Ingabe ingane yakho esanda kuzalwa inenkinga yokuphefumula? Ake sifunde nge-PPHN (Persistent Pulmonary Hypertension of the Newborn)!

Usana olusanda kuzalwa lungenye yezinto ezijabulisa kakhulu empilweni, akunjalo? Kodwa futhi kujwayelekile ukuzizwa wesaba futhi ukhathazekile, ikakhulukazi ngempilo yomntwana. Ngezinye izikhathi, izingane ezisanda kuzalwa zingaba nobunzima bokuphefumula. Leso yisimo esibucayi, kodwa esingasisingatha kahle sonke uma sonke sisazi. Ake sixoxe ngaso namuhla.

Iyini i-PPHN? Iyini ngempela?

Kalula nje, i-PPHN iyinkinga enkulu yokuphefumula eyenzeka ezinganeni ezisanda kuzalwa. Kwenzeka lapho ingane yakho iphuma esibelethweni sakho futhi iqala ukuphefumula endaweni engaphandle, futhi uhlelo lwayo lokujikeleza kwegazi lungaguquguquki kahle.

Cabanga ngale ndlela. Uma ingane yakho isesiswini sakho, ithola umoya-mpilo wayo ngentambo yesisu, nge-placenta. Ngaleso sikhathi, igazi elincane aliyi emaphashini ayo. Lokhu kungenxa yokuthi imithambo yegazi emaphashini (imithambo yamaphaphu) ivame ukuvinjwa futhi inciphe. Elinye igazi liyadlula emaphashini bese liya ngqo emzimbeni wonke. Kufana nokuthatha indlela ehlukile lapho umgwaqo uvinjiwe.

Kodwa-ke, ushintsho olukhulu kufanele lwenzeke ngokushesha nje lapho umntwana ezalwa futhi ephefumula okokuqala . Ngemuva kwalokho, imithambo yegazi emaphashini eyayivaliwe idinga ukuvula (`(ukwanda)`). Yilapho umoya-mpilo ungena khona emaphashini kanye nomoya. Ngemuva kwalokho, igazi liya emaphashini ngale mithambo yegazi evuliwe, lithathe umoya-mpilo, bese lisabalalisa lelo gazi eligcwele umoya-mpilo kuwo wonke umzimba, ikakhulukazi ebuchosheni, enhliziyweni nasezinso.

Esimweni esibizwa ngokuthi i-PPHN, imithambo yegazi emaphashini engane ayivuli kahle, noma ayanele. Kwenzekani-ke? Umfutho wegazi ophezulu emaphashini (i-pulmonary hypertension) uyavela. Lokhu kunciphisa inani lomoya-mpilo ofinyelela ebuchosheni bengane nakwezinye izitho ezibalulekile. Lesi yisimo esiphuthumayo sezokwelapha esisongela impilo futhi ukwelashwa kudinga ukuqaliswa ngokushesha.

Sivame kangakanani lesi simo esibizwa ngokuthi i-PPHN?

I-PPHN yenzeka cishe ezinganeni ezimbili kweziyi-1,000 ezizalwa ziphila. Ivame kakhulu ezinganeni ezizalwa ngesikhathi sokubeletha (phakathi kwamasonto angu-37 no-42) kanye nasezinsaneni ezizalwa ngemva kosuku lokuzalwa (ngemuva kwamasonto angu-42). Kodwa-ke, akuvamile ukwenzeka ezinganeni ezizalwa isikhathi esigcwele.

Ziyini izimpawu ze-PPHN? Sizibona kanjani?

Uma ingane yakho ine-PPHN, ingabonisa izimpawu ezifana nalezi:

• Ubunzima bokuphefumula: ukuphefumula ngokushesha kakhulu noma kancane kakhulu, ukwenza umsindo wokuphefumula lapho uphefumula, nokuzwa sengathi isifuba sakho sicwila ku-(`(ukuhoxa)`).
• Ukwanda kwesilinganiso senhliziyo (`(Isilinganiso senhliziyo esisheshayo)`).
• Isikhumba somntwana singase sibonakale siluhlaza okwesibhakabhaka (cyanosis), ikakhulukazi ezindaweni ezifana nezindebe, ulimi, kanye neminwe.
• Umfutho wegazi ophansi (hypotension).
• EgaziniAmazinga aphansi e-oxygen egazini .
• Ukuzwa imisindo engavamile noma engavamile (`(ukububula kwenhliziyo)`) lapho ulalele inhliziyo.

Uma ubona eyodwa noma ngaphezulu yalezi zimpawu ngokushesha ngemva kokuzalwa komntwana, noma phakathi namahora ambalwa, kubaluleke kakhulu ukwazisa odokotela ngokushesha.

Yiziphi izici ezibangela ukuthuthukiswa kwe-PPHN?

Abacwaningi abakaqiniseki ukuthi yini ngempela ebangela i-PPHN, kodwa kucatshangwa ukuthi ibangelwa amaphaphu engane angakhuli kahle noma ukungakwazi ukuzivumelanisa (nokuvuleka) nendawo engaphandle ngemva kokuphuma esibelethweni.

Yiziphi izinto ezandisa ingozi ye-PPHN?

Nakuba imbangela eqondile ingaziwa, izici ezithile zingandisa ingozi yengane yokuthola i-PPHN. Ake sibheke ukuthi ziyini:

• ` Isifiso seMeconium`: Yilapho indle yokuqala yomntwana (esiyibiza ngokuthi `(Meconium)`, ewugqinsi futhi enamathelayo kancane) ingena ohlelweni lwakhe lokuphefumula ngenkathi esesesibelethweni.
• Ukutheleleka: Ukutheleleka kwamaphaphu, njenge-pneumonia, noma ukutheleleka kwegazi.
• I-Respiratory distress syndrome (RDS): Lokhu kuvame ukubonakala ezinganeni ezizalwa ngaphambi kwesikhathi ezinamaphaphu angakakhuli ngokugcwele.
• Ukuphelelwa umoya ngesikhathi sokuzalwa: Ingane engatholi umoya-mpilo owanele ngaphambi noma ngesikhathi sokuzalwa.
• I-hernia ye-Diaphragmatic: Lokhu kwenzeka lapho kwakheka imbobo emsipheni ohlukanisa isifuba nesisu somntwana (okuthiwa i-diaphragm). Lokhu kuvumela ezinye zezitho zesisu ukuthi zidlule embobeni ziye esifubeni.
• Ezinye izinkinga zenhliziyo noma zamaphaphu azalwa nazo: Isibonelo, iphaphu elincane noma ivalvu yenhliziyo evalekile.
• Ukusetshenziswa kwemithi ethile ngesikhathi sokukhulelwa: Kuye kwaphakanyiswa ukuthi ukusetshenziswa kwemithi ebizwa ngokuthi "ama-NSAID" (imithi elwa nokuvuvukala engeyona eye-steroidal) kanye nethi "ama-SSRI" (ama-selective serotonin reuptake inhibitors), ikakhulukazi ngesikhathi sokukhulelwa, nakho kungathinteka. Ngakho-ke, uma uthatha noma yimuphi umuthi ngesikhathi sokukhulelwa, kubaluleke kakhulu ukukhuluma nodokotela wakho ngakho.

Iyini imiphumela yesikhathi eside ye-PPHN?

Cishe ingane eyodwa kwezine (1 kwezine) ezisindayo ku-PPHN ziba nokukhubazeka okuthile ngenxa yokuntuleka komoya-mpilo ebuchosheni. Lezi zinkinga zifaka:

• Ukulibaziseka kokukhula .
• Izinkinga zokuzwa, ngezinye izikhathi ngisho nokungezwa, zingaba khona.
• Ukukhubazeka kokufunda .
• Ukwehla kwamandla okwenza imisebenzi yomzimba .

Ngakho-ke, kubaluleke kakhulu ukuqhubeka nokugcina izingane esezilulame ku-PPHN ngaphansi kokuqashwa kwezokwelapha nokuqapha intuthuko yazo.

Itholakala kanjani i-PPHN?

Udokotela wengane yakho angenza izivivinyo ezahlukahlukene ukuze anqume ukuthi ingane yakho ine-PPHN. Ezinye zalezi zifo zifaka:

• Ukubalwa kwegazi okuphelele (i-CBC): Lokhu kulinganisa inani lamaseli amhlophe egazi, amaseli abomvu egazi, nama-platelet egazini lomntwana.
• I-pulse oximetry (i-pulse ox): Lena indlela elula, engangenisi umswakama yokulinganisa izinga lomoya-mpilo egazini lomntwana.
• Igesi yegazi lemithambo yegazi (ABG): Lokhu kulinganisa ukuthi umzimba womntwana uthola umoya-mpilo kahle kangakanani nokuthi uwukhipha kahle kangakanani umoya-mpilo.
• I-X-ray yesifuba: Lokhu kusiza ukubona ukuthi inhliziyo yengane ikhulisiwe noma ukuthi kukhona yini izinkinga zamaphaphu.
• I-Echocardiogram (echo): Lena i-ultrasound eningiliziwe yenhliziyo yengane. Ihlola ukuthi igazi ligeleza kanjani liye enhliziyweni nasemaphashini.
• I-ultrasound yekhanda: Lokhu kusiza ukuhlola noma yikuphi ukopha ebuchosheni bengane.
• Ukuhlolwa kwe-serum electrolyte: Lokhu kuhlolwa kusetshenziselwa ukuhlola ibhalansi yamaminerali egazini lomntwana.
• Ukubhoboza i-Lumbar (umpompi womgogodla): Lokhu kuhlolwa kungenziwa ngezinye izikhathi ukuze kuhlolwe ukuthi ingane inazo yini izifo.

Akudingeki ukwenza zonke lezi zivivinyo; odokotela bazonquma ukuthi yiziphi izivivinyo okufanele bazenze ngokusekelwe esimweni somntwana.

Iphathwa kanjani i-PPHN?

Umgomo oyinhloko wokwelapha i-PPHN ukwandisa ukugeleza komoya-mpilo ezithweni zomntwana nokuvimbela izinkinga ezinkulu. Kunezindlela ezahlukene zokwelapha lokhu:

• Umoya-mpilo: Ingane inganikwa umoya-mpilo ongu-100% nge-cannula yamakhala, izipikili zamakhala, noma imaski.
• Umoya womoya osebenza ngomshini: Udokotela ufaka ipayipi embhobheni womoya womntwana (i-trachea) bese esebenzisa umshini womoya wokusiza ingane ukuba iphefumule.
• Ukulawula umfutho wegazi: Ingane inganikwa imithi yokulawula umfutho wegazi ngomthambo (`(IV)`).
• I-nitric oxide: I-nitric oxide iyigesi esiza ukuvula (ukwandisa) imithambo yegazi emaphashini engane yakho, ithuthukise ukugeleza kwegazi emaphashini.
• Umoya ovunguzayo ohamba ngesivinini esiphezulu: Lolu futhi uhlobo olukhethekile lomoya ovunguzayo. Lungasiza ekuthuthukiseni amazinga omoya-mpilo egazini lomntwana.
• Ukuphefumula komoya-mpilo ngaphandle kwesikhumba (ECMO): Lo mshini usetshenziswa lapho inhliziyo noma amaphaphu engane ebuthakathaka kakhulu ukuba angalawulwa ngezinye izindlela zokwelapha. Uthatha igazi emzimbeni wengane okwesikhashana, wengeze umoya-mpilo kuwo, bese ulibuyisela emzimbeni, unikeze umoya-mpilo ebuchosheni nakwezinye izingxenye zomzimba. Usebenza njengephaphu lokwenziwa.

Singakwazi yini ukuvimbela i-PPHN?

Njengoba sesixoxile ngaphambili, ayikho indlela yokuvimbela ngokuphelele i-PPHN ngoba asikazi kahle ukuthi iyibangelani . Kodwa-ke, ukugwema imithi ethile ngesikhathi sokukhulelwa kungasiza ekunciphiseni ingozi yakho. Ngakho-ke, uma ukhulelwe, qiniseka ukuthi ukhuluma nodokotela wakho ngaphambi kokuthatha noma yimuphi umuthi ukuqinisekisa ukuthi kuphephile ukuwuthatha ngesikhathi sokukhulelwa.

Kuthatha isikhathi esingakanani ukululama ku-PPHN?

Iningi lezingane liyalulama ku-PPHN zingakapheli isonto noma amabili . Kodwa-ke, ezinye izingane zingathatha isikhathi eside, ngezinye izikhathi izinyanga, ukuze zilulame ngokugcwele. Ngisho nangemva kokuba ingane yakho isilulame, kubalulekile ukuyivikela emakhazeni, emkhunjini, nakwezinye izifo ezibangelwa amagciwane. Lokhu kungenziwa ngokugeza izandla zakho njalo, ukunciphisa ukuchayeka kwengane yakho ezixukwini, nokugcina ingane yakho kude nabantu abagulayo. Kungumqondo omuhle futhi ukuthi wonke umuntu ekhaya lakho athole umuthi wokugomela umkhuhlane njalo ngonyaka.

Ikakhulukazi, kubalulekile ukuyisa ingane yakho ekuhlolweni njalo kwezokwelapha kanye nokuvakashelwa ochwepheshe ukuqinisekisa ukuthi intuthuko yayo iqhubeka kahle.

Liyini izinga lokusinda kanye nombono we-PPHN?

I-PPHN iyisimo esibi kakhulu, futhi ngeshwa, phakathi kuka-7% no-10% wezingane ezinalesi simo ziyafa ngenxa yezinkinga. Kubantwana abasindayo, cishe u-25%, noma cishe oyedwa kwabane, bangaba nemiphumela yesikhathi eside (njengokulibaziseka kokukhula, ukukhubazeka kokufunda, kanye nokulahlekelwa ukuzwa) okubangelwa ukuntuleka komoya-mpilo ebuchosheni.

Kufanele uyiyise nini ingane yakho kudokotela?

Ngemva kokuba ingane yakho isilulame ku-PPHN, qiniseka ukuthi uyiyisa kuzo zonke izikhathi zokulandelela . Lokhu kuzosiza udokotela wakho ukuthi aqhubeke nokuqapha ingane yakho. Okwamanje, funa iseluleko sezokwelapha ngokushesha uma ingane yakho ibonisa noma yiziphi zalezi zimpawu ezilandelayo:

• Uma uthola umkhuhlane.
• Uma unciphisa ukudla ubisi, noma uma ungaphuzi ubisi nhlobo.
• Uma isifuba sakho singena ngaphakathi uma uphefumula, noma uma uphefumula uvulekile kakhulu.
• Uma wenza umsindo wokushaya ikhwela noma wokubhonga lapho uphefumula.
• Uma isikhumba siqala ukuba luhlaza okwesibhakabhaka noma ompunga.

Uma uthola ukuthi ingane yakho esanda kuzalwa inesimo esifana ne-PPHN, kuvamile ukuzizwa udabukile, ukwesaba, intukuthelo, nokudideka. Lokho kungokwemvelo. Funda okuningi ngangokunokwenzeka nge-PPHN kodokotela nabahlengikazi abaphatha ingane yakho. Bazokutshela konke ongakwenza ngesimo sengane yakho, nokuthi ungabaduduza futhi ubasize kanjani. Ngokuhamba kwesikhathi, uzoba uchwepheshe ngesimo sengane yakho, futhi uzothola ukuzethemba kokwenza konke ongakwenza ngengane yakho.

Izinto ezibalulekile okufanele uzikhumbule (Umyalezo Wokuya Ekhaya)

• I-PPHN iyinkinga enkulu yokuphefumula ezinganeni ezisanda kuzalwa. Kulesi simo, imithambo yegazi emaphashini ayivuli kahle, okuvimbela umzimba ekutholeni umoya-mpilo owanele.
• Nakuba imbangela eqondile yalokhu ingakaziwa okwamanje , kunezici eziyingozi ezifana nokufiswa kwe-meconium, ukutheleleka, i-RDS, kanye nokuncipha kokunikezwa komoya-mpilo ngesikhathi sokuzalwa.
• Uma uhlangabezana nezimpawu ezifana nobunzima bokuphefumula, isikhumba esiluhlaza okwesibhakabhaka, noma ukushaya kwenhliziyo okusheshayo, funa iseluleko sezokwelapha ngokushesha.
• Ukwelashwa kufaka phakathi umoya-mpilo, ukwesekwa komoya-mpilo, i-nitric oxide, kanye ne-ECMO.
• Nakuba kungenakwenzeka ukukuvimbela ngokuphelele , kubalulekile ukuthatha imithi ephephile kuphela ngesikhathi sokukhulelwa njengoba kuyalelwe udokotela.
• Ukuqapha kwezokwelapha isikhathi eside kanye nokuhlolwa kokukhula kubalulekile ngemva kokululama.
• Awuwedwa ngesikhathi esinjengalesi. Thola ukwesekwa kodokotela nomndeni. Kunezinto eziningi ongazenzela ingane yakho.

I- PPHN, usana olusanda kuzalwa, ukucindezeleka kokuphefumula, umfutho wegazi ophakeme emaphashini, umoya-mpilo, ukunakekelwa kwezingane ezisanda kuzalwa, i-cyanosis