Usana lwe-BRUE (Isiganeko esifutshane esisonjululwe esingachazwanga): Ukutshintsha koMbala ngesiquphe, ukutyhafa, okanye iApnea¶

Ukubukela usana olungaphantsi kweminyaka eyi-1 ubudala ngesiquphe kuyeka ukuphefumla, lujike lubhulowu okanye lube luthuthu, lube ngathi lunodoli okanye lugobe umqolo, luze luphinde luphole ngemizuzwana sesinye seziganeko ezoyikisayo ezinokubonwa ngumzali okanye umkhathaleli. Kwiyeza elingxamisekileyo labantwana, xa usana olungaphantsi kweenyanga ze-12 lufumana isiganeko ngokukhawuleza esingaphantsi kwemizuzu ye-1 ebandakanya i-cyanosis okanye i-pallor, ukungabikho okanye ukuphefumula okungaqhelekanga, utshintsho oluphawulweyo kwithoni ye-muscle, okanye ukuphendula okutshintshileyo okusombulula ngokupheleleyo kwisiseko ngaphandle kwesizathu esicacileyo, oogqirha bahlula njengeSiganeko esiSicombululo esifutshane BRUE). Nokuba umntwana wakho ujongeka i-100 yeepesenti ephaphile, epinki, kwaye evuya ngelixa uthatha ifowuni, yonke isiqendu esingachazwanga kwimveku engaphantsi kweminyaka eyi-1 ubudala ifuna uvavanyo lonyango olukhawulezileyo ngokufowunela indawo yakho. amanani kaxakeka (911 eUnited States naseKhanada, 112 kulo lonke elase-European Union, 999 e-United Kingdom) okanye ukuya ngqo kwisebe likaxakeka labantwana. Into ekhangeleka ngathi kukunqumama okungeyongozi kwemizuzwana engama-20 inokuba luphawu lokuqala lwesilumkiso lwe-apneic pertussis (ukhohlokhohlo olukhohlelayo), intsholongwane yokuphefumla ye-sycytial (RSV), i-arrhythmia ye-cardiac efana ne-Long QT Syndrome, isifo somzimba wokuzalwa, okanye i-laryngospasm, kwaye kufuneka ukwazi ukwenza CPR yabantwana kunye nosana kunye nokuminxeka hlangula kwaye uhlukanise usana BRUE ukusuka kwintsana ukubamba umoya kunye ne-apnea yomntwana okanye umkhuhlane weentsana ophezulu kunye nokuxhuzula kwe-febrile.

Yenza oku ngoku¶

1. Beka umcaba wosana kwicala labo kwindawo eqinileyo kwaye ujonge indlela yomoya kunye nokuphefumla kwangoko. Musa ukubamba usana oluqhwalelayo okanye olungaphenduliyo eme nkqo egxalabeni lakho, kuba ukuma okuthe nkqo kukhupha igazi kwi-brainstem kwaye kuvumela intloko yefloppy ukuba igibele isilevu ukuya esifubeni, icinezela uqhoqhoqho othambileyo uvale. Lalisa umntwana ngecala lakhe (indawo yokuchacha kwemveku) kumatrasi oqinileyo, emgangathweni, okanye kwitafile yokutshintsha ukuze naluphi na ubisi oluxutyiweyo okanye umfinya uphume emlonyeni kunokuba ungene emiphungeni.
2. Faka uvuselelo oluqinileyo lwe-tactile imizuzwana emi-5 ukuya kweyi-10 (ungaze umshukumise umntwana). Hlikihla ngokukhawuleza umqolo okanye ithambo lomntwana (sternum) Ungaze uvuse usana ngapha nangapha ukuze uluvuse, njengokungcangcazela kweenyembezi ezithambileyo ezivala imithambo engaphakathi kukhakhayi kwaye kubangela ukopha okubulalayo ebuchotsheni.
3. Qalisa iCPR yosana okanye ukukrwitsha ngokukhawuleza ukuba umntwana akaphefumli okanye akaphenduli kwimizuzwana eyi-10. Beka ifowuni yakho kwisithethi ukuze ufowunele inombolo yakho yexesha likaxakeka (911 eUnited States naseKhanada, 112 kwi-European Union, 999 eUnited Kingdom). Ukuba usana luthe cwaka kwaye alukwazi ukuphefumla kanye emva kokuncancisa okanye ukugquma ulwelo olungqindilili, nikezela izibetho ezi-5 zomqolo wosana (ukuxhasa umhlathi nesifuba ecaleni komphambili wakho ngentloko esezantsi kunomvambo) kulandele iminwe emi-5 yokutyhala esifubeni; ukuba umntwana akaphenduli ngaphandle kokuphefumla okuqhelekileyo kwaye akukho nto ecacileyo yokukhahlela, qalisa ** I-CPR yomntwana kwii-30 zesifuba sokunyanzeliswa kwesifuba ukuya kwi-2 imfucumfucu epholileyo yomoya ** (okanye i-15: 2 ukuba ngaba abahlanguli ababini abaqeqeshiweyo bakhona), ukucinezela i-4 centimeters (1.5 intshi) enzulu embindini wesifuba ngaphantsi nje komgca wengono kwi-10 ukuya kwi-10 ngomzuzu.
4. Jonga iwotshi yakho okanye iwotshi yefowuni kwaye uphawule elona xesha lichanekileyo kunye neenkcukacha ezine zekliniki. Oogqirha kwigumbi likaxakeka baxhomekeke kumbono wakho owazibonela ngawakhe amehlo ukuba baluhlele usana njengoMngcipheko oPhantsi okanye uMngcipheko oMkhulu. BRUE. Ngengqondo zitshixe okanye ubhale phantsi: (a) mingaphi imizuzwana eye yathatha isiganeko, (b) owona mbala wemilebe, ulwimi nowobuso (oblowu/mfusa, omhlophe/ongwevu, okanye obomvu oqaqambileyo), © ingaba umzimba wosana uye waphaphatheka ngokupheleleyo ©hypotonia) okanye iqinile kwaye i-arched (hypertonia), kunye (d) nento eyenziwa lusana kwimizuzu emi-5 ngaphambi kwesiganeko (ukulala iflethi, ukuhlala kwisihlalo semoto, ukutyisa, ukutshica, okanye ukukhala).
5. Yiya kwisebe likaxakeka ngokukhawuleza nokuba usana lukhangeleka luqhelekile ngokwe-100 ekhulwini ngoku. Musa ukulubuyisela usana ukuba lulale ekhaya kwaye ulinde idinga logqirha wabantwana kusasa. Kwiimveku ezingaphantsi kweenyanga ezili-12 (kwaye ingakumbi iintsana ezingaphantsi kweentsuku ezingama-60 ubudala okanye ezizalwe ngaphambi kwexesha phambi kweeveki ezingama-32 zokumitha), ukunqumama kwemizuzwana engama-30 yokuphuncuka komphefumlo kudla ngokuba sisiganeko esandulela isibini, ixesha elide, esibeka ubomi esichengeni sokubanjwa kwentliziyo emva kweeyure ezimbalwa emva kobuthongo obunzulu.
6. Fota ngqo indawo yokulala okanye yokutya kwaye uzise ifomula yomntwana, amayeza, kunye noluhlu lomnakekeli esibhedlele. Phambi kokuba uhambe okanye ngelixa omnye umntu omdala epakisha, thatha ifoto ekhawulezayo ye-smartphone apho umntwana ebelele khona (i-crib, i-bassinet, umntu olalayo, isihlalo semoto, okanye ibhedi yabantu abadala) kwaye uzise naziphi na iitoti ezivulekileyo zefomula, i-vitamin drops, i-herbal teething kunye ne-herbal teething i-gels ekhuselekileyo kunye ne-herbal-colding amayeza anokwenza uphicotho lwe-toxicology.

Umthi wesigqibo: Ukutshintsha kombala wosana ngesiquphe, ukunqumama ukuphefumla, okanye ukuqhwalela¶

flowchart TD
    A["Usana olungaphantsi kweenyanga ezili-12 luyayeka ukuphefumla ngesiquphe, lujike lube luhlaza/luthuthu, okanye luqhwalele/luqine"] --> B{"Lala caba kwicala + rub sternum / flick soles for 5 ukuya 10 sec. Ngaba ukuphefumla kuyabuya?"}
    B -->|"Hayi:Ayiphenduli kwaye ayiphefumli ngokuqhelekileyo"| C["Tsalela umnxeba ku-911/112/999 kwisithethi ngoko nangoko"]
    C --> D{"Ngaba isiqendu saqala ngokuminxeka/ukugawula ubisi okanye ngento?"}
    D -->|"Ikho: Umoya uvaliwe"| E["Yenza izibetho ezi-5 zangasemva + ezi-5 zesifuba; phinda ude uphume umoya okanye uqale iCPR ukuba ayiphenduli"]
    D -->|"Hayi: Ukunqumama okuphakathi okanye ukuqhwalela"| F["Qala i-CPR yomntwana: i-30 yesifuba soxinzelelo (4 cm / 1.5 enzulu, i-100 ukuya kwi-120 / min) + 2 ukuphefumula"]
    B -->|"Ewe: Usana luyachacha kwimizuzwana engama-60 kwaye lubuyela kwisiseko sesiqhelo"| G{"Ngaba umntwana unalo uphawu olusebenzayo ngoku? (Umkhuhlane, ukuncwina, ukugabha okuphindaphindiweyo, i-stridor, ukutyhafa)"}
    G -->|"Ikho: Ayichazwanga"| H["Uvavanyo olukhawulezileyo lweSebe eliNgxamisekileyo lokugula okusebenzayo (i-Sepsis, i-RSV, i-Pertussis, i-Aspiration, i-Sepsis)"]
    G -->|"Hayi: Umntwana ukhangeleka nge-100% eqhelekileyo kwisiseko (Inokwenzeka I-BRUE)"| I{"Jonga i-AAP High-Risk BRUE Criteria (Nayiphi na i-1 ekhoyo?)"}
    I -->|"Ubudala <= Iintsuku ezingama-60 OKANYE Ngaphambi kwexesha < 32 iiveki (< 45 iiveki zilungisiwe) OKANYE Ubude bexesha >= 1 min OKANYE Phinda iziganeko OKANYE i-CPR efunekayo"| J["UMNGCIPHEKO OMKHULU: UThutho oluNgxamisekileyo lweSebe eliNgxamisekileyo + Ukungeniswa kwesigulana + i-oximetry eqhubekayo, iPertussis/RSV PCR, 12-lead ECG, Sepsis/Metabolic screen"]
    I -->|"Ubudala > iintsuku ze-60 ukuya kwi-12 mos KUNYE Ixesha elipheleleyo >= iiveki ezingama-32 KUNYE nesiganeko sokuqala < 1 min KUNYE Akukho CPR efunekayo KUNYE noviwo oluQhelekileyo"| K["UMNGCIPHEKO OPHANTSI: Uvavanyo olungxamisekileyo lweSebe eliNgxamisekileyo + i-1 ukuya kwi-4 hr eqhubekayo ye-pulse oximetry, i-ECG ehamba phambili ye-12, uvavanyo lwe-Pertussis, i-Safe-Sleep Audit, kunye ne-24-hr yokulandela ugqirha wabantwana"]

Iikhrayitheriya zonyango: Yintoni echaza i-BRUE kwaye kutheni ithathe indawo ye-ALTE¶

Kwiminyaka engamashumi amathathu ngaphambi kwe-2016, oogqirha babantwana basebenzisa i-amburela ebanzi i-acronym ALTE (Isigigaba Esibonakalayo Esisongela Ubomi) ukuchaza nasiphi na isiganeko esothusayo kwimveku esenza umkhathaleli woyike ukuba usana luya kufa. Uphando lweklinikhi luye lwangqina oko ALTE yayingachanekanga ngendlela eyingozi: yayidibanisa iintsana ezazisagula kwigumbi likaxakeka kunye neentsana ezazichache ngokupheleleyo, kwaye yayixhomekeke kwiqondo lomnakekeli elizimeleyo endaweni yokumakisha okujoliswe kuko ngokwasemzimbeni. Kwi-2016 (kwaye yaqiniswa kwizikhokelo zabantwana zamazwe ngamazwe ezilandelayo), i- American Academy of Pediatrics (AAP) ulirholile ixesha ALTE kwaye yaseka uxilongo olungqongqo, olunenjongo ye BRUE (Isiganeko esifutshane esisonjululwe esingachazwanga).

Iintsika ezi-4 ezinyanzelekileyo zokuxilongwa kwe-BRUE¶

Ugqirha uya kuhlela isiqendu sosana njenge BRUE kuphela ukuba umntwana u-ngaphantsi kweenyanga ezili-12 (unyaka o-1) ubudala* kwaye isiqendu sanelisa zonke ezine zezi ntsika zokuxilonga zilandelayo:

1. Okufutshane (Ubude bexesha ngaphantsi kwemizuzwana engama-60): Isiqendu esingaqhelekanga siphela sithathe ngaphantsi komzuzu omnye (eyona nyani iyinyani BRUE iziqendu zihlala phakathi kwe-10 kunye ne-45 imizuzwana). Ukuba isiqendu sahlala ** 1 umzuzu (imizuzwana engama-60) okanye ngaphezulu **, idlula umda omfutshane kwaye ifakwe ngokuzenzekelayo kwi- ** High-Risk ** indlela yokuxilonga.
2. Isonjululwe (ipesenti ezili-100 zibuyela kwisiseko): Ngexesha usana lufika kuvavanyo lwezonyango, usana lubuyele ngokupheleleyo kwimeko yalo yesiqhelo yempilo. Ukubetha kwentliziyo, ukuphefumla, ukugcwala kweoksijini, ubushushu, ukutofela kolusu, ithoni yemisipha, nokujongana kwamehlo zimele zibe yinto eqhelekileyo ngokupheleleyo. Ukuba umntwana uhlala eyozela, ediniwe, e-tachypneic (ephefumla ngokukhawuleza), enomkhuhlane, okanye ecaphuka, eso siganeko asisonjululwanga. BRUE, yimeko engxamisekileyo yonyango efuna ukuvuselelwa ngokukhawuleza kunye nokusebenza okujoliswe kuyo.
3. Iphawulwe ubuncinane yi-1 ye-4 yotshintsho lwenjongo ethile:
4. Central cyanosis okanye pallor: Umbala oluhlaza okwesibhakabhaka, omfusa, omnyama omnyama, okanye ukutshintsha kombala omhlophe/uthuthu obandakanya imilebe, ulwimi, iintsini, ubuso, okanye umboko osembindini. (Izandla neenyawo eziluhlaza ezingeyongozi xa zipholile, ezaziwa ngokuba yi acrocyanosis, okanye ububomvu bexeshana emlonyeni ngelixa ulila okanye ukhupha isitulo *akufanelanga BRUE).
5. Ukungabikho, ukuncipha, okanye ukuphefumla ngokungaqhelekanga: Ukunqumama okukwenyani ekuphefumleni (apnea), ukuphefumla okungenzulu, okanye ukuminxeka ngequbuliso/ukuzabalazela ukufumana umoya. (Isiqhelo esandula ukuzalwa ukuphefumla ngamaxesha, apho usana oluleleyo luphefumla ngokukhawuleza okuphindaphindiweyo lulandelwa kukunqumama kwemizuzwana emi-5 ukuya kweye-10 ngelixa luhlala lupinki ngokupheleleyo, yiphysiology eqhelekileyo kwaye ayisiyiyo BRUE).
6. ** Utshintsho oluphawulweyo kwithoni yemisipha (hypotonia okanye hypertonia):** Usana lukhawuleza luqhwalele kwaye iRagdoll-floppy (hypotonia) okanye ngokukhawuleza uqina ngemilenze eqinile kunye ne-arched back (hypertonia okanye opisthotonos).
7. Inqanaba elitshintshileyo lokusabela: Usana lukhawuleza lungaphenduli kwilizwi naxa luphathwa, lujonge lungakhange lube namehlo eglasi, okanye lulahlekelwe zingqondo.
8. ** Ukungachazwanga emva kwembali kunye nokuhlolwa komzimba: ** Emva kokuba ugqirha ophuthumayo ethatha imbali ecacileyo kwaye ahlolisise umntwana ukusuka entloko ukuya enzwaneni, akukho sizathu esicacileyo esicacileyo. Umzekelo, ukuba usana olunobushushu obungama-39.2 degrees Fahrenheit (102.6 degrees Fahrenheit) kunye nesifuba esibambekayo sinqumama ukuphefumla, ukuxilongwa yintsholongwane ye-bronchiolitis okanye i-sepsis, hayi into engachazwanga. BRUE.

Itheyibhile yothelekiso: UMngcipheko oPhantsi we-BRUE vs. UMngcipheko oPhezulu we-BRUE vs. IiMimics ezingezizo eze-BRUE¶

Ukuqonda ukuba ngaba umntwana wakho uwela kwi-Low-Risk BRUE* okanye ** uMngcipheko omkhulu BRUE** udidi lukuxelela kanye ukuba zeziphi iimvavanyo kunye nokuqwalaselwa kwesibhedlele iqela likaxakeka eliya kukwenza. Ukuba usana luphosa nakunye lwendlela yoMngcipheko oPhantsi, zihlelwa njenge UMngcipheko omKhulu BRUE.

Izizathu ezifihliweyo ezisongela ubomi zihlolwe kwi-High-Risk BRUE¶

Kutheni oogqirha bengxamiseko bagxininisa ekuvumeni i-High-Risk BRUE iintsana (ezinjengalo naluphi na usana olungaphantsi kweentsuku ezingama-60 ubudala okanye naluphi na usana oluye lwesibini) ukuya esibhedlele naxa umntwana encumile kwaye esela ibhotile kwigumbi likaxakeka? Kuba kwiintsana eziselula ezinenkqubo ye-nervous autonomic engekakhuli, iimeko ezisixhenxe ezibeka ubomi esichengeni zihlala zibakho nge ** cwaka, i-apnea ekwanti okanye ukupela njengophawu lokuqala** phambi kokuba kuvele iimpawu zakudala ezifana nomkhuhlane okanye ukukhohlela.

1. ILaryngospasm kunye neLaryngeal Chemoreflex (LCR) ukusuka kwi-reflux¶

Kubantwana abadala kunye nabantu abadala, ukuba ithontsi le-asidi yesisu okanye amathe achukumisa iintambo zezwi (larynx), i-brainstem ibangela ukhohlokhohlo olunobundlobongela ukususa indlela yomoya. Kwiintsana ezisanda kuzalwa kunye neentsana ezingaphantsi kwe-4 ukuya kwiinyanga ze-6 ubudala, nangona kunjalo, i-nerve ephezulu ye-laryngeal ibangela indlela yokusinda yomntwana ebizwa ngokuba yi-Laryngeal Chemoreflex.LCR) (eyenzelwe ukunqanda imveku ekusezeleni iamniotic fluid esibelekweni). Xa ithontsi elincinane lobisi oluxutyiweyo okanye iasidi ecocekileyo yesisu ifika buthe cwaka emva komqala wosana, imithambo yelizwi ivaleka ngci***, i-laryngospasm egcweleyo*, ukuphefumla kombindi wobuchopho kuyanqumama, kunye nemithambo-luvo yevagus ithoba izinga lokubetha kwentliziyo.bradycardia).

• Okubonwa ngabazali ngexesha lexesha LCR I-spell: Isiqendu senzeke ngelixa usana lulele phantsi ngomqolo **15 ukuya kwimizuzu engama-60 emva kokutyisa ** (okanye kanye emva kokubhoboza okumanzi). Usana ngokukhawuleza luqina, lugobe umqolo walo, luvule amehlo luphangalele luloyiko, lukhuphe umlomo othuleyo okanye lushukume isifuba nge-*-zero sound **, lujike lubomvu bubomvu, luze luzukise imilebe, luze ekugqibeleni lukhuphe i-squeak ephezulu (inspiratory stridor) emva kwemizuzwana engama-20 ukuya kwengama-45 njengoko iintambo zezwi ziphumla.
• Ungenelelo olukhawulezileyo olusecaleni kwebhedi: Jika usana lulubeke kwicala lalo okanye ulubambe lume nkqo kwi-engile ye-45-degree kwisifuba sakho, lufunxe ngobunono ubisi olubonakalayo oluphuma ezimpumlweni ngesirinji yebhalbhu ethambileyo (kuba iintsana ezingaphantsi kweenyanga ezi-4 zibophelelekile ukuphefumla ngeempumlo), kwaye zivuthele umoya opholileyo esidleleni. Ungaze unyanzelise umnwe emqaleni.

2. I-Apneic pertussis (ukhohlokhohlo) kunye ne-RSV bronchiolitis¶

Abazali balindele umntwana one-pertussis (Bordetella pertussis) okanye Intsholongwane yokuphefumla yeSyncytial (RSV) ukuba nokhohlokhohlo olungxolayo okanye umkhuhlane. Kwiintsana ezingaphantsi kweenyanga ezi-3 ubudala, olo cinga lunokubulala:

• I-apnea phambi kokhohlokhohlo: Ukuya kuthi ga kwi-50 pesenti yabantwana abasandul' ukuzala kunye neentsana ezincinci ezingaphantsi kweeveki ezisi-8 ezifumana ukosuleleka. RSV okanye i-pertussis evela kumntakwenu omdala okanye omdala onomoya opholileyo "ocaphukisayo," ** i-apnea ephakathi ngequbuliso (ukuyeka ukuphefumla imizuzwana engama-20 ukuya kwe-60 kwaye ujike ube luhlaza okwesibhakabhaka) luphawu lokuqala lwekliniki **, olwenzeka ** iiyure ezingama-24 ukuya kwezingama-48 ngaphambi kokukhohlela, ukuxinana, okanye umkhuhlane.
• Ukungabikho kwe "whuu": Iintsana ezincinci azinawo amandla odonga lwesifuba ukwenza isandi esikhuthazayo esithi "whuuuu" sokhohlokhohlo. Endaweni yoko, bathe cwaka kufinya oluncangathi lwemicroscopic yomoya, badinwe, banqumame ukuphefumla, kwaye baphuhlise ibradycardia enzulu. Ngenxa yokuba usana olune-apneic pertussis yokuqala okanye RSV inokubukeka iqhelekile ngokupheleleyo phakathi kokupela kwangaphambili kwaye emva koko uyeke ukuphefumla ngokusisigxina ngexesha lokulala olunzulu kwiiyure ze-6 kamva, amasebe angxamisekileyo enza i-nasopharyngeal PCR swabs for Pertussis kunye RSV kwaye ugcine iintsana ezincinci kwi-pulse oximetry eqhubekayo kunye neemonitha ze-apnea.

3. I-Channelopathies ye-Cardiac (i-Long QT Syndrome, i-WPW, kunye neziphene ezixhomekeke kwi-ductal)¶

Isehlo sequbuliso apho usana lujika lube mhlophe, ngwevu, okanye luthuthu (pallor)** kwaye uyaqhwalela njenge ragdoll udla ngokuba yintliziyo okanye ivagal kunokuphefumla. Lonke usana luvavanyelwe a BRUE (zombini uMngcipheko oPhantsi kunye noMngcipheko oMkhulu) kufuneka bafumane 12-lead electrocardiogram (ECG):

• I-Congenital Long QT Syndrome (LQTS) kunye neBrugada Syndrome: Iziphene ze-ion-channel zemfuza kwinkqubo yombane yentliziyo zinokubangela ukuba kubekho imijikelo emfutshane, ephelisa i-polymorphic ventricular tachycardia (torsades de pointes). Ngexesha le-20-yesibini yokugijima kwe-arrhythmia, i-cardiac output iyancipha ukuya kwi-zero, iguqula umntwana ophuzi kwaye uqhwale; ukuba isingqisho sibuyela ngokuzenzekelayo kwisigqi esiqhelekileyo se-sinus, umntwana uvuka ekhangeleka kakuhle, de ubaleke emva koko ubangele ukubanjwa kwentliziyo ngokukhawuleza (SIDS).
• Wolff-Parkinson-White (WPWkunye neTachycardia ye-Supraventricular (SVT): Iintsana ezinesixhobo sombane entliziyweni zinokutsibela kwisantya sentliziyo 240 ukuya kuma-300 ebetha ngomzuzu, nto leyo ebangela ukuba luthuthuzele ngesiquphe, ulusu olunamabala, ukungondleki kakuhle, okanye i-syncope emfutshane.
• Unikezelo lwamva nje lwesifo sentliziyo esixhomekeke kwi-ductal okanye ALCAPA: Iimeko ezifana nokuqhawuka kwe-aorta okanye umthambo wegazi ongaqhelekanga osekhohlo osuka kumthambo we-pulmonary (ALCAPA) kunokubangela ukukhala ngesiquphe, ukubila, ukuntsundu, kunye nokuqhwalela ngexesha lokutya.

4. Ukuxhuzula okufihlakeleyo komntwana osandul’ ukusandul’ ukuzalwa kunye nosana (kubandakanywa ne-Infantile Spasms)¶

Ngokungafaniyo nabantwana abadala abanokuxhuzula okungcangcazelisayo okuqhelekileyo, iintsana ezingaphantsi kweenyanga ezi-6 zine-myelination engaphelelanga yeendlela zazo ze-cerebral cortex. Ngenxa yoko, ukubanjwa kokuxhuzula kuqala kwimimandla yethutyana okanye yengqondo ihlala ibonakalisa izinto ezizimele geqe okanye ezifihlakeleyo:

• I-Apneic seizures: Usana luyekile ukuphefumla ngesiquphe, lujonge kwelinye icala ngamehlo anjengeglasi, lwenze ukubetha imilebe okunesingqi, ukutyhalana ngolwimi, okanye ukushukuma ngebhayisekile emilenzeni, luze lujike lube luhlaza okwesibhakabhaka kangangemizuzwana engama-30 ukuya kuma-60.
• Ii-Infantile Spasms (West Syndrome): Iqala ngokuqhelekileyo phakathi kwe-3 kunye neenyanga ezisi-8 ubudala, ngokuqhelekileyo kanye njengoko usana luvuka okanye lulala, usana luba nexesha elifutshane, i-1-to-2-second jackknife flexible okanye ukuqina kwentamo, umboko, kunye neengalo rhoqo, rhoqo ngempazamo kwimizuzwana emi-5. "i-reflux cramps" okanye ukupela okothusayo. Ukurekhodwa kwevidiyo kwangoko ngabazali kunye ne-electroencephalogram ye-neurology engxamisekileyo (EEG) zibalulekile ukuthintela ukuhlehla okusisigxina kophuhliso.

5. Iimpazamo ezizalwayo ze-metabolism kunye ne-hypoglycemia¶

Iziphazamiso ezinqabileyo zokuzalwa (ezifana ne-*Medium-Chain Acyl-CoA Dehydrogenase Deficiency [MCADD]**, i-fatty acid oxidation defects, urea cycle disorders, kunye ne-organic acidemias) ikhusela usana ekuguquleni amanqatha agciniweyo kwi-glucose xa ezila ukutya phakathi kokutya. Ukuba usana lulala ixesha elide kancinane kunesiqhelo okanye londla kakubi, iswekile yegazi yalo iyehla okanye iammonia enetyhefu iyaqokelelana, nto leyo ebangela ukopha ngequbuliso, ukuqhwalela, ukuphefumla, okanye ukungaphenduli. Ukujonga ibhedi ekhawulezayo ** i-capillary blood glucose **, igesi yegazi, i-electrolytes, kunye ne-lactate kwisebe likaxakeka ngokukhawuleza ichonga iingxaki ze-metabolic.

6. Intsholongwane ebugqi, i-meningitis, usulelo lomchamo, kunye ne-botulism yeentsana¶

Kwiimveku ezingaphantsi kweentsuku ezingama-60 ubudala, usulelo olumandundu lwebhaktiriya (njengosulelo lomjelo womchamo, i-Streptococcus yokuqala yeQela B okanye i-E. coli bacteremia, okanye i-meningitis yokuqala) isoloko ibangela i-hypothermia (ubushushu be-rectal obungaphantsi kwama-36.0 degrees celcius / 96.8 degrees Fahrenheit) okanye ukupela ngaphandle kokulala ngequbuliso. Ngokufanayo, kwangethuba i-botulism yomntwana ukusuka ekuginyweni kwespores zothuli olusingqongileyo kubangela ukuba buthathaka kwemithambo-luvo ye-cranial, i-gag reflex engalunganga, ukuhlangana kwamathe, kunye ne-spea ephazamisayo ye-apnea.

7. Ukwenzakala okungeyongozi (i-Abusive Head Trauma) kunye nokutyhefwa ngengozi¶

Izifundo zeklinikhi zaphononongwa yi AAP bonisa ukuba phakathi kwe-1 kunye ne-3 yeepesenti zeentsana ezibonisa uMngcipheko oPhezulu okanye oqhelekileyo BRUE babe nesiseko i-abusive head trauma (i-shaken baby syndrome) kunye ne-occult subdural hematomas ezibangela i-brainstem apnea ephakathi, nangona kungekho mikrwelo yangaphandle kwi-scalp. Oogqirha ke ngoko benza uhlolo olululo lwentloko ukuya ezinzwaneni, jonga i-fontanelle yangaphambili (indawo ethambileyo) ukuba idumbile, jonga ngaphakathi kumlebe ongentla ukuze ufumane i-labial frenulum ekrazukileyo, kunye nescreen sokuvezwa ngengozi kumayeza okuthomalalisa (njengamathontsi abandayo amdala, i-diphenhydramine, i-lidocaine ye-topical / i-benzolliciine i-methemoglobinemia, i-gelzocaine okanye i-benzocaine i-opioids / i-cannabis).

Ukulala okukhuselekileyo kunye nophicotho lokuphefumla emva kwe-BRUE¶

Uninzi lwekhefu lokuphefumla kweentsana kunye ne-cyanotic spells zibangelwa yi-positional obstructive asphyxiation*, eyenzekayo xa intloko enzima yomntwana ibhekela phambili.neck flexion) ngoko isilevu sazo sicinezela esifubeni, sikrazula uqhoqhoqho oluthambileyo nolunerhashalala (trachea) zivaliwe, okanye xa izibatha zokulala ezithambileyo zikhupha ikharbon diokside emathatheni abo. Ngelixa ulinde isithuthi sikaxakeka okanye kanye emva kokubuyela ekhaya usuka esibhedlele, yenza olu phengululo lupheleleyo Ukulala okuKhuselekileyo kunye noPhononongo lwendlela yomoya:

• Hlola iZitulo zeMoto, iiStrollers, iiBouncers, kunye neeInfant Swings: Ungaze uvumele usana ukuba luhlale lulele kwisitulo semoto xa lukhutshwe emotweni, kwaye ungaze usebenzise isitulo esityekeleyo, ujingi, okanye umqamelo wokonga njengendawo yesiqhelo yokulala. Xa isihlalo semoto sicofa kwisiseko saso esisezantsi ngaphakathi kwemoto, sihlala kwi-engile ekhuselekileyo yokuhla; xa ibekwe kumgangatho othe tyaba wegumbi lokuhlala, isihlalo sijonge phambili, sibangela ukuba intloko yosana olusanda kuzalwa ilale isilevu isiya esifubeni kwaye ivale indlela yomoya.positional asphyxia).
• Hlola iZilingi zoBantwana kunye nokuSonga ngelaphu elithambileyo: Kwiintsana ezingaphantsi kweenyanga ezi-4 ubudala ezithwelwe ngesilingi okanye ukuzisonga, soloko ulandela le T.I.C.K.S. umthetho: gcina umthwali Tight, In view ngamaxesha onke (ungaze ugqume ubuso bomntwana ngelaphu), Culahlekelwe ngokwaneleyo ukuncamisa umphezulu wentloko yosana, gcina isilevu somntwana Ksisuse isifuba (ubuncinane umnwe omnye omdala wobubanzi bendawo phantsi kwesilevu), kwaye ugcine umqolo wosana uxhome.**
• Hlola iCrib okanye iBassinet (ABCs Lokulala ngokuKhuselekileyo): Ngalo lonke ixesha lokulala (ulale kunye nasebusuku) kufuneka ibe Ayodwa, ibekwe mcaba phezu kwe-*B**ack (supine), kwi-firm, flat **C ** i-rib okanye i-bassinet mattress egqunywe kuphela ngeshiti elifakwe ngokuqinileyo. Susa yonke imiqamelo, ii-bumpers ezifakwe kwi-quilted, iingxowa zokulala ezinobunzima, i-DockATot-style lounger padded, izilwanyana ezixutywe, kunye neengubo ezivulekileyo.
• Ubushushu beGumbi loHlolo kunye nokuBanda kakhulu: Ukushisa ngokugqithiseleyo kwenza ingqondo yosana ivuselele ingqondo ngexesha le-hypoxia. Gcina igumbi lokulala liphakathi kwe-20 kunye ne-22.2 degrees celcius (68 kunye ne-72 degrees Fahrenheit)* kwaye unxibise usana ubukhulu becala elinye elibhityileyo ngaphezu kokuba umntu omdala anganxiba kakuhle (njenge-cotton onesie ephefumlayo ngaphakathi kwengxowa yokulala engakwazi ukuthwala, intloko ingagqunywanga).
• Hlola uMsi WaseKhaya Umsi oSendini kunye neVape Aerosol Exposure: Ukuchanabeka kwinikotini, umsi wecuba, okanye i-aerosols efunxayo kwimpahla yomkhathaleli yonakalisa i-chemoreceptors yosana oluzimeleyo lwengqondo, okonakalise kakhulu isakhono somntwana sokuphefumla nokuvuka xa ioksijini isihla (auto-resuscitation).

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

Ukuba usana lwakho lunekhefu lokuphefumla elingachazwanga, utshintsho lombala, okanye ukupela, fowunela inkonzo ye-ambulensi yelizwe likaxakeka ngokukhawuleza kwaye uxelele umthumeli ngobudala obuchanekileyo bomntwana kwiiveki okanye kwiinyanga:

• I-United States neKhanada: Fowunela 911 ngokukhawuleza kwiinkonzo zonyango olungxamisekileyo (EMS) uthutho olusiwa kwisebe elingxamisekileyo labantwana. Ukuvavanywa kwesibhedlele kulandela ** I-American Academy of Pediatrics (AAP)** kunye ** noMbutho waBantwana baseCanada (CPS)** BRUE izikhokelo zonyango. Ukuba ukrokrela ukungeniswa ngengozi kwento yasekhaya okanye iyeza, kwakhona ufowunele ** Ukulawulwa kwePoison kwi-1-800-222-1222 ** (US) okanye ** 1-844-764-7669 ** (Canada).
• United Kingdom: Fowunela 999 ngokukhawuleza kwi-ambulensi yongxamiseko ukuba usana luyekile ukuphefumla, lujike lube luhlaza okanye lube luhlaza, okanye luqhwalele, luthathe usana luse kweyona ikufutshane Ingozi neNgxamiseko yaBantwana (A&E) isebe. Uvavanyo lweklinikhi lulandela ** Iziko leSizwe lezeMpilo kunye nokuGqwesa kweNkathalelo (NICE)** kunye neKholeji yaseRoyal yeZifundo zaBantwana kunye neMpilo yoMntwana (RCPCH) ukutshona kwesiquphe okungalindelekanga emva kokubeleka (SUPC) kunye BRUE izikhokelo. Ngemibuzo elandelayo emva kokukhutshwa, fowunela NHS 111.
• I-European Union: Fowunela 112 kuwo onke amazwe angamalungu e-EU ukuze kuthunyelwe i-ambulensi yabantwana ngokukhawuleza. Iiprothokholi zeklinikhi zilandela iBhunga le-European Resuscitation Council (ERC) izikhokelo zokuxhasa ubomi obusisiseko kubantwana (ezichaza 5 ukuphefumla kokuqala kokuhlangula phambi kokuba uqalise ukunyanzeliswa kwesifuba kwi-15:2 ratio kubaboneleli abaqeqeshiweyo) kunye nabantwana besizwe. BRUE imigangatho.
• ** I-Australia kunye neNew Zealand: ** Shayela ** 000 ** e-Australia okanye ** 111 ** eNew Zealand ukuze ufumane impendulo ye-ambulensi ngokukhawuleza. Amasebe angxamisekileyo kubantwana alandela Uphando lwaBantwana kumaSebe aNgxamisekileyo kwiNtsebenziswano yaMazwe ngaMazwe (PREDICT) kunye neSibhedlele saBantwana saseRoyal (RCH) Melbourne izikhokelo zokuziqhelanisa nekliniki BRUE.
• ** I-Indiya kunye ne-Asia-Pacific: ** Fowuna ** 112 ** (inombolo yelizwe likaxakeka yaseIndiya), ** 995 ** (eSingapore), ** 119 ** (eJapan kunye noMzantsi Korea), okanye inombolo yakho kaxakeka yendawo (bona zonke amanani kaxakeka) kwaye baqhubele phambili kwisibhedlele senqanaba lesithathu elineYunithi yokuNceda abaNtwana abaKhulayo okanye kuBantwana (NICU/PICU).

Imibuzo ebuzwa qho¶

Kutheni le nto ubuso bomntwana wam osandul' ukuzalwa bujike bubomvu bube bomvu kwaye bunqumame ukuphefumla imizuzwana eli-10 ngelixa bencwina ukukhupha isisu? Ngaba yiBRUE leyo?¶

Akunjalo. Xa usana olusempilweni lutsala nzima ukuze lukhuphe ilindle okanye igesi (imeko yokukhula engathandekiyo ebizwa ngokuba yi-infant dyschezia), lunyamezela kumzila womoya ovaliweyo (i-Valsalva maneuver), edla ngokujika ubuso balo bube bomvu okanye bubomvu ngokungqombela luze luthi nqumama kancinane ukuphefumla kwalo kangangemizuzwana emi-5 ukuya kweli-10 ngoxa imilenze yalo itsala phezulu. Ngenxa yokuba unobangela yinzame eqhelekileyo yokuqina komzimba kwaye imilebe esembindini yosana kunye nolwimi aluze lujike lube luhlaza okanye lube mhlophe njengesiporho, iAmerican Academy of Pediatrics ayibandakanyi ngokucacileyo ububomvu obuqhelekileyo kunye nokuxinezeleka kwesitulo kwinkcazo ye-BRUE.

Izandla neenyawo zosana lwam zikhangeleka ziblukhwe kancinane xa ndisombulula iqhiya yalo, nangona liphefumla ngokuqhelekileyo. Ngaba ndibize inqwelo yezigulana?¶

Ukutshintsha kombala oluhlaza okulinganiselwe ngokungqongqo ezandleni, kwiminwe, ezinyaweni, nasezinzwaneni kusana olusandul’ ukuzalwa okanye usana oluselula lubizwa ngokuba yiacrocyanosis, kwaye asiyongozi, ukusabela okuqhelekileyo kwemithambo kumoya opholileyo njengoko imithambo yegazi emincinci ibambene ukugcina umbilini wosana ushushu. Ngalo lonke ixesha jonga imifinya yosana: jonga imilebe, ulwimi, iintsini kunye nesifuba esisembindini phantsi kokukhanya okulungileyo. Ukuba ulwimi kunye nemilebe ifudumele kwaye i-pink ekhanyayo kwaye umntwana uphefumla ngokukhululekile kwaye uqaphele, i-acrocyanosis engenabungozi; ukuba imilebe, ulwimi, okanye ubuso bujike bubhlowu, bumfusa, bubesithukuthezi, okanye bubemhlophe qhwa, yicyanosis esembindini kwaye ifuna umnxeba ongxamisekileyo ngoko nangoko.