ʻO ke pēpē o ka makuahine diabetic

Hiki ke hōʻike ʻia kahi pēpē (pēpē) o kahi makuahine me ka maʻi kō i nā kiʻekiʻe o ke kō (glucose), a me nā kiʻekiʻe o nā meaola ʻē aʻe, i loko o ka hāpai ʻana.

ʻElua ʻano o ka maʻi kō i ka wā hāpai:

• ʻO ka maʻi diabetes Gestational - ke kō kiʻekiʻe o ke kō (diabetes) i hoʻomaka a ʻike ʻia paha i ka wā o ka hāpai ʻana
• ʻO ka maʻi diabetes ma mua a ma mua paha - ua loaʻa i ka maʻi diabetes ma mua o ka hāpai ʻana

Inā ʻaʻole mālama maikaʻi ʻia ka maʻi kō i ka wā hāpai, hōʻike ʻia ka pēpē i ke kiʻekiʻe o ke kō i ke kō. Hiki i kēia ke hoʻololi i ka pēpē a me ka makuahine i ka wā hāpai, i ka manawa o ka hānau ʻana, a ma hope o ka hānau ʻana.

ʻOi aku ka nui o nā pēpē o nā makuahine diabetic (IDM) ma mua o nā pēpē ʻē aʻe, inā ʻaʻole mālama maikaʻi ʻia ka maʻi kō. Hiki i kēia ke hana i ka hānau hānau paʻakikī a hoʻonui i ka makaʻu no nā ʻeha nerve a me nā ʻeha ʻē aʻe i ka wā hānau. Eia kekahi, ʻoi aku ka nui o ka hānau hānau cesarean.

Loaʻa paha kahi IDM i nā manawa o ke kō kō haʻahaʻa (hypoglycemia) ma hope koke o ka hānau ʻana, a i nā lā mua o ke ola. ʻO kēia no ka mea ua maʻa ka pēpē i ka loaʻa ʻana o ke kō ma mua o ka makemake o ka makuahine. Loaʻa iā lākou kahi kiʻekiʻe o ka insulin ma mua o ka pono ma hope o ka hānau ʻana. Hoʻoiho ka insulin i ke kō kō. Hiki iā ia ke hala i mau lā no ka pae o nā pēpē insulina e hoʻoponopono ai ma hope o ka hānau ʻana.

Loaʻa paha nā IDM:

• ʻO ka paʻakikī hanu ma muli o ka liʻiliʻi o nā ake māmā
• Helu helu ʻulaʻula koko kiʻekiʻe (polycythemia)
• Pākuʻi bilirubin kiʻekiʻe (jaundice hānau hou)
• ʻO ka mānoanoa o ka puʻuwai puʻuwai ma waena o nā keʻena nui (ventricles)

Inā ʻaʻole kāohi maikaʻi ʻia ka maʻi diabetes, ʻoi aku ka kiʻekiʻe o ka hāpai hāpai ʻana a i ʻole ke keiki hānau make.

ʻOi aku ka nui o ka makaʻu o ka IDM o nā hānau hānau inā loaʻa ka makuahine i ka maʻi kō ma mua o ka mālama pono ʻole ʻia mai kinohi mai.

ʻOi aku ka nui o ke pēpē ma mua o nā manawa maʻamau no nā pēpē i hānau ma hope o ka lōʻihi like o ka manawa i loko o ka ʻōpū o ka makuahine (nui no ka makahiki hānau). I kekahi mau hihia, ʻoi aku ka liʻiliʻi o ka pēpē (liʻiliʻi no ka makahiki hānau).

Hiki i nā ʻōuli ʻē aʻe ke:

• ʻO kaʻili o kaʻili polū, ka helu o ka puʻuwai wikiwiki, ka hanu wikiwiki (nā ʻōuli o nā mumū ʻole a me nā puʻuwai ʻole)
• Hānai hune maikaʻi ʻole, lethargy, uē nāwaliwali
• ʻO ka hopu ʻana (hōʻailona o ke kō kō i lalo loa)
• ʻAi hānai maikaʻi ʻole
• ʻO ka helehelena puʻupuʻu
• Nā haʻalulu a luliluli koke paha ma hope o ka hānau ʻana
• Jaundice (melemele kala kala)

Ma mua o ka hānau ʻia ʻana o ka pēpē:

• Hana ʻia ʻo Ultrasound ma luna o ka makuahine i nā mahina i hala iho nei o ka hāpai ʻana e nānā i ka nui o ka pēpē e pili ana i ka wehe ʻana i ka puka hānau.
• Hana ʻia paha ka hoʻāʻo ʻana o ka ʻōpio ma ka wai amniotic. Kākaʻikahi kēia hana akā kōkua ʻia inā ʻaʻole i hoʻoholo ʻia ka lā palena i ka wanaʻao.

Ma hope o ka hānau ʻana o ka pēpē:

• E nānā ʻia ke kō kō o ka pēpē i loko o ka hola mua a ʻelua paha ma hope o ka hānau ʻana, a e nānā pinepine ʻia a hiki i ka maʻamau maʻamau. Hoʻokahi paha lā a ʻelua paha mau lā, a ʻoi aku paha o ka lōʻihi.
• E nānā ʻia ka pēpē no nā hōʻailona o ka pilikia me ka puʻuwai a i ʻole nā ​​ake māmā.
• E nānā ʻia ka bilirubin o ka pēpē ma mua o ka hoʻi ʻana i ka home mai ka haukapila, a i ka wā pōkole inā he hōʻailona o ka jaundice.
• Hana ʻia paha kahi echocardiogram e nānā i ka nui o ka puʻuwai o ka pēpē.

ʻO nā pēpē āpau i hānau ʻia i nā makuahine me ka maʻi kō e pono e hoʻāʻo ʻia no ke kō kō kō, ʻoiai inā ʻaʻohe o lākou hōʻailona.

Hana ʻia e hōʻoia i ka lawa o ka glucose o ka pēpē i ke koko.

• ʻO ka hānai ʻana ma hope koke o ka hānau ʻana e pale ai i ke kō kō i lalo i nā hihia māmā. ʻOiai ʻo ka hoʻolālā e hānai i ka waiū, pono paha i ka pēpē kekahi ʻano hana i ka manawa o 8 a 24 mau hola inā haʻahaʻa ke kō kō.
• Ke hāʻawi nei nā haukapila he nui i ka gel dextrose (kō) i loko o ka pāpālina o ka pēpē ma kahi o ka hāʻawi ʻana i ka haʻilula inā ʻaʻole lawa ka waiū o ka makuahine.
• ʻO ke kō kōpaʻa haʻahaʻa e hoʻomaikaʻi ʻole me ka hānai ʻana e mālama ʻia me ka wai i loaʻa ke kō (glucose) a me ka wai i hāʻawi ʻia ma o kahi aa (IV).
• I nā hihia koʻikoʻi, inā pono ka pēpē i ka nui o ke kō, pono e hāʻawi ʻia ka wai e loaʻa ana i ka glucose ma o ka ʻume umbilical (ʻōpū ʻōpū) no kekahi mau lā.

Kākaʻikahi, pono ka pēpē i ke kākoʻo hanu a i nā lāʻau e mālama ai i nā hopena ʻē aʻe o ka maʻi kō. Mālama ʻia nā pae bilirubin kiʻekiʻe me ka light therapy (phototherapy).

I ka hapanui o nā hihia, hele aku nā ʻōuli o ke pēpē i loko o nā hola, nā lā, a i ʻole kekahi mau pule. Eia nō naʻe, hiki i kahi puʻuwai hoʻonui i mau mau mahina e hoʻomaikaʻi ai.

Maʻalahi loa, haʻahaʻa loa ke kō kō e hiki ai ke hōʻino i ka lolo.

ʻOi aku ka makaʻu o ka hānau hānau i nā wahine me ka maʻi kō ʻole e kaohi maikaʻi ʻia. Aia kekahi piʻi nui aʻe no ka nui o nā hānau hānau a i ʻole nā ​​pilikia.

• Nā hemahema puʻuwai Congenital.
• Ka pae bilirubin kiʻekiʻe (hyperbilirubinemia).
• Nā māmā māmā ʻole.
• Neonatal polycythemia (ʻoi aku nā kikoʻula o ke koko ma mua o ka maʻamau). Hiki i kēia ke hoʻopaʻa i nā kīʻaha koko a i ʻole hyperbilirubinemia.
• Liʻiliʻi kolona hema. ʻO kēia ke kumu o nā ʻōpū o ke kō ʻana o ka ʻōpū.

Inā hāpai ʻoe a loaʻa i ka mālama prenatal maʻamau, e hōʻike ʻia ka hoʻāʻo maʻamau inā ʻoe e hoʻomohala i ka maʻi diabetes.

Inā hāpai ʻoe a loaʻa ka maʻi diabetes ʻaʻole kaohi, kāhea koke i kāu mea lawelawe.

Inā hāpai ʻoe a loaʻa ʻole ka mālama prenatal, kāhea i kahi mea hoʻolako no kahi manawa.

Pono nā wahine me ka maʻi diabetes i ka mālama kūikawā i ka wā hāpai e pale ai i nā pilikia. Hiki i ka kaohi ʻana i ke kō i ke kō ke pale aku i nā pilikia he nui.

Mālama pono ʻia ka pēpē i nā hola mua a me nā lā ma hope o ka hānau ʻana hiki ke pale i nā pilikia olakino ma muli o ke kō kō kō.

IDM; ʻO ka maʻi diabetes Gestational - IDM; Mālama neonatal - makuahine diabetic

ʻO Garg M, Devaskar SU. Nā maʻi o ka pūnao carbohydrate i ka neonate. 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 86.

Landon MB, Catalano PM, Gabbe SG. ʻO ka maʻi diabetes mellitus e hoʻokūkū nei i ka hāpai ʻana. I: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Nā Kāpena Gabbe: Nā Pregnancies Maʻamau a me nā Pilikia. 8th ed. Piladelapia, PA: Elsevier; 2021: chap 45.

Moore TR, Hauguel-De Mouzon S, Catalano P. Diabetes i ka hāpai keiki. 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 59.

ʻO Sheanon NM, Muglia LJ. ʻO ka ʻōnaehana endocrine. 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 127.