He aha ka Hernia Diaphragmatic Congenital? Nā Hōʻailona, Nā Kumu, a me ka Lapaʻau

ʻO ka hernia diaphragmatic congenital (CDH) kahi hemahema hānau kahi e loaʻa ai kahi puka ma ka diaphragm, ʻo ia ka ʻiʻo e kōkua ana iā ʻoe e hanu. Hiki i kēia puka ke ʻae i nā ʻōpū mai ka ʻōpū e neʻe i loko o ka lumi umauma, kahi e paʻakikī ai ka hanu ʻana o nā pēpē.

E noʻonoʻo i kāu diaphragm e like me ka pā ikaika e hoʻokaʻawale i kou umauma mai kou ʻōpū. Ke loaʻa kahi puka ma kēia pā, hiki i nā ʻōpū e like me ka ʻōpū a i ʻole nā ​​pāpū ke komo i loko o kahi e pono ai nā māmā. Hoʻopili kēia kūlana ma kahi o 1 i kēlā me kēia 2,500 a 3,000 mau pēpē i hānau ʻia.

He aha nā hōʻailona o ka hernia diaphragmatic congenital?

ʻO ka hapa nui o nā pēpē me CDH e hōʻike ana i nā pilikia hanu ma hope koke o ka hānau ʻana. Hiki i nā hōʻailona ke piʻi mai ka māmā a i ka nui, ma muli o ka nui o ka wahi i lawe ʻia e nā ʻōpū i hoʻoneʻe ʻia i loko o ka umauma.

Eia nā hōʻailona nui āu e ʻike ai:

• Hanu wikiwiki, paʻakikī a i ʻole pilikia i ka hopu ʻana i ka hanu
• ʻIli uliuli a hina hina paha, ʻoi aku hoʻi a puni nā lehelehe a me nā kui
• ʻO ka wikiwiki o ka naʻau
• Umauma ʻano pahu e nānā aku ana i ka puni
• ʻŌpū e nānā aku ana i ka hohonu a i ʻole concave
• Hōʻemi ʻia nā leo hanu ma kekahi ʻaoʻao o ka umauma

Hiki i kekahi mau pēpē ke loaʻa pū kekahi mau pilikia hānai a i ʻole e ʻike ʻia he fussy. I nā hihia kakaikahi, ʻaʻole paha e hoʻokumu ka CDH māmā i nā hōʻailona i ʻike ʻia a hiki i ka wā ma hope i ka wā kamaliʻi, i ka wā e ʻike ai ke keiki i ka pneumonia hou a i ʻole nā ​​pilikia digestive.

He aha nā ʻano o ka hernia diaphragmatic congenital?

Loaʻa ka CDH i kekahi mau ʻano like ʻole, ma muli o kahi i loaʻa ai ka puka ma ka diaphragm. ʻO ka ʻano maʻamau ka hernia Bochdalek, kahi i hana ʻia ma ke kua a me ka ʻaoʻao o ka diaphragm.

ʻO nā ʻano nui e komo pū ana:

• Hernia Bochdalek: Hana i kahi 85-90% o nā hihia, maʻamau ma ka ʻaoʻao hema
• Hernia Morgagni: Hana ma mua o ka diaphragm, ʻaʻole maʻamau akā māmā pinepine
• Hernia diaphragmatic Central: Kakaikahi loa, hana ma waenakonu o ka diaphragm
• Eventration: ʻO ka ʻiʻo diaphragm he lahilahi a nāwaliwali ma mua o ka loaʻa ʻana o kahi puka

ʻOi aku ka nui o nā hernias hema no ka mea e pili pinepine ana i nā ʻōpū hou aku e neʻe i loko o ka umauma. ʻAʻole maʻamau nā hernias ʻākau akā hiki ke hoʻokumu i nā pilikia hanu nui.

He aha ke kumu o ka hernia diaphragmatic congenital?

Hana ʻia ka CDH i ka wā ʻaʻole i hoʻokumu piha ʻia ka diaphragm i ka wā hāpai mua. Hana kēia ma waena o ka 8 a me ka 12 mau pule o ka hāpai ʻana, i ka wā e ulu mau ana nā ʻōpū o kāu pēpē.

ʻAʻole maopopo loa ke kumu pololei, akā manaʻo nā mea noiʻi he hui pū ʻana paha ia o nā kumu genetic a me nā kumu kūlohelohe. I ka hapa nui o nā hihia, ʻaʻohe kumu maopopo no ke kumu e hana ai, a ʻaʻole ia he mea i hana a i ʻole i hana ʻole ʻia e nā mākua.

ʻO kekahi mau kumu hiki ke kōkua pū me:

• Nā hoʻololi genetic a i ʻole nā ​​mutations e hoʻopilikia i ka hoʻomohala ʻana o ka diaphragm
• Nā hemahema chromosomal e like me trisomy 18 a i ʻole 13
• Mōʻaukala ʻohana o CDH, ʻoiai he mea maʻamau ʻole kēia
• Nā lāʻau lapaʻau i lawe ʻia i ka wā hāpai
• Ka maʻi maʻi o ka makuahine a i ʻole nā ​​kūlana olakino ʻē aʻe

He mea nui e ʻike he hana kūpono ʻia ka CDH i ka hapa nui o nā hihia. ʻOiai inā loaʻa iā ʻoe kekahi keiki me CDH, ʻo ka manawa e loaʻa ai kekahi pēpē ʻē aʻe me ka kūlana like he haʻahaʻa loa.

I ka wā e ʻike ai i ke kauka no ka hernia diaphragmatic congenital?

Hoʻomaopopo pinepine ʻia ka CDH ma mua o ka hānau ʻana ma o nā ultrasound prenatal maʻamau, maʻamau ma kahi o 18-20 mau pule. Hiki i kāu kauka ke ʻike i nā ʻōpū i kū ma kahi kūpono ʻole a i ʻole nā ​​māmā o ka pēpē e nānā aku ana ma mua o ka mea i manaʻo ʻia.

Hiki i nā ho'āʻo diagnostic ke komo pū me:

• Ultrasound kikoʻī e ʻike i ke kūlana o nā ʻōpū
• MRI fetal no nā kiʻi kikoʻī hou aku
• Amniocentesis e nānā i nā kūlana genetic
• X-ray umauma ma hope o ka hānau ʻana e hōʻoia i ka hōʻailona
• Echocardiogram e nānā i ka hana o ka naʻau
• Nā ho'āʻo koko e loiloi i nā pae oxygen

I kekahi manawa ʻaʻole i ʻike ʻia ka CDH a hiki i ka hope o ka hānau ʻana, ʻoi aku hoʻi i nā hihia māmā. E hoʻohana kāu hui lapaʻau i nā X-ray umauma a me nā ho'āʻo kiʻi ʻē aʻe e hōʻoia i ka hōʻailona a hoʻolālā i ka lapaʻau.

He aha ka lapaʻau no ka hernia diaphragmatic congenital?

ʻO ka lapaʻau no CDH maʻamau e komo pū ana i ka ʻoki e hoʻoponopono i ka diaphragm, akā ʻo ka manawa e hilinaʻi ana i ke kūlana o kāu pēpē. E kau mua ka hui lapaʻau i ka hoʻoikaika ʻana i ka hanu a me ke kākoʻo ʻana i nā māmā ma mua o ka ʻoki ʻana.

ʻO nā hana lapaʻau mua e komo pū ana:

• Kākoʻo hanu me ka ventilator
• Nā lāʻau lapaʻau e kōkua i ke kaomi koko a me ka hana o ka naʻau
• Hānai IV ʻoiai paha he paʻakikī ka hānai
• Nānā ʻana i kahi ʻāpana neonatal intensive care kūikawā

Hana pinepine ʻia ka hoʻoponopono ʻoki i ka wā e kūpaʻa ai kāu pēpē, pinepine i loko o nā lā mua a i ʻole nā ​​pule o ke ola. E hoʻoneʻe ka mea ʻoki i nā ʻōpū i hoʻoneʻe ʻia i ka ʻōpū a hoʻoponopono i ka puka ma ka diaphragm. I kekahi manawa pono kahi pā inā nui ka puka.

Hoʻololi ka ho'ōla ma muli o ka nui o ke kūlana. Pono paha kekahi mau pēpē i ke kākoʻo hanu mau, ʻoiai e ho'ōla koke kekahi. E hana pū kāu hui lapaʻau me ʻoe e nānā i ka holomua a hoʻoponopono i ka lapaʻau e like me ka pono.

Pehea e hāʻawi ai i ka mālama home i ka wā ho'ōla hernia diaphragmatic congenital?

ʻO ka hapa nui o nā pēpē me CDH e hoʻolilo i nā hebedoma a i ʻole nā ​​mahina i ka haukapila ma mua o ka hele ʻana i ka home. Ke hoʻi i ka home, pono ʻoe e hoʻomau i ka mālama kūikawā e kākoʻo i ka ho'ōla a me ka hoʻomohala ʻana o kāu pēpē.

ʻO ka mālama home maʻamau e komo pū ana:

• Ke hahai nei i nā papa hānai a me ka nānā ʻana i ka loaʻa kaumaha
• Ke hāʻawi nei i nā lāʻau lapaʻau e like me ka mea i kuhikuhi ʻia
• Ke nānā nei i nā ʻano hanu a me nā pae oxygen inā pono
• Ke hele nei i nā hālāwai kūkākūkā ma hope
• Ke nānā nei i nā hōʻailona o nā pilikia e like me ka pilikia hanu a i ʻole nā ​​pilikia hānai
• Ke hāʻawi nei i ke kākoʻo hoʻomohala a me ka lapaʻau kino e like me ka mea i kuhikuhi ʻia

E hāʻawi kāu hui olakino i nā ʻōlelo kuhikuhi kikoʻī a me nā kumuwaiwai kākoʻo. Mai kānalua e kāhea inā ʻike ʻoe i nā loli i ka hanu, hānai, a i ʻole ke kūlana holoʻokoʻa o kāu pēpē.

Pehea ʻoe e hoʻomākaukau ai no kāu hālāwai kauka?

ʻO ka hoʻomākaukau ʻana no nā hālāwai lapaʻau hiki ke kōkua iā ʻoe e loaʻa ka nui loa mai kāu mau kipa a hōʻoia i ka pane ʻia o kāu mau hopohopo āpau. E kākau i kāu mau nīnau ma mua i ʻole ʻoe e poina i nā mea nui.

E noʻonoʻo e hoʻomākaukau:

• He papa inoa o nā hōʻailona āpau i kēia manawa a me ka wā i hoʻomaka ai lākou
• Nā nīnau e pili ana i nā koho lapaʻau a me ka mea e manaʻo ai
• ʻIke e pili ana i ka mōʻaukala lapaʻau ʻohana
• Nā lāʻau lapaʻau i kēia manawa a me nā dosages
• ʻIke ʻinikua a me nā pepa kuhikuhi
• Kekahi kanaka kākoʻo e kōkua iā ʻoe e hoʻomanaʻo i ka ʻike

Mai makaʻu e noi i ka wehewehe inā pilikia nā huaʻōlelo lapaʻau. Makemake kāu hui olakino e hōʻoia i kou hoʻomaopopo piha i ke kūlana a me ka hoʻolālā lapaʻau o kāu pēpē.

He aha ka lawe nui e pili ana i ka hernia diaphragmatic congenital?

ʻO CDH kahi hemahema hānau koʻikoʻi akā hiki ke mālama ʻia e hoʻopilikia ana i ka ʻiʻo diaphragm. ʻOiai e pono ai ka mālama lapaʻau kūikawā a me ka ʻoki ʻana, nui nā keiki me CDH e ola i nā ola olakino, maʻamau me ka lapaʻau kūpono.

ʻO ka mea nui loa e hoʻomanaʻo ai, ʻo ka hōʻailona mua a me ka lapaʻau e hana i kahi ʻokoʻa nui i nā hopena. Inā ʻike ʻia ka CDH i ka wā hāpai, hiki i kāu hui lapaʻau ke hoʻomākaukau no ka hānau ʻana a me ka mālama koke. Me nā holomua i ka ʻenehana lapaʻau a me nā ʻenehana ʻoki, ke hoʻomaikaʻi mau nei ka manaʻo no nā pēpē me CDH.

E hoʻomanaʻo he ʻokoʻa kēlā me kēia hihia, a e hana pū kāu hui olakino me ʻoe e hoʻomohala i ka hoʻolālā lapaʻau maikaʻi loa no kāu kūlana kikoʻī. E noho pili me kāu hui lapaʻau, e nīnau i nā nīnau, a mai kānalua e ʻimi i ke kākoʻo i ka wā e pono ai.

Nā nīnau i nīnau pinepine ʻia e pili ana i ka hernia diaphragmatic congenital

Hiki ke pale ʻia ka hernia diaphragmatic congenital?

I kēia manawa, ʻaʻohe ala i ʻike ʻia e pale aku ai i ka CDH no ka mea e hana ia i ka wā hoʻomohala fetal mua. ʻO ka lawe ʻana i nā huaora prenatal, ka pale ʻana i nā mea ʻino i ka wā hāpai, a me ka mālama ʻana i ka mālama prenatal maikaʻi e manaʻo mau ʻia no ke olakino fetal holoʻokoʻa, akā ʻaʻole kēia mau hana e pale kūikawā i ka CDH.

He aha ka nui o ka ola no nā pēpē me CDH?

Ua hoʻomaikaʻi nui ka nui o ka ola no CDH i nā makahiki i hala a i kēia manawa mai 70-90%, ma muli o ka nui o ke kūlana. Loaʻa i nā pēpē me CDH māmā a me nā māmā i hoʻomohala maikaʻi nā hopena maikaʻi loa, ʻoiai nā mea me nā hihia koʻikoʻi loa paha e kū i nā pilikia hou aku akā loaʻa mau nā manawa maikaʻi o ke ola me ka mālama lapaʻau kūpono.

Pono anei kāu keiki i ka mālama lapaʻau mau ma hope o ka ʻoki ʻana o CDH?

Pono ka hapa nui o nā keiki i ka mālama ma hope mau e nānā i ka hana o nā māmā, ka ulu ʻana, a me ka hoʻomohala ʻana. Pono paha kekahi i nā lapaʻau hou aku no nā pilikia e like me ka gastroesophageal reflux a i ʻole nā ​​pilikia lohe. Eia naʻe, hiki i nā keiki he nui me CDH ke komo i nā hana maʻamau i ko lākou ulu ʻana, me nā haʻuki a me nā hana kino ʻē aʻe.

Hiki anei ke hana hou ʻia ka CDH i nā hāpai ʻana i ka wā e hiki mai ana?

He haʻahaʻa loa ka pilikia o ka loaʻa ʻana o kekahi pēpē ʻē aʻe me CDH, ma lalo o 2%. ʻO ka hapa nui o nā hihia o CDH e hana kūpono ʻia a ʻaʻole hoʻoilina ʻia. Eia naʻe, inā loaʻa nā kumu genetic, hiki i kāu kauka ke kuhikuhi i ka ʻōlelo aʻo genetic e kūkākūkā i kāu kūlana kikoʻī a me nā koho ho'āʻo.

Pehea ka wikiwiki ma hope o ka hānau ʻana e hana pinepine ʻia ai ka ʻoki ʻana o CDH?

Hoʻololi ka manawa ʻoki ma muli o ke kūlana o kāu pēpē. Pono kekahi mau pēpē i ka ʻoki ʻana i loko o nā lā mua o ke ola, ʻoiai e kali paha kekahi i nā hebedoma he nui a hiki i ko lākou kūpaʻa ʻana. E kau mua ka hui lapaʻau i ke kākoʻo ʻana i ka hanu a me ke olakino holoʻokoʻa ma mua o ka hoʻomau ʻana i ka ʻoki ʻana e hoʻoponopono i ka diaphragm.