Kudziletsa kwa Neonatal syndrome

Neonatal abstinence syndrome (NAS) ndi gulu lamavuto omwe amapezeka mwa mwana wakhanda yemwe adakumana ndi mankhwala opioid kwa nthawi yayitali ali m'mimba mwa mayi.

NAS imatha kuchitika mayi wapakati akamamwa mankhwala monga heroin, codeine, oxycodone (Oxycontin), methadone, kapena buprenorphine.

Zinthu izi ndi zina zimadutsa mu placenta yomwe imagwirizanitsa mwana ndi mayi ake m'mimba. Mwana amadalira mankhwalawo limodzi ndi mayi ake.

Mayi akapitiliza kugwiritsa ntchito mankhwalawo pasanathe sabata kapena asanabadwe, mwana amadalira mankhwalawo akabadwa. Chifukwa chakuti mwanayo sakupezanso mankhwalawa atabadwa, zizindikiro zakutha zimatha kuchitika chifukwa mankhwalawa amachotsedwa pang'onopang'ono m'thupi la mwanayo.

Zizindikiro zosiya kubwereranso zitha kuchitika mwa ana omwe amamwa mowa, benzodiazepines, barbiturates, ndi ma anti-depressants (SSRIs) omwe ali m'mimba.

Ana a amayi omwe amagwiritsa ntchito ma opioid ndi mankhwala ena osokoneza bongo (chikonga, amphetamines, cocaine, chamba, mowa) atha kukhala ndi mavuto okhalitsa. Ngakhale kulibe umboni wowonekera wa NAS wa mankhwala ena, atha kuthandizira kukulitsa zizindikiritso za NAS za mwana.

Zizindikiro za NAS zimadalira:

• Mtundu wa mankhwala omwe mayi ake adagwiritsa ntchito
• Momwe thupi limasokonekera ndikuyeretsa mankhwalawo (chifukwa cha majini)
• Kuchuluka kwa mankhwala omwe amamwa
• Anagwiritsa ntchito mankhwalawa nthawi yayitali bwanji
• Kaya mwanayo wabadwa mokwanira kapena asanabadwe (asanakwane)

Zizindikiro nthawi zambiri zimayamba patadutsa masiku atatu kapena atatu kuchokera pakubadwa, koma zimatha kutenga sabata kuti ziwonekere. Chifukwa chaichi, nthawi zambiri mwanayo amafunika kukhala mchipatala kuti awone ndi kuwunika kwa sabata limodzi.

Zizindikiro zimaphatikizapo:

• Khungu loyera (loyenda)
• Kutsekula m'mimba
• Kulira kwambiri kapena kulira kwambiri
• Kuyamwa kwambiri
• Malungo
• Zosokoneza maganizo
• Kuchuluka kwa minofu
• Kukwiya
• Kudya moperewera
• Kupuma mofulumira
• Kugwidwa
• Mavuto ogona
• Kuchepetsa kunenepa
• Mphuno yampweya, kuyetsemula
• Kutuluka thukuta
• Kunjenjemera (kunjenjemera)
• Kusanza

Zina zambiri zitha kutulutsa zofananira ndi NAS. Pofuna kuti adziwe, wothandizira zaumoyo adzafunsa mafunso okhudza momwe mayi amagwiritsira ntchito mankhwala osokoneza bongo. Mayi angafunsidwe za mankhwala omwe adamwa ali ndi pakati, komanso kuti adamaliza liti. Mkodzo wa mayi amathanso kuwunika mankhwala osokoneza bongo.

Mayeso omwe angachitike kuti athandizire kuzindikira kuti mwana wakhanda wachoka ndi awa:

• Ndondomeko ya NAS, yomwe imapereka mfundo kutengera chizindikiritso chilichonse komanso kuuma kwake. Mapepala a khanda angathandize kudziwa chithandizo.
• Kuwunika kwa ESC (kudya, kugona, kutonthoza)
• Chithunzi chazakumwa cha mkodzo komanso matumbo oyamba (meconium). Chidutswa chaching'ono cha umbilical chitha kugwiritsidwanso ntchito poyesa mankhwala.

Chithandizo chimadalira:

• Mankhwalawa anali nawo
• Zaumoyo wonse wa khanda ndi kudziletsa
• Kaya mwanayo anabadwa mokwanira kapena asanabadwe

Gulu lazachipatala limayang'anira wakhanda mosamala kwa sabata limodzi (kapena kupitilira kutengera momwe mwanayo akuchitira) akabadwa ngati ali ndi zizindikilo zakutha, mavuto akudya, komanso kunenepa. Ana omwe amasanza kapena amene ataya madzi m'thupi angatenge madzi kudzera mumtsempha (IV).

Makanda omwe ali ndi NAS nthawi zambiri amakhala ovuta komanso ovuta kudekha. Malangizo oti muchepetse pamakhala njira zomwe nthawi zambiri zimatchedwa "TLC" (chisamaliro chachikondi):

• Pogwedeza mwanayo modekha
• Kuchepetsa phokoso ndi magetsi
• Khungu kusamalira khungu ndi amayi, kapena kukulunga mwana mu bulangeti
• Kuyamwitsa (ngati mayi ali mu pulogalamu ya methadone kapena buprenorphine popanda kugwiritsa ntchito mankhwala osokoneza bongo)

Ana ena omwe ali ndi zizindikilo zowopsa amafunikira mankhwala monga methadone kapena morphine kuti athetse vutoli ndikuwathandiza kuti azitha kudya, kugona komanso kupumula. Ana awa angafunike kukhala mchipatala milungu ingapo kapena miyezi atabadwa. Cholinga cha mankhwalawa ndikupatsa khanda mankhwala ofanana ndi omwe mayi adagwiritsa ntchito ali ndi pakati ndikuchepetsa pang'onopang'ono mankhwalawo pakapita nthawi. Izi zimathandiza kuyamwitsa mwana pamankhwalawa ndikuchepetsa zizindikiritso zina zobwerera.

Ngati zizindikirozo ndizolimba, monga ngati mankhwala ena adagwiritsidwa ntchito, mankhwala ena achiwiri monga phenobarbital kapena clonidine amatha kuwonjezeredwa.

Ana omwe ali ndi vutoli nthawi zambiri amakhala ndi zotupa zazikulu kapena malo ena owonongeka pakhungu. Izi zimafuna chithandizo ndi mafuta kapena zonona zapadera.

Ana amathanso kukhala ndi mavuto ndi kudyetsa kapena kukula pang'onopang'ono. Ana awa angafunike:

• Zakudya zamafuta apamwamba kwambiri zomwe zimapatsa thanzi zakudya zabwino
• Zakudya zazing'ono zomwe zimaperekedwa pafupipafupi

Chithandizo chimathandiza kuthetsa zizindikiro zakusuta. Ngakhale atalandira chithandizo cha NAS ndipo ana atuluka mchipatala, angafunikire "TLC" yowonjezera kwa milungu ingapo kapena miyezi.

Kugwiritsa ntchito mankhwala osokoneza bongo ndi mowa panthawi yapakati kumatha kubweretsa mavuto ambiri azaumoyo mwa mwana kupatula NAS. Izi zingaphatikizepo:

• Zolepheretsa kubadwa
• Kulemera kochepa kubadwa
• Kubadwa msanga
• Mzere wazing'ono wamutu
• Matenda aimfa mwadzidzidzi (SIDS)
• Mavuto pakukula ndi machitidwe

Chithandizo cha NAS chimatha kuyambira sabata limodzi mpaka miyezi 6.

Onetsetsani kuti opereka chithandizo akudziwa za mankhwala ndi mankhwala omwe mumamwa mukakhala ndi pakati.

Itanani omwe akukuthandizani ngati mwana wanu ali ndi zizindikiro za NAS.

Kambiranani za mankhwala, mankhwala osokoneza bongo, mowa ndi fodya ndi omwe amakupatsani.

Funsani omwe akukuthandizani kuti akuthandizeni posachedwa ngati muli:

• Kugwiritsa ntchito mankhwala osokoneza bongo
• Kugwiritsa ntchito mankhwala omwe sanakulamulireni
• Kugwiritsa ntchito mowa kapena fodya

Ngati muli ndi pakati kale ndipo mumamwa mankhwala kapena mankhwala omwe simunapatsidwe, kambiranani ndi omwe akukuthandizani za njira yabwino yotetezera inu ndi mwana. Mankhwala ena sayenera kuyimitsidwa popanda kuyang'aniridwa ndi azachipatala, kapena zovuta zimatha kupezeka. Wothandizira anu adziwa momwe angathetsere zoopsa.

NAS; Zizindikiro zakudziletsa kwa Neonatal

• Kudziletsa kwa Neonatal syndrome

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Hudak ML. Makanda a amayi omwe amagwiritsa ntchito mankhwala osokoneza bongo. Mu: Martin RJ, Fanaroff AA, Walsh MC, olemba., Eds. Fanaroff ndi Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2020: mutu 46.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Magulu odziletsa. Ku Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, .eds. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 126.