Maʻi maʻi ʻōpū neonatal

ʻO ka Neonatal respiratory respiratory syndrome (RDS) kahi pilikia i ʻike pinepine ʻia i nā pēpē ma mua. He mea paʻakikī kēia ʻano no ka hanu ʻana o ka pēpē.

Hana ʻia ʻo RDS Neonatal i nā pēpē i hoʻomohala piha ʻole ʻia nā māmā.

Hoʻokumu nui ʻia ka maʻi e ka nele o kahi mea paheʻe i loko o nā akemāmā i kapa ʻia he surfactant. Kōkua kēia mea i nā māmā e hoʻopiha i ka ea a mālama i nā ʻeke lewa mai ka hoʻoliʻiliʻi. Aia ka Surfactant ke hoʻomohala piha ʻia nā māmā.

Hiki i nā Neonatal RDS ma muli o nā pilikia kūpuna me ka ulu ʻana o ka hū.

ʻO ka hapa nui o nā hihia o RDS kū i nā pēpē i hānau ma mua o 37 a 39 mau pule. ʻO ka nui o ka pēpē, ʻoi aku ka kiʻekiʻe o ka manawa o RDS ma hope o ka hānau ʻana. ʻAʻole pinepine ka pilikia i nā pēpē i hānau wā piha (ma hope o 39 mau pule).

ʻO nā kumu ʻē aʻe hiki ke hoʻonui i ka makaʻu o RDS me:

• He kaikaina a kaikaina paha i loaʻa iā RDS
• Diabetes i ka makuahine
• Ka lawe ʻana a Cesarean a i ʻole ka hoʻokomo ʻana i ka hana ma mua o ka piha o ka manawa o ka pēpē
• Nā pilikia me ka lawe ʻana e hōʻemi i ke kahe o ke koko i ka pēpē
• Hapai hāpai keiki (māhoe a ʻoi aku)
• Hana wikiwiki

ʻO ka hapanui o nā manawa, ʻike ʻia nā ʻōuli ma waena o nā minuke o ka hānau ʻana. Eia nō naʻe, ʻaʻole paha lākou e ʻike ʻia no kekahi mau hola. Pākuʻi ʻia paha nā ʻōuli:

• ʻO kaʻula Bluish o kaʻili a me nā membrane mucus (cyanosis)
• Kū iki i ka hanu ʻana (apnea)
• Hoʻoemi i ka puka mimi
• Nasal ahi
• Hanu wikiwiki
• Hā hanu
• Hoʻomaha ka hanu a me ke kaniʻuhū i ka hanu ʻana
• ʻO ka neʻe ʻana o ka hanu maʻamau (e like me ke kua ʻana o nāʻiʻo o ka umauma me ka hanu)

Hoʻohana ʻia nā hōʻike aʻe e ʻike ai i ke ʻano.

• Nānā ke kinoea kōkō - hōʻike i ka oxygen haʻahaʻa a me nā waikawa nui i nā wai o ke kino.
• ʻO x-ray umauma - hōʻike i kahi hiʻohiʻona "aniani honua" i nā akemāmā ke ʻano o ka maʻi. Hoʻolālā pinepine kēia i 6 a 12 mau hola ma hope o ka hānau ʻana.
• Nā ho'āʻo Lab - kōkua i ka pale ʻana i ka maʻi ma ke kumu o nā pilikia hanu.

ʻO nā pēpē ma mua a i ʻole nā ​​kūlana ʻē aʻe e hōʻeha nui iā lākou no ka pilikia e pono ke mālama ʻia i ka wā hānau e kahi hui kauka e loea i nā pilikia hanu hou.

Hāʻawi ʻia nā pēpē i ka oxygen mehana, a pulu hoʻi. Eia nō naʻe, pono e nānā pono ʻia kēia lāʻau e hōʻalo ai i nā hopena o ka oxygen.

ʻO ka hāʻawi ʻana he surfactant keu i kahi pēpē maʻi ua hōʻike ʻia he mea kōkua. Eia nō naʻe, hāʻawi pololei ʻia ka mea heʻe nalu i ke alahele o ke pēpē, no laila pili kekahi pilikia. Pono e hana hou i kahi noiʻi e pili ana i nā pēpē e loaʻa ai kēia lāʻau a pehea ka nui e hoʻohana ai.

Kōkua ʻia ka hoʻokomo ʻana me ka ʻeae (mīkini hanu) i kekahi ola no kekahi mau pēpē. Eia nō naʻe, hiki i ka hoʻohana ʻana i ka mīkini hanu ke hoʻopōʻino i kaʻiʻo māmā, no laila e hōʻalo ʻia kēia hana inā hiki. Pono i nā pēpē i kēia hana inā loaʻa iā lākou:

• ʻO ke kiʻekiʻe o ke kalapona kalapona i ke koko
• Ka oxygen liʻiliʻi o ke koko
• Ke koko haʻahaʻa pH (acidity)
• Hoʻomaha hou i ka hanu ʻana

Kāohi ʻia kahi lapaʻau i hoʻomau ʻia i ke kaomi ʻūlū maikaʻi mau (CPAP) i ka pono o ka ea i kōkua ʻia a i ʻole surfactant i nā pēpē he nui. Hoʻouna ka CPAP i ka ea i loko o ka ihu e kōkua i ka hāmama o nā ala ākea. Hiki ke hāʻawi ʻia e ka mea hoʻāhā (ʻoiai e hanu kūʻokoʻa ana ka pēpē) a i ʻole me kahi hāmeʻa CPAP ʻokoʻa.

Pono e mālama pono nā pēpē me RDS. Pākuʻi ʻia kēia:

• Loaʻa i kahi hoʻonohonoho mālie
• Ka lawelawe mālie ʻana
• Noho i kahi mahana wela o ke kino
• Mālama pono i nā wai a me ka meaʻai
• Ke mālama koke nei i nā maʻi

Hoʻonui pinepine ka maʻi i 2 a 4 mau lā ma hope o ka hānau ʻana a hoʻomaikaʻi maikaʻi ma hope o kēlā. E make ana kekahi pēpē me ka maʻi hanu ʻeha nui. Kū pinepine kēia ma waena o nā lā 2 a me 7.

E ulu paha nā pilikia lōʻihi ma muli o:

• Ka oxygen loa.
• Hāʻawi ʻia ke kaomi kiʻekiʻe i nā ake māmā.
• ʻO nā maʻi ʻoi aku ka maikaʻi a makua ʻole paha. Hiki i ka RDS ke hoʻopili ʻia me ka mumū e hiki ai i ka lolo a me ka lolo ke hōʻino.
• Nā wā i loaʻa ʻole ka lolo i ka lolo a i ʻole nā ​​mea ʻē aʻe.

E kūkulu paha ka lewa a me ke kōkō i:

• Ka hakahaka e hoʻopuni ana i nā akemāmā (pneumothorax)
• ʻO ka hakahaka i ka umauma ma waena o ʻelua mau māmā (pneumomediastinum)
• ʻO ka wahi ma waena o ka puʻuwai a me ka ʻeke lahilahi e hoʻopuni ana i ka puʻuwai (pneumopericardium)

ʻO nā kūlana ʻē aʻe e pili ana me RDS a i ʻole prematurity nui e komo pū paha:

• Kahe i ka lolo (intraventricular hemorrhage of the newborn)
• Kahe i loko o ka hū (pulmonary hemorrhage; kekahi manawa pili me surfactant hoʻohana)
• Nā pilikia me ka ulu ʻana o ka hanu a me ka ulu ʻana (bronchopulmonary dysplasia)
• Hoʻolohi ʻia ka hoʻomohala a i ʻole ke kīnā ʻole o ka noʻonoʻo e pili ana i ka ʻeha o ka lolo a i ʻole ke kahe ʻana o ke kahe
• Nā pilikia me ka hoʻomohala ʻana o ka maka (retinopathy o prematurity) a me ka makapō

ʻO ka hapa nui o ka manawa, ulu kēia pilikia ma hope koke iho o ka hānau ʻana aia nō ka pēpē i ka haukapila. Inā ua hānau ʻoe ma ka home a ma waho paha o kahi kikowaena olakino, e loaʻa i ke kōkua pilikia inā loaʻa nā pilikia hanu o kāu pēpē.

ʻO ka hana ʻana i nā hana e pale ai i ka hānau mua ʻana hiki ke kōkua i ka pale ʻana i ka RDS neonatal. ʻO ka mālama prenatal maikaʻi a me nā loiloi maʻamau e hoʻomaka ana ke ʻike ka wahine he hāpai ʻo ia hiki ke pale i ka hānau ʻōpio.

Hiki ke hoʻemi ʻia ka makaʻu o RDS e ka manawa kūpono o ka lawe ʻana. Pono paha kahi hoʻouna i hoʻokomo ʻia a i ʻole cesarean. Hiki ke hana i kahi hōʻike lab ma mua o ka lawe ʻana e nānā i ka mākaukau o nā ake māmā o ka pēpē. Inā ʻaʻole pono i ka lāʻau, pono e hoʻopaneʻe i ka lawe ʻana a i ʻole cesarean a hiki i ka hala ʻana o 39 mau pule a i ʻole nā ​​hōʻike e hōʻike ai ua oʻo nā māmā o ka pēpē.

Hiki i nā lāʻau i kapa ʻia ʻo Corticosteroids ke kōkua i ka wikiwiki i ka hoʻomohala ʻana o ka māmā ma mua o ka hānau ʻana o kahi pēpē. Hāʻawi pinepine ʻia lākou i nā wahine hāpai ma waena o 24 a 34 mau pule o ka hāpai ʻana e manaʻo ʻia e hāʻawi i ka pule aʻe. Pono e noiʻi hou e ʻike inā he pōmaikaʻi paha nā corticosteroids i nā pēpē ma mua o 24 a ʻoi paha ma mua o 34 mau wiki.

I kekahi manawa, hiki paha ke hāʻawi i nā lāʻau ʻē aʻe e hoʻopaneʻe i ka hana a me ka lawe ʻana a hiki i ka manawa o ka lāʻau steroid i manawa e hana ai. Hiki i kēia lapaʻau ke hōʻemi i ke koʻikoʻi o RDS. Hiki iā ia ke kōkua i ka pale ʻana i nā pilikia ʻē aʻe o ka prematurity. Eia naʻe, ʻaʻole ia e hemo loa i nā pilikia.

Maʻi maʻi membrane Hyaline (HMD); ʻO ka maʻi hanu pēpē pēpē; ʻO ka maʻi hanu hanu i nā pēpē; RDS - nā pēpē

Kamath-Rayne BD, Jobe AH. Hoʻonui a me ka surfactant lung fetal. I: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. ʻO Medicine a Maternal-Fetal a Creasy a me Resnik: Nā Manaʻo a me ka Hoʻomeheu. 8th ed. Piladelapia, PA: Elsevier; 2019: chap 16.

Klilegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Hoʻolahalaha nā maʻi maʻi i ka wā kamaliʻi. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 434.

ʻO Rozance PJ, Rosenberg AA. ʻO ka neonate. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 22.

ʻO Wambach JA, ʻo Hamvas A. ʻO ka maʻi hanu hanu ma ka neonate. I Martin RJ, ʻo Fanaroff AA, ʻo Walsh MC, nā ʻaoʻao. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine. 10 o ka lā.Piladelapia, PA: Elsevier Saunders; 2015: chap 72.