Ingaba umntwana wakho osandul’ ukuzalwa unengxaki yokuphefumla? Masifunde nge-PPHN (i-Persistent Pulmonary Hypertension of the Newborn)!

Usana olusandul’ ukuzalwa lolunye lwezona zinto zivuyisayo ebomini, akunjalo? Kodwa kuqhelekile ukuba noloyiko nokukhathazeka kancinci, ingakumbi ngempilo yosana. Ngamanye amaxesha, iintsana ezisandul’ ukuzalwa zinokuba nobunzima bokuphefumla. Leyo yimeko enzima, kodwa esinokuyilawula kakuhle ukuba sonke siyazi. Masithethe ngayo namhlanje.

Yintoni i-PPHN? Yintoni kanye kanye?

Ngamafutshane, i-PPHN yingxaki enkulu yokuphefumla eyenzeka kwiintsana ezisandul’ ukuzalwa. Yenzeka xa umntwana wakho ephuma esibelekweni aze aqalise ukuphefumla kwindawo engaphandle, kwaye inkqubo yakhe yokujikeleza kwegazi ayihambelani kakuhle.

Cinga ngale ndlela. Xa umntwana wakho esesibelekweni sakho, ufumana ioksijini yakhe ngentambo yomlomo, nge-placenta. Ngelo xesha, akukho gazi lininzi liya emiphungeni yakhe. Oku kungenxa yokuba imithambo yegazi emiphungeni (imithambo yemiphunga) idla ngokuvaleka kwaye inciphe. Elinye igazi liyadlula emiphungeni lize liye ngqo emzimbeni wonke. Kufana nokuthatha indlela eyahlukileyo xa indlela ivaliwe.

Nangona kunjalo, utshintsho olukhulu kufuneka lwenzeke kwangoko nje ukuba umntwana abelekwe aze aphefumle okokuqala . Emva koko, imithambo yegazi emiphungeni eyayivaliwe kufuneka ivuleke (`(yandiswe)`). Kulapho ke ioksijini ingena khona emaphungeni kunye nomoya. Emva koko, igazi liya emiphungeni ngale mithambo yegazi ivuliweyo, lithathe ioksijini, lize lisasaze elo gazi lizaliswe yioksijini emzimbeni wonke, ngakumbi kwingqondo, entliziyweni, nakwizintso.

Kwimeko ebizwa ngokuba yi-PPHN, imithambo yegazi emiphungeni yomntwana ayivuli kakuhle, okanye ayaneli. Kwenzeka ntoni ke ngoko? Uxinzelelo lwegazi oluphezulu emiphungeni (i-pulmonary hypertension) luyakhula. Oku kunciphisa ubungakanani beoksijini efikelela kwingqondo yomntwana nakwezinye izitho ezibalulekileyo. Le yingxamiseko yezonyango esongela ubomi kwaye unyango kufuneka luqalwe ngoko nangoko.

Ixhaphake kangakanani le meko ibizwa ngokuba yi-PPHN?

I-PPHN yenzeka kwiintsana ezizalwa ziphila ezimalunga nezimbini kweziyi-1,000. Ixhaphake kakhulu kwiintsana ezizalwa ngexesha lokuzala (phakathi kweeveki ezingama-37 nezingama-42) nakwiintsana ezizalwa emva komhla wokugqibela (emva kweeveki ezingama-42). Nangona kunjalo, ayinakwenzeka rhoqo kwiintsana ezizelwe ixesha elizeleyo.

Zithini iimpawu ze-PPHN? Siyibona njani?

Ukuba umntwana wakho une-PPHN, unokubonisa iimpawu ezifana nezi:

• Ubunzima bokuphefumla: ukuphefumla ngokukhawuleza kakhulu okanye kancinci kakhulu, ukwenza isandi sokuphefumla xa uphefumla, kunye nokuziva ngathi isifuba sakho sitshona (`(ukurhoxa)`).
• Ukunyuka kwesantya sentliziyo (`(Isantya sentliziyo esikhawulezayo)`).
• Ulusu lomntwana lunokubonakala luluhlaza okwesibhakabhaka (i-cyanosis), ingakumbi kwiindawo ezifana nemilebe, ulwimi, kunye neminwe.
• Uxinzelelo lwegazi oluphantsi (uxinzelelo lwegazi oluphantsi).
• EgaziniAmanqanaba e-oksijini egazini aphantsi .
• Ukuva izandi ezingaqhelekanga okanye ezingaqhelekanga (`(intliziyo ikhala)`) xa umamele intliziyo.

Ukuba ubona enye okanye ngaphezulu kwezi mpawu emva kokuba umntwana ezelwe, okanye kwiiyure ezimbalwa, kubaluleke kakhulu ukwazisa oogqirha ngoko nangoko.

Ziziphi izinto ezibangela uphuhliso lwe-PPHN?

Abaphandi abakaqiniseki ukuba yintoni kanye kanye ebangela i-PPHN, kodwa kucingelwa ukuba ibangelwa yimiphunga yosana engakhuli kakuhle okanye ukungakwazi ukuzivumelanisa (nokuvuleka) nemeko-bume yangaphandle emva kokuba iphumile esibelekweni.

Zeziphi izinto ezinyusa umngcipheko we-PPHN?

Nangona unobangela ochanekileyo ungaziwa, ezinye izinto zinokunyusa umngcipheko womntwana wokufumana i-PPHN. Makhe sijonge ukuba zeziphi:

• `I-Meconium aspiration` : Kulapho indle yokuqala yomntwana (esiyibiza ngokuba yi-`(Meconium)`, etyebileyo kwaye inamathelayo kancinci) ingena kwinkqubo yakhe yokuphefumla ngelixa esesesibelekweni.
• Izifo: Izifo zemiphunga, ezifana ne-pneumonia, okanye izifo zegazi.
• Isifo sokuphefumla esibizwa ngokuba yi-Respiratory Distress Syndrome (RDS): Oku kubonakala rhoqo kwiintsana ezizelwe ngaphambi kwexesha ezinemiphunga engakakhuli ngokupheleleyo.
• Ukuphelelwa ngamandla kokuzalwa: Usana olungafumani ioksijini eyaneleyo ngaphambi okanye ngexesha lokuzalwa.
• I-Diaphragmatic hernia: Oku kwenzeka xa kwakheka umngxuma kwisihlunu esahlula isifuba nesisu somntwana (esibizwa ngokuba yi-diaphragm). Oku kuvumela ezinye izitho zesisu ukuba zityhale umngxuma ziye esifubeni.
• Ezinye iingxaki zentliziyo okanye zemiphunga ezizalwa nazo: Umzekelo, umphunga omncinci okanye ivalvu yentliziyo evalekileyo.
• Ukusetyenziswa kwamayeza athile ngexesha lokukhulelwa: Kuye kwacetyiswa ukuba ukusetyenziswa kwamayeza abizwa ngokuba yi-"NSAIDs" (iziyobisi ezichasene nokuvuvukala ezingezizo ii-steroidal) kunye ne-"SSRIs" (i-selective serotonin reuptake inhibitors), ingakumbi ngexesha lokukhulelwa okukhawulezileyo, nako kunokuchaphazeleka. Ke ngoko, ukuba uthatha naliphi na iyeza ngexesha lokukhulelwa, kubaluleke kakhulu ukuthetha nogqirha wakho ngalo mba.

Zithini iziphumo zePPHN ezihlala ixesha elide?

Malunga nesana elinye kwabane (1 kwaba-4) elisinda kwi-PPHN liba nokukhubazeka okuthile ngenxa yokunqongophala kweoksijini engqondweni. Ezi ngxaki ziquka:

• Ukulibaziseka kophuhliso .
• Iingxaki zokuva, ngamanye amaxesha kwanokungeva, zinokubakho.
• Ukukhubazeka kokufunda .
• Ukuncipha kwamandla okwenza imisebenzi yomzimba .

Ngoko ke, kubaluleke kakhulu ukuqhubeka nokugcina iintsana eziphulukene ne-PPHN phantsi kweliso logqirha kunye nokujonga uphuhliso lwazo.

Ifunyaniswa njani i-PPHN?

Ugqirha womntwana wakho angenza uvavanyo olwahlukeneyo ukuze abone ukuba umntwana wakho une-PPHN. Ezinye zezi ziquka:

• Ubalo lwegazi olupheleleyo (CBC): Olu lulinganisa inani leeseli ezimhlophe zegazi, iiseli ezibomvu zegazi, kunye neeplatelets egazini lomntwana.
• I-pulse oximetry (i-pulse ox): Le yindlela elula, engangenisi gazi yokulinganisa inqanaba le-oksijini egazini lomntwana.
• Igesi yegazi yemithambo (ABG): Oku kulinganisa ukuba umzimba womntwana ufumana njani ioksijini kunye nokuba uyisusa kakuhle kangakanani na ikharbon diokside.
• I-X-reyi yesifuba: Oku kunceda ukubona ukuba intliziyo yomntwana ikhulisiwe okanye ukuba kukho isifo semiphunga.
• I-Echocardiogram (i-echo): Le yi-ultrasound eneenkcukacha zentliziyo yomntwana. Ihlola indlela igazi elihamba ngayo liye entliziyweni nasemiphungeni.
• I-ultrasound yentloko: Oku kunceda ukujonga ukuba akukho nakuphi na ukopha engqondweni yomntwana.
• Uvavanyo lwe-electrolyte ye-serum: Olu vavanyo lusetyenziselwa ukujonga ibhalansi yeeminerali egazini lomntwana.
• Ukubhobozwa kwethambo lomqolo (i-spinal tap): Olu vavanyo ngamanye amaxesha lunokwenziwa ukujonga ukuba umntwana unezifo na.

Akunyanzelekanga ukuba kwenziwe zonke ezi mvavanyo; oogqirha baya kugqiba ukuba zeziphi iimvavanyo ekufuneka zenziwe ngokusekelwe kwimeko yomntwana.

Iphathwa njani i-PPHN?

Injongo ephambili yokunyanga i-PPHN kukwandisa ukuhamba kweoksijini kumalungu omzimba omntwana nokuthintela iingxaki ezinkulu. Kukho iindlela ezahlukeneyo zonyango zoku:

• Ioksijini: Umntwana anganikwa ioksijini eyi-100% nge-cannula yempumlo, ii-prongs zempumlo, okanye imaski.
• Umoya ongeniswa ngoomatshini: Ugqirha ufaka ityhubhu kwi-windpipe yomntwana (i-trachea) aze asebenzise i-ventilator ukunceda umntwana aphefumle.
• Ukulawula uxinzelelo lwegazi: Umntwana anganikwa amayeza okulawula uxinzelelo lwegazi ngomthambo (`(IV)`).
• I-nitric oxide: I-nitric oxide yigesi enceda ukuvula (ukwandisa) imithambo yegazi kwimiphunga yomntwana wakho, iphucula ukuhamba kwegazi ukuya kwimiphunga.
• Umoya ohamba rhoqo: Olu luhlobo olukhethekileyo lomoya. Lunokunceda ukuphucula amanqanaba eoksijini egazini lomntwana.
• I-oxygenation ye-membrane yangaphandle komzimba (ECMO): Lo matshini usetyenziswa xa intliziyo okanye imiphunga yomntwana ibuthathaka kakhulu ukuba ingalawulwa zezinye iindlela zonyango. Uthatha igazi emzimbeni womntwana okwethutyana, wongeze i-oxygen kuwo, aze alibuyisele emzimbeni, enika i-oxygen engqondweni nakwamanye amalungu omzimba. Usebenza njengomphunga wokwenziwa.

Ngaba singayithintela i-PPHN?

Njengoko besikhe sathetha ngaphambili, akukho ndlela yokuthintela ngokupheleleyo i-PPHN kuba asikazi ukuba yintoni ebangela oko . Nangona kunjalo, ukuphepha amayeza athile ngexesha lokukhulelwa kunokunceda ukunciphisa umngcipheko wakho. Ngoko ke, ukuba ukhulelwe, qiniseka ukuba uthetha nogqirha wakho ngaphambi kokuba uthathe naliphi na iyeza ukuqinisekisa ukuba kukhuselekile ukulithatha ngexesha lokukhulelwa.

Kuthatha ixesha elingakanani ukuchacha kwi-PPHN?

Uninzi lweentsana luyaphola kwi-PPHN kwiveki enye okanye ezimbini . Nangona kunjalo, ezinye iintsana zinokuthatha ixesha elide, ngamanye amaxesha iinyanga, ukuba ziphile ngokupheleleyo. Kwanasemva kokuba umntwana wakho ephilile, kubalulekile ukubakhusela kwiingqele, umkhuhlane, kunye nezinye izifo ezibangelwa yintsholongwane. Oku kungenziwa ngokuhlamba izandla zakho rhoqo, ukunciphisa ukubonakaliswa komntwana wakho kwizihlwele, kunye nokugcina umntwana wakho kude nabantu abagulayo. Kwakhona, licebo elihle ukuba wonke umntu okwikhaya lakho afumane ugonyo lomkhuhlane minyaka le.

Ngokukodwa, kubalulekile ukusa umntwana wakho kuvavanyo lwezonyango rhoqo kunye notyelelo lweengcali ukuqinisekisa ukuba uphuhliso lwakhe luqhubeka ngokufanelekileyo.

Ingakanani izinga lokusinda kunye nombono we-PPHN?

I-PPHN yimeko enzima, kwaye ngelishwa, phakathi kwe-7% kunye ne-10% yeentsana ezinesi sifo ziyafa ngenxa yeengxaki. Kwiintsana ezisindayo, malunga ne-25%, okanye malunga nenye kwabane, zinokuba nemiphumo yexesha elide (njengokulibaziseka kokukhula, ukukhubazeka kokufunda, kunye nokulahlekelwa kukuva) okubangelwa kukungabikho kweoksijini engqondweni.

Ufanele umse nini umntwana wakho kugqirha?

Emva kokuba umntwana wakho ephilile kwi-PPHN, qiniseka ukuba umsa umntwana wakho kuzo zonke iindibano zokulandelela . Oku kuya kunceda ugqirha wakho aqhubeke nokujonga umntwana wakho. Okwangoku, funa ingcebiso kagqirha ngokukhawuleza ukuba umntwana wakho ubonisa naziphi na ezi mpawu zilandelayo:

• Ukuba ufumana umkhuhlane.
• Ukuba unciphisa ukungenisa ubisi, okanye ukuba awuseli ubisi konke konke.
• Ukuba isifuba sakho siyatshona xa uphefumla, okanye ukuba uphefumla uvulekile impumlo yakho.
• Ukuba wenza isandi sokukhala okanye sokubhonga xa uphefumla.
• Ukuba ulusu luqala ukuba luhlaza okwesibhakabhaka okanye ngwevu.

Xa ufumanisa ukuba umntwana wakho osandul’ ukuzalwa unemeko efana ne-PPHN, kuyinto eqhelekileyo ukuziva unxulunyaniswa nosizi, uloyiko, umsindo, kunye nokudideka. Yinto eqhelekileyo leyo. Funda kangangoko unako malunga ne-PPHN koogqirha kunye nabongikazi abanyanga umntwana wakho. Baza kukuxelela konke onokukwazi ukukwenza malunga nemeko yomntwana wakho, kunye nendlela onokubathuthuzela kwaye ubancede ngayo. Ekuhambeni kwexesha, uya kuba yingcali kwimeko yomntwana wakho, kwaye uya kufumana ukuzithemba kokwenza konke onokukwenza ngomntwana wakho.

Izinto ezibalulekileyo ekufuneka uzikhumbule (Umyalezo Wokuya Ekhaya)

• I-PPHN yingxaki enkulu yokuphefumla kwiintsana ezisandul’ ukuzalwa. Kule meko, imithambo yegazi emiphungeni ayivuleki kakuhle, nto leyo ethintela umzimba ekufumaneni ioksijini eyaneleyo.
• Nangona unobangela ochanekileyo woku ungekaziwa okwangoku , kukho izinto ezinobungozi ezifana nokufunxwa yi-meconium, usulelo, i-RDS, kunye nokuncipha kwe-oxygenation ngexesha lokuzalwa.
• Ukuba ufumana iimpawu ezinje ngobunzima bokuphefumla, ulusu oluluhlaza okwesibhakabhaka, okanye ukubetha kwentliziyo ngokukhawuleza, funa ingcebiso kagqirha ngoko nangoko.
• Unyango luquka ioksijini, inkxaso yomoya, i-nitric oxide, kunye ne-ECMO.
• Nangona kungenakwenzeka ukuyithintela ngokupheleleyo le nto , kubalulekile ukuthatha amayeza akhuselekileyo kuphela ngexesha lokukhulelwa njengoko kuyalelwe ngugqirha.
• Ukuhlolwa kwezonyango ixesha elide kunye nokuhlolwa kokukhula kubalulekile emva kokuphila.
• Awuwedwa ngeli xesha. Fumana inkxaso koogqirha nakusapho. Zininzi izinto onokuzenzela umntwana wakho.

I- PPHN, usana olusandul' ukuzalwa, uxinzelelo lokuphefumla, uxinzelelo lwegazi oluphezulu emaphaphu, ioksijini, ukhathalelo lweentsana ezisandul' ukuzalwa, i-cyanosis