Isifo sokubandezeleka sokuphefumla

Isifo seNeonatal sokuphefumla koxinzelelo (i-RDS) yingxaki edla ngokubonakala kwiintsana ezizelwe ngaphambi kwexesha. Le meko yenza kube nzima ukuba umntwana aphefumle.

I-RDS ye-Neonatal yenzeka kwiintsana ezinemiphunga yazo engekakhuli ngokupheleleyo.

Esi sifo sibangelwa kukusilela kwento emtyibiliziyo emiphungeni ebizwa ngokuba yi-surfactant. Le nto inceda imiphunga igcwalise umoya kwaye igcina iingxowa zomoya zingangcolisi. I-Surfactant ikhona xa imiphunga ikhule ngokupheleleyo.

I-RDS ye-Neonatal inokubakho ngenxa yeengxaki zofuzo ngokukhula kwemiphunga.

Uninzi lweziganeko ze-RDS zivela kwiintsana ezizalwe ngaphambi kweeveki ezingama-37 ukuya kwezingama-39. Okukhona umntwana ezalwa ngaphambi kwexesha, kokukhona liphezulu ithuba le-RDS emva kokuzalwa. Ingxaki ayiqhelekanga kwiintsana ezizelwe ixesha elipheleleyo (emva kweeveki ezingama-39).

Ezinye izinto ezinokunyusa umngcipheko we-RDS zibandakanya:

• Umzalwana okanye udade one-RDS
• Isifo seswekile kunina
• Ukuhanjiswa kwe-cearean okanye ukufakwa kwabasebenzi ngaphambi kokuba umntwana azalise ngokupheleleyo
• Iingxaki ngokuhanjiswa okunciphisa ukuhamba kwegazi emntwaneni
• Ukukhulelwa okuninzi (amawele okanye nangaphezulu)
• Umsebenzi ngokukhawuleza

Uninzi lwexesha, iimpawu zivela kwimizuzu yokuzalwa. Nangona kunjalo, abanakubonwa kangangeeyure ezininzi. Iimpawu zingabandakanya:

• Umbala oluhlaza okwesibhakabhaka kunye nenwebu yencindi (cyanosis)
• Misa ngokufutshane ukuphefumla (i-apnea)
• Ukuncipha kwemveliso yomchamo
• Ukuqhuma kwempumlo
• Ukuphefumla ngokukhawuleza
• Ukuphefumla kancinci
• Ukuphefumla okufutshane kunye nezandi ezikrokrisayo ngelixa uphefumla
• Intshukumo yokuphefumla engaqhelekanga (njengokuzoba izihlunu zesifuba ngokuphefumla)

Ezi mvavanyo zilandelayo zisetyenziselwa ukukhangela imeko:

• Uhlalutyo lwegesi yegazi-ibonisa ioksijini esezantsi kunye neasidi egqithileyo kulwelo lomzimba.
• X-ray esifubeni - ibonisa "iglasi yomhlaba" imbonakalo kwimiphunga esiqhelekileyo sesi sifo. Oku kuhlala kukhula kwiiyure ezi-6 ukuya kwezi-12 emva kokuzalwa.
• Uvavanyo lweLebhu- lunceda ukulawula ukosuleleka njengonobangela weengxaki zokuphefumla.

Iintsana ezingaphambi kwexesha okanye ezinezinye iimeko ezibenza babe semngciphekweni omkhulu wengxaki kufuneka baphathwe ngokuzalwa liqela lezonyango elijolise kwiingxaki zokuphefumla ezisanda kuzalwa.

Iintsana ziya kunikwa ioksijini efudumeleyo, efumileyo. Nangona kunjalo, olu nyango kufuneka lubekwe esweni ngononophelo ukuthintela iziphumo ebezingalindelekanga ezivela kwioksijini eninzi.

Ukunikezela ngoncedo olongezelelekileyo losana olugulayo kubonisiwe kuluncedo. Nangona kunjalo, i-surfactant ihanjiswa ngokuthe ngqo kwindlela yomoya yosana, ngoko ke umngcipheko othile ubandakanyekile. Kusafuneka kwenziwe uphando oluthe kratya malunga nokuba loluphi na usana ekufuneka belufumene olu nyango kwaye lusebenzise malini.

Uncedo lokungenisa umoya nge-ventilator (umatshini wokuphefumla) unokusindisa ubomi kubantwana abathile. Nangona kunjalo, ukusetyenziswa komatshini wokuphefumla kungonakalisa izicwili zemiphunga, ke olu nyango kufuneka luthintelwe ukuba kunokwenzeka. Iintsana zingalufuna olu nyango ukuba:

• Inqanaba eliphezulu lekhabhon dayokhsayidi egazini
• Ioksijini yegazi ephantsi
• I-pH yegazi ephantsi (asidi)
• Ukuphindaphindwa kwekhefu ekuphefumleni

Unyango olubizwa ngokuba luqhubekekayo ngoxinzelelo lomoya (CPAP) lunokuthintela isidingo somoya oncedisayo okanye i-surfactant kwiintsana ezininzi. I-CPAP ithumela umoya empumlweni ukunceda ukugcina iindlela zomoya zivulekile. Inganikwa ngumatshini wokuphefumla (ngelixa umntwana ephefumla ngokuzimeleyo) okanye ngesixhobo seCPAP esahlukileyo.

Iintsana ezine-RDS zifuna unonophelo olusondeleyo. Oku kubandakanya:

• Ukuba nendawo ezolileyo
• Ukuphatha ngobumnene
• Ukuhlala kubushushu obufanelekileyo bomzimba
• Ukulawula ngononophelo ulwelo kunye nesondlo
• Ukunyanga usulelo kwangoko

Imeko ihlala iba mandundu kangangeentsuku ezi-2 ukuya kwezi-4 emva kokuzalwa kwaye iphuhla kancinci emva koko. Abanye abantwana abanesifo esibuhlungu sokuphefumla baya kufa. Oku kuhlala kwenzeka rhoqo phakathi kweentsuku 2 kunye 7.

Iingxaki zexesha elide zinokukhula ngenxa:

• Ioksijini eninzi.
• Uxinzelelo oluphezulu luthunyelwa emiphungeni.
• Isifo esiqatha okanye ukungakhuli. I-RDS inokudityaniswa nokudumba okubangela ukonakala kwemiphunga okanye kwengqondo.
• Amaxesha xa ingqondo okanye amanye amalungu engakhange afumane ioksijini eyaneleyo.

Umoya okanye irhasi inokwakha kwi:

• Isithuba esijikeleze imiphunga (pneumothorax)
• Isithuba esifubeni phakathi kwemiphunga emibini (pneumomediastinum)
• Indawo phakathi kwentliziyo kunye nengxowa encinci ejikeleze intliziyo (pneumopericardium)

Eminye imiqathango enxulunyaniswa ne-RDS okanye ukungakhuli ngokugqithisileyo kunokubandakanya:

• Ukopha ebuchotsheni (ukuphuma kwegazi kosana olusandul 'ukuzalwa)
• Ukopha kumphunga (ukuphuma kwegazi kwimiphunga, ngamanye amaxesha kunxulunyaniswa nokusetyenziswa okungafunekiyo)
• Iingxaki ngokukhula kwemiphunga kunye nokukhula (i-bronchopulmonary dysplasia)
• Ukulibaziseka kophuhliso okanye ukukhubazeka kwengqondo okunxulumene nomonakalo wobuchopho okanye ukopha
• Iingxaki ngokukhula kwamehlo (ukuphinda ubenokubona kwangaphambili) kunye nokungaboni

Amaxesha amaninzi, le ngxaki ikhula msinyane emva kokuzalwa komntwana ngelixa esesesibhedlele. Ukuba ubelekele ekhaya okanye ngaphandle kweziko lonyango, fumana uncedo olungxamisekileyo ukuba umntwana wakho unengxaki yokuphefumla.

Ukuthatha amanyathelo okuthintela ukuzalwa ngaphambi kwexesha kunokunceda ekuthinteleni i-RDS yeentsana. Ukunyamekela ngaphambi kokubeleka kunye nokuhlolwa rhoqo ukuqala ngokukhawuleza xa umfazi efumanisa ukuba ukhulelwe kunokunceda ukuphepha ukuzalwa kwangaphambili.

Umngcipheko weRDS unokuncitshiswa ngexesha elifanelekileyo lokuhanjiswa. Ukuhanjiswa okunyanzelisiweyo okanye ukuyeka okokoko kungafuneka. Uvavanyo lwelebhu lunokwenziwa ngaphambi kokubeleka ukujonga ukulungela kwemiphunga yosana. Ngaphandle kokuba kunyanzelekile ngokwezamayeza, ukuhanjiswa okanye ukuhanjiswa okwexeshana kufuneka kulibaziseke de kube ubuncinci iiveki ezingama-39 okanye de kuvavanyo lubonise ukuba imiphunga yomntwana ikhule

Amayeza abizwa ngokuba yi-corticosteroids anokunceda ukukhawulezisa ukukhula kwemiphunga ngaphambi kokuba umntwana azalwe. Bahlala benikwa abasetyhini abakhulelweyo phakathi kweeveki ezingama-24 ukuya kwezingama-34 zokukhulelwa ababonakala ngathi banokuhambisa kwiveki ezayo. Uphando oluthe kratya luyafuneka ukumisela ukuba ngaba ii-corticosteroids zinokunceda na iintsana ezingaphantsi kwe-24 okanye ngaphezulu kweeveki ezingama-34.

Ngamaxesha athile, kunokwenzeka ukuba unike amanye amayeza ukulibazisa umsebenzi kunye nokuhanjiswa kude kube liyeza lonyango elinexesha lokusebenza. Olu nyango lunokubunciphisa ubunzima be-RDS. Inokukunceda ukuthintela ezinye iingxaki zokungakhuli kuqala. Nangona kunjalo, ayizukuyisusa ngokupheleleyo ingozi.

Isifo se-Hyaline membrane (HMD); Ukuphefumla kosana; Uxinzelelo lokuphefumla kwiintsana; I-RDS - iintsana

UKamath-Rayne BD, uJobe AH. Ukuphuhliswa kwemiphunga yosana kunye nomsebenzi osebenzayo. Ku: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Isilivere RM, ii-eds. I-Creasy kunye neResnik's Maternal-Fetal Medicine: Imigaqo kunye nokuziqhelanisa. Ngomhla we-8. IPhiladelphia, PA: Elsevier; I-2019: isahluko 16.

IKlilegman RM, iSt. Geme JW, iBlum NJ, i-Shah SS, iTasker RC, uWilson KM. Ukusasaza izifo zemiphunga ebuntwaneni. 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. 434.

IRozance PJ, iRosenberg AA. Umntwana osemtsha. Ku: Gabbe SG, Niebyl JR, Simpson JL, et al, ii-eds. I-Obstetrics: Ukukhulelwa okuqhelekileyo kunye neengxaki. Umhla wesi-7. IPhiladelphia, PA: Elsevier; I-2017: isahluko 22.

I-Wambach JA, i-Hamvas A. Isifo sokuphefumla kwisifo se-neonate. KuMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFanaroff kunye noMartin's Neonatal-Perinatal Medicine. Ngomhla we-10.IPhiladelphia, PA: Elsevier Saunders; 2015: isahluko 72.