Khanda lisanabadwe

Khanda lobadwa msanga ndi khanda lobadwa asanakwanitse milungu 37 yobereka (kutadutsa milungu itatu isanakwane).

Pobadwa, mwana amadziwika kuti ndi amodzi mwa awa:

• Kutha msanga (osakwana milungu 37)
• Nthawi yonse (milungu 37 mpaka 42 yoyembekezera)
• Post term (wobadwa patatha milungu 42 ali ndi pakati)

Ngati mayi agwira ntchito asanakwane milungu 37, amatchedwa preterm labor.

Ana obadwa kumene asanakwane omwe amabadwa pakati pa masabata 35 ndi 37 ali ndi pakati sangamawoneke msanga. Mwina sangaloledwe kuchipatala cha ana osamalidwa bwino (NICU), komabe ali pachiwopsezo cha zovuta zambiri kuposa ana obadwa kwathunthu.

Matenda omwe mayi amakhala nawo, monga matenda ashuga, matenda amtima, ndi matenda a impso, amathandizira kuti agwire ntchito asanabadwe. Nthawi zambiri, chomwe chimayambitsa ntchito isanakwane sichidziwika. Ena obadwa masiku asanakwane amakhala ndi pakati kangapo, monga mapasa kapena atatu.

Mavuto osiyanasiyana okhudzana ndi pakati amachulukitsa chiopsezo chobereka asanabadwe kapena kubereka msanga:

• Khomo lachiberekero lofooka lomwe limayamba kutsegula (kutambasula) koyambirira, lotchedwanso kulephera kwa khomo lachiberekero
• Zolepheretsa kubadwa kwa chiberekero
• Mbiri yakubweretsa asanakwane
• Kutenga (matenda opatsirana mumkodzo kapena matenda a nembanemba ya amniotic)
• Zakudya zoperewera musanatenge kapena mukakhala ndi pakati
• Preeclampsia: kuthamanga kwa magazi ndi mapuloteni mumkodzo omwe amapezeka pambuyo pa sabata la 20 la mimba
• Kutuluka msanga kwa nembanemba (placenta previa)

Zinthu zina zomwe zimawonjezera chiopsezo cha kubereka msanga komanso kubereka mwana asanakwane ndi awa:

• Zaka za amayi (amayi omwe ali ochepera zaka 16 kapena kupitirira 35)
• Kukhala African American
• Kuperewera kwa chisamaliro chapakati
• Mkhalidwe wotsika wachuma
• Kugwiritsa ntchito fodya, cocaine, kapena amphetamines

Khanda limakhala ndi vuto lopuma komanso kutentha thupi nthawi zonse.

Mwana wakhanda asanabadwe atha kukhala ndi zizindikilo za mavuto awa:

• Maselo ofiira okwanira (kuchepa magazi)
• Kuthira magazi mu ubongo kapena kuwonongeka kwa zoyera zaubongo
• Matenda kapena sepsis wakhanda
• Shuga wamagazi ochepa (hypoglycemia)
• Matenda opatsirana a Neonatal, mpweya wowonjezera m'mapapu (pulmonary interstitial emphysema), kapena kutuluka magazi m'mapapu (m'mapapo mwazi)
• Khungu lachikaso ndi azungu amaso (jaundice wakhanda)
• Mavuto kupuma chifukwa chamapapo mwana, chibayo, kapena patent ductus arteriosus
• Kutupa kwamatumbo kwakukulu (necrotizing enterocolitis)

Mwana wakhanda asanabadwe amakhala ndi vuto lochepa lobadwa kuposa mwana wakhanda. Zizindikiro zodziwika za kusakhwima ndizo:

• Kupuma kosazolowereka (kosaya, kopumira pang'ono kopumira kotchedwa apnea)
• Tsitsi la thupi (lanugo)
• Kukulitsa clitoris (mwa makanda achikazi)
• Mafuta ochepa thupi
• Kutsika kwaminyewa yocheperako komanso zocheperako poyerekeza ndi ana akhanda
• Mavuto kudyetsa chifukwa chovuta kuyamwa kapena kuwongolera kumeza ndi kupuma
• Kachilombo kakang'ono kosalala komanso kopanda mizere, komanso machende osavomerezeka (mwa makanda achimuna)
• Cartilage wofewa, wosinthasintha
• Khungu lowonda, losalala, lowala lomwe nthawi zambiri limakhala lowonekera (limatha kuwona mitsempha pansi pa khungu)

Mayeso omwe mwana amachita asanakwane ndi awa:

• Kusanthula mpweya wamagazi kuti muwone kuchuluka kwa oxygen m'magazi
• Kuyesa magazi kuti muwone kuchuluka kwa glucose, calcium, ndi bilirubin
• X-ray pachifuwa
• Kuwunika kosalekeza kwa mtima (kuwunika kupuma ndi kugunda kwa mtima)

Ntchito yantchito isanakwane ndipo singaletsedwe, gulu lazachipatala lidzakonzekera kubadwa koopsa. Mayi atha kusamutsidwa kupita ku malo omwe akhazikitsidwa kuti azisamalira ana akhanda asanakwane ku NICU.

Atabadwa, mwanayo amaloledwa kupita ku NICU. Khanda limayikidwa pansi pa zotentha kapena m'bokosi loyera, lotenthedwa lotchedwa incubator, lomwe limayang'anira kutentha kwa mpweya. Makina owunikira amayang'anira kupuma kwa mwana, kugunda kwa mtima, komanso kuchuluka kwa mpweya m'magazi.

Ziwalo za khanda lobadwa msanga sizinakule bwino. Khanda limafunikira chisamaliro chapadera ku nazale mpaka ziwalozo zitakula mokwanira kuti mwanayo akhale ndi moyo popanda thandizo la mankhwala. Izi zitha kutenga masabata mpaka miyezi.

Makanda nthawi zambiri sangagwirizane akuyamwa ndi kumeza asanakwanitse milungu 34. Mwana wakhanda asanabadwe atha kukhala ndi chubu chofewa chofewa chomwe chimayikidwa pamphuno kapena pakamwa m'mimba. Ana akhanda asanakwane kapena odwala, zakudya zimatha kuperekedwa kudzera mumitsempha mpaka mwana atakhazikika kuti athe kulandira zakudya zonse kudzera m'mimba.

Ngati khanda lili ndi vuto lakupuma:

• Thubhu itha kuyikidwa mu phewa (trachea). Makina otchedwa mpweya wabwino amathandizira kupuma kwa mwana.
• Ana ena omwe kupuma kwawo kumakhala kovuta kwambiri amalandira mpweya wabwino (CPAP) wokhala ndi timachubu tamphuno m'malo mwa trachea. Kapenanso angalandire mpweya wowonjezera chabe.
• Oxygen imatha kuperekedwa ndi makina opumira, CPAP, ma prongs amphongo, kapena mpweya wa oxygen pamutu pa mwana.

Makanda amafunikira chisamaliro chapadera cha nazale mpaka atha kupuma popanda kuthandizidwa, kudya pakamwa, ndi kutentha thupi ndi kulemera kwa thupi. Makanda ocheperako atha kukhala ndi mavuto ena omwe amalepheretsa chithandizo ndipo amafunika kukhala nthawi yayitali kuchipatala.

Pali magulu ambiri othandizira makolo a makanda obadwa masiku asanakwane. Funsani wogwira ntchito yazaumoyo kuchipatala cha ana osamalidwa kumene.

Kusakhwima m'mimba kumayambitsa vuto lalikulu la imfa za ana. Njira zabwino zachipatala ndi unamwino zawonjezera kupulumuka kwa makanda asanakwane.

Kutha msanga kumatha kukhala ndi zotsatira zazitali. Makanda ambiri asanakwane amakhala ndi mavuto azachipatala, amakula, kapena amakhalidwe omwe amapitilira akadali ana kapena amakhala okhazikika. Mwana akangobadwa msanga komanso kuchepa kwake kwakubadwa kwake, ndiye kuti chiopsezo chimakhala chachikulu pamavuto. Komabe, ndizosatheka kuneneratu zotulukapo zazitali za mwana potengera msinkhu wa msinkhu kapena kunenepa kwambiri.

Mavuto omwe angakhalepo kwa nthawi yayitali ndi awa:

• Vuto lalitali lamapapu lotchedwa bronchopulmonary dysplasia (BPD)
• Kukula kwakuchedwa ndikukula
• Kulemala kwamaganizidwe kapena kuthupi kapena kuchedwa
• Vuto la masomphenya lotchedwa retinopathy la prematurity, lomwe limapangitsa kuti munthu asamaone bwino kapena akhale wakhungu

Njira zabwino zopewera kukhwima ndi:

• Khalani ndi thanzi labwino musanatenge mimba.
• Pezani chisamaliro chobereka msanga m'mimba.
• Pitilizani kulandira chithandizo asanabadwe mpaka mwana abadwe.

Kufika msanga komanso kusamalidwa bwino musanabadwe kumachepetsa mwayi wobadwa msanga.

Kugwira ntchito isanakwane nthawi zina kumachiritsidwa kapena kuchedwa ndi mankhwala omwe amaletsa kufinya kwa chiberekero. Nthawi zambiri, komabe, kuyesera kuchedwa kugwira ntchito asanakwane sikukuyenda bwino.

Betamethasone (mankhwala a steroid) omwe amapatsidwa kwa amayi omwe akugwira ntchito asanakwane angapangitse mavuto ena asanachitike msanga.

Msanga khanda; Preemie; Premie; Neonatal - msanga; NICU - msanga

• Mwana wakhanda jaundice - kumaliseche

Brady JM, Barnes-Davis INE, Poindexter BB. Khanda lomwe lili pachiwopsezo chachikulu. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 117.

Parsons KV, Jain L. Mwana wakhanda wam'mbuyomu. Mu: Martin RJ, Fanaroff AA, Walsh MC, olemba., Eds. Faranoff ndi Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 40.

Simhan HN, Romero R. Preterm ntchito ndi kubadwa. Mu: Landon MB, Galan HL, Jauniaux ERM et al, eds. Obstetrics a Gabbe: Mimba Yachibadwa ndi Mavuto. 8th ed. Philadelphia, PA: Elsevier; 2021: chaputala 36.