Isifo sokuthintela ukungabikho kwengqondo

I-Neonatal abstinence syndrome (NAS) liqela leengxaki ezenzeka kusana olusandul 'ukuvezwa iziyobisi ze-opioid ixesha elide ngelixa likwisibeleko sikanina.

I-NAS inokwenzeka xa umfazi okhulelweyo ethatha iziyobisi ezifana ne-heroin, i-codeine, i-oxycodone (i-Oxycontin), i-methadone, okanye i-buprenorphine.

Ezi kunye nezinye izinto zidlula kwi-placenta edibanisa umntwana kumama wakhe esibelekweni. Usana luxhomekeke kwichiza kunye nonina.

Ukuba umama uyaqhubeka nokusebenzisa amayeza kwiveki okanye engaphambi kokubeleka, umntwana uya kuxhomekeka kwichiza xa ezalwa. Kuba umntwana akasafumani chiza emva kokuzalwa, iimpawu zokurhoxa zinokwenzeka njengoko ichiza lisuswa kancinci kwinkqubo yomntwana.

Iimpawu zokurhoxa nazo zinokwenzeka kwiintsana eziveze utywala, i-benzodiazepines, i-barbiturates, kunye ne-anti-depressants (i-SSRIs) ngelixa lisesibelekweni.

Iintsana zoomama abasebenzisa i-opioids kunye nezinye iziyobisi (i-nicotine, i-amphetamines, icocaine, intsangu, utywala) banokuba neengxaki zexesha elide. Ngelixa kungekho bungqina bucacileyo be-NAS yezinye iziyobisi, zinokuba negalelo kubukhali beempawu zomntwana ze-NAS.

Iimpawu ze-NAS zixhomekeke:

• Uhlobo lweziyobisi olusetyenziswa ngumama
• Indlela ophuka ngayo umzimba kwaye ucoca iziyobisi (ezichaphazeleka zizinto zofuzo)
• Lungakanani ichiza ebelithatha
• Usebenzise ixesha elingakanani iyeza
• Nokuba umntwana uzalwe ngokusisigxina okanye kwangoko (ngaphambi kwexesha)

Iimpawu zihlala ziqala kwithuba leentsuku ezi-1 ukuya kwezi-3 emva kokuzalwa, kodwa kungathatha ukuya evekini ukuvela. Ngenxa yoku, umntwana uhlala efuna ukuhlala esibhedlele ukuze abonwe kwaye abekwe esweni ukuya kuthi ga evekini.

Iimpawu zingabandakanya:

• Umbala wolusu obala (ukujija)
• Urhudo
• Ukulila kakhulu okanye ukulila okuphezulu
• Ukufunxa kakhulu
• Ifiva
• Ukucinga okuqinisekileyo
• Ukwanda kwethoni yemisipha
• Ukucaphuka
• Ukutya okungalunganga
• Ukuphefumla ngokukhawuleza
• Ukuxhuzula
• Iingxaki zokulala
• Ukuthoba ubunzima
• Impumlo emuncu, ukuthimla
• Ukubila
• Ukungcangcazela (ukungcangcazela)
• Ukuhlanza

Ezinye iimeko ezininzi zinokuvelisa iimpawu ezifanayo ne-NAS. Ukukunceda ekwenzeni uxilongo, umboneleli wezempilo uya kubuza imibuzo malunga nokusetyenziswa kweziyobisi ngumama. Umama angabuzwa ukuba zeziphi iziyobisi azithathileyo ngexa lokukhulelwa, kwaye ukuba ugqibele nini ukuzisebenzisa. Umchamo womama unokuvavanywa kwiziyobisi ngokunjalo.

Uvavanyo olunokuthi lwenziwe ukunceda ukufumanisa ukurhoxa kusana olusandula kuzalwa lubandakanya:

• Inkqubo yokufumana amanqaku ye-NAS, enika amanqaku ngokusekwe kwiimpawu kunye nobukhali bayo. Amanqaku omntwana anokunceda ekuchongeni unyango.
• Uvavanyo lwe-ESC (yitya, lala, console)
• Iscreen sechiza lomchamo kunye nokuhamba kwamathumbu okuqala (meconium). Iqhekeza elincinci lenkaba linokusetyenziselwa ukuvavanywa kweziyobisi.

Unyango luxhomekeke:

• Iyeza elibandakanyekayo
• Impilo yosana ngokubanzi kunye namanqaku okuyeka
• Nokuba umntwana uzelwe ngokusisigxina okanye ngaphambi kwexesha

Iqela lokhathalelo lwempilo liza kujonga usana olusandul 'ukuzalwa ngononophelo ukuya kuthi ga kwiveki (okanye nangaphezulu kuxhomekeke kwindlela umntwana aqhuba ngayo) emva kokuzalwa kweempawu zokurhoxa, iingxaki zokondla, kunye nokuzuza komzimba. Iintsana ezigabayo okanye eziphelelwe ngamanzi emzimbeni zinokudinga ukufumana ulwelo ngomthambo (IV).

Iintsana ezine-NAS zihlala zinomdla kwaye kunzima ukuzola. Iingcebiso zokubazolisa zibandakanya amanyathelo adla ngokubizwa ngokuba yi "TLC" (inkathalo yothando):

• Umnyikimise umntwana ngobunono
• Ukunciphisa ingxolo kunye nezibane
• Ulusu kukhathalelo lolusu kunye nomama, okanye ukusongela umntwana ngengubo
• Ukuncancisa (ukuba umama ukwinkqubo yonyango ye-methadone okanye ye-buprenorphine ngaphandle kwezinye iziyobisi ezingekho mthethweni)

Olunye usana olunempawu ezinzima lufuna amayeza afana ne-methadone okanye i-morphine ukunyanga iimpawu zokurhoxa kunye nokubanceda bakwazi ukutya, ukulala nokuphumla. Ezi ntsana kungafuneka zihlale esibhedlele iiveki okanye iinyanga emva kokuzalwa. Injongo yonyango kukumisela usana ichiza elifana nelo lalisetyenziswa ngunina ngexesha lokukhulelwa kwaye unciphise kancinci umthamo ngokuhamba kwexesha. Oku kunceda ukulunyula umntwana kwichiza kwaye kunciphise ezinye iimpawu zokurhoxa.

Ukuba iimpawu zinzima, ngokungathi kusetyenziswe amanye amayeza, iyeza lesibini elinjenge phenobarbital okanye i-clonidine linokongezwa.

Iintsana ezinale meko zihlala zine-diaper rash okanye ezinye iindawo zokonakala kolusu. Oku kufuna unyango ngamafutha okanye cream ekhethekileyo.

Iintsana nazo zinokuba neengxaki ngokondla okanye ukukhula kancinci. Ezi ntsana zingadinga:

• Ukutya okuphezulu kweekhalori ezibonelela ngesondlo esikhulu
• Ukutya okuncinci kunikwa rhoqo

Unyango lunceda ekunciphiseni iimpawu zokurhoxa. Kwanasemva kokuba unyango lwe-NAS luphelile kwaye abantwana baphuma esibhedlele, banokufuna "i-TLC" eyongezelelweyo kangangeeveki okanye iinyanga.

Ukusetyenziswa kweziyobisi notywala ngexesha lokukhulelwa kunokukhokelela kwiingxaki ezininzi zempilo emntwaneni ngaphandle kwe-NAS. Oku kunokubandakanya:

• Iziphene zokuzalwa
• Ubunzima bokuzalwa obuphantsi
• Ukuzalwa ngaphambi kwexesha
• Isangqa sentloko encinci
• Isifo sokufa kweentsana ngesiquphe (SIDS)
• Iingxaki ngokukhula kunye nokuziphatha

Unyango lwe-NAS lunokuhlala kwiveki e-1 ukuya kwiinyanga ezi-6.

Qinisekisa ukuba umboneleli wakho uyazi ngawo onke amayeza kunye neziyobisi ozithathayo ngexa lokukhulelwa.

Biza umboneleli wakho ukuba umntwana wakho uneempawu ze-NAS.

Xoxa ngawo onke amayeza, iziyobisi, utywala kunye nokusetyenziswa kwecuba nomboneleli wakho.

Cela uncedo kumboneleli wakho ngokukhawuleza ukuba:

• Sebenzisa iziyobisi ezingezizo ezonyango
• Sebenzisa iziyobisi ongamiselwanga zona
• Ukusebenzisa utywala okanye icuba

Ukuba sele ukhulelwe kwaye uthatha amayeza okanye iziyobisi ezingamiselwanga wena, thetha nomboneleli wakho ngeyona ndlela yokugcina wena nosana ukhuselekile. Amanye amayeza akufuneki ayekiswe ngaphandle kolawulo lwezonyango, okanye iingxaki zinokuvela. Umboneleli wakho uya kuyazi indlela efanelekileyo yokulawula umngcipheko.

NAS; Iimpawu zokuthintela ukungazalwa

• Isifo sokuthintela ukungabikho kwengqondo

I-Balest AL, iRiley MM, iBogen DL. Neonatology. Ku: Zitelli BJ, McIntire SC, Nowalk AJ, ii-eds. UZitelli no-Davis ’Atlas of Pediatric Physical Diagnosis. Umhla wesi-7. IPhiladelphia, PA: Elsevier; I-2018: isahluko 2.

I-Hudak ML. Iintsana zoomama abasebenzisa iziyobisi. Ku: UMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFanaroff kunye noMartin's Neonatal-Perinatal Medicine. Ngomhla we-11. IPhiladelphia, PA: Elsevier Saunders; 2020: isahluko 46.

IKliegman RM, iSt. Geme JW, iBlum NJ, i-Shah SS, iTasker RC, uWilson KM. Iimpawu zokuziyeka. Kwi-Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, .ed. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahluko 126.