Meconium aspiration maʻi maʻi

Meconium aspiration Syndrome (MAS) pili i nā pilikia hanu i loaʻa i kahi pēpē hānau hou ke:

• ʻAʻohe kumu ʻē aʻe, a
• Ua hala ka pēpē meconium (stool) i loko o ka wai amniotic i ka wā hana a hānau paha

Hiki paha iā MAS ke hanu ka pēpē i (aspirates) i kēia wai i loko o nā akemāmā.

ʻO Meconium ka pahu mua i hala i kahi keiki hānau hou ma hope koke o ka hānau ʻana, ma mua o ka hoʻomaka ʻana o ka pēpē e hānai a ʻānai i ka waiū a i ʻole ka haʻilula.

I kekahi mau hihia, hala ka pēpē i ka meconium ʻoiai ia i loko o ka kōpū. Hiki i kēia ke hana inā "ma lalo o ke koʻikoʻi" nā pēpē ma muli o ka hōʻemi ʻana o ke koko a me ka hāʻawi ʻana o ka oxygen. ʻO kēia pinepine ma muli o nā pilikia me ka placenta a i ʻole ka umbilical cord.

Ke hala ka pēpē i ka meconium i loko o ka wai amniotic a puni, hanu paha lākou i loko o nā akemāmā. Hiki paha kēia:

• ʻOiai ke pēpē i loko o ka kōpū
• I ka wā o ka lawe ʻana
• Ma hope koke o ka hānau ʻana

Hiki i ka meconium ke ālai i ke alaloa o ke pēpē ma hope pono o ka hānau ʻana. Hiki iā ia ke hoʻopilikia i nā pilikia hanu ma muli o ka pehu (mumū) i nā māmā o ka pēpē ma hope o ka hānau ʻana.

Nā kumuhana kūpilikiʻi i hiki ke hoʻonāukiuki i ka pēpē ma mua o ka hānau ʻana:

• ʻO "ʻelemakule" o ka placenta inā hele ka hāpai ma mua o ka lā palena
• Hoemi i ka oxygen i ke pēpē ʻoiai i ka pūpū
• Diabetes i ka makuahine hāpai
• Hāʻawi paʻakikī a hana lōʻihi paha
• ʻO ke koko kiʻekiʻe i ka makuahine hāpai

ʻO ka hapa nui o nā pēpē i hala i ka meconium i loko o ka wai amniotic ʻaʻole hanu ia i loko o kā lākou mau māmā i ka wā o ka hana a me ka hānau ʻana. ʻAʻole paha lākou e loaʻa i kekahi mau ʻōuli a pilikia paha.

ʻO nā pēpē e hanu i kēia wai i kēia mau mea:

• ʻO kaʻula o kaʻili polū (cyanosis) i loko o ka pēpē
• Ke hana ikaika nei e hanu (hanu walaʻau, ʻōhumu, me ka hoʻohana ʻana i nā mākala keu e hanu ai, hanu wikiwiki ʻana
• ʻAʻohe hanu (hemahema o ka hanu hoʻoikaika ʻana, a i ʻole apnea)
• Limpness i ka wā hānau

Ma mua o ka hānau ʻana, hōʻike paha ka mea nānā Fetal i ka wikiwiki o ka puʻuwai. I ka wā o ka hānau ʻana a i ʻole hānau ʻia, hiki ke ʻike ʻia ka meconium i ka wai amniotic a i ka pēpē.

Pono paha i ke pēpē ke kōkua me ka hanu ʻana a i ʻole ke kuʻi puʻuwai ma hope pono o ka hānau ʻana. Loaʻa paha iā lākou kahi helu Apgar haʻahaʻa.

E hoʻolohe ka hui olakino i ka umauma o ka pēpē me kahi stethoscope. Hōʻike paha kēia i nā kani hanu kūpono ʻole, ʻoi aku ke kani a me ke kani ʻole.

E hōʻike ʻia kahi kānana kinoea koko:

• Low (ʻākika) pH koko
• ʻĀkene hoʻemi
• Hoʻonui ʻia ke kalapona kalapona

Hōʻike paha kahi pahu x-ray i nā wahi patchy a i ʻole streaky i nā māmā o ke pēpē.

Pono kahi kime mālama kūikawā ke hānau ʻia ka pēpē inā loaʻa nā kuhi o ka meconium i ka wai amniotic. Hana ʻia kēia ma 10% o nā hāpai maʻamau. Inā hana ka pēpē a uē hoʻi, ʻaʻole pono ka lapaʻau.

Inā ʻeleu ʻole ka pēpē a uē pono ma hope o ka hānau ʻana, e:

• Mahana a mālama i ka mahana maʻamau
• Maloo a hoʻoulu i ka pēpē

Inā ʻaʻole hanu ka pēpē a i ʻole he haʻahaʻa haʻahaʻa o ka puʻuwai.

• E kōkua ka kime i ka pēpē e hanu me ka hoʻohana ʻana i ka pale maka i hoʻopili ʻia i kahi ʻeke e hāʻawi i kahi hui oxygen e hoʻonui ai i nā ake māmā o ka pēpē.
• Hoʻokomo ʻia paha ke pēpē i loko o kahi mālama mālama kūikawā a i ʻole ke keʻena mālama mālama hānau hou i mea e nānā pono ai.

Hiki i nā mālama ʻē aʻe ke:

• Nā Antibiotics e mālama i ka maʻi hiki.
• Mīkini hanu (ventilator) inā ʻaʻole hiki i ka pēpē ke hanu iā lākou iho a i ʻole pono i kahi nui o ka oxygen.
• Ka oxygen e mālama i nā pae o ke koko i maʻamau.
• ʻO ka hānai hānai (IV) - ka meaʻai ma o nā veins - inā pilikia nā hanu e mālama i ka pēpē mai ka hiki ke hānai ʻia e ka waha.
  
• Mehana mehana e mālama i ka mahana o ke kino.
• Surfactant e kōkua i nā māmā e hoʻololi i ka oxygen. Hoʻohana wale ʻia kēia i nā hihia ʻoi loa.
• ʻO Nitric oxide (i kapa ʻia hoʻi me NO, he kinoea i hoʻomo ʻia) e kōkua i ke kahe o ke koko a me ka hoʻololi ʻana o ka oxygen i nā akemāmā. Hoʻohana wale ʻia kēia i nā hihia koʻikoʻi.
• ʻO ECMO (oxygenation membrane extracorporeal) kahi ʻano o ke alo o ka puʻuwai / māmā. Hiki ke hoʻohana ʻia i nā hihia koʻikoʻi loa.

I ka hapanui o nā hihia o ka wai i uhi ʻia i ka meconium, maikaʻi ka nānā ʻana a ʻaʻohe hopena olakino lōʻihi.

• Ma kahi o hoʻokahi hapalua o nā pēpē me ka wai inu meconium-staced e loaʻa i nā pilikia hanu a ma kahi o 5% wale nō e loaʻa iā MAS.
• Pono paha nā pēpē i ke kākoʻo hou me ka hanu a me ka meaʻai i kekahi mau hihia. E hala pinepine kēia hemahema i 2 a 4 mau lā. Eia nō naʻe, e hoʻomau ka hanu wikiwiki ʻana i kekahi mau lā.
• ʻAʻole alakaʻi iki ka MAS i ka hōʻino mau loa o ka lung.

Hiki ke ʻike ʻia ka MAS me kahi pilikia koʻikoʻi me ke kahe o ke koko i a mai nā akemāmā. Kapa ʻia kēia he hypertension pulmonary hoʻomau o ka hānau hou (PPHN).

I mea e pale aku ai i nā pilikia e alakaʻi ai i ka meconium e noho nei, e noho olakino i ka wā hāpai a hahai i ka ʻōlelo aʻo a kāu kahu mālama ola.

Makemake kāu mea hoʻolako e mākaukau no ka meconium e noho nei i ka wā hānau inā:

• Ua haki kou wai i ka home a maopopo a maʻemaʻe paha ka wai me kahi mea ʻōmaʻomaʻo a ʻeleʻele paha.
• Hōʻike kekahi hoʻokolohua i ka wā o kou hāpai ʻana e loaʻa paha nā pilikia i kēia manawa.
• Hōʻike ka nānā pono ʻana i ka Fetal i nā hōʻailona o ka pilikia o ka fetal.

MAS; Meconium pneumonitis (pehu o nā akemāmā); Hana hana - meconium; Ka lawe ʻana - meconium; Neonatal - meconium; Mālama hānau hou - meconium

• Meconium

Ahlfeld SK. Nā maʻi maʻi hanu. 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 122.

ʻO Crowley MA. Nā maʻi hanu neonatal. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine: Nā maʻi o ka Fetus a me ka pēpē. 11th hua. Piladelapia, PA: Elsevier; 2020: chap 66.

Wyckoff MH, Aziz K, Escobedo MB, a me al. Mahele 13: Neusatal resuscitation: 2015 American Heart Association alakaʻi i hoʻohou no ka resuscitation cardiopulmonary a me ka mālama maʻi maʻi maʻi maʻi. Kaapuni. 2015; 132 (18 Hōʻuluʻulu 2): S543-S560. PMID: 26473001 pubmed.ncbi.nlm.nih.gov/26473001/.