’omwana obutakula bulungi oba obutasobola kukwatagana (kuggulawo) mbeera ya bweru nga bamaze okuva mu lubuto.

Biki ebiyongera ku bulabe bwa PPHN?

Wadde ng’ekivuddeko ekituufu tekimanyiddwa, ensonga ezimu ziyinza okwongera ku bulabe bw’omwana okufuna PPHN. Ka tulabe kiki kye bali:

• `Meconium aspiration` : Wano omusulo gw'omwana ogusooka (tuguyita `(Meconium)`, nga gugonvu katono ate nga gukwata) bwe guyingira mu nkola ye ey'okussa ng'akyali mu lubuto.
• Yinfekisoni: Yinfekisoni z’amawuggwe, gamba ng’ekifuba oba yinfekisoni z’omusaayi.
• Obuzibu bw’okussa (RDS): Kino kisinga kulabibwa mu baana abazaalibwa nga tebanneetuuka nga amawuggwe gaabwe tegakula mu bujjuvu.
• Birth asphyxia: Omwana obutafuna mukka gwa oxygen gumala nga tannazaalibwa oba nga tannazaalibwa.
• Diaphragmatic hernia: Kino kibaawo ng’ekituli kikoleddwa mu kinywa ekyawula ekifuba ky’omwana n’olubuto (ekiyitibwa diaphragm). Kino kisobozesa ebimu ku bitundu by’olubuto okusika okuyita mu kinnya ne biyingira mu kifuba.
• Ebirala ebizibu by’omutima oba amawuggwe ebizaalibwa: Okugeza, amawuggwe amatono oba ekisenge ky’omutima ekizibiddwa.
• Okukozesa eddagala erimu ng’oli lubuto: Kigambibwa nti okukozesa eddagala eriyitibwa ``NSAIDs`` (nonsteroidal anti-inflammatory drugs) ne ``SSRIs`` (selective serotonin reuptake inhibitors), naddala ng’oli lubuto olukeerezi, nakyo kiyinza okukosebwa. N’olwekyo, bw’oba ​​omira eddagala lyonna ng’oli lubuto, kikulu nnyo okwogera n’omusawo ku nsonga eno.

Biki ebiva mu PPHN okumala ebbanga eddene?

Abalongo nga omu ku buli bana (1 ku buli 4) abawona PPHN bafuna obulemu ku ddaala eritali limu olw’obutaba na mukka gwa oxygen mu bwongo. Ebizibu bino mulimu:

• Okulwawo kw'enkulaakulana .
• Ensonga z’okuwulira , oluusi n’okuziba amatu, ziyinza okubaawo.
• Obulemu mu kuyiga .
• Okukendeera kw'obusobozi bw'okukola emirimu gy'omubiri .

N’olwekyo, kikulu nnyo okugenda mu maaso n’okukuuma abalongo abawonye PPHN nga balabirirwa abasawo n’okulondoola enkula yaabwe.

PPHN ezuulibwa etya?

Omusawo w’omwana wo asobola okukola ebigezo eby’enjawulo okuzuula oba omwana wo alina PPHN. Ebimu ku bino mulimu:

• Complete blood count (CBC): Kino kipima omuwendo gw’obutoffaali obweru, obutoffaali obumyufu n’obutoffaali obuyitibwa platelets mu musaayi gw’omwana.
• Pulse oximetry (pulse ox): Eno nkola nnyangu, etali ya kuyingira mu mubiri ey’okupima omukka gwa oxygen mu musaayi gw’omwana.
• Omukka gw’omusaayi mu misuwa (ABG): Guno gupima omubiri gw’omwana bwe gufuna omukka gwa oxygen n’engeri gye guggyamu omukka gwa kaboni dayokisayidi.
• X-ray y’ekifuba: Kino kiyamba okulaba oba omutima gw’omwana gugaziye oba waliwo obulwadde bw’amawuggwe.
• Echocardiogram (echo): Kino kye kifaananyi ekikwata ku mutima gw’omwana mu bujjuvu. Ekebera engeri omusaayi gye gukulukuta okutuuka ku mutima n’amawuggwe.
• Head ultrasound: Kino kiyamba okukebera oba omusaayi gwonna guvaamu mu bwongo bw’omwana.
• Okukebera amasannyalaze mu musaayi (serum electrolyte tests): Okukebera kuno kukozesebwa okukebera bbalansi y’eby’obuggagga eby’omu ttaka mu musaayi gw’omwana.
• Okuboola omugongo (spinal tap): Okukebera kuno oluusi kuyinza okukolebwa okukebera oba omwana alina yinfekisoni yonna.

Tekyetaagisa kukola bigezo bino byonna; abasawo bajja kusalawo okukebera kwe balina okukola okusinziira ku mbeera y’omwana.

PPHN ejjanjabwa etya?

Ekigendererwa ekikulu eky’okujjanjaba PPHN kwe kwongera okutambula kwa oxygen mu bitundu by’omwana n’okuziyiza ebizibu eby’amaanyi. Waliwo obujjanjabi obw’enjawulo ku kino:

• Oxygen: Omwana asobola okuweebwa oxygen 100% ng’ayita mu cannula y’ennyindo, ennyindo oba masiki.
• Okussa empewo mu makanika: Omusawo ayingiza ttanka mu payipu y’empewo (trachea) y’omwana n’akozesa ekyuma ekissa omwana okuyamba omwana okussa.
• Okufuga puleesa: Omwana ayinza okuweebwa eddagala okufuga puleesa ng’ayita mu musuwa (`(IV)`).
• Nitric oxide: Nitric oxide ggaasi ayamba okuggulawo (okugaziya) emisuwa mu mawuggwe g’omwana wo, okulongoosa entambula y’omusaayi mu mawuggwe.
• Okufuuwa empewo ey’amaanyi (high-frequency oscillatory ventilation): Kino nakyo kika kya njawulo eky’okufuuwa empewo. Kiyinza okuyamba okulongoosa omukka gwa oxygen mu musaayi gw’omwana.
• Extracorporeal membrane oxygenation (ECMO): Ekyuma kino kikozesebwa ng’omutima oba amawuggwe g’omwana munafu nnyo nga tesobola kufugibwa bujjanjabi bulala. Guggya omusaayi mu mubiri gw’omwana okumala akaseera, ne gugattako omukka gwa oxygen, n’aguzza mu mubiri, ne guwa omukka gwa oxygen mu bwongo n’ebitundu by’omubiri ebirala. Kikola ng’amawuggwe ag’ekikugu.

Tusobola okuziyiza PPHN?

Nga bwe twayogeddeko emabegako, tewali ngeri yonna gye tuyinza kuziyizaamu ddala PPHN kubanga tetunnaba kumanya bulungi kiki ekigireeta . Kyokka okwewala eddagala erimu ng’oli lubuto kiyinza okuyamba okukendeeza ku bulabe bwo. Kale bw’oba ​​oli lubuto, kakasa nti oyogera n’omusawo wo nga tonnamira ddagala lyonna okukakasa nti teririna bulabe bwonna okulimira ng’oli lubuto.

Kitwala bbanga ki okuwona PPHN?

Abalongo abasinga bawona ekirwadde kya PPHN mu wiiki emu oba bbiri . Kyokka abalongo abamu bayinza okutwala ekiseera ekiwanvu, oluusi n’emyezi, okuwona mu bujjuvu. Omwana ne bw’amala okuwona, kikulu okumukuuma obutakwatibwa musujja, ssennyiga n’obulwadde obulala obuva ku buwuka. Kino osobola okukikola ng’onaaba mu ngalo enfunda eziwera, omwana wo n’akoma ku kukwatibwa mu bantu abangi, n’okukuuma omwana wo ng’atava ku bantu abalwadde. Era kirungi buli muntu mu maka go okugema ssennyiga buli mwaka.

Okusingira ddala, kyetaagisa okutwala omwana wo okwekebejjebwa buli kiseera n’okukyalira abasawo abakugu okukakasa nti enkula ye egenda mu maaso bulungi.

Omuwendo gw‟okuwangaala n‟entunula ki eri PPHN?

PPHN mbeera ya maanyi, era ebyembi, wakati wa 7% ne 10% ku baana abalina embeera eno bafa olw’ebizibu. Ku baana abawona, nga 25%, oba nga omu ku bana, bayinza okuba n’ebikosa eby’ekiseera ekiwanvu (nga okulwawo mu nkula, obuzibu mu kuyiga, n’okubulwa okuwulira) ebiva ku butabeera na mukka gwa oxygen mu bwongo.

Ddi lw’osaanidde okutwala omwana wo ew’omusawo?

Oluvannyuma lw’omwana wo okuwona PPHN, kakasa nti otwala omwana wo mu ssaawa zonna ez’okugoberera . Kino kijja kuyamba omusawo wo okugenda mu maaso n’okulondoola omwana wo. Mu kiseera kino, funa amagezi mu bwangu omusawo singa omwana wo alaga obubonero buno wammanga:

• Bw’ofuna omusujja.
• Bw’okendeeza ku mata g’olya, oba nga tonywa mata n’akatono.
• Singa ekifuba kyo kibbira mu ng’ossa, oba bw’ossa ng’ennyindo ziggule.
• Singa okola eddoboozi ery’okuwuuma oba ery’okuwuuma ng’ossa.
• Singa olususu lutandika okufuuka bbululu oba enzirugavu.

Bw’okizuula nti omwana wo omuwere alina embeera nga PPHN, kya bulijjo okuwulira ennaku, okutya, obusungu n’okutabulwa. Ekyo kya butonde. Yiga bingi nga bw’osobola ku PPHN okuva mu basawo ne ba nurse abajjanjaba omwana wo. Bajja kukubuulira byonna by’osobola ku mbeera y’omwana wo, n’engeri gy’oyinza okumubudaabuda n’okumuyamba. Ekiseera bwe kinaagenda kiyitawo, ojja kufuuka omukugu mu mbeera y’omwana wo, era ojja kufuna obwesige okukolera omwana wo buli ky’osobola.

Ebintu ebikulu by'olina okujjukira (Take-Home Message)

• PPHN kizibu kya maanyi mu kussa mu balongo. Mu mbeera eno, emisuwa mu mawuggwe tegigguka bulungi ekiziyiza omubiri okufuna omukka ogumala.
• Wadde nga ekituufu ekivaako kino tekinnamanyika , waliwo ebintu eby’obulabe nga meconium aspiration, infection, RDS, n’okukendeeza ku oxygenation nga ozaala.
• Bw’ofuna obubonero ng’okukaluubirirwa okussa, olususu olwa bbululu, oba omutima okukuba amangu, genda mangu omusawo amagezi.
• Obujjanjabi mulimu oxygen, obuyambi bw’ekyuma ekissa, nitric oxide, ne ECMO.
• Wadde tekisoboka kukiziyiza ddala , kikulu okumira eddagala eritaliiko bulabe lyokka ng’oli lubuto ng’omusawo bw’amulagira.
• Okulondoola abasawo okumala ebbanga eddene n’okukebera enkula kyetaagisa oluvannyuma lw’okuwona.
• Mu kiseera kino toli wekka . Funa obuwagizi okuva mu basawo n’ab’omu maka. Waliwo ebintu bingi by’osobola okukolera omwana wo.

` PPHN, abalongo, obuzibu mu kussa, puleesa y’amawuggwe, oxygen, okulabirira abaana abaakazaalibwa, cyanosis