Ukuphinda ubenakho ukuphamba ngaphambi kwexesha

I-retinopathy ye-prematurity (ROP) kukukhula ngokungaqhelekanga kwemithambo yegazi kwi-retina yamehlo. Kwenzeka kwiintsana ezizalwe kwangoko (ngaphambi kwexesha).

Imithambo yegazi ye-retina (ngasemva kweliso) iqala ukukhula malunga neenyanga ezintathu zokukhulelwa. Kwiimeko ezininzi, zikhule ngokupheleleyo ngexesha lokuzalwa kwesiqhelo. Amehlo anokungakhuli kakuhle ukuba umntwana uzelwe kwangethuba. Iinqanawa zinokuyeka ukukhula okanye zikhule ngokungaqhelekanga ukusuka kwiretina ukuya ngasemva kweliso. Kuba iinqanawa zibuthathaka, zinokuvuza kwaye zibangele ukopha kwiliso.

Izicubu ezinqabileyo zinokuphuhla zitsale i-retina ikhululeke kumphezulu wangaphakathi wamehlo (i-retinal detachment). Kwiimeko ezinzima, oku kunokubangela ukulahleka kombono.

Kwixesha elidlulileyo, ukusetyenziswa kweoksijini eninzi kunyango lweentsana ezizelwe ngaphambi kwexesha kwabangela ukuba iinqanawa zikhule ngokungaqhelekanga. Iindlela ezingcono ngoku ziyafumaneka ukubeka esweni ioksijini. Ngenxa yoko, ingxaki iye yaxhaphaka, ngakumbi kumazwe ahambele phambili. Nangona kunjalo, kusekho ukungaqiniseki malunga nenqanaba elifanelekileyo leoksijini kubantwana abazelwe ngaphambi kwexesha kwiminyaka eyahlukeneyo. Abaphandi bafunda ezinye izinto ngaphandle kweoksijini ebonakala ngathi inefuthe kumngcipheko weROP.

Namhlanje, umngcipheko wokuphuhlisa i-ROP uxhomekeke kwinqanaba lokungakhuli. Iintsana ezincinci ezineengxaki zonyango zisemngciphekweni omkhulu.

Phantse zonke iintsana ezizalwe ngaphambi kweeveki ezingama-30 okanye ezinobunzima obungaphantsi kweepawundi ezi-3 (i-1500 yeigram okanye i-1.5 yeekhilogremu) xa zizalwa zihlolwa imeko. Abanye abantwana abasemngciphekweni onobunzima obuziikhilogram ezi-3 ukuya kwezi-4.5 (1.5 ukuya kwezi-2 zeekhilogram) okanye abazalwa emva kweeveki ezingama-30 kufuneka nabo bahlolwe.

Ukongeza kwi-prematurity, ezinye izinto ezinobungozi zingabandakanya:

• Misa ngokufutshane ukuphefumla (i-apnea)
• Isifo sentliziyo
• Ikharbon dioksayidi ephezulu (CO2) egazini
• Usulelo
• Iasidi yegazi esezantsi (pH)
• Ioksijini yegazi ephantsi
• Uxinzelelo lokuphefumla
• Izinga lentliziyo elicothayo (bradycardia)
• Utofelo-gazi

Ireyithi ye-ROP kuninzi lweentsana ezingaphambi kwexesha iye yehla kakhulu kumazwe athuthukileyo kula mashumi ambalwa eminyaka adlulileyo ngenxa yokhathalelo olungcono kwicandelo lokhathalelo olunamandla lwe-neonatal (NICU). Nangona kunjalo, abantwana abaninzi abazelwe kwangoko kakhulu ngoku bayakwazi ukuphila, kwaye aba bantwana bazelwe ngaphambi kwexesha basemngciphekweni omkhulu we-ROP.

Utshintsho lwemithambo yegazi alunakubonwa ngamehlo. Uvavanyo lwamehlo olwenziwa ngugqirha wamehlo luyafuneka ukuveza iingxaki ezinjalo.

Kukho amanqanaba amahlanu e-ROP:

• Isigaba I: Kukho ukukhula okungaqhelekanga kwemithambo yegazi.
• Isigaba II: Ukukhula kwenqanawa yegazi kumodareyitha ngokungaqhelekanga.
• Isigaba III: Ukukhula kwenqanawa yegazi akuqhelekanga.
• Isigaba IV: Ukukhula kwenqanawa yegazi akuqhelekanga kwaye kukho i-retina engacacanga.
• Isigaba V: Kukho i-retinal detachment epheleleyo.

Usana olune-ROP lunokuhlelwa "njengesifo esongeziweyo" ukuba imithambo yegazi engaqhelekanga ifana nemifanekiso esetyenziselwa ukuxilonga imeko.

Iimpawu zeROP ezinzima zibandakanya:

• Ukuhamba kwamehlo okungaqhelekanga
• Amehlo awele
• Ukubona okukude kakhulu
• Abafundi abajongeka emhlophe (leukocoria)

Iintsana ezizalwe ngaphambi kweeveki ezingama-30, zinobunzima obungaphantsi kwe-1,500 gram (malunga neepawundi ezi-3 okanye i-1.5 yeekhilogremu) xa zizalwa, okanye zinomngcipheko omkhulu wezinye izizathu kufuneka zibe neemviwo ze-retinal.

Kwiimeko ezininzi, uviwo lokuqala kufuneka lube kwiiveki ezi-4 ukuya kwezi-9 emva kokuzalwa, kuxhomekeke kubudala bokukhulelwa komntwana.

• Iintsana ezizalwe kwiiveki ezingama-27 okanye kamva zihlala zinovavanyo lwazo kwiiveki ezi-4 ubudala.
• Abo bazalwa kwangoko bahlala benemviwo kamva.

Uviwo lokulandelela lusekwe kwiziphumo zoviwo lokuqala. Iintsana azidingi olunye uvavanyo ukuba imithambo yegazi kwii-retina zombini zigqibile ukukhula okuqhelekileyo.

Abazali kufuneka bazi ukuba zeziphi iimviwo zokulandela iliso ezifunekayo ngaphambi kokuba usana luphume enkulisa.

Unyango lwakwangoko luye lwabonisa ukuphucula amathuba omntwana kumbono oqhelekileyo. Unyango kufuneka luqale kwisithuba seeyure ezingama-72 kuvavanyo lwamehlo.

Abanye abantwana abane "plus isifo" bafuna unyango kwangoko.

• Unyango lwe-Laser (i-photocoagulation) inokusetyenziselwa ukuthintela iingxaki ze-ROP ehambele phambili.
• I-laser iyeka imithambo yegazi engaqhelekanga ukuba ikhule.
• Unyango lunokwenziwa kwigumbi lokugcina abantwana kusetyenziswa izixhobo eziphathwayo. Ukuze usebenze kakuhle, kufuneka wenziwe ngaphambi kokuba i-retina iqale ukuba namabala okanye ikhuphe kwiliso lonke.
• Olunye unyango, njengokufaka intsholongwane kwi-VEG-F (into yokukhula kwenqanawa yegazi) esweni, kusafundwa.

Ugqirha luyafuneka ukuba i-retina iyaziva. Utyando alusoloko lukhokelela kumbono olungileyo.

Uninzi lweentsana ezinokuphulukana nombono omkhulu onxulumene ne-ROP zinezinye iingxaki ezinxulumene nokuzalwa kwangaphambi kokuzalwa. Baza kufuna unyango olwahlukeneyo.

Malunga neentsana ezi-1 kwezili-10 ezinotshintsho lwakwangoko ziya kukhula ngakumbi sisifo se-retinal. Ukuqina kwe-ROP kungakhokelela kwiingxaki ezinkulu zombono okanye ukungaboni. Into ephambili kwisiphumo kukufumanisa kwangaphambili kunye nonyango.

Iingxaki zinokubandakanya ukungaboni kakuhle okanye ukungaboni kakuhle.

Eyona ndlela yokuthintela le meko kukuthatha amanyathelo okuthintela ukuzalwa ngaphambi kwexesha. Ukuthintela ezinye iingxaki zokungakhuli ngaphambi kwexesha kunokunceda ukukhusela i-ROP.

I-fibroplasia ebuyayo; ROP

Fierson WM; I-American Academy yeCandelo lePediatrics kwiOphthalmology; IAmerican Academy yeOphthalmology; Umbutho waseMelika woNyango lwezifo zabantwana kunye neStrabismus; Umbutho waseMelika woo-Orthoptists abaqinisekisiweyo. Ukuvavanywa kovavanyo lweentsana ezingekaphambi kwexesha kwi-retinopathy ye-prematurity. IPediatrics. 2018; 142 (6): e20183061. IPediatrics. 2019; 143 (3): 2018-3810. IINKCUKACHA: 30824604 www.ncbi.nlm.nih.gov/pubmed/30824604.

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