Ake sifunde nge-Necrotizing Enterocolitis (NEC), isifo esibi samathumbu esivame ukwenzeka ezinganeni ezizalwa ngaphambi kwesikhathi.

Ingabe ingane yakho yazalwa ngaphambi kwesikhathi? Siyazi ukuthi umama noma ubaba angaba novalo futhi akhathazeke kangakanani uma bethola umntwana ngaphambi kwesikhathi. Ikakhulukazi uma ingane ise-NICU ( Neonatal Intensive Care Unit), lowo muzwa uba mkhulu nakakhulu. Lapho udokotela efika ngokuzumayo ekutshela ukuthi ingane yakho inenkinga enkulu yamathumbu, isimo esibizwa ngokuthi i-NEC (Necrotizing Enterocolitis), kunzima ukusho ngamazwi ukuthi izizwa kanjani. Namuhla sikhuluma ngalesi simo esibizwa ngokuthi i-NEC, esesaba omama nobaba abaningi, kodwa okubaluleke kakhulu ukuqaphela.

Kalula nje, iyini le NEC?

I-Necrotizing Enterocolitis (NEC) yisifo sokugaya ukudla esibi kakhulu esithinta kakhulu izingane ezizalwa ngaphambi kwesikhathi. Kulesi simo, izicubu zamathumbu omntwana ziyalimala, zivuvuke, bese ziqala ukufa. Igama elithi "necrotizing" lisho "ukufa kwezicubu." Igama elithi "Enterocolitis" lisho ukuvuvukala kwamathumbu.

Cabanga ngakho, amathumbu ethu awawona nje umbhobho. Ayisitho esiyinkimbinkimbi esenziwe ngezicubu eziphilayo esiza ekugayeni ukudla futhi simunce izakhamzimba. Ku-NEC, udonga lwamathumbu luba buthakathaka, lonakale, futhi ngezinye izikhathi luze lubhoboke . Uma kwakheka umgodi onjalo, amagciwane, njengebhaktheriya, angaphakathi kwamathumbu angangena esiswini noma egazini lomntwana. Lesi yisimo esiyingozi kakhulu.

I-NEC ivame ukwenzeka phakathi kwamasonto amabili kuya kwayisithupha ngemva kokuzalwa. Kwabanye abantwana, ithambile kakhulu futhi iba ngcono. Kwabanye, ingaba nzima futhi isongela ukuphila.

Ubani osengozini enkulu yokuthola lesi simo?

Kubantwana abayi-10 abathola i-NEC, abayi-9 bangabantwana abazalwa ngaphambi kwesikhathi . Akuvamile kakhulu ukuthi izingane ezizalwa ngesikhathi sokukhulelwa zikhule. Lokhu okulandelayo kusengozini enkulu:

• Izingane ezizalwa ngaphambi kwamasonto angu-37 okukhulelwa: Ingozi iphezulu kakhulu ezinganeni ezizalwa ngaphambi kwamasonto angu-32.
• Izingane ezizalwa zinesisindo esiphansi kakhulu: Izingane ezinesisindo esingaphansi kwamakhilogremu angu-2.5 (amakhilogremu angu-5.5) zisengozini enkulu kakhulu ekuzalweni. Izingane ezinesisindo esingaphansi kwekhilogremu elilodwa (amakhilogremu angu-2.2) zisengozini enkulu kakhulu.
• Kwabantwana abanceliswa ngepayipi (ukudla okunomsoco): Ngenxa yokuthi izingane ezizalwa ngaphambi kwesikhathi zinekhono elincane lokuncela, ubisi lunikezwa ngepayipi elifakwa ngekhala liye esiswini.
• Kwabantwana ababenezinkinga ngesikhathi sokuzalwa: Isibonelo, izingane ezazinezinkinga ezifana nobunzima bokuphefumula noma isifo senhliziyo.

Cishe oyedwa kwabayi-1,000 abazalwa ngaphambi kwesikhathi uba ne-NEC. Kodwa-ke, lesi simo senzeka cishe koyedwa kwabayi-10,000 abazalwa isikhathi esigcwele. Ngakho-ke kunembile ukusho ukuthi lesi yisifo esivame kakhulu ezinganeni ezizalwa ngaphambi kwesikhathi.

Yiziphi izinhlobo eziyinhloko zama-NEC?

Odokotela bahlukanisa lesi sifo ngezinhlobo eziningana, kuye ngokuthi izimpawu ziqala nini kanye nembangela yalesi sifo.

Ngezinye izikhathi, kube nemibiko yezingane eziningi ezithola i-NEC ngesikhathi esisodwa e-NICU ( i-Neonatal Intensive Care Unit). Ezimweni ezinjalo, imbangela ingaba ukutheleleka ngamagciwane njenge-E. Coli.

Kungani le NEC yenzeka? Iyini imbangela?

Eqinisweni, odokotela abakakatholi imbangela eyodwa ye-NEC. Kukholakala ukuthi kuyinhlanganisela yezici eziningana.

Amaphuzu ayinhloko yilawa:

1. Amathumbu angakavuthwa: Amathumbu engane ezalwa ngaphambi kwesikhathi awakakhuli ngokugcwele. Athambile kakhulu futhi abuthakathaka. Ngakho-ke, anenkinga ngenqubo yokugaya ukudla.

2. Isimiso somzimba esibuthakathaka: Isimiso somzimba esilwa nezifo ezinganeni ezizalwa ngaphambi kwesikhathi asikakhuli ngokugcwele. Ngakho-ke, ngisho nokutheleleka okuncane emathunjini kungaba nzima ngomzimba ukulwa nakho.

3. Ukwehla kokugeleza kwegazi emathunjini: Uhlelo lokujikeleza kwegazi lwezingane ezizalwa ngaphambi kwesikhathi lubeka phambili ukuthumela igazi ezithweni ezibalulekile njengobuchopho nenhliziyo. Ngezikhathi zokucindezeleka (isib. ukuntuleka komoya-mpilo), umzimba unciphisa inani legazi eligeleza emathunjini. Lapho ukugeleza kwegazi kuncipha, izicubu emathunjini azitholi umoya-mpilo eziwudingayo. Ngenxa yalokho, lezo zicubu ziyalimala bese ziqala ukufa.

Uma lezi zici zihlangana, udonga lwamathumbu luba buthakathaka, okuvumela amagciwane ukuba akhule lapho, okubangela ukuvuvukala futhi kuholele ku-NEC.

Ziyini izimpawu ze-NEC?

Odokotela nabahlengikazi bahlala beqapha ingane ese-NICU. Ngakho-ke, noma ngabe babona uphawu oluncane lwe-NEC, bathatha isinyathelo ngokushesha. Njengomzali, kubalulekile ukuthi uqaphele lezi zimpawu.

Izimpawu zingase zivele kancane kancane ezinsukwini ezimbalwa, noma zingase zivele ngokuzumayo enganeni ephilile.

• Ukuvuvukala kwesisu nobuhlungu: Isisu somntwana sizwakala sinzima uma sithintekile, umntwana uyakhala uma ebekwe kuso, futhi isisu sibonakala sigcwele.
• Ukwenqaba ukuphuza ubisi: Umntwana obephuza kahle ngokuzumayo wenqaba ukuphuza ubisi, okushiya izinsalela zesisu.
• Ukuhlanza: Ukuhlanza, ikakhulukazi okuluhlaza noma okuphuzi, kungaba uphawu lokuvaleka kwamathumbu.
• Izinguquko ekuhambeni kwamathumbu: Izinguquko ekuhambeni kwamathumbu, indle efana nohudo, kanye negazi esitulweni .
• Ushintsho esimweni sempilo jikelele:
• Ukushaya kwenhliziyo kwengane kuyehla noma kukhuphuke.
• Izinga lokuphefumula liyashintsha, ngezinye izikhathi kuyeke ukuphefumula isikhashana (i-apnea).
• Umfutho wegazi uyehla.
• Izinga lokushisa lomzimba alikwazi ukugcinwa.
• Ingane ikhathele kakhulu futhi ibonakala ingaphili.

Uma kubonakala eyodwa noma ngaphezulu yalezi zimpawu, abasebenzi be-NICU bazophenya ngokushesha.

Odokotela bakuthola kanjani lokhu?

Into yokuqala udokotela wengane yakho azokwenza ukuhlola ingane yakho ngokucophelela. Bazohlola ukuvuvukala nokuthamba kwayo. Bazophinde benze izivivinyo ezimbalwa ukuqinisekisa ukuthi inesifo.

• I-X-ray yesisu:Lesi yisilingo esibaluleke kakhulu. Singahlola amabhamuza egesi ngaphakathi kodonga lwamathumbu. Lokhu kubizwa ngokuthi 'i-pneumatosis intestinalis'. Futhi, uma amathumbu ebhobokile, ungabona umoya okhululekile ngaphakathi kwesisu.
• Ukuhlolwa kwegazi: Lokhu kuhlola ukutheleleka (amabhaktheriya) egazini, inani eliphansi lamaseli amhlophe egazi, kanye nezinkinga zokujiya kwegazi.
• Ukuhlolwa kwendle: Lokhu kuhlolwa kusiza ukuthola igazi esitulweni elingabonakali emehlweni.

Yiziphi izinkinga ezingaba khona ze-NEC?

Ngenxa yokuthi i-NEC iyisimo esibucayi, izinkinga zingavela ngemva kwayo.

• I-Peritonitis: Uma kukhona imbobo emathunjini, amabhaktheriya angangena emgodini wesisu futhi abangele ukutheleleka okukhulu (i-peritonitis). Lokhu kungaholela esimweni esisongela ukuphila esibizwa ngokuthi i-sepsis , lapho amabhaktheriya esakazeka khona emzimbeni wonke.
• Ukuqina Kwamathumbu: Ngemva kokuba i-NEC isipholile, ingxenye yamathumbu eyonakele ingaba nezibazi futhi inciphe njengoba iphola. Lokhu kwenza kube nzima ukudla. Lokhu kungadinga ukuhlinzwa ngosuku olulandelayo.
• I-Short Bowel Syndrome: Uma ingxenye enkulu yamathumbu ifa ngenxa ye-NEC futhi kufanele isuswe ngokuhlinzwa, ingxenye esele yamathumbu ayanele ukumunca izakhamzimba kahle. Lesi simo sibizwa ngokuthi i-short bowel (short gut) syndrome . Izingane ezinalesi simo zizodinga ukunakwa okukhethekile ekudleni okunempilo impilo yazo yonke.
• Ukulibaziseka Kokukhula Nokuthuthukiswa: Izingane eziye zaba ne-NEC, ikakhulukazi lezo eziye zahlinzwa, zingase zithole ukulibaziseka ekukhuleni nasekuthuthukisweni kobuchopho kamuva ekuphileni. Ngakho-ke, kubaluleke kakhulu ukugcina lezi zingane ngaphansi kokubhekwa okuqhubekayo kwezokwelapha.

Iphathwa kanjani?

Lapho nje kusolwa ukuthi i-NEC iyasebenza, odokotela baqala ukwelashwa. Umgomo oyinhloko ukunikeza amathumbu ukuphumula okuphelele .

1. Yeka ukuncelisa: Into yokuqala okufanele uyenze ukuyeka ngokuphelele ukuncelisa umntwana ngomlomo noma ngepayipi. Lokhu kuzonikeza amathumbu ukuphumula futhi kuqale ukuphola.

2. Ukudla Okunomsoco Nge-IV: Konke ukudla okunomsoco kanye noketshezi umntwana akudingayo kunikezwa nge-saline (i-IV fluids) efakwa ngqo emthanjeni.

3. Ukubekwa kwepayipi le-nasogastric: Ipayipi (ipayipi le-nasogastric) lifakwa ngekhala liye esiswini, likhiphe umoya kanye noketshezi oluqongeleleke esiswini. Lokhu kunciphisa ukuvuvukala esiswini futhi kunciphisa ingcindezi emathunjini.

4. Ama-antibiotic: Ukuze kulwiwe nokutheleleka futhi kuvinjelwe ukusabalala kokutheleleka, ama-antibiotic anamandla anikezwa ngemithambo yegazi.

5. Ukuqapha njalo:Ingane iqashwe ngokucophelela. Ukuhlolwa kwegazi kanye ne-X-ray kwenziwa njalo ukuze kubonakale ukuthi isimo siyathuthuka noma siyaba sibi kakhulu.

Kunini lapho kudingeka khona ukuhlinzwa?

Cishe ingane eyodwa kwezine ingadinga ukuhlinzwa. Ukuhlinzwa kwenziwa ukuze:

• Uma kuqinisekiswe ukubhoboka emathunjini.
• Uma isimo somntwana singathuthuki ngokwelashwa ngemithi.

Ngesikhathi sokuhlinzwa, udokotela ohlinzayo ususa ingxenye efile yamathumbu bese exhumanisa kabusha izingxenye ezimbili zamathumbu eziphilile. Ngezinye izikhathi, uma amathumbu evuvukele kakhulu, kunzima ukuwaxhumanisa kabusha ngokushesha. Ezimweni ezinjalo, kwenziwa ukuhlinzwa okubizwa ngokuthi i-ostomy .

Uma ingane incane kakhulu noma igula kakhulu ukuba ihlinzwe, udokotela angase afake ipayipi elincane (idreyini) esiswini ukuze akhiphe uketshezi olunegciwane nomoya oqongeleleke emgodini wesisu. Lokhu kuzonciphisa izimpawu. Kamuva, lapho ingane isikhulile kancane futhi inempilo enhle, kuzokwenziwa ukuhlinzwa.

Liyini ikusasa lomntwana one-NEC?

Nakuba i-NEC iyisifo esesabekayo, ingelapheka. Izingane ezingu-8 kwezingu-10 ezine-NEC ziyasinda. Nakuba ezinye zalezi zingane zingase zibe nezinkinga zempilo zesikhathi eside, iningi lazo liphila impilo evamile negcwele.

Ingabe zikhona izindlela zokuvimbela lokhu?

Nakuba kungenakuvinjelwa ngokuphelele, kunezinto eziningana ongazenza ukuze unciphise ingozi ye-NEC.

• Ukuvimbela ukuzalwa ngaphambi kwesikhathi: Kungcono ukugcina umntwana esibelethweni isikhathi eside ngangokunokwenzeka. Ukuze wenze lokhu, landela iseluleko sezokwelapha esifanele ngesikhathi sokukhulelwa.
• Imijovo ye-corticosteroid: Odokotela banikeza omama abasengozini yokubeletha ngaphambi kwesikhathi umjovo obizwa ngokuthi i-corticosteroid. Lokhu kusiza ukuthi amaphaphu namathumbu engane akhule.
• Ukuncelisa: Ukuncelisa ibele kuyindlela engcono kakhulu yokuvikela ingane ezalwa ngaphambi kwesikhathi. Ubisi lwebele lunekhono elimangalisayo lokunciphisa ingozi ye-NEC. Izakhi eziqinisa amasosha omzimba ebisini lwebele zivikela amathumbu engane.
• Ama-Probiotic: Ezinye izifundo zibonise ukuthi ukufaka ama-probiotic (amabhaktheriya amahle) ebisini lebele noma efomini kunganciphisa ingozi ye-NEC. Kodwa-ke, kufanele ukhulume nodokotela wengane yakho ngaphambi kokwenza lokhu.

Kungaba yinto eshaqisayo kubazali ukuba nezinkinga ezifana ne-NEC ngenkathi ingane yabo ise-NICU. Kodwa khumbula, odokotela nabahlengikazi e-NICU baqeqeshwe ngokukhethekile ukuqaphela nokwelapha lezi zimo ngokushesha. Bathembe. Khuluma nabo nganoma yimiphi imibuzo noma ukukhathazeka ongase ube nakho.