Syndrome abstinence neonatal

ʻO ka neonatal abstinence Syndrome (NAS) kahi hui o nā pilikia i kū i kahi keiki hānau hou i hōʻike ʻia i nā lāʻau opioid no kahi lōʻihi i ka wā o ka ʻōpū o ka makuahine.

Hiki paha ʻo NAS ke lawe ka wahine hāpai i nā lāʻau e like me heroin, codeine, oxycodone (Oxycontin), methadone, a i ʻole buprenorphine.

Hōʻalo kēia a me nā mea ʻē aʻe i ka placenta e hoʻopili i ka pēpē i kona makuahine i ka ʻōpū. Lilo ka pēpē i ka lāʻau me ka makuahine.

Inā hoʻomau ka makuahine i ka hoʻohana ʻana i nā lāʻau i loko o hoʻokahi pule a ʻoi paha ma mua o ka hānau ʻana, kaukaʻi ka pēpē i ka lāʻau i ka wā hānau. Ma muli o ka loaʻa ʻole o ka pēpē i ka pēpē ma hope o ka hānau ʻana, hiki mai paha nā hōʻailona haʻalele ʻana i ka holoi ʻia ʻana o ka lāʻau mai ka ʻōnaehana o ka pēpē.

Hiki paha ke puka i waho nā ʻōuli i nā pēpē i hōʻike ʻia i ka wai ʻona, benzodiazepines, barbiturates, a me kekahi mau antidepressants (SSRI) ʻoiai i ka ʻōpū.

ʻO nā pēpē o nā makuwahine e hoʻohana ana i nā opioids a me nā lāʻau hoʻomohala ʻē aʻe (nicotine, amphetamines, cocaine, mariuana, ʻalekoke) he mau pilikia lōʻihi paha. ʻOiai ʻaʻohe hōʻike maopopo o kahi NAS no nā lāʻau ʻē aʻe, hāʻawi paha lākou i ke koʻikoʻi o nā ʻōuli NAS o kahi pēpē.

Pili nā ʻōuli o NAS ma:

• Ke ʻano o ka lāʻau i hoʻohana ʻia e ka makuahine
• Pehea e wāwahi ai ke kino a hoʻomaʻemaʻe i ka lāʻau (hoʻohuli ʻia e nā kumu kūlohelohe)
• Ehia mau lāʻau i lawe ʻia e ia
• Pehea ka lōʻihi o kona hoʻohana ʻana i ka lāʻau
• Inā paha i hānau ʻia ka pēpē i ka wā holoʻokoʻa a i ʻole ke kakahiaka nui (premature)

Hoʻomaka pinepine nā ʻōuli ma waena o 1 a 3 mau lā ma hope o ka hānau ʻana, akā hiki paha i hoʻokahi pule ke puka. Ma muli o kēia, pono pinepine ka pēpē e noho i ka haukapila no ka nānā a nānā ʻana a i hoʻokahi pule.

Pākuʻi ʻia paha nā ʻōuli:

• Waihoʻoluʻu Blotchy ʻili (mottling)
• Pohā
• Uē nui a i ʻole ka uē kiʻekiʻe ʻana
• Omo nui loa
• Fiva
• Nā reflexes hyperactive
• Hoʻonui i ke kani o ka mākala
• Huhū
• ʻAi hānai maikaʻi ʻole
• Hanu wikiwiki
• Ka hopu ʻana i nā maʻi
• Pilikia hiamoe
• Loaʻa ka loaʻa o ka kaumaha lohi
• Ihu ʻaʻano, honi
• Hoʻoulu
• Haʻalulu (haʻalulu)
• ʻO ka luaʻi

Hiki i nā kūlana ʻē aʻe ke hana i nā hōʻailona like me NAS. I mea e kōkua ai i kahi kuhi, e nīnau ka mea mālama ola i nā nīnau e pili ana i ka hoʻohana ʻana i ka lāʻau a ka makuahine. E nīnau ʻia paha ka makuahine e pili ana i nā lāʻau i lawe ʻia i ka wā hāpai, a iā ia i lawe hope ai iā lākou. E kānana ʻia paha ka mimi o ka makuahine no nā lāʻau pū kekahi.

Nā hoʻāʻo e hiki ke hana ʻia e kōkua i ke kuhi ʻana i ka haʻalele ʻana i kahi keiki hānau hou:

• ʻŌnaehana helu ʻo NAS, nāna e hāʻawi i nā helu ma muli o kēlā me kēia hōʻailona. Hiki i ka helu o ke pēpē ke kōkua i ka hoʻoholo ʻana i ka lāʻau.
• ESC (ʻai, hiamoe, hōʻoluʻolu) loiloi
• Pākuʻi lāʻau o ka mimi a me nā neʻe mua o ka ʻōpū (meconium). Hiki ke hoʻohana ʻia kahi ʻāpana liʻiliʻi o ka umbilical cord no ka nānā ʻana i ka lāʻau.

Ma muli o ka mālama ʻana:

• Pili ka lāʻau
• Nā helu olakino olakino a me nā helu ʻai abstinence
• Inā paha i hānau ʻia ka pēpē a piha paha

E nānā pono ka hui mālama ola i ke keiki hānau hou a hiki i hoʻokahi pule (a ʻoi paha e pili ana i ka hana a ka pēpē) ma hope o ka hānau ʻana no nā hōʻailona o ka haʻalele ʻana, nā pilikia hānai, a me ka loaʻa ʻana o ke kaumaha. ʻO nā pēpē e luaʻi a i ʻole make wai loa paha e pono e loaʻa nā wai ma o ke aa (IV).

ʻO nā pēpē me NAS pinepine fussy a paʻakikī hoʻi e hoʻomaha. Nā ʻōlelo aʻoaʻo e hoʻomālie iā lākou e hoʻopili i nā ana i kapa ʻia ʻo "TLC" (mālama aloha aloha):

• Luli mālie i ke keiki
• Hoʻoemi i ka walaʻau a me nā kukui
• Mālama ka ʻili i ka ʻili me ka makuahine, a i ʻole ka hoʻopaʻa ʻana i ka pēpē i kahi kapa
• ʻO ka hānai hānai (inā ʻo ka makuahine i loko o kahi methadone a i ʻole buprenorphine papa hana lapaʻau me ka hoʻohana ʻole ʻana i nā lāʻau ʻino)

Pono kekahi mau pēpē me nā ʻōuli koʻikoʻi i nā lāʻau e like me methadone a i ʻole morphine e mālama i nā hōʻailona haʻalele a kōkua iā lākou e ʻai, hiamoe a hoʻomaha. Pono paha kēia mau pēpē e noho i ka haukapila no mau pule a mau mahina paha ma hope o ka hānau ʻana. ʻO ka pahuhopu o ka mālama ʻana e kuhikuhi i ka pēpē i kahi lāʻau like me ka mea a ka makuahine i hoʻohana ai i ka wā hāpai a hoʻemi haʻahaʻa i ka lāʻau i ka manawa. Kōkua kēia i ka ukuhi ʻana i ka pēpē mai ka lāʻau a hoʻomaha i kekahi mau hōʻailona haʻalele.

Inā koʻikoʻi nā ʻōuli, e like me inā hoʻohana ʻia nā lāʻau ʻē aʻe, hiki ke hoʻohui ʻia kahi lāʻau ʻelua e like me phenobarbital a i ʻole clonidine.

ʻO nā pēpē me kēia ʻano loaʻa pinepine ka popoki nui a i ʻole nā ​​wahi ʻē aʻe o ka haki ʻili. Pono kēia i ka mālama ʻana me ka hamo kūikawā a i ʻole ka kirimalu.

Pilikia paha nā pēpē i ka hānai ʻana a i ʻole ka lohi o ka ulu ʻana. Koi paha kēia mau pēpē:

• ʻO nā hānai kiʻekiʻe kiʻekiʻe-calorie e hāʻawi i ka meaʻai nui aʻe
• Hāʻawi pinepine ʻia nā hānai liʻiliʻi

Mālama ka mālama ʻana i nā ʻōuli o ka haʻalele ʻana. ʻOiai ma hope o ka pau ʻana o ka lāʻau no NAS a haʻalele nā ​​pēpē i ka haukapila, pono paha lākou i kahi "TLC" hou aʻe no mau pule a mau mahina paha.

ʻO ka hoʻohana ʻana i ka lāʻau a me ka waiʻona i ka wā o ka hāpai ʻana hiki ke alakaʻi i nā pilikia olakino he nui i ka pēpē ma waho o NAS. Pākuʻi ʻia kēia mau mea:

• Hewa hānau
• Kaumaha hānau haʻahaʻa
• Hānau hānau ʻole
• Liʻiliʻi poʻo liʻiliʻi
• ʻO ka maʻi make pēpē hū ʻole (SIDS)
• Nā pilikia me ka hoʻomohala a me ka lawena

Hiki ke mālama iā NAS mai ka pule 1 a 6 mau mahina.

E ʻike pono i ka ʻike o kāu mea lawelawe e pili ana i nā lāʻau āpau a me nā lāʻau i lawe ʻia i ka wā hāpai.

Kāhea i kāu mea hāʻawi inā loaʻa kāu pēpē i nā ʻōuli o NAS.

E kūkākūkā i nā lāʻau a pau, nā lāʻau, ka wai ʻona a me ka paka me kāu mea hāʻawi.

E noi i kāu mea nāna e hāʻawi mai i ke kōkua i ka wā hiki ke hiki inā ʻoe:

• Ke hoʻohana nei i nā lāʻau ʻole
• Ke hoʻohana nei i nā lāʻau i kauoha ʻole ʻia iā ʻoe
• Ke hoʻohana ʻana i ka wai ʻona a paka paha

Inā hāpai ʻoe a lawe i nā lāʻau a i ʻole nā ​​lāʻau i kuhikuhi ʻole ʻia iā ʻoe, e kamaʻilio me kāu mea hoʻolako e pili ana i ke ala maikaʻi e mālama ai iā ʻoe a me ka pēpē. ʻAʻole pono e hoʻokau ʻia kekahi mau lāʻau me ka ʻole o ka mālama olakino, a i ʻole e ulu paha nā pilikia. E ʻike kāu mea hāʻawi i ka maikaʻi e hoʻokele i nā pilikia.

NAS; Nā hōʻailona abstinence neonatal

• Syndrome abstinence neonatal

ʻO Balest AL, Riley MM, Bogen DL. Neonatology. I: Zitelli BJ, McIntire SC, Nowalk AJ, eds. ʻO Zitelli lāua ʻo Davis 'Atlas o ka Pediatric Physical Diagnosis. ʻEpekema 7 Piladelapia, PA: Elsevier; 2018: chap 2.

Hudak ML. Nā pēpē o nā makuahine hoʻohana i nā mea hoʻohana. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine. 11th hua. Piladelapia, PA: Elsevier Saunders; 2020: chap 46.

ʻO Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Nā syndrome abstinence. 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 126.