I-Meconium aspiration syndrome

I-Meconium aspiration syndrome (MAS) ibhekisa ezinkingeni zokuphefumula ingane esanda kuzalwa engaba nayo lapho:

• Azikho ezinye izimbangela, futhi
• Ingane idlulise i-meconium (indle) ku-amniotic fluid ngesikhathi sokubeletha noma sokubeletha

I-MAS ingenzeka uma ingane iphefumulela (aspirates) lolu ketshezi emaphashini.

I-Meconium yisitokisi sokuqala esidluliswa usana olusanda kuzalwa ngemuva nje kokuzalwa, ngaphambi kokuba ingane iqale ukondla nokugaya ubisi noma ifomula.

Kwezinye izimo, ingane idlula i-meconium ngenkathi ingaphakathi kwesibeletho. Lokhu kungenzeka lapho izingane "zingaphansi kwengcindezi" ngenxa yokwehla kokutholakala kwegazi nokomoya. Lokhu kuvame ukubangelwa izinkinga nge-placenta noma intambo.

Lapho nje ingane isidlulisa i-meconium iya ku-amniotic fluid ezungezile, ingayiphefumulela emaphashini. Lokhu kungenzeka:

• Ngenkathi ingane isesibelethweni
• Ngesikhathi sokubeletha
• Ngokushesha ngemuva kokuzalwa

I-meconium nayo ingavimba izindlela zomoya zosana ngemuva nje kokuzalwa. Kungadala izinkinga zokuphefumula ngenxa yokuvuvukala (ukuvuvukala) emaphashini engane ngemuva kokuzalwa.

Izici ezinobungozi ezingadala ingcindezi enganeni ngaphambi kokuzalwa zifaka:

• "Ukuguga" kweplasenta uma ukukhulelwa kudlula kude usuku olubekiwe
• Ukwehlisa umoya-mpilo enganeni lapho isesibelethweni
• Isifo sikashukela kumama okhulelwe
• Ukulethwa okunzima noma ukusebenza isikhathi eside
• Umfutho wegazi ophezulu kumama okhulelwe

Iningi lezingane ezedlulise i-meconium ku-amniotic fluid aziyiphefumuli emaphashini azo ngesikhathi sokubeletha nokubeletha. Akunakwenzeka ukuthi babe nezimpawu noma izinkinga.

Izingane eziphefumula kulolu ketshezi zingaba nokulandelayo:

• Umbala wesikhumba o-Bluish (cyanosis) enganeni
• Ukusebenza kanzima ukuphefumula (ukuphefumula okunomsindo, ukububula, ukusebenzisa imisipha eyengeziwe ukuphefumula, ukuphefumula ngokushesha)
• Akukho ukuphefumula (ukungabi namandla okuphefumula, noma i-apnea)
• Ukuxhugela lapho ezalwa

Ngaphambi kokuzalwa, umqaphi wombungu angabonisa ukushaya kwenhliziyo okuhamba kancane. Ngesikhathi sokubeletha noma lapho kuzalwa, i-meconium ingabonakala ku-amniotic fluid nasenganeni.

Usana lungadinga usizo ngokuphefumula noma ukushaya kwenhliziyo ngemuva nje kokuzalwa. Bangaba nesilinganiso esiphansi se-Apgar.

Ithimba lokunakekelwa kwezempilo lizolalela esifubeni sengane nge-stethoscope. Lokhu kungaveza imisindo yokuphefumula engajwayelekile, ikakhulukazi imisindo emahhadla, egqashukayo.

Ukuhlaziywa kwegesi yegazi kuzobonisa:

• Igazi eliphansi (eline-asidi) i-pH
• Ukwehla komoya-mpilo
• Ukwandisa isikhutha

I-x-ray yesifuba ingakhombisa izindawo ezi-patchy noma ezi-streaky emaphashini wosana.

Ithimba lokunakekelwa okukhethekile kufanele libe khona lapho kuzalwa ingane uma kutholakala iminonjana ye-meconium ku-amniotic fluid. Lokhu kwenzeka ngaphezu kwe-10% yokukhulelwa okujwayelekile. Uma ingane isebenza futhi ikhala, akudingeki ukwelashwa.

Uma ingane ingasebenzi futhi ikhala ngemuva nje kokubeletha, iqembu lizo:

• Ukufudumala nokugcina izinga lokushisa elijwayelekile
• Yomile futhi uvuselele ingane

Uma ingane ingaphefumuli noma inenhliziyo ephansi:

• Ithimba lizosiza ingane iphefumule lisebenzisa imaski yobuso enamathiselwe esikhwameni eletha ingxube ye-oksijini ukufuthelana amaphaphu engane.
• Usana lungabekwa enkulisa ekhethekile noma egunjini labagula kakhulu elisanda kuzalwa ukuze libhekwe ngeso lokhozi.

Ezinye izindlela zokwelashwa zingafaka:

• Ama-antibiotic ukwelapha ukutheleleka okungenzeka.
• Umshini wokuphefumula (umshini wokuphefumula) uma ingane ingakwazi ukuziphefumlela yodwa noma idinga inani elikhulu le-oxygen eyengeziwe.
• Oxygen ukugcina amazinga egazi ejwayelekile.
• Ukudla okunomthambo (IV) - ukondleka ngemithambo - uma izinkinga zokuphefumula zigcina ingane ingakwazi ukondla ngomlomo.
  
• Ukushisa okukhazimulayo ukugcina ukushisa komzimba.
• I-Surfactant ukusiza amaphaphu ukuthi ashintshe i-oxygen. Lokhu kusetshenziswa kuphela ezimweni ezinzima kakhulu.
• I-nitric oxide (ebizwa nangokuthi i-NO, igesi ehogelwayo) ukusiza ukugeleza kwegazi nokushintshaniswa komoya-mpilo emaphashini. Lokhu kusetshenziswa kuphela ezimweni ezinzima.
• I-ECMO (i-extracorporeal membrane oxygenation) uhlobo lokudlula kwenhliziyo / kwamaphaphu. Ingasetshenziswa ezimweni ezinzima kakhulu.

Ezimweni eziningi zoketshezi olunamabala we-meconium, ukubukeka kuhle kakhulu futhi akunamphumela wezempilo wesikhathi eside.

• Cishe ingxenye eyodwa kuphela yezingane ezinoketshezi olunamabala we-meconium zizoba nezinkinga zokuphefumula futhi cishe ama-5% kuphela azoba neMAS.
• Izingane zingadinga ukwesekwa okwengeziwe ngokuphefumula nangokondleka kwezinye izimo. Lesi sidingo sizohamba ngezinsuku ezimbili kuya kwezingu-4. Kodwa-ke, ukuphefumula okusheshayo kungaqhubeka izinsuku ezimbalwa.
• I-MAS ayivamile ukuholela ekulimaleni unomphela kwamaphaphu.

I-MAS ingabonakala kanye nenkinga enkulu ngokugeleza kwegazi kuye noma kubuya emaphashini. Lokhu kubizwa ngokuthi ukuphikelela komfutho wegazi ophezulu wamaphaphu wosana olusanda kuzalwa (PPHN).

Ukuvimbela izinkinga eziholela ekubeni i-meconium ibe khona, hlala uphilile ngesikhathi sokukhulelwa bese ulandela iseluleko somhlinzeki wakho wezokunakekelwa kwempilo.

Umhlinzeki wakho uzofuna ukulungela i-meconium ukuba khona lapho kuzalwa uma:

• Amanzi akho aqhekeka ekhaya futhi uketshezi belucacile noma lungcoliswe ngento eluhlaza noma ensundu.
• Noma yikuphi ukuhlolwa okwenziwe ngesikhathi ukhulelwe kubonisa ukuthi kungaba nezinkinga ezikhona.
• Ukuqapha kwe-Fetal kubonisa noma yiziphi izimpawu zokucindezeleka kwengane.

MAS; IMeconium pneumonitis (ukuvuvukala kwamaphaphu); Umsebenzi - meconium; Ukulethwa - meconium; Neonatal - meconium; Ukunakekelwa okusanda kuzalwa - meconium

• I-Meconium

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UCrowley MA. Izinkinga zokuphefumula ezingakazalwa. Ku: Martin RJ, Fanaroff AA, Walsh MC, ama-eds. UFanaroff noMartin's Neonatal-Perinatal Medicine: Izifo Zengane Nengane. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 66.

UWyckoff MH, u-Aziz K, u-Escobedo MB, et al. Ingxenye 13: Ukuvuselelwa kweNonatal: Ukuvuselelwa kwemihlahlandlela ye-American American Heart Association yokuvuselelwa kwe-cardiopulmonary kanye nokunakekelwa okuphuthumayo kwenhliziyo. Ukujikeleza. 2015; 132 (18 Suppl 2): ​​S543-S560. I-PMID: 26473001 pubmed.ncbi.nlm.nih.gov/26473001/.