Intraventricular hemorrhage o ke keiki hānau

Intraventricular hemorrhage (IVH) o ke keiki hānau e kahe ana i loko o nā wahi piha i ka wai (ventricle) i loko o ka lolo. Kū pinepine ke ʻano i nā pēpē i hānau mua ʻia (premature).

ʻO nā keiki pēpē i hānau ma mua o 10 mau pule i ka makaʻu kiʻekiʻe loa no kēia ʻano koko. ʻO ka pēpē liʻiliʻi a ʻoi aku ka nui o ka pēpē, ʻoi aku ke kiʻekiʻe o ka makaʻu no ka IVH. ʻO kēia no ka mea ʻaʻole i hoʻomohala piha ʻia nā kīʻaha koko i ka lolo o nā pēpē premature. Palupalu loa lākou i ka hopena. Ulu ikaika nā kīʻaha koko i nā hebedoma he 10 i hala o ka hāpai ʻana.

ʻOi aku ka maʻamau o ka IVH i nā pēpē premature me:

• ʻO ka maʻi hanu hanu
• Kaomi koko paʻa ʻole
• Nā kūlana olakino ʻē aʻe i ka wā hānau

E kupu paha ka pilikia ma nā pēpē olakino ʻole i hānau mua ʻia. Kākaʻikahi, hoʻomohala ʻo IVH i nā pēpē wā piha.

ʻAʻohe loaʻa ʻo IVH i ka wā hānau. Kū pinepine ia i nā lā mua o ke ola. Laha ka maʻi ma hope o ka malama mua o ka makahiki, ʻoiai inā hānau hānau ʻia ka pēpē.

ʻEhā ʻano o ka IVH. Kapa ʻia kēia mau mea he "papa" a kau ʻia ma ke kēkelē o ke kahe ʻana.

• Pili ka papa 1 a me 2 i ka liʻiliʻi o ke kahe. ʻO ka hapa nui o ka manawa, ʻaʻohe pilikia lōʻihi ma ke ʻano he hopena o ke kahe ʻana. Kāhea ʻia ka papa 1 ma ke ʻano he hemorrhage germinal matrix (GMH).
• Pili nā papa 3 a me 4 i ke kahe o ke koko. Kaomi ke koko ma (grade 3) a i ʻole pili pololei (grade 4) kaʻiʻo lolo. Kapa ʻia ka papa 4 he hemapera intraparenchymal. Hiki i nā kahe koko ke hana a ālai i ke kahe o ka wai cerebrospinal. Hiki i kēia ke alakaʻi i ka hoʻonui ʻia o ka wai i ka lolo (hydrocephalus).

ʻAʻohe paha ʻōuli. ʻO nā ʻōuli maʻamau e ʻike ʻia i nā pēpē premature me:

• Hoʻomaha hoʻomaha hanu (apnea)
• Nā loli i ke kahe o ke koko a me ka helu o ka puʻuwai
• Hoʻoiho i ke kani o ka mākala
• Hoʻoemi i nā reflexes
• Hiamoe nui loa
• Lethargy
• Omo palupalu
• Ka hopu ʻana a me nā neʻe ʻē aʻe

ʻO nā pēpē āpau i hānau ʻia ma mua o 30 mau pule he ultrasound ke poʻo e nānā ai no IVH. Hana ʻia ka hōʻoia ma ka 1 a i ka 2 mau pule o ke ola. ʻO nā pēpē i hānau ma waena o 30 a 34 mau pule paha he loiloi ultrasound inā loaʻa nā ʻōuli o ka pilikia.

Hiki ke hana ʻia kahi ultrasound kānana ʻelua a puni ka manawa e manaʻo ʻia ai e hānau ʻia ka pēpē (ka lā kūpono).

ʻAʻohe ala e hōʻoki ai i ke kahe e pili me IVH. E hoʻāʻo ka pūʻulu mālama ola e mālama paʻa i ka pēpē a mālama i nā ʻōuli e loaʻa paha i ka pēpē. ʻO kahi laʻana, hāʻawi ʻia paha kahi transfusion e hoʻomaikaʻi i ke kahe o ke koko a me ka helu o ke koko.

Inā kūkulu ka wai a hiki i kahi e hopohopo ai e pili ana i ke kaomi i ka lolo, hiki ke hana ʻia i kahi kaʻi ʻōiwi e hoʻokahe i ka wai a hoʻāʻo e hoʻomaha i ke kaomi. Inā kōkua kēia, pono paha ke kahakaha e waiho i kahi Tube (shunt) i ka lolo e hoʻokahe i ka wai.

Aia ka maikaʻi o ke pēpē i ka hilinaʻi o ka pēpē a me ka papa o ka heʻe hemorrhage. Ma lalo o ka hapalua o nā pēpē me ke kahe haʻahaʻa e loaʻa ana nā pilikia lōʻihi. Eia nō naʻe, alakaʻi pinepine ke kahe koko nui i nā lohi hoʻomohala a me nā pilikia e kaohi ana i ka neʻe. Hiki i ka hapakolu o nā pēpē me ke kahe koko ke make.

ʻO nā ʻōuli neurological a i ʻole ke kuni i loko o kahi pēpē me kahi shunt ma kahi e hōʻike ai i kahi blockage a maʻi paha. Pono ka pēpē e mālama pono i ka lāʻau lapaʻau inā kū kēia.

ʻO ka hapa nui o nā keʻena mālama maʻi hānau hou (NICU) i kahi papahana ukali e kiaʻi pono i nā pēpē i loaʻa i kēia ʻano a hiki i ka liʻiliʻi o 3 mau makahiki.

I nā mokuʻāina he nui, pēpē pū nā pēpē me IVH no nā lawelawe kōkua wawe (EI) e kōkua me ka ulu maʻamau.

ʻO nā wahine hāpai i ka makaʻu nui i ka lawe ʻana i ka wanaʻao e hāʻawi ʻia i nā lāʻau i kapa ʻia ʻo corticosteroids. Hiki i kēia mau lāʻau ke kōkua i ka hōʻemi ʻana i ka pilikia o ka pēpē no IVH.

ʻO kekahi mau wahine e pili ana i nā lāʻau e hoʻopili i nā pilikia o ke kahe e pono e loaʻa ka huaora K ma mua o ka hānau ʻana.

ʻO nā pēpē ʻōpio ʻaʻole paʻa ʻia nā kaula umbilical i kēia manawa, ua liʻiliʻi ka makaʻu no ka IVH.

ʻO nā pēpē āpau i hānau ʻia i ka haukapila me kahi NICU a ʻaʻole pono e lawe ʻia ma hope o ka hānau ʻana he mea liʻiliʻi ka hopohopo no IVH.

IVH - hānau hou; GMH-IVH

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ʻO Dlamini N, deVebar GA. Paʻi pēpē. 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 619.

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