Ukuphuma kwangaphakathi kosana olusandul 'ukuzalwa

I-intraventricular hemorrhage (IVH) yosana olusandul 'ukuzalwa lopha kwiindawo ezinamanzi (ii-ventricles) ngaphakathi kwengqondo. Imeko yenzeka rhoqo kwiintsana ezizalwe kwangoko (ngaphambi kwexesha).

Iintsana ezizalwe ngaphezulu kweeveki ezili-10 zisemngciphekweni omkhulu kolu hlobo lokopha. Ubuncinci kwaye ngaphambi kwexesha usana, umngcipheko we-IVH. Kungenxa yokuba imithambo yegazi kwingqondo yeentsana ngaphambi kwexesha ayikakhuli ngokupheleleyo. Zibuthathaka kakhulu ngenxa yoko. Imithambo yegazi iyakhula yomelele kwiiveki ezili-10 zokukhulelwa.

IVH ixhaphake kakhulu kwiintsana ezizelwe ngaphambi kwexesha ezine:

• Unyango lwesifo sokuphefumla
• Uxinzelelo lwegazi olungazinzanga
• Ezinye iimeko zonyango ekuzalweni

Ingxaki inokuthi yenzeke nakwezinye iintsana ezisempilweni ezizalwe kwangoko. Ngokuqhelekileyo, i-IVH inokukhula kwiintsana ezipheleleyo.

IVH kunqabile ukuba ibekhona xa kuzalwa. Kwenzeka rhoqo kwiintsuku zokuqala zobomi. Imeko inqabile emva kwenyanga yokuqala yobudala, nokuba umntwana uzalwe kwangoko.

Kukho iintlobo ezine ze-IVH. Ezi zibizwa ngokuba "ngamabanga" kwaye zisekwe kwinqanaba lokopha.

• AmaBakala 1 no-2 abandakanya inani elincinci lokopha. Uninzi lwexesha, akukho ngxaki zexesha elide ngenxa yokopha. IBakala 1 likwabizwa ngokuba yi-germinal matrix hemorrhage (GMH).
• AmaBakala 3 no-4 abandakanya ukopha kakhulu. Uxinzelelo lwegazi kwi (grade 3) okanye ibandakanya ngqo (grade 4) izicwili zobuchopho. IBakala 4 ikwabizwa ngokuba yi-intraparenchymal hemorrhage. Amahlwili egazi angenza kwaye athintele ukuhamba kwe-cerebrospinal fluid. Oku kungakhokelela ekwandeni kolwelo kwingqondo (i-hydrocephalus).

Kungangabikho mpawu. Iimpawu eziqhelekileyo ezibonakalayo kwiintsana ezingaphambi kwexesha ziquka:

• Ukuphefumla ikhefu (i-apnea)
• Utshintsho kuxinzelelo lwegazi kunye nokubetha kwentliziyo
• Ukuncipha kwemisipha
• Ukuhla kwengqondo
• Ukulala kakhulu
• Ukuhamba
• Incanca ebuthathaka
• Ukuxhuzula kunye nezinye iintshukumo ezingaqhelekanga

Zonke iintsana ezizalwe ngaphambi kweeveki ezingama-30 kufuneka zibe ne-ultrasound yentloko kwiscreen se-IVH. Uvavanyo lwenziwa kwiiveki ezi-1 ukuya kwezi-2 zobomi. Iintsana ezizalwe phakathi kweeveki ezingama-30 ukuya kwezingama-34 zisenokuba nokuhlolwa kwe-ultrasound ukuba baneempawu zengxaki.

Uvavanyo lwesibini lwe-ultrasound lunokwenziwa malunga nexesha umntwana ekulindeleke ukuba azalwe ngalo (umhla obekiweyo).

Akukho ndlela yokumisa ukopha okunxulunyaniswa ne-IVH. Iqela lokhathalelo lwempilo liya kuzama ukugcina usana luzinzile kwaye lunyange naziphi na iimpawu umntwana anokuba nazo. Umzekelo, ukongezwa kwegazi kunganikezelwa ukuphucula uxinzelelo lwegazi kunye nokubala kwegazi.

Ukuba ulwelo luyakhula luye kwinqanaba lokuba kukho inkxalabo malunga noxinzelelo kwingqondo, umpompo womqolo unokwenziwa ukukhupha ulwelo kwaye uzame ukunciphisa uxinzelelo. Ukuba oku kuyanceda, kunokufuneka kwenziwe utyando ukubeka ityhubhu (shunt) kwingqondo ukukhupha ulwelo.

Indlela usana olwenza kakuhle ngayo ixhomekeke kwindlela umntwana azalwe ngayo ngaphambi kwexesha kunye nenqanaba lokopha. Ngaphantsi kwesiqingatha seentsana ezinegazi elisezantsi zinengxaki yexesha elide. Nangona kunjalo, ukopha kakhulu kuhlala kukhokelela kulibaziseko lokukhula kunye neengxaki zokulawula ukuhamba. Ukuya kuthi ga kwisithathu kwiintsana ezinegazi elibi kakhulu zinokufa.

Iimpawu ze-Neurological okanye umkhuhlane kusana olunendawo eshukumayo endaweni inokubonisa ukuvaleka okanye usulelo. Usana kufuneka lufumane unyango ngokukhawuleza ukuba oku kuyenzeka.

Uninzi lweeyunithi zokhathalelo olusandul

Kumazwe amaninzi, iintsana ezine-IVH zikwanelungelo lokungenelela kwangethuba (EI) iinkonzo zokunceda kuphuhliso oluqhelekileyo.

Abafazi abakhulelweyo abasemngciphekweni omkhulu wokuhambisa ngokukhawuleza kufuneka banikwe amayeza abizwa ngokuba yi-corticosteroids. La machiza anokunceda ukunciphisa umngcipheko womntwana kwi-IVH.

Abanye abantu basetyhini abakumayeza achaphazela ingozi yokopha kufuneka bafumane ivithamin K ngaphambi kokubeleka.

Iintsana ezizalwe ngaphambi kokuba iintambo zazo zingabotshelelwa kwangoko zinomngcipheko omncinci we-IVH.

Iintsana ezisandula ukuzalwa esibhedlele ezine-NICU kwaye akufuneki zithuthwe emva kokuzalwa nazo zinomngcipheko omncinci we-IVH.

IVH - usana olusanda kuzalwa; GMH-IVH

I-LV. Ukuphuma kwegazi ngaphakathi kunye nezilonda ze-vascular kwi-neonate. Ku: UMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFanaroff kunye noMartin's Neonatal-Perinatal Medicine. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 53.

UDlamini N, deVebar GA. Ukubethwa kwabantwana. 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: isahluko 619.

Umphefumlo JS, Ment LR. Ukonzakala kwengqondo ekhulayo yangaphambi kwexesha: ukuphuma kwegazi ngaphakathi kunye nokulimala komcimbi omhlophe. Ku: Swaiman KF, Ashwal S, Ferriero DM, et al, ii-eds. I-Swaiman's Pediatric Neurology. Umhla wesi-6. IPhiladelphia, PA: Elsevier; I-2017: isahluko 22.