Ukopha okungaphakathi kosana olusanda kuzalwa

Ukopha ngaphakathi kwe-intraventricular (IVH) kosana olusanda kuzalwa kuyopha ezindaweni ezigcwele uketshezi (ama-ventricles) ngaphakathi kobuchopho. Isimo sivela kaningi ezinganeni ezizalwa kusenesikhathi (ngaphambi kwesikhathi).

Izinsana ezizalwe ngaphezu kwamasonto ayishumi kusenesikhathi zisengozini enkulu yalolu hlobo lokopha. Uma usana luncane futhi lusheshe lufike, inkulu ingozi ye-IVH. Lokhu kungenxa yokuthi imithambo yegazi ebuchosheni bezinsana ezizalwe ngaphambi kwesikhathi ayikakhuli ngokuphelele. Zintekenteke kakhulu ngenxa yalokho. Imithambo yegazi iyaqina emasontweni ayishumi edlule wokukhulelwa.

I-IVH ivame kakhulu ezinganeni ezizalwe ngaphambi kwesikhathi ezine:

• Isifo sokucindezeleka sokuphefumula
• Umfutho wegazi ongazinzile
• Ezinye izimo zezokwelapha lapho kuzalwa

Inkinga ingahle ivele nakwezinye izingane ezinempilo ezizalwe kusenesikhathi. Ngokuvamile, i-IVH ingahle ikhule ezinganeni ezigcwele.

I-IVH ayitholakali lapho kuzalwa. Kwenzeka kaningi ezinsukwini ezimbalwa zokuqala zokuphila. Isimo asivamile ngemuva kwenyanga yokuqala yokuzalwa, noma ngabe ingane izalwe kusenesikhathi.

Kunezinhlobo ezine ze-IVH. Lawa abizwa ngokuthi "amamaki" futhi asuselwa ezingeni lokopha.

• Amabanga 1 no-2 afaka inani elincane lokopha. Isikhathi esiningi, azikho izinkinga zesikhathi eside ngenxa yokopha. IBanga 1 libizwa nangokuthi yi-germinal matrix hemorrhage (GMH).
• Amabanga 3 no 4 ahilela ukopha kakhulu. Ukucindezelwa kwegazi ku- (grade 3) noma kuhilela ngqo (grade 4) izicubu zobuchopho. Ibanga lesi-4 libizwa nangokuthi i-intraparenchymal hemorrhage. Amahlule egazi angakha futhi avimbe ukugeleza koketshezi lwe-cerebrospinal. Lokhu kungaholela ekwandeni koketshezi ebuchosheni (i-hydrocephalus).

Kungase kungabikho zimpawu. Izimpawu ezivame ukubonakala ezinganeni ezingakazalwa zihlanganisa:

• Ukuphefumula ikhefu (i-apnea)
• Izinguquko kumfutho wegazi nokushaya kwenhliziyo
• Ukwehla kwethoni yemisipha
• Ukucabanga okunciphile
• Ukulala ngokweqile
• Imikhuba emibi
• Ncela obuthakathaka
• Ukuquleka nokunye ukunyakaza okungavamile

Zonke izingane ezizalwe ngaphambi kwamasonto angama-30 kufanele zibe ne-ultrasound yekhanda ukuze ihlole i-IVH. Isivivinyo senziwa emavikini ayi-1 kuya kwayi-2 empilo. Izingane ezizalwa phakathi kwamaviki angama-30 kuye kwangama-34 nazo zingahlolwa i-ultrasound uma zinezimpawu zenkinga.

Ukuhlolwa kwesibili kwe-ultrasound kungenziwa ngesikhathi ingane obekulindeleke ukuthi izalwe ngaso ekuqaleni (usuku olubekiwe).

Ayikho indlela yokumisa ukopha okuhlobene ne-IVH. Ithimba labanakekeli bezempilo lizozama ukugcina usana luzinzile futhi belaphe noma yiziphi izimpawu ingane engaba nazo. Isibonelo, ukumpontshelwa igazi kunganikezwa ukuthuthukisa umfutho wegazi nokubala kwegazi.

Uma uketshezi lukhula luze lufike ezingeni lokuthi kukhona ukukhathazeka mayelana nengcindezi ebuchosheni, umpompi womgogodla ungenziwa ukukhipha uketshezi bese uzama ukunciphisa ingcindezi. Uma lokhu kusiza, kungadingeka ukuhlinzwa ukuze kufakwe ishubhu (shunt) ebuchosheni ukukhipha uketshezi.

Ukuthi ingane yenza kahle kangakanani kuncike ekutheni ingane ingakabi yisikhathi esingakanani kanye nezinga lokopha. Ngaphansi kwengxenye yezingane ezinegazi elisezingeni eliphansi banezinkinga zesikhathi eside. Kodwa-ke, ukopha kakhulu kuvame ukuholela ekubambezelekeni kokukhula kanye nezinkinga zokulawula ukunyakaza. Kufinyelela kwengxenye eyodwa kwezintathu yezingane ezinegazi elibi kakhulu zingafa.

Izimpawu zemizwa noma imfiva enganeni ene-shunt endaweni ingakhombisa ukuvinjelwa noma ukutheleleka. Ingane idinga usizo lwezokwelashwa ngokushesha uma lokhu kwenzeka.

Amayunithi amaningi okunakekelwa kwabagula kakhulu asanda kuzalwa (ama-NICUs) anohlelo lokulandelela lokuqapha ngokucophelela izingane ezinalesi simo zize zibe neminyaka okungenani emithathu ubudala.

Ezifundazweni eziningi, izingane ezine-IVH nazo ziyafaneleka ukuthola izinsizakalo zokungenelela kusenesikhathi (EI) ukusiza ngentuthuko ejwayelekile.

Abesifazane abakhulelwe abasengozini enkulu yokulethwa ngaphambi kwesikhathi kufanele banikezwe imithi ebizwa nge-corticosteroids. Le mithi ingasiza ukunciphisa ingozi yengane ye-IVH.

Abanye besifazane abasebenzisa imishanguzo ethinta izingozi zokopha kufanele bathole uvithamini K ngaphambi kokubeletha.

Izingane ezizalwe ngaphambi kwesikhathi lapho izintambo zazo zingaboshwa khona manjalo zisengozini encane ye-IVH.

Izingane ezizalwe ngaphambi kwesikhathi ezizalelwa esibhedlela ezine-NICU futhi akudingeki ukuba zithuthwe ngemuva kokuzalwa nazo zinengozi encane ye-IVH.

IVH - osanda kuzalwa; GMH-IVH

deVries LS. Ukopha okungaphakathi kwe-Intracranial kanye nezilonda zemithambo yegazi ku-neonate. Ku: Martin RJ, Fanaroff AA, Walsh MC, ama-eds. UFanaroff kanye neMithi kaMartin's Neonatal-Perinatal Medicine. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 53.

UDlamini N, deVebar GA. Unhlangothi wezingane. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 619.

Umphefumulo JS, Ment LR. Ukulimala ebuchosheni bokuqala obukhulayo: ukuphuma kwegazi kwangaphakathi nokulimala kwendaba emhlophe. Ku: Swaiman KF, Ashwal S, Ferriero DM, et al, abahleli. I-Swaiman's Pediatric Neurology. Umhlaka 6. IPhiladelphia, PA: Elsevier; I-2017: isahluko 22.