Ingabe ingane yakho inenkinga phakathi kwesifuba nesisu? Ake sixoxe nge- (Congenital Diaphragmatic Hernia - CDH) !

Uma ungumama ozayo noma ulindele ilungu elisha ukuthi lijoyine umndeni wakho, le ndaba izoba yinto ebaluleke kakhulu kuwe. Ngezinye izikhathi izingane zethu zingafika kuleli zwe zineziphako zokuzalwa esingakaze sizizwe. Leso ngesinye sezimo esizokhuluma ngazo namuhla, eziyinkimbinkimbi kancane, kodwa ezifanele kakhulu ukuzazi.

Kuyini i-CDH? Ake sikuqonde kalula.

Kulungile, manje ake sibone ukuthi iyini le (Congenital Diaphragmatic Hernia) noma (CDH) ngamafuphi. Kalula nje, lesi yisimo esenzeka lapho kuzalwa. Lokhu kwenzeka ngesikhathi umntwana esesesibelethweni. Kukhona umsipha ohlukanisa isifuba sethu nesisu, esiwubiza ngokuthi i-Diaphragm . Ufana nodonga oluhlukanisa amakamelo amabili. Uma le diaphragm ingaqinile ngokwanele, noma uma kukhona imbobo kuyo, izitho ezisesiswini - okungukuthi, isisu, amathumbu, isibindi, njll. - zingangena emgodini wesifuba. Yilokho esikubiza ngokuthi (i-Hernia), noma i-hernia.

Manje cabanga ukuthi kuzokwenzekani uma kwenzeka into efana nale ngesikhathi umntwana ekhula esibelethweni. Lapho izitho ezisesiswini zingena esifubeni, akukho ndawo eyanele lapho, akunjalo? Inkinga enkulu ukuthi amaphaphu awanandawo eyanele yokukhula kahle. Uma amaphaphu emancane, okungukuthi, lapho kuvela isimo esibizwa ngokuthi (Pulmonary Hypoplasia), umntwana uba nobunzima bokuphefumula ngemva kokuzalwa, futhi igazi alitholi umoya-mpilo owanele. Akukhona lokho kuphela, kodwa nomfutho wegazi emaphashini nawo ungakhuphuka. Lokhu kubeka nengcindezi enkulu enhliziyweni. Ngakho-ke, umntwana one-(CDH) udinga ukwelashwa okukhethekile ngemva nje kokuzalwa.

Ziyini izimpawu zomntwana one-CDH?

Uma ingane yakho inobunzima obukhulu bokuphefumula ngemva nje kokuzalwa, kungaba uphawu olukhulu lwesimo (i-CDH). Ngaphezu kwalokho, ungase ubone nezinto ezifana nalezi:

• Ukushaya kwenhliziyo okusheshayo kakhulu (i-Tachycardia).
• I-Cyanosis ukushintsha kombala wesikhumba okuluhlaza okwesibhakabhaka ngenxa yokuntuleka komoya-mpilo.
• Imisindo yokuphefumula ephansi kakhulu (ikakhulukazi ohlangothini olulodwa).
• Ukuzwa umsindo wamathumbu uma ubeka indlebe yakho esifubeni.
• Isifuba siyavuvukala futhi sibukeka njengebhodlela, kuyilapho isisu sibonakala sengathi siyacwila ngaphakathi.

Uma ingane yakho inesinye noma ngaphezulu salezi zimpawu, kungcono ukubona udokotela ngokushesha.

Kungani le CDH ikhula? Ziyini izimbangela?

Empeleni kunzima kodokotela ukusho ngqo ukuthi iyini imbangela yangempela yalesi simo "(CDH)". Kodwa-ke, ucwaningo luthole ukuthi izici ezilandelayo zingase zihileleke:

• Izici zofuzo: Okusho ukuthi, izinto ezithile ezidluliselwa ezizukulwaneni ngezizukulwane.
• Ukuchayeka ezintweni eziyingozi ngesikhathi sokukhulelwa: Izinto ezifana namakhemikhali athile nogwayi.
• Ukungondleki kahle komntwana osanda kuzalwa: Umntwana uthola ukudla kwakhe ekudleni okudliwa ngumama.

Lezi yizizathu zamanje, kodwa kwenziwa ucwaningo olwengeziwe ngalokhu.

Yiziphi izinkinga ezingaba khona ngenxa ye-CDH?

Njengoba sesixoxile ngaphambili, izingane eziningi ezine-CDH zinamaphaphu angakakhuli kahle (i-Pulmonary Hypoplasia). Lokhu kungabangela izinkinga ezahlukahlukene:

• Amazinga aphansi omoya-mpilo egazini (i-Hypoxemia): Lokhu kuthinta zonke izitho zomntwana, ikakhulukazi ubuchopho nenhliziyo. Uma lesi simo sibi noma siqhubeka, singabangela umonakalo wesikhathi eside.
• Umfutho wegazi ophezulu emithanjeni yamaphaphu (Pulmonary Hypertension): Lokhu kubeka ukucindezeleka okukhulu ohlangothini lwesokudla lwenhliziyo futhi kungabangela ngisho nokwehluleka kwenhliziyo.
• Ukutheleleka Kwamaphaphu: Amaphaphu angakhuli kahle angathuthuka kalula ezifweni ezifana ne-pneumonia. Ngisho nangemva kokuba i-hernia isilungisiwe ngokuhlinzwa, ingozi yalezi zifo ingaqhubeka impilo yonke.

Ngaphezu kwalokhu, izingane ezine-(CDH) cishe zizoba nezinye izinkinga:

• Ubunzima bokudla: Lokhu kungaba ngenxa yokucindezeleka kwezitho zesisu noma ngenxa yokungenelela okuningi kwezokwelapha ngesikhathi sokuzalwa. Ezinye izingane zingadinga ukunceliswa ngamapayipi isikhathi eside, futhi zingase zibhekane nokukhula okungahambi kahle.
• Ukulibaziseka Kokukhula: Ezinye izingane zingadinga ukwelashwa ngokomzimba, ukukhuluma noma umsebenzi isikhathi esithile ngenxa yokuntuleka komoya-mpilo.
• Ukulahlekelwa Yizinzwa: Ezinye izingane ezine-CDH zilahlekelwa ukuzwa kancane kancane. Ososayensi abakaqiniseki ukuthi lokhu kubangelwa yisimo ngokwaso, ukwelashwa, noma kokubili.

Cabanga ukuthi umama noma ubaba kumelwe ukuba uzizwa ethwele kanzima kangakanani lapho ezwa into efana nale. Kodwa khumbula, isayensi yezokwelapha isithuthuke kakhulu manje.

Odokotela bayixilonga kanjani i-CDH?

Esikhathini esiningi, odokotela bangasithola lesi simo ngesikhathi sokuhlolwa kwe-ultrasound kwangaphambi kokukhulelwa okuvamile ngesikhathi sokukhulelwa kwakho. Uma sesitholakele, bazokwenza ezinye izivivinyo. Isibonelo, bazokwenza i-MRI yengane ukuze babheke i-hernia ngokucacile. Bazokwenza ne-echocardiogram yengane ukuze babone ukuthi inhliziyo yengane ithintekile yini.

Ngezinye izikhathi, odokotela bangase bangayiboni i-CDH kuze kube yilapho ingane isizelwe. Ngemva kokuzalwa kwengane, ithimba lezokwelapha lingase likusole uma libona izinto ezifana nobunzima bokuphefumula, i-septum ephambukile, noma isifuba esivuvukele. Bazobe sebethatha i-X-ray yesifuba kanye ne-echocardiogram . Bangase futhi bathathe isampula yegazi ukuhlola amazinga e-oxygen egazini lomntwana kanye nokuhlola ezinye izinkinga zofuzo .

Akuvamile kakhulu, izingane ezine-CDH zingase zingabonisi izimpawu ezinkulu lapho zizalwa. Uma i-hernia incane kakhulu, ingase ingatholakali ngesikhathi sobuntwana, noma ngisho nasebudaleni.

Yiziphi izindlela zokwelapha i-CDH?

Ukwelashwa kwalesi simo, i-"Congenital Diaphragmatic Hernia", kuqala ngokushesha nje lapho sitholakala. Ungase uzizwe wesaba uma uzwa ngalokhu kwelashwa, kodwa khumbula ukuthi odokotela benza konke okusemandleni abo ukuvikela ingane yakho.

Ukwelashwa Kwangaphambi Kokubeletha

Uma kutholakala ukuthi une-CDH ngesikhathi sokukhulelwa kwakho, udokotela wakho uzokuqapha ngokucophelela. Bazohlola izinkinga kwezinye izinhlelo zezitho zomzimba, njengoba ngezinye izikhathi kungaba yingxenye yesimo esiyinkimbinkimbi kakhulu. Bazohlola futhi ukuze babone ukuthi ingane yakho izozalwa ngaphambi kwesikhathi (ukubeletha ngaphambi kwesikhathi), futhi uma kunjalo, bazonquma ukuthi bazobangela yini ukubeletha (ukubeletha ngaphambi kwesikhathi) ukuze kusizwe impilo yengane.

Kwezinye izimo ezikhethekile, ithimba lezokwelapha lingelapha umbungu ngaphambi kokuba umntwana azalwe. "I-Fetoscopic Tracheal Occlusion (FETO)" ingenye yokuhlinzwa okunjalo kombungu. Kuyasiza ekuthuthukiseni usayizi kanye nokusebenza kwamaphaphu ombungu njengoba umntwana ekhula esibelethweni. Lokhu kwenziwa kusetshenziswa ikhamera encane ebizwa ngokuthi "i-Fetoscopy", ngokusebenzisa ukuchezuka okuncane okwenziwe ngesikhumba sakho esibelethweni sakho.

Kule nqubo ethi (FETO), udokotela ufaka ibhaluni elincane ku-(Trachea) yengane esanda kuzalwa. Bese kuthi (Amniotic Fluid) eqoqwa ngumntwana ngemuva kwebhaluni nangaphakathi kwamaphaphu, okubangela ukuba amaphaphu afuthwe. Lokhu kufuthwa kuthuthukisa ukukhula nokusebenza kwamaphaphu, futhi kusiza ukulungisa omunye umonakalo obangelwe yi-(CDH).

Ukwelashwa kwezinsana

Izingane ezizalwa zine-CDH zivame ukudinga ukunakekelwa okujulile okuvela eqenjini lochwepheshe ngokushesha nje ngemva kokuzalwa. Uma amaphaphu engane engakakhuli ngokugcwele (i-Pulmonary Hypoplasia), azoqala anikezwe ukwesekwa komoya-mpilo. Kwabanye abantwana, lokhu kungaba yipayipi lokuphefumula elixhunywe kumshini wokuphefumula .

Ezinye izingane zingadinga ukwesekwa kokuphila okunamandla nakakhulu. Lokhu kubizwa ngokuthi i-Extracorporeal Membrane Oxygenation (ECMO) . Lokhu kuhilela ukudlula amaphaphu engane angakavuthwa futhi ngezinye izikhathi inhliziyo, nokusebenzisa umshini ukwengeza umoya-mpilo egazini bese uwubuyisela emzimbeni wengane.

Okulandelayo, ingane izodinga ukuhlinzwa. Ingane izogcinwa eYunithi Yokunakekelwa Okujulile Kwezingane Ezisanda Kuzalwa (i-NICU) kuze kube yilapho ingane isizinzile ngokwanele ukuhlinzwa. Lokhu kuvame ukusho kuze kube yilapho umfutho wegazi ophezulu emaphashini (i-pulmonary hypertension) usuphelile futhi i-extracorporeal membrane oxygenation (ECMO) ingasadingeki.

Ngesikhathi sokuhlinzwa, udokotela wezingane obulala izinzwa uzolalisa umntwana ngaphansi kwe-anesthesia . Ngemuva kwalokho udokotela ohlinzayo wezingane uzomhlinza.Ukuhlinzwa kuhilela ukuhambisa izitho zomzimba ezisusiwe esifubeni zibuyele esiswini nokulungisa iphutha eliku-diaphragm. Ezimweni eziningi, okuyingxenye yazo zonke izinhlobo zokuhlinzwa, odokotela bayakwazi ukwenza ukuhlinzwa okuncane okungavamile (i-MIS) okuhilela ukwenza ukusikwa okuncane okungamamilimitha amathathu esikhundleni sokusikwa okukhulu .

Sinjani isikhathi sokululama?

Njengoba ingane yakho ilulama ngemva kokuhlinzwa, kancane kancane uzokhishwa umoya-mpilo. Uzoqhubeka nokunikezwa ukudla ngepayipi kuze kube yilapho ipayipi lokuphefumula likhishwa. Ngemva kwalokho, abelaphi bezinkulumo kanye nochwepheshe bokuncelisa bazokusiza wena kanye nengane yakho ukuthi niqale ukuncelisa ngomlomo. Ezinye izingane zithatha isikhathi eside ukuyeka umoya-mpilo kanye nokuncelisa ngepayipi kunezinye. Ithimba lakho lezokwelapha lizokusekela uma nje kudingeka.

Liyini ikusasa lezingane ezine-CDH?

Izindaba ezinhle ukuthi izinga lokusinda kwezingane ezizalwa zine-CDH lithuthuke kakhulu. Phakathi kwezingane ezi-7 nezi-9 kweziyi-10 ziyasinda. Nakuba lezi zingane zizalwa zinezimo ezibucayi kakhulu, uma zidlula ezinsukwini ezimbalwa zokuqala, amathuba azo okusinda angcono kakhulu. Ezinye izingane zingase zibe nezinkinga zesikhathi eside, kodwa zingaphila impilo ende negcwele. Ngokuthuthuka kwesayensi yezokwelapha, amazinga okusinda kwesikhashana kanye nemiphumela yempilo yesikhathi eside kuyathuthuka usuku nosuku.

Ukubikezela kwesikhathi eside kuncike ezintweni eziningana:

• Ingabe umntwana wazalwa ngaphambi kwesikhathi?
• Yeka ukuthi isimo somntwana sasibi kangakanani ngesikhathi ezalwa.
• Usayizi we-hernia.
• Yisiphi isitho esingene esifubeni?
• Zikhona yini ezinye izinkinga zempilo?

Izinsana ezidinga usizo lokuphefumula noma lokuncelisa isikhathi eside zisengozini enkulu yokuthola izinkinga eziqhubekayo, njengesifo samaphaphu esingamahlalakhona, ukwehluleka ukukhula, ukulahlekelwa ukuzwa, kanye nokubambezeleka kokukhula. Udokotela wengane yakho uzobaqapha ngokucophelela eminyakeni yayo yokuqala.

Ukuthola ukuthi ingane yakho ine-hernia yokuzalwa ebangela ukukhubazeka kungaba yinto eyesabekayo futhi ekhungathekisayo. Ingane yakho izoyiswa egunjini lokunakekelwa okujulile (ICU) ngokushesha nje ngemva kokuzalwa, futhi kungase kudingeke ihlale esibhedlela isikhathi eside. Kodwa ngentuthuko yesayensi yezokwelapha, isimo salesi simo singcono kunanini ngaphambili. Ngisho noma lesi isikhathi esinzima, kunethimba lodokotela nabahlengikazi lapha ukuzokusiza wena nosana lwakho olusanda kuzalwa. Bazokusekela kusukela ngesikhathi sokuxilongwa, kuyo yonke impilo yengane yakho yokuqala.

Izinto okudingeka sizikhumbule

Nakuba lesi simo esibizwa ngokuthi (Congenital Diaphragmatic Hernia - CDH) sibi kakhulu, uma usazi kusengaphambili, ungabhekana naso ngaphandle kokwethuka.

• I-CDH yisimo esenzeka ngesikhathi sokuzalwa futhi esibangela ukuthi izitho ezisesiswini zingene esifubeni ngenxa yephutha eliku-diaphragm.
• Lokhu kuthinta kakhulu ukukhula kwamaphaphu.
• Lokhu kungatholakala ngokusebenzisa ama-scan ngesikhathi sokukhulelwa.
• Zidinga ukwelashwa okukhethekile kanye nokuhlinzwa ngokushesha ngemva kokuzalwa.
• Ngokuthuthuka kwesayensi yezokwelapha, iningi lalezi zingane lingaphila impilo enhle.

Uma uneminye imibuzo noma ukukhathazeka ngalokhu, qiniseka ukuthi ukhuluma nodokotela wakho noma umhlengikazi. Bangakunikeza ulwazi olwengeziwe futhi bakusize ukhiphe ukucindezeleka engqondweni yakho. Khumbula, awuwedwa.

I- CDH, I-Congenital Diaphragmatic Hernia, I-Diaphragmatic hernia, Ukukhubazeka kokuzalwa, Ukukhula kwamaphaphu, Impilo yomntwana, Ukuhlinzwa