Ingaba umntwana wakho unengxaki phakathi kwesifuba nesisu sakhe? Masithethe nge-(Congenital Diaphragmatic Hernia - CDH)!

Ukuba ungumama ozayo okanye ulindele ukuba ilungu elitsha lize kujoyina usapho lwakho, eli bali liza kubaluleka kakhulu kuwe. Ngamanye amaxesha abantwana bethu abancinci banokuza kweli hlabathi beneziphene zokuzalwa esingazange sive ngazo. Le yenye yeemeko esiza kuthetha ngazo namhlanje, ezintsonkothileyo kancinci, kodwa zifanele ukuqatshelwa.

Yintoni iCDH? Masiyiqonde ngokulula.

Kulungile, ngoku masibone ukuba yintoni le `(Congenital Diaphragmatic Hernia)` okanye `(CDH)` ngamafutshane. Ngamafutshane, le yimeko eyenzeka xa umntwana ezalwa. Oku kwenzeka ngelixa umntwana esesesibelekweni. Kukho umsipha owahlula isifuba sethu nesisu, esiwubiza ngokuba yi`Diaphragm` . Ufana nodonga olwahlula amagumbi amabini. Ukuba le diaphragm ayomelelanga ngokwaneleyo, okanye ukuba kukho umngxuma kuyo, amalungu esiswini - oko kukuthi, isisu, amathumbu, isibindi, njl.njl. - angangena emngxunyeni wesifuba. Yiloo nto siyibiza ngokuba yi`(Hernia)`, okanye ihernia.

Khawucinge nje ukuba bekuya kwenzeka ntoni ukuba into efana nale iyenzeka ngelixa umntwana ekhula esibelekweni. Xa amalungu esiswini esiya esifubeni, akukho ndawo yaneleyo apho, akunjalo? Ingxaki ephambili kukuba imiphunga ayinayo indawo eyaneleyo yokukhula ngokufanelekileyo. Xa imiphunga incinci, oko kukuthi, xa kuvela imeko ebizwa ngokuba yi-`(Pulmonary Hypoplasia)`, umntwana uba nobunzima bokuphefumla emva kokuzalwa, kwaye igazi alifumani ioksijini eyaneleyo. Akunjalo kuphela, kodwa uxinzelelo lwegazi emiphungeni nalo lunokunyuka. Oku kukwabeka uxinzelelo olukhulu entliziyweni. Ke ngoko, umntwana one-`(CDH)` udinga unyango olukhethekileyo emva nje kokuzalwa.

Zithini iimpawu zomntwana one-CDH?

Ukuba umntwana wakho unengxaki enkulu yokuphefumla emva nje kokuzalwa, oko kungaba luphawu olukhulu lwesi sifo (CDH). Ukongeza, ungabona nezinto ezifana nezi:

• Ukubetha kwentliziyo okukhawulezayo kakhulu (iTachycardia).
• I-Cyanosis kukutshintsha kombala wesikhumba oluhlaza okwesibhakabhaka ngenxa yokunqongophala kweoksijini.
• Izandi zokuphefumla eziphantsi kakhulu (ingakumbi kwicala elinye).
• Ukuva isandi samathumbu xa ubeka indlebe yakho esifubeni.
• Isifuba siyavuvukala size sibonakale ngathi yibhere, ngelixa isisu sibonakala ngathi siyatshona ngaphakathi.

Ukuba umntwana wakho unenye okanye ngaphezulu kwezi mpawu, kungcono ukubona ugqirha ngokukhawuleza.

Kutheni le CDH ikhula? Zithini izizathu?

Kunzima ngokwenene koogqirha ukutsho kanye kanye ukuba yintoni kanye kanye imbangela yale meko "(CDH)". Nangona kunjalo, uphando lufumanise ukuba ezi zinto zilandelayo zinokuba negalelo:

• Izinto ezibangela ufuzo: Oko kukuthi, izinto ezithile ezidluliselwa kwizizukulwana ngezizukulwana.
• Ukuchanabeka kwizinto ezinobungozi ngexesha lokukhulelwa: Izinto ezifana neekhemikhali ezithile kunye neecuba.
• Ukondleka okungonelanga komntwana ongekazalwa: Umntwana ufumana izondlo zakhe ngokutya okutyiwa ngumama.

Ezi zezona zizathu zangoku, kodwa uphando olongezelelekileyo lwenziwa ngale nto.

Ziziphi iingxaki ezinokwenzeka ngenxa ye-CDH?

Njengoko besitshilo ngaphambili, iintsana ezininzi ezine-CDH zinemiphunga engakhulanga kakuhle (i-Pulmonary Hypoplasia). Oku kunokubangela iingxaki ezahlukeneyo:

• Amanqanaba aphantsi eoksijini egazini (iHypoxemia): Oku kuchaphazela onke amalungu omzimba omntwana, ingakumbi ingqondo nentliziyo. Ukuba le meko inzima okanye iyaqhubeka, inokubangela umonakalo wexesha elide.
• Uxinzelelo lwegazi oluphezulu kwimithambo yegazi yemiphunga (Pulmonary Hypertension): Oku kubeka uxinzelelo olukhulu kwicala lasekunene lentliziyo kwaye kunokubangela nokungasebenzi kakuhle kwentliziyo.
• Usulelo lweMiphunga: Imiphunga engakhulanga kakuhle inokuba nosulelo olufana ne-pneumonia. Nokuba emva kokuba i-hernia ilungisiwe ngotyando, umngcipheko wosulelo olunjalo unokuphila ubomi bonke.

Ukongeza koku, iintsana ezine-`(CDH)` zinokuba nezinye iingxaki:

• Ubunzima bokutya: Oku kunokubangelwa kuxinzelelo kwizitho zesisu okanye kukungenelela okuninzi kwezonyango ngexesha lokuzalwa. Abanye abantwana banokufuna ukondliwa ngetyhubhu ixesha elide, kwaye banokubona ukukhula kuncipha.
• Ukulibaziseka kokukhula: Ezinye iintsana zinokufuna unyango lomzimba, lokuthetha okanye lomsebenzi kangangexesha elithile ngenxa yokunqongophala kweoksijini.
• Ukulahlekelwa Kukuva Kweenzwa: Ezinye iintsana ezine-CDH ziyayeka ukuva kancinci kancinci. Oososayensi abakaqiniseki nokuba oku kubangelwa yimeko ngokwayo, unyango, okanye zombini.

Khawucinge nje ukuba umama okanye utata uziva njani xa esiva into efana nale. Kodwa khumbula, isayensi yezonyango ihambele phambili kakhulu ngoku.

Oogqirha bayixilonga njani i-CDH?

Uninzi lwexesha, oogqirha banokuyibona le meko ngexesha le-ultrasound yesiqhelo yokukhulelwa kwakho. Nje ukuba ifunyanwe, baya kwenza olunye uvavanyo. Umzekelo, baya kwenza i-MRI ye-fetal ukujonga i-hernia ngokucacileyo. Baya kwenza ne-echocardiogram ye-fetal ukubona ukuba intliziyo ye-fetal ichaphazelekile na.

Ngamanye amaxesha, oogqirha basenokungayiboni i-CDH de kube semva kokuba umntwana ezelwe. Emva kokuba umntwana ezelwe, iqela lezonyango lisenokuyikrokrela into yokuba libona izinto ezifana nobunzima bokuphefumla, i-septum ephambukile, okanye isifuba esivuvukileyo. Emva koko baya kwenza i-X-ray yesifuba kunye ne-echocardiogram . Basenokuthatha isampuli yegazi ukujonga amanqanaba eoksijini egazini lomntwana kunye nokujonga ezinye iingxaki zemfuza .

Kunqabile kakhulu ukuba iintsana ezine-CDH zingabonakalisi zimpawu zibalulekileyo ekuzalweni. Ukuba i-hernia incinci kakhulu, isenokungabonwa ebuntwaneni, okanye nasebudaleni.

Ziziphi iindlela zonyango ze-CDH?

Unyango lwale meko, ``Congenital Diaphragmatic Hernia'', luqala kwangoko emva kokuba lufunyenwe. Usenokuziva usoyika xa usiva ngolu nyango, kodwa khumbula ukuba oogqirha benza konke okusemandleni abo ukukhusela umntwana wakho.

Unyango lwangaphambi kokubeleka

Ukuba ufunyaniswe une-CDH ngexesha lokukhulelwa kwakho, ugqirha wakho uza kukujonga ngokusondeleyo. Baza kujonga iingxaki kwezinye iinkqubo zomzimba, njengoko ngamanye amaxesha kunokuba yinxalenye yemeko enzima ngakumbi. Baza kujonga nokuba umntwana wakho uza kuzalwa ngaphambi kwexesha (ukubeletha ngaphambi kwexesha), kwaye ukuba kunjalo, baza kugqiba ukuba baza kuqalisa na ukubeletha (ukuzala ngaphambi kwexesha) ukunceda impilo yomntwana.

Kwezinye iimeko ezikhethekileyo, iqela lezonyango linokunyanga umntwana ongekazalwa ngaphambi kokuba umntwana azalwe. ``Fetoscopic Tracheal Occlusion (FETO)`` lolunye utyando olunjalo lwe-fetus. Lunceda ukuphucula ubungakanani kunye nokusebenza kwemiphunga ye-fetus njengoko umntwana ekhula esibelekweni. Oku kwenziwa kusetyenziswa ikhamera encinci ebizwa ngokuba yi-``Fetoscopy``, ngokusebenzisa imingxunya emincinci eyenziwe ngesikhumba sakho ukuya kwisibeleko sakho.

Kule nkqubo `(FETO)`, ugqirha ufaka ibhaluni encinci kwi`(Trachea)` yemveku. Emva koko, i`(Amniotic Fluid)` eqokelelwa ngumntwana emva kwebhaluni nangaphakathi kwemiphunga, nto leyo ebangela ukuba imiphunga ivuvuke. Oku kuvuvuka kuphucula ukukhula nokusebenza kwemiphunga, kwaye kunceda ukulungisa umonakalo obangelwe yi`(CDH)`.

Unyango lweentsana ezisandul' ukuzalwa

Iintsana ezizelwe zine-CDH zihlala zifuna unyango olunzulu oluvela kwiqela leengcali emva nje kokuzalwa. Ukuba imiphunga yomntwana ayikhuliswanga ngokupheleleyo (i-Pulmonary Hypoplasia), ziya kuqala zinikwe inkxaso yeoksijini. Kwabanye abantwana, le isenokuba yityhubhu yokuphefumla eqhagamshelwe kwi-ventilator yomatshini .

Ezinye iintsana zisenokufuna inkxaso yobomi engakumbi. Oku kubizwa ngokuba yi -Extracorporeal Membrane Oxygenation (ECMO) . Oku kuquka ukudlula imiphunga yomntwana engavuthwanga kwaye ngamanye amaxesha intliziyo, nokusebenzisa umatshini ukongeza ioksijini egazini uze uyibuyisele emzimbeni womntwana.

Okulandelayo, umntwana uza kufuna utyando. Umntwana uza kugcinwa kwiYunithi yoKhathalelo oluNzulu lweZifo eziSandulelayo (i-NICU) de umntwana abe sempilweni ngokwaneleyo ukuba atyandwe. Oku kuthetha ukuba uxinzelelo lwegazi oluphezulu emiphungeni (i-pulmonary hypertension) luye lwaphela kwaye i-extracorporeal membrane oxygenation (ECMO) ayisekho mfuneko.

Kwinkqubo yotyando, ingcali yokubulala iintlungu yabantwana iya kulalisa umntwana phantsi kwe-anesthesia . Emva koko ingcali yotyando yabantwana iya kwenza utyando.Olu tyando lubandakanya ukuhambisa amalungu asuswe esifubeni abuyele esiswini kunye nokulungisa isiphene esikwi-diaphragm. Kwiimeko ezininzi, malunga nesiqingatha sazo zonke iintlobo zotyando, oogqirha bayakwazi ukwenza utyando oluncinci olubandakanya ukwenza imingxunya emincinci emalunga ne-3 millimeters endaweni yokusika okukhulu .

Linjani ixesha lokuchacha?

Njengoko umntwana wakho ephila emva kotyando, uya kususwa kancinci kancinci ioksijini. Uya kuqhubeka unikwa ityhubhu de ityhubhu yokuphefumla isuswe. Emva koko, iingcali zonyango lokuthetha kunye neengcali zokuncancisa ziya kukunceda wena nomntwana wakho niqale ukondla ngomlomo. Ezinye iintsana zithatha ixesha elide ukuyeka ioksijini kunye nokondla ngetyhubhu kunabanye. Iqela lakho lezonyango liya kukuxhasa kangangoko kuyimfuneko.

Liyintoni ikamva leentsana ezine-CDH?

Iindaba ezimnandi zezokuba izinga lokusinda kweentsana ezizelwe zine-CDH liphucuke kakhulu. Phakathi kweentsana ezisi-7 nezisi-9 kwezili-10 ziyasinda. Nangona ezi ntsana zizalwa zineemeko ezinzima kakhulu, ukuba zidlula kwiintsuku zokuqala ezimbalwa, amathuba azo okusinda angcono kakhulu. Abanye abantwana banokuba neengxaki zexesha elide, kodwa banokuphila ubomi obude, obupheleleyo. Ngokuhambela phambili kwisayensi yezonyango, amazinga okusinda kwexesha elifutshane kunye neziphumo zempilo zexesha elide ziyaphucuka imihla ngemihla.

Ukuqikelela kwexesha elide kuxhomekeke kwizinto ezininzi:

• Ingaba umntwana wazalwa ngaphambi kwexesha?
• Hayi indlela eyayimbi ngayo imeko yomntwana ekuzalweni kwakhe.
• Ubungakanani be-hernia.
• Leliphi ilungu lomzimba elingene esifubeni?
• Ngaba kukho ezinye iingxaki zempilo?

Iintsana ezifuna uncedo lokuphefumla okanye lokuncedwa ixesha elide zisengozini enkulu yokufumana iingxaki eziqhubekayo, ezifana nesifo semiphunga esingapheliyo, ukungaphumeleli kokukhula, ukulahlekelwa kukuva, kunye nokulibaziseka kokukhula. Ugqirha womntwana wakho uya kumjonga ngokusondeleyo kwiminyaka yakhe yokuqala.

Ukufumanisa ukuba umntwana wakho une-hernia ye-diaphragmatic yokuzalwa kunokuba yinto eyoyikisayo neyoyikisayo. Umntwana wakho uza kuthathwa aye kwigumbi lokunyamekela abagula kakhulu (ICU) emva nje kokuzalwa, kwaye kusenokufuneka ahlale esibhedlele ixesha elide. Kodwa ngenxa yenkqubela phambili kwisayensi yezonyango, imeko ingcono kunangaphambili. Nangona eli lixesha elinzima, kukho iqela loogqirha kunye nabahlengikazi apha ukukunceda wena kunye nosana lwakho olusandul' ukuzalwa. Baza kukuxhasa ukususela ngexesha lokufunyaniswa kwesifo, kuyo yonke iminyaka yobomi bomntwana wakho.

Izinto ekufuneka sizikhumbule

Nangona le meko ibizwa ngokuba yi-`(Congenital Diaphragmatic Hernia - CDH)` imbi kancinci, ukuba uyazi kwangaphambili, ungayijongana nayo ngaphandle kokukhathazeka.

• I-CDH yimeko eyenzeka xa umntwana ezalwa kwaye ibangela ukuba amalungu esiswini angene esifubeni ngenxa yesiphene kwi-diaphragm.
• Oku kuchaphazela kakhulu uphuhliso lwemiphunga.
• Oku kunokubonwa ngeeskeni ngexesha lokukhulelwa.
• Bafuna unyango olukhethekileyo kunye notyando kwangoko emva kokuzalwa.
• Ngenxa yenkqubela phambili kwisayensi yezonyango, uninzi lwaba bantwana lunokuphila ubomi obumnandi.

Ukuba uneminye imibuzo okanye iinkxalabo malunga noku, qiniseka ukuba uthetha nogqirha wakho okanye umongikazi. Banokukunika ulwazi oluthe kratya kwaye bakuncede ukhuphe uxinzelelo engqondweni yakho. Khumbula, awuwedwa.

I- CDH, I-Congenital Diaphragmatic Hernia, I-Diaphragmatic hernia, Iziphene zokuzalwa, Uphuhliso lwemiphunga, Impilo yomntwana, Utyando