Isifo sokucindezeleka sokuphefumula se-Neonatal

I-Neonatal respiratory stress syndrome (RDS) yinkinga evame ukubonwa ezinganeni ezizalwe ngaphambi kwesikhathi. Isimo senza kube nzima ukuthi ingane iphefumule.

I-RDS ye-Neonatal yenzeka ezinganeni ezingamaphaphu azo angakakhuli ngokuphelele.

Lesi sifo sidalwa kakhulu ukungabi bikho kwezinto ezishelelayo emaphashini okuthiwa i-surfactant. Le nto isiza amaphaphu ukuthi agcwalise umoya futhi igcina amasaka omoya angahluzi. I-Surfactant ikhona lapho amaphaphu esekhule ngokuphelele.

I-RDS yeNonatal nayo ingabangelwa izinkinga zofuzo ngokukhula kwamaphaphu.

Izimo eziningi ze-RDS zenzeka ezinganeni ezizalwe ngaphambi kwamasonto angama-37 kuya kwangu-39. Lapho ingane izalwa ngaphambi kwesikhathi, kuba nethuba eliphezulu le-RDS ngemuva kokuzalwa. Inkinga ayijwayelekile ezinganeni ezizalwe isikhathi esigcwele (ngemuva kwamasonto angama-39).

Ezinye izinto ezingakhuphula ubungozi be-RDS zifaka:

• Umfowethu noma udade obene-RDS
• Isifo sikashukela kumama
• Ukulethwa kokuhlinzwa noma ukwenziwa komsebenzi ngaphambi kokuba ingane ibe yisikhathi esigcwele
• Izinkinga ngokulethwa ezinciphisa ukugeleza kwegazi kuya enganeni
• Ukukhulelwa okuningi (amawele noma ngaphezulu)
• Umsebenzi osheshayo

Isikhathi esiningi, izimpawu zivela kungakapheli nemizuzu yokuzalwa. Kodwa-ke, kungenzeka bangabonwa amahora amaningi. Izimpawu zingafaka:

• Umbala we-Bluish wesikhumba nolwelwesi lwamafinyila (cyanosis)
• Misa okwesikhashana ekuphefumuleni (i-apnea)
• Ukwehla kokukhishwa komchamo
• Ukuqhuma kwamakhala
• Ukuphefumula ngokushesha
• Ukuphefumula okungatheni
• Ukuphefumula okuncane nemisindo ebubulelayo ngenkathi uphefumula
• Ukunyakaza okungavamile (njengokudonsela emuva imisipha yesifuba ngokuphefumula)

Ukuhlolwa okulandelayo kusetshenziselwa ukuthola isimo:

• Ukuhlaziywa kwegesi yegazi - kukhombisa umoya-mpilo omncane ne-asidi eyeqile oketshezini lomzimba.
• I-x-ray yesifuba - ikhombisa ukubukeka "kwengilazi yaphansi" emaphashini okufana nalesi sifo. Lokhu kuvame ukukhula emva kwamahora ayisithupha kuya kwayi-12 ngemuva kokuzalwa.
• Ukuhlolwa kweLab - kusiza ukukhipha ukutheleleka njengesizathu sezinkinga zokuphefumula.

Izingane ezingakafiki isikhathi noma ezinezinye izimo ezibenza babe sengozini enkulu yenkinga badinga ukwelashwa ngesikhathi sokuzalwa yithimba lezokwelapha eligxile ezinkingeni zokuphefumula ezisanda kuzalwa.

Izinsana zizonikezwa umoya-mpilo ofudumele, omanzi. Kodwa-ke, le ndlela yokwelashwa idinga ukubhekwa ngokucophelela ukugwema imiphumela emibi evela ku-oxygen eningi kakhulu.

Ukunikeza usana olugulayo ukuthinteka okwengeziwe kukhonjisiwe ukuthi kuyasiza. Kodwa-ke, umuntu osebenza ngokusezingeni eliphezulu uhanjiswa ngqo emgwaqweni womoya wengane, ngakho-ke ingozi ethile iyabandakanyeka. Kusadingeka kwenziwe ucwaningo oluningi lokuthi yiziphi izingane okufanele zithole le ndlela yokwelashwa nokuthi zingakanani okufanele zisetshenziswe.

Ukuphefumula okusizwayo nge-ventilator (umshini wokuphefumula) kungasindisa impilo kwezinye izingane. Kodwa-ke, ukusetshenziswa komshini wokuphefumula kungalimaza izicubu zamaphaphu, ngakho-ke le ndlela yokwelashwa kufanele igwenywe uma kungenzeka. Izingane zingadinga lokhu kwelashwa uma zine:

• Izinga eliphakeme lesikhutha elisegazini
• I-oxygen ephansi yegazi
• I-pH yegazi eliphansi (i-asidi)
• Ikhefu eliphindiwe ekuphefumuleni

Ukwelashwa okubizwa ngokuthi yi-constant positive airway pressure (CPAP) kungavimbela isidingo sokusizwa komoya noma i-surfactant ezinganeni eziningi. I-CPAP ithumela umoya emakhaleni ukusiza ukugcina imigwaqo yomoya ivulekile. Inganikezwa nge-ventilator (ngenkathi ingane iphefumula ngokuzimela) noma ngedivayisi ehlukile ye-CPAP.

Izingane ezine-RDS zidinga ukunakekelwa okuseduze. Lokhu kufaka:

• Ukuba nesimo esizolile
• Ukuphatha ngobumnene
• Ukuhlala ezingeni lokushisa lomzimba elifanele
• Ukuphatha ngokucophelela uketshezi nokondleka
• Ukwelapha izifo ngokushesha

Isimo sivame ukuba sibi kakhulu ezinsukwini ezi-2 kuya kwezi-4 ngemuva kokuzalwa futhi sithuthuka kancane emva kwalokho. Ezinye izingane ezinezinkinga zokuphefumula ezinzima zizofa. Lokhu kuvame ukwenzeka phakathi kwezinsuku 2 no 7.

Izinkinga zesikhathi eside zingakhula ngenxa:

• I-oxygen eningi kakhulu.
• Ingcindezi ephezulu ilethwa emaphashini.
• Isifo esibi kakhulu noma ukungavuthwa. I-RDS ingahlotshaniswa nokuvuvukala okubangela ukulimala kwamaphaphu noma kobuchopho.
• Izikhathi lapho ubuchopho noma ezinye izitho zingatholanga i-oxygen eyanele.

Umoya noma igesi kungakha ku:

• Isikhala esizungeze amaphaphu (pneumothorax)
• Isikhala esifubeni phakathi kwamaphaphu amabili (i-pneumomediastinum)
• Indawo ephakathi kwenhliziyo nesaka elincanyana elizungeze inhliziyo (pneumopericardium)

Ezinye izimo ezihlotshaniswa ne-RDS noma ukungakhuli ngokweqile ngokweqile kungafaka:

• Ukopha ebuchosheni (ukopha ngaphakathi kwengane esanda kuzalwa)
• Ukopha emaphashini (ukopha kwamaphaphu, kwesinye isikhathi kuhlotshaniswa nokusetshenziswa kwe-surfactant)
• Izinkinga ngokukhula kwamaphaphu nokukhula (i-bronchopulmonary dysplasia)
• Ukukhula okulibazisekile noma ukukhubazeka kwengqondo okuhambisana nokulimala kobuchopho noma ukopha
• Izinkinga ngokuthuthuka kwamehlo (ukuphinda ujonge ukubukeka ngaphambi kokuvuthwa) nokungaboni

Isikhathi esiningi, le nkinga iba khona ngemuva nje kokuzalwa ingane isasesibhedlela. Uma ubelethele ekhaya noma ngaphandle kwesikhungo sezokwelapha, thola usizo oluphuthumayo uma ingane yakho inezinkinga zokuphefumula.

Ukuthatha izinyathelo zokuvimbela ukuzalwa ngaphambi kwesikhathi kungasiza ekuvikeleni i-RDS ebelethayo. Ukunakekelwa okuhle ngaphambi kokubeletha nokuhlolwa njalo okuqala ngokushesha nje lapho owesifazane ethola ukuthi ukhulelwe kungasiza ekugwemeni ukuzalwa ngaphambi kwesikhathi.

Ubungozi be-RDS bungancishiswa futhi nangesikhathi esifanele sokulethwa. Ukulethwa okwenziwe noma ukuyeka ukubeletha kungadingeka. Ukuhlolwa kwebhu kungenziwa ngaphambi kokubeletha ukuhlola ukulungela kwamaphaphu engane. Ngaphandle kokuthi kudingekile ngokwezokwelapha, ukulethwa okwenziwe noma kokuhlinzwa kufanele kubambezeleke kuze kube okungenani amasonto angama-39 noma kuze kube yilapho ukuhlolwa kukhombisa ukuthi amaphaphu engane akhulile.

Imithi ebizwa nge-corticosteroids ingasiza ekusheshiseni ukukhula kwamaphaphu ngaphambi kokuba ingane izalwe. Zivame ukunikezwa abesifazane abakhulelwe phakathi kwamasonto angama-24 kuya kwangama-34 okukhulelwa ababonakala ngathi bangabeletha ngesonto elizayo. Ucwaningo oluningi luyadingeka ukuthola ukuthi ngabe i-corticosteroids ingazuzisa yini izingane ezingaphansi kweminyaka engama-24 noma ngaphezulu kunamasonto angama-34.

Ngezinye izikhathi, kungenzeka ukuthi unikeze eminye imithi ukubambezela ukubeletha nokulethwa kuze kube yilapho umuthi we-steroid unesikhathi sokusebenza. Lokhu kwelashwa kunganciphisa ubunzima be-RDS. Kungasiza futhi ukuvimbela ezinye izinkinga zokungakhuli kuqala. Noma kunjalo, ngeke izisuse ngokuphelele izingozi.

Isifo se-Hyaline ulwelwesi (HMD); Isifo sokuphefumula kwezinsana; Isifo sokuphefumula ezinganeni; I-RDS - izinsana

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