Masifunde ngeNecrotizing Enterocolitis (NEC), isifo esibi samathumbu esixhaphake kakhulu kwiintsana ezisandula kuzalwa.

Ngaba umntwana wakho wazalwa ngaphambi kwexesha? Siyazi ukuba umama okanye utata unokoyika kwaye uxhalabile kangakanani xa benomntwana ozelwe ngaphambi kwexesha. Ingakumbi ukuba umntwana ukwi-NICU ( i-Neonatal Intensive Care Unit), loo mvakalelo iba nkulu nangakumbi. Xa ugqirha efika ngequbuliso ekuxelela ukuba umntwana wakho unengxaki enkulu yamathumbu, imeko ebizwa ngokuba yi-NEC (Necrotizing Enterocolitis), kunzima ukuyichaza ngamazwi indlela evakalelwa ngayo. Namhlanje sithetha ngale meko ebizwa ngokuba yi-NEC, eyoyikwa ngoomama nootata abaninzi, kodwa ebaluleke kakhulu ukuba uyiqaphele.

Kalula nje, yintoni le NEC?

I-Necrotizing Enterocolitis (NEC) sisifo esibi kakhulu sokugaya ukutya esichaphazela kakhulu abantwana abasandula kuzalwa. Kwimeko enjalo, izicwili zamathumbu omntwana ziyabola, zidumbe, zize ziqale ukufa. Igama elithi "necrotizing" lithetha "ukufa kwezicubu." Igama elithi "Enterocolitis" lithetha ukudumba kwamathumbu.

Cinga nje, amathumbu ethu akangombhobho nje kuphela. Zizitho ezintsonkothileyo ezenziwe ngezicubu eziphilayo ezinceda ekugayeni ukutya nasekufunxeni izondlo. Kwi-NEC, udonga lwamathumbu luba buthathaka, lonakale, kwaye ngamanye amaxesha lude luvuleke . Ukuba loo mngxuma uvela, iintsholongwane, ezifana neebhaktheriya, ezingaphakathi kwamathumbu zinokungena esiswini okanye egazini lomntwana. Le yimeko eyingozi kakhulu.

I-NEC idla ngokuvela phakathi kweeveki ezimbini ukuya kwezintandathu emva kokuzalwa. Kwabanye abantwana, ithambile kakhulu kwaye iba ngcono. Kwabanye, inokuba yingozi kwaye ibeke ubomi esichengeni.

Ngubani osengozini enkulu yokuhlaselwa yile meko?

Kwiintsana ezili-10 eziphuhlisa i-NEC, ezili-9 ziintsana ezizelwe ngaphambi kwexesha . Kunqabile kakhulu ukuba iintsana ezizelwe ngexesha elipheleleyo ziyiphuhlise. Ezi zilandelayo zisengozini enkulu:

• Iintsana ezizelwe ngaphambi kweeveki ezingama-37 zokukhulelwa: Umngcipheko uphezulu kakhulu kwiintsana ezizelwe ngaphambi kweeveki ezingama-32.
• Iintsana ezizalwa zinobunzima obuphantsi kakhulu: Iintsana ezinobunzima obungaphantsi kweekhilogram eziyi-2.5 (iikhilogram eziyi-5.5) xa zizalwa zisengozini enkulu. Iintsana ezinobunzima obungaphantsi kwekhilogram eyi-1 (iikhilogram eziyi-2.2) zisengozini enkulu kakhulu.
• Kwiintsana ezityiswa ngetyhubhu (isondlo sangaphakathi): Ngenxa yokuba iintsana ezizelwe ngaphambi kwexesha zinamandla okuncancisa, ubisi lunikwa ngetyhubhu efakwe ngempumlo esiswini.
• Kwiintsana ebezineengxaki ekuzalweni kwazo: Umzekelo, iintsana ebezineengxaki ezifana nobunzima bokuphefumla okanye isifo sentliziyo.

Malunga ne-1 kwi-1,000 yeentsana ezizelwe ngaphambi kwexesha ziba ne-NEC. Nangona kunjalo, le meko yenzeka kwi-1 kwi-10,000 yeentsana ezizelwe ixesha elizeleyo. Ngoko ke kuchanekile ukuthi esi sisifo seentsana ezizelwe ngaphambi kwexesha.

Ziziphi iintlobo eziphambili ze-NECs?

Oogqirha bahlula esi sifo sibe ziintlobo ezahlukeneyo, kuxhomekeke kwixesha eziqala ngalo iimpawu kunye nesizathu sesifo.

Ngamanye amaxesha, kuye kwakho iingxelo zeentsana ezininzi eziphuhliswa yi-NEC ngaxeshanye kwi-NICU (iYunithi yoKhathalelo oluNzulu lweZifo eziSandulelayo ). Kwiimeko ezinjalo, unobangela usenokuba lusulelo lwebhaktheriya olufana ne-E. Coli.

Kutheni le NEC yenzeka? Yintoni unobangela?

Enyanisweni, oogqirha abakafumani sizathu sithile se-NEC. Bakholelwa ukuba yindibaniselwano yezinto ezininzi.

Amanqaku aphambili ngala:

1. Amathumbu angakavuthwa: Amathumbu omntwana ozelwe ngaphambi kwexesha akakakhuli ngokupheleleyo. Abuthathaka kakhulu kwaye abuthathaka. Ngenxa yoko, anobunzima kwinkqubo yokugaya ukutya.

2. Inkqubo yomzimba yokuzikhusela ebuthathaka: Inkqubo yomzimba yokulwa nezifo kwiintsana ezizelwe ngaphambi kwexesha ayikakhuli ngokupheleleyo. Ngenxa yoko, nokuba usulelo oluncinci emathunjini lunokuba nzima ukuba umzimba ulwe nalo.

3. Ukuncipha kokuhamba kwegazi ukuya emathunjini: Inkqubo yokujikeleza kwegazi yeentsana ezizelwe ngaphambi kwexesha ibeka phambili ukuthumela igazi kwiindawo ezibalulekileyo ezifana nengqondo nentliziyo. Ngamaxesha oxinzelelo (umz., ukunqongophala kweoksijini), umzimba unciphisa inani legazi eliya emathunjini. Xa ukuhamba kwegazi kunciphile, izicubu ezisemathunjini azifumani ioksijini eziyidingayo. Ngenxa yoko, ezo zicubu zonakala kwaye ziqale ukufa.

Xa ezi zinto zidibana, udonga lwamathumbu luba buthathaka, nto leyo evumela iintsholongwane ukuba zikhule apho, nto leyo ebangela ukudumba kwaye ikhokelele kwi-NEC.

Zithini iimpawu ze-NEC?

Oogqirha kunye nabongikazi bahlala bejonga umntwana okwi-NICU. Ngoko ke, nokuba babona uphawu oluncinci lwe-NEC, bathatha amanyathelo ngokukhawuleza. Njengomzali, kubalulekile ukuba uqaphele ezi mpawu.

Iimpawu zingabonakala kancinci kancinci kwiintsuku ezimbalwa, okanye zingabonakala ngequbuliso kumntwana oye waphila kakuhle.

• Ukudumba kunye nentlungu esiswini: Isisu somntwana sivakala sinzima xa sichukunyiswa, umntwana uyakhala xa ebekwe kuso, kwaye isisu sibonakala sigcwele.
• Ukwala ukusela ubisi: Usana olusele kakuhle ngequbuliso luyala ukusela ubisi, nto leyo eshiya isisu sisele.
• Ukugabha: Ukugabha, ingakumbi okuluhlaza okanye okumthubi, kusenokuba luphawu lokuvaleka kwamathumbu.
• Utshintsho kwindlela ezihamba ngayo izisu: Utshintsho kwindlela ezihamba ngayo izisu, indle efana norhudo, kunye negazi elikwizisu .
• Utshintsho kwimeko yempilo ngokubanzi:
• Isantya sentliziyo yomntwana siyehla okanye sinyuke.
• Izinga lokuphefumla liyatshintsha, ngamanye amaxesha kuyeke ukuphefumla okomzuzwana (i-apnea).
• Uxinzelelo lwegazi luyehla.
• Ubushushu bomzimba abunakugcinwa.
• Usana ludiniwe kakhulu kwaye lubonakala lungenabomi.

Ukuba kubonwa enye okanye ezingaphezulu kwezi mpawu, abasebenzi be-NICU baya kuphanda ngoko nangoko.

Oogqirha bayifumana njani le nto?

Into yokuqala ugqirha womntwana wakho aza kuyenza kukumhlola umntwana wakho ngononophelo. Baza kujonga ukudumba nokuthamba kwakhe. Baza kwenza novavanyo oluthile ukuqinisekisa ukuba unesifo.

• I-X-reyi yesisu:Olu lolona vavanyo lubalulekileyo. Lunokujonga amaqamza egesi ngaphakathi kodonga lwamathumbu. Oku kubizwa ngokuba yi-'pneumatosis intestinalis'. Kwakhona, ukuba amathumbu agqobhokile, ungabona umoya okhululekileyo ngaphakathi kwesisu.
• Uvavanyo lwegazi: Olu vavanyo lujonga ukuba kukho usulelo (iibhaktheriya) egazini, ukubala okuphantsi kweeseli ezimhlophe zegazi, kunye neengxaki zokujiya kwegazi.
• Uvavanyo lwendle: Olu vavanyo lunceda ekufumaneni igazi elikwindle elingabonakaliyo emehlweni.

Ziziphi iingxaki ezinokubakho ze-NEC?

Ngenxa yokuba i-NEC yimeko enzima, iingxaki zinokwenzeka emva kwayo.

• I-Peritonitis: Ukuba kukho umngxuma emathunjini, iintsholongwane zinokungena kwisisu zize zibangele usulelo olunzima (i-peritonitis). Oku kunokukhokelela kwimeko esongela ubomi ebizwa ngokuba yi-sepsis , apho iintsholongwane zisasazeka emzimbeni wonke.
• Ukuqina Kwamathumbu: Emva kokuba i-NEC ipholile, inxalenye yamathumbu eyonakeleyo inokuba nezibazi kwaye inciphe njengoko iphola. Oku kwenza kube nzima ukutya. Oku kunokufuna utyando kamva.
• Isifo Sokudumba Okufutshane: Ukuba inxalenye enkulu yamathumbu iyafa ngenxa ye-NEC kwaye kufuneka isuswe ngotyando, inxalenye eseleyo yamathumbu ayanelanga ukufunxa izondlo ngokufanelekileyo. Le meko ibizwa ngokuba yi -short bowel (short gut) syndrome . Iintsana ezinale meko ziya kufuna ingqalelo ekhethekileyo kwisondlo ubomi bazo bonke.
• Ukulibaziseka Kokukhula Nophuhliso: Iintsana eziye zafumana i-NEC, ingakumbi ezo ziye zatyandwa, zinokufumana ukulibaziseka ekukhuleni nasekuphuhlisweni kwengqondo kamva ebomini. Ke ngoko, kubaluleke kakhulu ukugcina ezi ntsana phantsi kweliso lonyango oluqhubekayo.

Iphathwa njani?

Kwakuba kurhanelwa ukuba i-NEC iyasebenza, oogqirha baqala unyango. Injongo ephambili kukunika amathumbu ukuphumla okupheleleyo .

1. Yeka ukuncancisa: Into yokuqala ekufuneka uyenze kukuyeka ngokupheleleyo ukuncancisa umntwana ngomlomo okanye ngetyhubhu. Oku kuya kunika amathumbu ukuphumla aze aqale ukuphola.

2. Isondlo se-IV: Zonke izondlo kunye nolwelo olufunwa ngumntwana lufumaneka nge-saline (i-IV fluids) efakwa ngqo emthanjeni.

3. Ukubekwa kwetyhubhu ye-nasogastric: Ityhubhu (ityhubhu ye-nasogastric) ifakwa ngempumlo iye esiswini, ikhupha umoya kunye nolwelo oluqokelelene esiswini. Oku kunciphisa ukudumba esiswini kwaye kunciphisa uxinzelelo emathunjini.

4. Ii-antibiotics: Ukuze kuliwe nosulelo kwaye kuthintelwe ukusasazeka kosulelo, ii-antibiotics ezinamandla zinikwa ngemithambo yegazi.

5. Ukubekwa esweni rhoqo:Usana lujongwa ngononophelo olukhulu. Uvavanyo lwegazi kunye nee-X-ray zenziwa rhoqo ukuze kubonwe ukuba imeko iyaphucuka okanye iyawohloka.

Kunini apho kufuneka khona utyando?

Malunga nosana olunye kwabane lunokufuna utyando. Utyando lwenziwa ukuze:

• Ukuba ukugqobhoka kuqinisekisiwe emathunjini.
• Ukuba imeko yomntwana ayiphucuki ngonyango ngamayeza.

Ngexesha lotyando, ugqirha ususa inxalenye efileyo yamathumbu aze aphinde adibanise iindawo ezimbini eziphilileyo zamathumbu. Ngamanye amaxesha, ukuba amathumbu adumbile kakhulu, kunzima ukuwadibanisa kwakhona ngoko nangoko. Kwiimeko ezinjalo, kwenziwa utyando olubizwa ngokuba yi-ostomy .

Ukuba umntwana mncinane kakhulu okanye ugula kakhulu ukuba angatyandwa, ugqirha unokubeka umbhobho omncinci (idreyini) esiswini ukuze akhuphe ulwelo olusulelekileyo nomoya oqokelelene esiswini. Oku kuya kunciphisa iimpawu. Kamva, xa umntwana ekhulile kancinci kwaye esempilweni, utyando luya kwenziwa.

Liyintoni ikamva lomntwana one-NEC?

Nangona i-NEC sisifo esoyikekayo, iyanyangeka. Iintsana ezisi-8 kwezili-10 ezine-NEC ziyasinda. Nangona ezinye zezi zingane zinokuba neengxaki zempilo ezihlala ixesha elide, uninzi lwazo luphila ubomi obuqhelekileyo nobupheleleyo.

Ngaba zikho iindlela zokuthintela oku?

Nangona ingenakuthintelwa ngokupheleleyo, kukho izinto ezininzi onokuzenza ukunciphisa umngcipheko we-NEC.

• Ukuthintela ukuzalwa ngaphambi kwexesha: Kungcono ukugcina umntwana esibelekweni ixesha elide kangangoko kunokwenzeka. Ukuze wenze oku, landela iingcebiso zonyango ezifanelekileyo ngexesha lokukhulelwa.
• Iinaliti ze-corticosteroid: Oogqirha banika oomama abasengozini yokuzalwa ngaphambi kwexesha inaliti ebizwa ngokuba yi-corticosteroid. Oku kunceda ukukhula kwemiphunga namathumbu omntwana.
• Ukuncancisa: Ukuncancisa lukhuselo olungcono kumntwana ozelwe ngaphambi kwexesha. Ubisi lwebele lunamandla amangalisayo okunciphisa umngcipheko we-NEC. Izinto eziqinisa amasosha omzimba kubisi lwebele zikhusela amathumbu omntwana.
• Iiprobiotics: Ezinye izifundo zibonise ukuba ukongeza iiprobiotics (iibhaktheriya ezilungileyo) kubisi lwebele okanye kwifomyula kunokunciphisa umngcipheko we-NEC. Nangona kunjalo, ngokuqinisekileyo kufuneka uthethe nogqirha womntwana wakho ngaphambi kokuba wenze oku.

Kungothusa abazali ukuba neengxaki ezifana neze-NEC ngelixa umntwana wabo ese-NICU. Kodwa khumbula, oogqirha kunye nabongikazi kwi-NICU baqeqeshwe ngokukodwa ukuba baqaphele kwaye banyange ezi meko ngokukhawuleza. Bathembe. Thetha nabo ngayo nayiphi na imibuzo okanye iinkxalabo onokuba nazo.