Ukuthini i-Congenital Diaphragmatic Hernia? Izimpawu, Izimbangela, Nokwelapha

I-Congenital diaphragmatic hernia (CDH) iwukonakala lokufana ezelweni lapho kukhona khona isikhala esivaliweyo esiswini, umsipha osikhuza siphefumule. Lesi sikhala sivumela izitho zesisu ukuba zifikele ehlombe, okwenza kube nzima kubantwana ukuphefumula.

Cabanga ngesiswini sakho njengodonga oluqinile oluhlukanisa isifuba nesisu. Uma lodonga lunekhala, izitho ezifana nesisu noma amabele zingangena endaweni lapho kufanele kube khona khona amaphaphu. Lesi simo sithinta cishe umntwana oyedwa ku-2,500 kuya ku-3,000 abazalwayo.

Ziyini izimpawu ze-congenital diaphragmatic hernia?

Abantwana abaningi abane-CDH babonisa ukuphefumula okunzima ngokushesha ngemva kokuzalwa. Izimpawu zingaba ezincinci kuya kwezinkulu, kuye ngokuthi izitho ezihambile zithatha indawo engakanani ehlombe.

Nazi izimpawu eziphambili ongazibona:

• Ukuphefumula okusheshayo, okunzima noma ukuphefumula okunzima
• Umbala oluhlaza okwesibhakabhaka noma oluhlaza okwesiliva, ikakhulukazi ezindebeni nasezinzipeni
• Izinga lokugijima lenhliziyo elikhulu kakhulu
• Isifuba esinobukhulu besibhakabhaka esibukeka siqonde kakhulu
• Isisu esibukeka sisontekile noma esiqondile
• Imisindo yokuphumula ephansi ngakwesinye uhlangothi lwesifuba

Abanye abantwana bangaba nezinkinga zokudla noma babukeke bekhungathekile kakhulu. Kwezinye izimo ezingavamile, i-CDH ephansi ingase ingabangeli zimpawu eziphawulekayo kuze kube kamuva ebuntwaneni, lapho umntwana engaba nezifo zokuphefumula noma izinkinga zokugaya.

Ziyini izinhlobo ze-congenital diaphragmatic hernia?

I-CDH iza ngezinhlobo eziningi ezahlukene, kuye ngokuthi isikhala siphi esiswini. Uhlobo oluvamile kakhulu lubizwa ngokuthi i-Bochdalek hernia, eyenzeka ngemuva nangakwesinye uhlangothi lwesisu.

Izinhlobo eziphambili zihlanganisa:

• I-Bochdalek hernia: Yenza cishe u-85-90% yezimo, ngokuvamile ivela ngakwesobunxele
• I-Morgagni hernia: Ivela phambi kwesiswini, ayivamile kodwa ngokuvamile iphansi
• I-Central diaphragmatic hernia: Ayivamile kakhulu, ivela ebukhoneni besisu
• I-Eventration: Umusipha wesisu unqunu futhi ubuthakathaka kunokuba unekhala

Ama-hernia avela ngakwesobunxele avame ukuba nzima kakhulu ngoba avame ukubandakanya izitho eziningi eziya ehlombe. Ama-hernia avela ngakwesokudla awavamile kodwa angasabangela izinkinga zokuphefumula ezinkulu.

Yini ebangela i-congenital diaphragmatic hernia?

I-CDH iyenzeka lapho isisu singakhiwa ngokuphelele ngesikhathi sokukhulelwa. Lokhu kwenzeka phakathi kwamasonto angu-8 nangu-12 okukhulelwa, lapho izitho zomntwana wakho zisathuthuka.

Imbangela eqondile ayiqondakali ngokuphelele, kodwa abacwaningi bakholelwa ukuthi kungenzeka kube ukuxubana kwezinto zofuzo nezimo ezingaphandle. Ezimweni eziningi, ayikho imbangela ebonakalayo yokuthi kwenzekani, futhi akuyona into abazali abayenzile noma abangayenzanga.

Ezinye izinto ezingase zifake isandla zihlanganisa:

• Ukushintsha kwezinto zofuzo noma ukuguqulwa okubangela ukuthuthukiswa kwesiswini
• Ukungahambisani kwe-chromosomal njenge-trisomy 18 noma i-13
• Umlando womndeni we-CDH, nakuba lokhu kungavamile
• Imithi ethile ethathwe ngesikhathi sokukhulelwa
• Ukuqina kweswekile kwabameme noma ezinye izimo zempilo

Kubalulekile ukwazi ukuthi i-CDH iyenzeka ngokungahleliwe ezimweni eziningi. Ngisho noma unembele we-CDH, amathuba okuthi ube nomntwana omunye onalesi simo aphansi kakhulu.

Nini okufanele ubona udokotela nge-congenital diaphragmatic hernia?

I-CDH ngokuvamile ibonakala ngaphambi kokuzalwa ngokuhlolwa okuvamile kwe-ultrasound ngesikhathi sokukhulelwa, ngokuvamile cishe emasontweni angu-18-20. Udokotela wakho angase aphawule ukuthi izitho zibonakala zisesikhundleni esingalungile noma ukuthi amaphaphu omntwana abukeka emancane kunalokho okulindelekile.

Izivivinyo zokuxilonga zingafaka:

• I-ultrasound eningiliziwe ukubona indawo yezitho
• I-MRI yomntwana ukuze uthole izithombe ezininingi
• I-Amniocentesis ukuhlola izimo zofuzo
• I-X-ray yesifuba ngemva kokuzalwa ukuqinisekisa ukuxilongwa
• I-Echocardiogram ukuhlola umsebenzi wenhliziyo
• Izivivinyo zegazi ukuhlola amazinga oksijini

Ngezinye izikhathi i-CDH ayibonakali kuze kube ngemva kokuzalwa, ikakhulukazi ezimweni ezincane. Iqembu lakho lezokwelapha lizosebenzisa i-X-rays yesifuba nezinye izivivinyo zokuthola izithombe ukuqinisekisa ukuxilongwa nokucwangcisa ukwelashwa.

Yini ukwelashwa kwe-congenital diaphragmatic hernia?

Ukwelashwa kwe-CDH ngokuvamile kubandakanya ukuhlinzwa ukuze kulungiswe isisu, kodwa isikhathi siye ngesimo somntwana wakho. Iqembu lezokwelapha lizokuqala ligxile ekuzinziseni ukuphefumula nasekusekeleni amaphaphu ngaphambi kokuhlinzwa.

Izinyathelo zokuqala zokwelapha zihlanganisa:

• Ukusekelwa kokuphefumula ngomshini wokuphefumula
• Imithi yokusiza ngezinga lokucindezela kwegazi nomsebenzi wenhliziyo
• Ukudla nge-IV ngoba ukudla kungase kube nzima
• Ukuqapha endaweni ekhethekile yokunakekelwa kwabantwana abasanda kuzalwa

Ukulungiswa okuhlinzwayo ngokuvamile kwenzeka lapho umntwana wakho enesimo esiqinile, ngokuvamile phakathi nezinsuku ezimbalwa kuya kwamasonto ambalwa okuphila. Udokotela uzohambisa izitho ezihambile ebukhoneni futhi alungise ikhala esiswini. Ngezinye izikhathi kufanele kube khona iphethini uma ikhala likhulu.

Ukuphulukisa kuyahluka kuye ngokuthi isimo sibunzima kangakanani. Abanye abantwana bangadinga ukusekelwa kokuphefumula okuqhubekayo, kanti abanye baphulukisa ngokushesha. Iqembu lakho lezokwelapha lizosebenza eduze nawe ukuqapha intuthuko nokulungisa ukwelashwa njengoba kudingeka.

Unganakekela kanjani ekhaya ngesikhathi sokuphulukisa i-congenital diaphragmatic hernia?

Abantwana abaningi abane-CDH bazochitha amasonto noma izinyanga eziningi esibhedlela ngaphambi kokuba baye ekhaya. Uma usekhaya, kuzodingeka uqhubeke unakekela ngendlela ekhethekile ukuze usekele ukuphulukisa nokuthuthuka komntwana wakho.

Ukukhathalela ekhaya ngokuvamile kuhlanganisa:

• Ukulandela izikhathi zokudla nokuqapha ukwanda kobunzima
• Ukupha imithi ngokuqondile njengoba kuqokiwe
• Ukuqapha izindlela zokuphefumula namazinga oksijini uma kudingeka
• Ukuya emihlanganweni yokuqapha njalo
• Ukubuka izimpawu zezinkinga ezifana nobunzima bokuphumula noma izinkinga zokudla
• Ukupha ukusekelwa kokuthuthuka nokwelashwa komzimba njengoba kunconywe

Iqembu lakho lezokwelapha lizonika imiyalo eningiliziwe nezinto zokusekela. Unganqikazi ukubiza uma uqaphela noma yikuphi ukushintsha ekuphefumuleni komntwana wakho, ukudleni, noma isimo jikelele.

Kufanele ulungiselele kanjani umhlangano wakho nodokotela?

Ukuba ulungile ngemihlangano yezokwelapha kungakusiza ukuthi uthole okuningi emihlanganweni yakho futhi kuqinisekise ukuthi zonke izinkinga zakho zixazululwe. Bhala phansi imibuzo yakho ngaphambi kwesikhathi ukuze ungakhohlwa lutho olubalulekile.

Cabanga ngokulungiselela:

• Uhlu lwezimpawu zakho zamanje kanye nendlela ezaqala ngayo
• Imibuzo mayelana nezinketho zokwelapha nokuthi yini okulindelekile
• Ulwazi mayelana nomlando womndeni wezokwelapha
• Imithi yamanje kanye nezinga
• Ulwazi lwe-inshorensi nama-paperwork okudluliselwa
• Umuntu osekela ukukusiza ukuba ukhumbule ulwazi

Unganqikazi ukucela incazelo uma amagama ezokwelapha ekuphazamisa. Iqembu lakho lezokwelapha lifuna ukuqinisekisa ukuthi uyayiqonda ngokuphelele isimo somntwana wakho kanye nelenkaneli yokwelapha.

Yini okubalulekile mayelana ne-congenital diaphragmatic hernia?

I-CDH iwukonakala lokufana ezelweni olukhulu kodwa oluphulukiswayo oluthinta umsipha wesisu. Nakuba kudinga ukunakekelwa kwezokwelapha okukhethekile nokuhlinzwa, abantwana abaningi abane-CDH bayaqhubeka bephila impilo enempilo, evamile ngokwelashwa okufanele.

Into ebaluleke kakhulu okumele uyikhumbule ukuthi ukuxilongwa okusheshayo nokwelashwa kwenza umehluko omkhulu ezimpumelelweni. Uma i-CDH itholakala ngesikhathi sokukhulelwa, iqembu lakho lezokwelapha lingalungiselela ukubeletha nokunakekelwa okusheshayo. Ngokuthuthuka kwezobuchwepheshe bezobuchwepheshe nezinqubo zokuhlinzwa, ukubheka abantwana abane-CDH kuyaqhubeka kuphucuka.

Khumbula ukuthi yonke isimo ihlukile, futhi iqembu lakho lezokwelapha lizosebenza nawe ukwenza uhlelo lokwelapha oluhle kakhulu lesimo sakho esithile. Hlala uxhumene neqembu lakho lezokwelapha, buza imibuzo, futhi unganqikazi ukufuna ukusekelwa uma ulikhulu.

Imibuzo evamile ebuzwayo mayelana ne-congenital diaphragmatic hernia

Ingavinjelwa yini i-congenital diaphragmatic hernia?

Okwamanje, ayikho indlela eyaziwayo yokuvimbela i-CDH ngoba iyenzeka ngesikhathi sokuthuthukiswa komntwana. Ukuthatha amavithamini okukhulelwa, ukugwema izinto eziyingozi ngesikhathi sokukhulelwa, nokunakekelwa okuhle kokukhulelwa kunconywa njalo ngempilo yomntwana jikelele, kodwa lezi zinyathelo azivimbeli ngokuqondile i-CDH.

Iyini izinga lokuphila kwabantwana abane-CDH?

Izinga lokuphila le-CDH liye laphucuka kakhulu phakathi neminyaka futhi manje liphakathi kuka-70-90%, kuye ngokuthi isimo sibunzima kangakanani. Abantwana abane-CDH ephansi namaphaphu athuthukile banemiphumela emihle, kanti labo abanezimo ezinzima bangase bahlangabezane nezinselele ezengeziwe kodwa basenamathuba amahle okuphila ngokunakekelwa okufanele kwezokwelapha.

Ingabe umntwana wami uzodinga ukunakekelwa okuqhubekayo kwezokwelapha ngemva kokuhlinzwa kwe-CDH?

Abantwana abaningi bazodinga ukunakekelwa okuqondile okuqhubekayo ukuqapha umsebenzi wamaphaphu, ukukhula, nokuthuthuka. Abanye bangadinga ukwelashwa okwengeziwe kwezinkinga ezifana nokubuyela emuva kwesisu noma izinkinga zokuzwa. Noma kunjalo, abantwana abaningi abane-CDH bangabamba iqhaza emisebenzini evamile njengoba bekhula, kuhlanganise nezemidlalo nezinye imisebenzi yomzimba.

Ingabe i-CDH ingase iphinde ibe khona ekukhulelweni kwesikhathi esizayo?

Ubungozi bokuthi ube nomntwana omunye onale CDH buphansi kakhulu, ngokuvamile kungaphansi kuka-2%. Izimo eziningi ze-CDH ziyenzeka ngokungahleliwe futhi azidluliselwa. Noma kunjalo, uma kukhona izinto zofuzo ezihilelekile, udokotela wakho angase ancome ukwelulekwa kwezinto zofuzo ukuxoxa ngesimo sakho esithile nanoma yiziphi izinketho zokuhlola.

Ngesikhathi esingakanani ngemva kokuzalwa ukuhlinzwa kwe-CDH ngokuvamile kwenzeka?

Isikhathi sokuhlinzwa sihluka kuye ngesimo somntwana wakho. Abanye abantwana badinga ukuhlinzwa phakathi nezinsuku ezimbalwa zokuphila, kanti abanye bangase balinde amasonto ambalwa kuze kube yilapho beqinile. Iqembu lezokwelapha lizokuqala ligxile ekusekleni ukuphefumula nempilo jikelele ngaphambi kokuba liqhubeke nokuhlinzwa ukulungisa isisu.