Ngaphambi kokuba usana luzalwe

Usana ngaphambi kwexesha ngumntwana ozelwe ngaphambi kweeveki ezingama-37 ezigqityiweyo zokumitha (ngaphezulu kweeveki ezintathu ngaphambi komhla omiselweyo).

Ekuzalweni, umntwana uhlelwa njengenye yezi zinto zilandelayo:

• Ngaphambi kwexesha (ngaphantsi kweeveki ezingama-37)
• Ixesha elipheleleyo (iiveki ezingama-37 ukuya kuma-42 zokukhulelwa)
• Ixesha lokuposa (ozelwe emva kweeveki ezingama-42 ekhulelwe)

Ukuba umfazi uya kubeleka ngaphambi kweeveki ezingama-37, kuthiwa ngumsebenzi wokuqala.

Emva kwexesha iintsana ezizalwe phakathi kweeveki ezingama-35 ukuya kwezingama-37 ukumitha zisenokungabonakali ngaphambi kwexesha. Banokungamkelwa kwicandelo lokhathalelo olunzulu lwe-neonatal (NICU), kodwa basesemngciphekweni weengxaki ezininzi kunabasana abasisigxina.

Iimeko zempilo kunina, ezinjengesifo seswekile, isifo sentliziyo, kunye nesifo sezintso, zinokuba negalelo ekusebenzeni ngaphambi kwexesha. Rhoqo, unobangela womsebenzi wokuqala awaziwa. Abanye abantu abazalwa ngaphambi kwexesha kukukhulelwa okuninzi, njengamawele okanye amawele amathathu.

Iingxaki ezahlukeneyo ezinxulumene nokukhulelwa zonyusa umngcipheko wokusebenza ngaphambi kwexesha okanye ukuhanjiswa kwangoko:

• Umlomo wesibeleko obuthathaka oqala ukuvula (ukunciphisa) kwangoko, okwabizwa ngokuba kukungakwazi ukusebenza komlomo wesibeleko
• Iziphene zokuzalwa kwesibeleko
• Imbali yokuhanjiswa kwangaphambi kwexesha
• Usulelo (usulelo lwe-urinary tract okanye usulelo lwe-membrane ye-amniotic)
• Ukungondleki kakuhle phambi okanye ngexesha lokukhulelwa
• I-Preeclampsia: uxinzelelo lwegazi oluphezulu kunye neprotein kumchamo ophuhla emva kweveki ye-20 yokukhulelwa
• Ukuqhekeka kwangaphambili kweembumba (i-placenta previa)

Eminye imiba eyonyusa umngcipheko kubasebenzi ngaphambi kwexesha kunye nokuhanjiswa kwangoko kubandakanya:

• Ubudala bukamama (oomama abangaphantsi kwe-16 okanye ngaphezulu kwe-35)
• Ukuba ngumAfrika waseMelika
• Ukunqongophala kokhathalelo lwangaphambi kokubeleka
• Imeko yezoqoqosho ephantsi
• Ukusetyenziswa kwecuba, icocaine, okanye iiamphetamines

Usana lunokuba nengxaki yokuphefumla kunye nokugcina iqondo lobushushu lomzimba rhoqo.

Usana ngaphambi kwexesha lunokuba neempawu zezi ngxaki zilandelayo:

• Azonelanga iiseli ezibomvu zegazi (ianemia)
• Ukopha ebuchotsheni okanye ukonakala kwimiba emhlophe yobuchopho
• Usulelo okanye isifo sepsis
• Iswekile esezantsi yegazi (hypoglycemia)
• Isifo sokubandezeleka sokuphefumla kwangaphambi kokubeleka, umoya owongezelelweyo kwimisipha yemiphunga (i-pulmonary interstitial emphysema), okanye ukopha emiphungeni (hemorrhage pulmonary)
• Isikhumba esimthubi kunye namhlophe ngamehlo (i-jaundice esandula ukuzalwa)
• Iingxaki zokuphefumla ngenxa yemiphunga engafakwanga, inyumoniya, okanye ipatent ductus arteriosus
• Ukuvuvukala kwamathumbu emathunjini (i-necrotizing enterocolitis)

Usana olungekazalwa luza kuba nesisindo esisezantsi sokuzalwa kunosana olupheleleyo. Iimpawu eziqhelekileyo zokungakhuli kuqala zibandakanya:

• Iipateni zokuphefumla ezingaqhelekanga (nzulu, ikhefu elingaqhelekanga lokuphefumla elibizwa ngokuba yi-apnea)
• Iinwele zomzimba (lanugo)
• I-clitoris eyandisiweyo (kwiintsana zabasetyhini)
• Amanqatha omzimba amancinci
• Ithoni yemisipha engaphantsi kunye nomsebenzi ongaphantsi kunexesha elipheleleyo leentsana
• Iingxaki zokondla ngenxa yengxaki yokufunxa okanye yokulungelelanisa ukugwinya nokuphefumla
• Iscrotum esincinci egudileyo kwaye engenazintaba, kunye namasende angafunekiyo (kwiintsana ezingamadoda)
• I-cartilage yendlebe ethambileyo, eguqukayo
• Isikhumba esibhityileyo, esigudileyo, nesikhazimlayo esidla ngokubonakala (ingabona imithambo phantsi kolusu)

Uvavanyo oluqhelekileyo olwenziwe kwimveku ngaphambi kwexesha lubandakanya:

• Uhlalutyo lwegesi yegazi ukujonga amanqanaba eoksijini egazini
• Uvavanyo lwegazi ukujonga iswekile, ikhalsiyam, kunye namanqanaba ebilirubin
• I-x-ray yesifuba
• Ukujonga esweni okuqhubekayo kokuphefumula (ukubeka esweni ukuphefumla kunye nentliziyo)

Xa umsebenzi ongaphambi kwexesha ukhula kwaye ungenakumiswa, iqela lokhathalelo lwempilo liza kulungiselela ukuzalwa okusemngciphekweni omkhulu. Umama angahanjiswa kwiziko elimiselwe ukukhathalela iintsana ezingaphambi kwexesha kwi-NICU.

Emva kokuzalwa, umntwana uyangeniswa kwi-NICU. Usana lubekwa phantsi kweshushu okanye kwibhokisi ecacileyo, eshushu ebizwa ngokuba yi-incubator, elawula ubushushu bomoya. Oomatshini bokubeka esweni ukulandelela ukuphefumla komntwana, ukubetha kwentliziyo, kunye nenqanaba leoksijini egazini.

Izitho zomntwana ngaphambi kwexesha azikakhuli ngokupheleleyo. Usana lufuna ukhathalelo olukhethekileyo kwindawo yokugcina abantwana de amalungu akhule ngokwaneleyo ukugcina umntwana ephila ngaphandle kwenkxaso yezonyango. Oku kungathatha iiveki ukuya kwiinyanga.

Iintsana zihlala zingenakho ukulungelelanisa ukuncanca nokuginya ngaphambi kweeveki ezingama-34 zokukhulelwa. Umntwana ngaphambi kwexesha unokuba netyhubhu encinci, ethambileyo yokondla ebekwe ngempumlo okanye emlonyeni kwisisu. Kwiintsana ezingaphambi kwexesha okanye ezigulayo, isondlo sinokunikezelwa ngomthambo de umntwana azinze ngokwaneleyo ukuba afumane konke ukutya ngesisu.

Ukuba usana luneengxaki zokuphefumla:

• Umbhobho unokufakwa kwi-windpipe (trachea). Umatshini obizwa ngokuba sisixhobo sokuphefumla uya kulunceda usana ukuba luphefumle.
• Olunye usana olunengxaki yokuphefumla engaphantsi kakhulu lufumana uxinzelelo oluqinisekileyo lokuhamba komoya (CPAP) ngeetyhubhu ezincinci empumlweni endaweni yetrachea. Okanye banokufumana ioksijini eyongezelelweyo.
• I-oksijeni inokunikezwa nge-ventilator, i-CPAP, i-prongs prongs, okanye i-oxygen hood phezu kwentloko yomntwana.

Iintsana zifuna ukhathalelo olukhethekileyo lwe-nursery de zikwazi ukuphefumla ngaphandle kwenkxaso eyongezelelweyo, ukutya ngomlomo, kunye nokugcina ubushushu bomzimba kunye nobunzima bomzimba. Iintsana ezincinci kakhulu zinokuba nezinye iingxaki ezenza nzima unyango kwaye zifuna ukuhlala ixesha elide esibhedlele.

Maninzi amaqela enkxaso kubazali babantwana abazelwe ngaphambi kwexesha. Buza unontlalontle kwicandelo lokhathalelo lweentsana olusandul 'ukuzalwa.

Ukuqalwa kobuntwana kusengoyena nobangela wokufa kweentsana. Ukuphuculwa kweendlela zonyango kunye nokonga kukonyuse ukusinda kweentsana ngaphambi kwexesha.

Ubungangamsha bokuqala bunokuba neziphumo zexesha elide. Uninzi lweentsana ezingaphambi kwexesha zineengxaki zonyango, ukukhula, okanye indlela yokuziphatha eziqhubeka zisengumntwana okanye zisisigxina. Okukhona umntwana ezalwa ngaphambi kwexesha kwaye kuncinci ubunzima bokuzalwa kwakhe, ke umngcipheko mkhulu weengxaki. Nangona kunjalo, akunakwenzeka ukuqikelela isiphumo sexesha elide somntwana ngokusekwe kubudala bokukhulelwa okanye ubunzima bokuzalwa.

Iingxaki ezinokubakho zexesha elide zibandakanya:

• Ingxaki yexesha elide yemiphunga ebizwa ngokuba yi-bronchopulmonary dysplasia (BPD)
• Ukukhula okulibazisekileyo kunye nophuhliso
• Ukukhubazeka kwengqondo okanye komzimba okanye ukulibaziseka
• Ingxaki yombono ebizwa ngokuba yi-retinopathy prematurity, ekhokelela kumbono ophantsi okanye ubumfama

Ezona ndlela zingcono zokuthintela ukungakhuli kuqala zezi:

• Yiba nempilo entle ngaphambi kokukhulelwa.
• Fumana ukhathalelo lwaphambi kokubeleka kwangoko xa ukhulelwa.
• Qhubeka ufumana unonophelo lwangaphambi kokubeleka de umntwana azalwe.

Ukufumana ukhathalelo kwangoko kunye nokulunga kokubeleka kunciphisa ithuba lokuzalwa ngaphambi kwexesha.

Umsebenzi ngaphambi kwexesha ngamanye amaxesha unokunyangwa okanye ulibaziseke liyeza elithintela ukubetheka kwesibeleko. Amaxesha amaninzi, nangona kunjalo, iinzame zokulibazisa ukusebenza ngaphambi kwexesha aziphumeleli.

I-Betamethasone (iyeza le-steroid) elinikwa oomama kwimisebenzi engaphambi kwexesha linokwenza ukuba iingxaki ezithile ngaphambi kokukhula zingabi nzima.

Ukuzalwa kosana; Preemie; Premie; I-Neonatal - indawo yangaphambi kokuzalwa; I-NICU - indawo yangaphambili

• Isifo senyongo esanda kuzalwa - ukubhobhoza

UBrady JM, uBarnes-Davis ME, uPoindexter BB. Usana olunomngcipheko ophezulu. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahl 117.

Iiparsons KV, Jain L. Ixesha lokuzalwa ngaphambi kwexesha. Ku: UMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFaranoff kunye noNyango lukaMartin lweNeatalatal-Perinatal. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 40.

USimhan HN, uRomero R. Umsebenzi wokuqala kunye nokuzalwa. Ku: Landon MB, Galan HL, Jauniaux ERM okqhubekayo, eds. Ii-Obstetrics zikaGabbe: Ukukhulelwa okuqhelekileyo kunye neengxaki. Ngomhla we-8. IPhiladelphia, PA: Elsevier; 2021: isahluko 36.