Usana ngaphambi kwesikhathi

Usana oluzalwe ngaphambi kwesikhathi ngumntwana ozalwe ngaphambi kwamasonto angama-37 aqediwe ukukhulelwa (ngaphezu kwamasonto amathathu ngaphambi kosuku olubekiwe).

Lapho izalwa, ingane ihlukaniswa njengokulandelayo:

• Ngaphambi kwesikhathi (ukukhulelwa okungaphansi kwamasonto angama-37)
• Isikhathi esigcwele (ukukhulelwa kwamasonto angama-37 kuya kwangu-42)
• Isikhathi sokubhala (esazalwa ngemuva kokukhulelwa kwamasonto angama-42)

Uma owesifazane ebeletha ngaphambi kwamasonto angama-37, kubizwa ngokuthi yi-preterm labor.

Izinsana ezisanda kuzalwa ezizalwa phakathi kwamasonto angama-35 kuya kwangu-37 ukukhulelwa kungenzeka zingabukeki ngaphambi kwesikhathi. Kungenzeka bangangeniswa egunjini lokunakekela izingane ezisanda kuzalwa (i-NICU), kepha basengozini yezinkinga eziningi kunezingane zesikhathi esigcwele.

Izimo zezempilo kumama, njengesifo sikashukela, isifo senhliziyo, nesifo sezinso, zingaba nomthelela ekusebenzeni kwangaphambi kokubeletha. Imvamisa, imbangela yokusebenza ngaphambi kwesikhathi ayaziwa. Okunye ukuzalwa ngaphambi kwesikhathi ukukhulelwa kaningi, njengamawele noma amawele amathathu.

Izinkinga ezahlukahlukene ezihlobene nokukhulelwa zandisa ingozi yokusebenza ngaphambi kwesikhathi noma ukulethwa ngaphambi kwesikhathi:

• Umlomo wesibeletho obuthakathaka oqala ukuvula (ukunwebeka) kusenesikhathi, obizwa nangokuthi ukungakwazi komlomo wesibeletho
• Ukukhubazeka kokuzalwa kwesibeletho
• Umlando wokulethwa kwangaphambi kwesikhathi
• Ukutheleleka (ukutheleleka komgudu womchamo noma ukutheleleka kolwelwesi lwe-amniotic)
• Ukungondleki kahle ngaphambi noma ngesikhathi sokukhulelwa
• I-Preeclampsia: umfutho wegazi ophakeme kanye namaprotheni emchameni akhula ngemuva kweviki lama-20 lokukhulelwa
• Ukuqhekeka kwangaphambi kwesikhathi kolwelwesi (i-placenta previa)

Ezinye izinto ezandisa ubungozi bokusebenza ngaphambi kwesikhathi kanye nokulethwa ngaphambi kwesikhathi kufaka:

• Iminyaka kamama (omama abangaphansi kweminyaka engu-16 noma ngaphezulu kunama-35)
• Ukuba yi-African American
• Ukuntuleka kokunakekelwa ngaphambi kokubeletha
• Isimo esiphansi sezomnotho
• Ukusetshenziswa kukagwayi, i-cocaine, noma ama-amphetamine

Usana lungaba nenkinga yokuphefumula nokugcina izinga lokushisa komzimba lihlala njalo.

Usana oluzalwe ngaphambi kwesikhathi lungaba nezimpawu zalezinkinga ezilandelayo:

• Awanele amaseli abomvu egazi (i-anemia)
• Ukopha ebuchosheni noma ukulimala kwendaba emhlophe yobuchopho
• Ukutheleleka noma i-sepsis engakazalwa
• Ushukela wegazi ophansi (i-hypoglycemia)
• Isifo sokucindezeleka sokuphefumula se-Neonatal, umoya owengeziwe ezicutshini zamaphaphu (i-pulmonary interstitial emphysema), noma ukuphuma kwegazi emaphashini (pulmonary hemorrhage)
• Isikhumba esiphuzi nabamhlophe bamehlo (i-jaundice esanda kuzalwa)
• Izinkinga zokuphefumula ngenxa yamaphaphu angavuthiwe, inyumoniya, noma i-patent ductus arteriosus
• Ukuvuvukala okukhulu kwamathumbu (necrotizing enterocolitis)

Usana oluzalwe ngaphambi kwesikhathi luzoba nesisindo esiphansi sokuzalwa kunosana oluphelele. Izimpawu ezivamile zokungakhuli zihlanganisa:

• Amaphethini angajwayelekile okuphefumula (angajulile, amakhefu angajwayelekile ekuphefumuleni abizwa nge- apnea)
• Izinwele zomzimba (i-lanugo)
• I-clitoris ekhulisiwe (ezinganeni zezinsikazi)
• Amafutha omzimba amancane
• Ithoni yemisipha ephansi nomsebenzi omncane kunezinsana ezigcwele
• Izinkinga ukondla ngenxa yenkinga ukuncela noma ukuxhumanisa ukugwinya nokuphefumula
• Isirobhothi esincane esibushelelezi futhi esingenamagquma, namasende angafuneki (ezinganeni zesilisa)
• Uqwanga lwendlebe oluthambile, oluguquguqukayo
• Isikhumba esincanyana, esibushelelezi nesicwebezelayo esivamise ukubonakala (singabona imithambo ngaphansi kwesikhumba)

Ukuhlolwa okuvamile okwenziwa enganeni ezalwe ngaphambi kwesikhathi kufaka:

• Ukuhlaziywa kwegesi yegazi ukuhlola amazinga e-oxygen egazini
• Ukuhlolwa kwegazi ukuhlola amazinga e-glucose, calcium, ne-bilirubin
• I-x-ray yesifuba
• Ukuqapha okuqhubekayo kwe-cardiorespiratory (ukuqapha ukuphefumula nokushaya kwenhliziyo)

Lapho ukusebenza ngaphambi kwesikhathi kukhula futhi kungamiswa, iqembu lezokunakekelwa kwempilo lizolungiselela ukuzalwa okuyingozi kakhulu. Umama angathunyelwa esikhungweni esisethelwe ukunakekela izingane ezisanda kuzalwa e-NICU.

Ngemuva kokuzalwa, ingane ingeniswa ku-NICU. Usana lubekwa ngaphansi kwesifudumezi noma ebhokisini elicacile nelifudumele elibizwa ngokuthi i-incubator, elilawula izinga lokushisa lomoya. Imishini yokuqapha ilandelela ukuphefumula kwengane, ukushaya kwenhliziyo, nezinga leoksijini egazini.

Izitho zomntwana ezisanda kuzalwa azithuthuki ngokugcwele. Usana ludinga ukunakekelwa okukhethekile enkulisa kuze kube yilapho izitho sezikhulile ngokwanele ukugcina ingane iphila ngaphandle kosizo lwezokwelapha. Lokhu kungathatha amasonto kuya ezinyangeni.

Izinsana ngokuvamile azikwazi ukuxhumanisa ukuncela nokugwinya ngaphambi kokukhulelwa kwamasonto angama-34. Ingane engakazalwa ingase ibe nethubhu encane yokuthambisa ebekwe ngamakhala noma ngomlomo esiswini. Ezinsaneni ezingakafiki isikhathi noma ezigulayo, ukudla kunganikezwa ngomthambo kuze kube yilapho ingane izinzile ngokwanele ukuthola konke ukudla ngesisu.

Uma usana lunezinkinga zokuphefumula:

• Ishubhu lingafakwa ku-windpipe (trachea). Umshini obizwa ngokuthi i-ventilator uzosiza ingane ukuthi iphefumule.
• Ezinye izingane ezinezinkinga zokuphefumula ezingaphansi kakhulu zithola ingcindezi yomoya oqhubekayo (CPAP) enamashubhu amancane emakhaleni esikhundleni se-trachea. Noma bangathola oksijini owengeziwe kuphela.
• I-oksijeni inganikezwa nge-ventilator, i-CPAP, i-prongs prongs, noma i-oxygen hood ekhanda lengane.

Izinsana zidinga ukunakekelwa okukhethekile kwezinkulisa kuze kube yilapho zikwazi ukuphefumula ngaphandle kokusekelwa okwengeziwe, ukudla ngomlomo, nokugcina izinga lokushisa komzimba nesisindo somzimba. Izinsana ezincane kakhulu zingaba nezinye izinkinga eziyinkimbinkimbi zokwelashwa futhi ezidinga ukuhlala isikhathi eside esibhedlela.

Kunamaqembu amaningi okusekela abazali bezingane ezizalwe ngaphambi kwesikhathi. Buza usonhlalonhle osegunjini labagula kakhulu.

Ukukhulelwa ngaphambi kwesikhathi kwakuyimbangela enkulu yokufa kwezinsana. Izindlela ezithuthukisiwe zezokwelapha nezobuhlengikazi zikhulise ukusinda kwezinsana ezizalwe ngaphambi kwesikhathi.

Ukukhulelwa kuqala kungaba nemiphumela yesikhathi eside. Izinsana eziningi ngaphambi kwesikhathi zinezinkinga zezokwelapha, zokukhula, noma zokuziphatha eziqhubeka zisencane noma zihlala unomphela. Lapho ingane ingakafiki isikhathi futhi isisindo sayo sokuzalwa sincane, ingozi iba nkulu ezinkingeni. Kodwa-ke, akunakwenzeka ukubikezela imiphumela yesikhathi eside yengane ngokuya ngobudala bokukhulelwa noma isisindo sokuzalwa.

Izinkinga ezingaba khona zesikhathi eside zifaka:

• Inkinga yamaphaphu yesikhathi eside ebizwa nge-bronchopulmonary dysplasia (BPD)
• Ukukhula okubambezelekile nentuthuko
• Ukukhubazeka kwengqondo noma komzimba noma ukubambezeleka
• Inkinga yombono ebizwa ngokuthi i-retinopathy yokungakhuli ngaphambi kwesikhathi, okuholela ekutheni ungaboni kahle noma ungaboni

Izindlela ezinhle kakhulu zokuvimbela ukungakhuli ngaphambi kwesikhathi yilezi:

• Yiba nempilo enhle ngaphambi kokukhulelwa.
• Thola ukunakekelwa ngaphambi kokubeletha ngokushesha ngangokunokwenzeka ekukhulelweni.
• Qhubeka nokuthola ukunakekelwa ngaphambi kokubeletha kuze kube yilapho ingane izalwa.

Ukuthola ukunakekelwa ngaphambi kwesikhathi nokubeletha okuhle kunciphisa ithuba lokuzalwa ngaphambi kwesikhathi.

Ukusebenza ngaphambi kwesikhathi kungaphathwa noma kubambezeleke ngomuthi ovimba ukucindezela kwesibeletho. Izikhathi eziningi, noma kunjalo, imizamo yokubambezela ukusebenza ngaphambi kwesikhathi ayiphumeleli.

I-Betamethasone (umuthi we-steroid) onikezwa omama abasebenza ngaphambi kwesikhathi kungenza ezinye izinkinga zokukhulelwa zingabi nzima kakhulu.

Usana olungaphambi kwesikhathi; U-Preemie; Premie; I-Neonatal - i-premie; I-NICU - i-premie

• I-jaundice esanda kuzalwa - ukukhipha

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AmaParsons KV, uJain L. Usana lwangaphambi kwesikhathi ngaphambi kwesikhathi. Ku: Martin RJ, Fanaroff AA, Walsh MC, ama-eds. Faranoff noMartin's Neonatal-Perinatal Medicine. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 40.

USimhan HN, uRomero R. Umsebenzi wokuqala nokuzalwa. Ku: Landon MB, Galan HL, Jauniaux ERM et al, eds. Ama-Obstetrics kaGabbe: Ukukhulelwa Okujwayelekile Nenkinga. Umhlaka 8. IPhiladelphia, PA: Elsevier; 2021: isahluko 36.