I-BRUE Yosana (Isenzakalo Esifushane Esingachazwanga Esixazululwe Kafushane): Ukushintsha Kombala Ngokungazelelwe, Ukukhathala, noma I-Apnea¶

Ukubuka ingane engaphansi konyaka owodwa ngokuzumayo kuyeka ukuphefumula, ibe luhlaza okwesibhakabhaka noma iphaphatheke njengesipoki, ixhuga njengodoli we-rag noma igobe iqolo, bese ilulama ngemizuzwana kungesinye sezenzakalo ezisabisa kakhulu umzali noma umnakekeli angasibona. Emithini yezimo eziphuthumayo zezingane, lapho usana olungaphansi kwezinyanga eziyi-12 luba nesiqephu esingazelelwe esihlala isikhathi esingaphansi komzuzu ongu-1 esihlanganisa i-cyanosis noma i-pallor, ukungabikho noma ukuphefumula okungajwayelekile, ukuguquka okuphawulekayo kwethoni yemisipha, noma ukusabela okushintshile okuxazulula ngokuphelele ukubuyela esisekelweni ngaphandle kwesizathu esisobala, odokotela basihlukanisa njengesehlakalo esixazululwe kafushane BRUE). Ngisho noma ingane yakho ibonakala iqaphile ngamaphesenti angu-100, ibomvana, futhi ijabule ngesikhathi ubamba ucingo, sonke isiqephu esingachazwanga sosana oluneminyaka engu-1 ubudala sidinga ukuhlolwa kwezokwelapha ngokushesha ngokushayela indawo yangakini. izinombolo eziphuthumayo (911 e-United States naseCanada, 112 ngaphesheya kwe-European Union, 999 e-United Kingdom) noma ukuya ngqo emnyangweni wezimo eziphuthumayo zezingane. Okubukeka njengokuhlaba ikhefu kwemizuzwana engama-20 okungenangozi kungaba wuphawu lokuqala oluyisixwayiso lwe-apneic pertussis (ukukhwehlela), igciwane le-syncytial yokuphefumula (RSV), i-arrhythmia yenhliziyo efana ne-Long QT Syndrome, isifo se-congenital metabolic, noma i-laryngospasm, futhi kufanele wazi ukuthi kwenziwa kanjani i-CPR yezingane kanye nezinsana kanye nokuklinywa hlenga futhi uhlukanise usana BRUE kusukela encane Iziphonso zokubamba umoya kanye ne-apnea yezingane noma imfiva ephezulu yosana kanye nokuquleka kwe-febrile.

Yenza lokhu manje¶

1. Beka usana endaweni eqinile ohlangothini lwalo bese uhlola indlela yokuphefumula kanye nokuphefumula ngokushesha. Ungayibambi ingane exhugayo noma engaphenduli iqonde ehlombe lakho, ngoba ukuma okume mpo kukhipha igazi ku-brainstem futhi kuvumela ikhanda elithambile ukuba ligexeke liye esilevini liye esifubeni, licindezele uqhoqhoqho oluthambile. Lalisa ingane phansi ngohlangothi (indawo yokululama kwengane) kumatilasi oqinile, phansi, noma etafuleni elishintshayo ukuze noma yiluphi ubisi oluxutshwe kabusha noma amafinyila aphume emlonyeni kunokuba aye emaphashini.
2. Faka i-stimulation eqinile ye-tactile imizuzwana emi-5 kuya kweyi-10 (ungalokothi uyinyakazise ingane). Gcoba iqolo noma ithambo lengane ngokushesha (sternum), baqhwebe noma bachofoze ematheni ezinyawo zabo ezingenalutho, bese bevuthela umoya opholile esihlathini sabo ukuze baqalise i-reflex yokuphefumula engunxantathu. Ungalokothi unyakazise usana emuva naphambili ukuze uluvuse, njengoba ukuvevezela izinyembezi ezivala imithambo ethambile ngaphakathi kogebhezi futhi kubangela ukopha okubulalayo ebuchosheni.
3. Qala i-CPR yosana noma ukutakula okuklinyiweyo ngokushesha uma ingane ingaphefumuli noma ingaphenduli phakathi nemizuzwana eyi-10. Faka ifoni yakho esipikheni ukuze ushayele inombolo yakho yasendaweni yezimo eziphuthumayo (911 e-United States nase-Canada, 112 ngaphesheya kwe-European Union, 999 e-United Kingdom). Uma ingane ithule futhi ingakwazi ukuphefumula ngemva nje kokuncelisa noma ukuvala uketshezi oluwugqinsi, belethisa amagalelo amahlanu emuva kwengane (esekele umhlathi nesifuba eduze kwengalo yakho ikhanda libe phansi kunesinqe) kulandele iminwe emi-5 yesifuba esifubeni; uma ingane ingasabeli futhi ingaphefumuli okuvamile futhi ingekho ukuminyanisa okusobala, qala I-CPR yosana ekuminyanisweni kwesifuba okungu-30 ukuya ekuphefumuleni komoya oku-2 okuthambile (noma ngo-15:2 uma abatakuli ababili abaqeqeshiwe bekhona), icindezela amasentimitha angu-4 (1.5 amayintshi) ekujuleni maphakathi nesifuba ngezansi nje komugqa wengono0 kuya emikhawulweni engu-10 ngomzuzu ngamunye.
4. Bheka iwashi lakho noma iwashi locingo bese uphawula ubude besikhathi esiqondile kanye nemininingwane yomtholampilo emine. Odokotela abasegunjini lezimo eziphuthumayo bathembele ekuboneni kofakazi bokuzibonela ukuze bahlukanise umntwana njengeNgozi Encane noma Enobungozi obukhulu BRUE. Vala ngaphakathi noma ubhale phansi: (a) ukuthi umcimbi uthathe imizuzwana emingaki, (b) umbala oqondile wezindebe, ulimi, nobuso (oluhlaza okwesibhakabhaka/onsomi, omhlophe/ompunga oyisipoki, noma obomvu ngokugqamile), © ukuthi umzimba womntwana ubushelelezi ngokuphelele yini (hypotonia) noma iqinile futhi i-arched (hypertonia), kanye (d) nokuthi ingane yenzani emizuzwini emi-5 ngaphambi komcimbi (ifulethi lokulala, ihlezi esihlalweni semoto, imfunza, ikhafula, noma ikhala).
5. Yiya emnyangweni wezimo eziphuthumayo ngokushesha ngisho noma ingane ibukeka ijwayelekile ngamaphesenti angu-100 manje. Ungamphindiseli phansi ukuze alale ekhaya futhi ulinde ukubonana nodokotela wezingane ekuseni. Ezinsaneni ezingaphansi kwezinyanga ezingu-12 (ikakhulukazi izinsana ezingaphansi kwezinsuku ezingu-60 ubudala noma ezizalwe ngaphambi kwesikhathi ngaphambi kwamasonto angu-32 okukhulelwa), ukuphumula okuxazululiwe kwamasekhondi angu-30 ngokuvamile kuyisenzakalo somlindi owandulela isekhondi, isikhathi eside, esisongela ukuphila sokuboshwa kwenhliziyo ngemva kwamahora kamuva phakathi nokulala okujulile.
6. Thatha isithombe esiqondile indawo yokulala noma yokudla bese uletha ifomula yengane, imithi, nohlu lwabanakekeli esibhedlela. Ngaphambi kokuhamba noma ngenkathi omunye umuntu omdala epakisha, thwebula isithombe se-smartphone esisheshayo salapho ilele khona ingane (i-crib, i-bassinet, indawo yokulala, isihlalo semoto, noma umbhede wabantu abadala) futhi ulethe noma yimaphi amathini efomula avulekile, amaconsi kavithamini, imithi yokwelapha yasendlini epholile noma imithi ebandayo yasendlini ikwazi ukuqeda. ukuhlolwa kwe-toxicology.

Isihlahla sesinqumo: Ukushintsha kombala wengane esanda kuzalwa, ikhefu lokuphefumula, noma ukuxhuga¶

flowchart TD
    A["Usana olungaphansi kwezinyanga eziyi-12 luyayeka ukuphefumula kungazelelwe, luba luhlaza okwesibhakabhaka/luphaphatheke, noma luxhuga/luqine"] --> B{"Lala phansi ohlangothini + hlikihla i-sternum / flick soles imizuzwana emi-5 ukuya kweyi-10. Ingabe ukuphefumula kuyabuya?"}
    B -->|"Cha: Ayiphenduli futhi ayiphefumuli ngokujwayelekile"| C["Shayela ku-911/112/999 esipikheni ngokushesha"]
    C --> D{"Ingabe isiqephu saqala ngokuminyanisa/ukugaxa ubisi noma ngento ethile?"}
    D -->|"Yebo: Indiza ivinjiwe"| E["Yenza Amagalelo Emhlane Wezingane Ezingu-5 + 5 Ama-Chest Thrust; phinda kuze kube yilapho indlela yomoya iyavuleka noma qala i-CPR uma ingaphenduli"]
    D -->|"Cha: Ukuma kancane noma ukuxhuga"| F["Qala i-CPR Yosana: Ukucindezelwa kwesifuba okungu-30 (4 cm / 1.5 ekujuleni, 100 kuya ku-120/min) + 2 umoya omnene"]
    B -->|"Yebo: Umntwana uyalulama phakathi namasekhondi angu-60 futhi ubuyela esimweni esivamile"| G{"Ingabe ingane inezimpawu ezisobala ezisebenzayo njengamanje? (Umkhuhlane, ukukhwehlela, ukuhlanza okuphindaphindayo, i-stridor, ukukhathala)"}
    G -->|"Yebo: Ayichazi"| H["Ukuhlolwa koMnyango Wezimo Eziphuthumayo ngokushesha kokugula okusebenzayo (i-Sepsis, i-RSV, i-Pertussis, i-Aspiration, i-Seizure)"]
    G -->|"Cha: Ingane ibukeka ijwayelekile ngo-100% ekuqaleni (Kungenzeka i-BRUE)"| I{"Hlola i-AAP High-Risk BRUE Criteria (Noma iyiphi ekhona engu-1?)"}
    I -->|"Ubudala <= Izinsuku ezingu-60 NOMA Ngaphambi kwesikhathi < 32 amaviki (< 45 amaviki alungisiwe) NOMA Ubude besikhathi >= 1 iminithi NOMA Phinda imicimbi NOMA I-CPR Edingekayo"| J["I-BRUE ENOBUNGOZI OBUKHULU: Ezokuthutha ezisheshayo zoMnyango Wezimo Eziphuthumayo + Ukungeniswa kweziguli + I-oximetry eqhubekayo, i-Pertussis/RSV PCR, i-ECG ehamba phambili engu-12, isikrini se-Sepsis/Metabolic"]
    I -->|"Ubudala > izinsuku ezingu-60 ukuya ku-12 mos KANYE Nesikhathi esigcwele >= amaviki angu-32 KANYE NOmcimbi wokuqala < 1 iminithi FUTHI Ayikho i-CPR edingekayo KANYE nokuhlolwa Okuvamile"| K["UBUNGOZI OBUNINGI: Ukuhlolwa Okuphuthumayo Komnyango Wezimo Eziphuthumayo + 1 kuya ku-4 ihora le-pulse oximetry eqhubekayo, i-ECG ehamba phambili engu-12, ukuhlolwa kwe-Pertussis, Ukuhlolwa Kokulala Okuphephile, kanye nokulandelela kukadokotela wezingane amahora angu-24"]

Imibandela yomtholampilo: Yini echaza i-BRUE nokuthi kungani imiselele i-ALTE¶

Emashumini amathathu eminyaka ngaphambi kuka-2016, odokotela bezingane basebenzisa isambulela esishubile ALTE (Isigigaba Esibonakala Sisongela Ukuphila) ukuchaza noma isiphi isiqephu esesabisayo esinganeni esenza umnakekeli esabe ukuthi umntwana uyafa. Ucwaningo lwezokwelapha lwafakazela lokho kamuva ALTE yayingaqondile ngendlela eyingozi: yayihlanganisa izingane ezazisagula egumbini lezimo eziphuthumayo kanye nezingane eseziluleme ngokuphelele, futhi incike ezingeni lokusabela komnakekeli esikhundleni sokumaka okuqondile komzimba. Ngo-2016 (futhi yaqiniswa emiqondisweni yezingane yamazwe ngamazwe eyalandela), i- American Academy of Pediatrics (AAP) ulisusile leli gama ALTE futhi yasungula ukuxilongwa okuqinile, okuhloswe kwe- BRUE (Umcimbi Ongachazwa Kafushane Oxazululiwe).

Izinsika ezi-4 eziyisibopho zokuxilongwa kwe-BRUE¶

Udokotela uzohlukanisa isiqephu sosana njenge BRUE kuphela uma ingane ingaphansi kwezinyanga eziyi-12 (unyaka ongu-1) ubudala futhi isiqephu sikwanelisa zonke ezine zalezi zinsika zokuxilonga ezilandelayo:

1. Kafushane (Isikhathi esingaphansi kwamasekhondi angu-60): Sonke isiqephu esingavamile sithathe ngaphansi komzuzu ongu-1 (iqiniso kakhulu BRUE iziqephu zihlala phakathi kwemizuzwana eyi-10 nengama-45). Uma isiqephu sithatha iminithi elingu-1 (imizuzwana engu-60) noma ngaphezulu*, seqa umkhawulo omfushane futhi sicutshungulwa ngokuzenzakalelayo ku-High-Risk endleleni yokuxilonga.
2. Kuxazululiwe (amaphesenti angu-100 abuyela esisekelweni): Ngesikhathi usana lufika ukuze luhlolwe ngokwezempilo, umntwana usebuyele ngokuphelele esimweni sawo esivamile sempilo. Izinga lokushaya kwenhliziyo, izinga lokuphefumula, ukugcwala komoya-mpilo, izinga lokushisa, ukugcwala kwesikhumba, imisipha, nokuthintana kwamehlo kumelwe kube yinto evamile ngokuphelele. Uma umntwana ehlala ewozela, ekhathele, e-tachypneic (ephefumula ngokushesha), enomkhuhlane, noma ecasukile, umcimbi awu uxazululiwe. BRUE, kuyisimo esiphuthumayo esisebenzayo esidinga ukuvuselelwa ngokushesha kanye nokusebenza okuhlosiwe.
3. Ibonakala okungenani ngoshintsho lwenhloso olu-1 kwezi-4:
4. Central cyanosis noma pallor: Ushintsho oluluhlaza okwesibhakabhaka, onsomi, olumnyama olumnyama, noma umbala omhlophe/umlotha onjengesipoki ohlanganisa izindebe, ulimi, izinsini, ubuso, noma isiqu esimaphakathi. (Izandla nezinyawo eziluhlaza okwesibhakabhaka okungenangozi uma kupholile, okwaziwa ngokuthi acrocyanosis, noma ububomvu besikhashana emlonyeni ngenkathi ukhala noma udlula indle akufanele BRUE).
5. Ukungabikho, ukuncipha, noma ukuphefumula okungajwayelekile: Ukuma kweqiniso ekuphefumuleni (apnea), ukuhefuzela okungajulile, noma ukuklinywa kungazelelwe/ukuzabalazela ukuthola umoya. (Ukuphefumula okuvamile okusanda kuzalwa *, lapho umntwana olele ephefumula ngokushesha okuningana okulandelwa ukuhlaba ikhefu kwemizuzwana emi-5 kuya kweyi-10 kuyilapho ebomvana ngokuphelele, kuyisayensi yokwakheka komzimba evamile hhayi BRUE).
6. Ushintsho olumakiwe kwithoni yemisipha (hypotonia noma hypertonia): Usana luyaxhuga ngokuzumayo kanye ne-Ragdoll-floppy (hypotonia) noma ngokuzumayo iqine ibe nemikhawulo eqinile kanye nomhlane ogobile (hypertonia noma opisthotonos).
7. Izinga elishintshile lokusabela: Usana luvele lungasabeli ezwini nasekuthinteni, lugqolozele lutho ngamehlo ayingilazi, noma luquleke.
8. Okungachazwanga ngemva komlando nokuhlolwa komzimba: Uma udokotela ophuthumayo ethatha umlando onemininingwane futhi ehlola umntwana kusukela ekhanda kuye ozwaneni, asikho isizathu esisobala esisheshayo. Isibonelo, uma ingane enomkhuhlane ongu-39.2 degrees Fahrenheit (102.6 degrees Fahrenheit) kanye nokuhosha okukhulu kwesifuba ima ikhefu, ukuxilongwa kuyi-viral bronchiolitis noma i-sepsis, hhayi indlela engachazeki. BRUE.

Ithebula lokuqhathanisa: I-BRUE Yengcuphe Ephansi vs. I-BRUE Eyingozi Ephezulu vs. IMifanekiso Okungeyona eye-BRUE¶

Ukuqonda ukuthi ingabe ingane yakho iwela ku-Low-Risk BRUE* noma Ingozi Ephezulu BRUE isigaba sikutshela kahle ukuthi yiziphi izivivinyo nokubhekwa esibhedlela ithimba lezimo eziphuthumayo elizokwenza. Uma usana lugeja ngisho neyodwa yemibandela Yokuba Nengozi Ephansi, ihlukaniswa ngokuthi Ingozi Ephezulu BRUE.

Izimbangela ezifihliwe ezisongela ukuphila zihlolwe ku-BRUE Enobungozi obukhulu¶

Kungani odokotela bezimo eziphuthumayo bephikelela ekuvumeni ubungozi obuphezulu BRUE izinsana (njenganoma iyiphi ingane engaphansi kwezinsuku ezingu-60 ubudala noma noma iyiphi ingane eke yalunywa okwesibili) esibhedlela ngisho nalapho ingane imamatheka futhi iphuza ibhodlela egumbini lezimo eziphuthumayo? Ngoba ezinganeni ezisanda kuzalwa ezinesistimu yezinzwa ezizimele, izimo eziyisikhombisa ezisongela ukuphila zivame ukuba khona ne-ethule, i-apnea eyedwa noma ukuxhuga njengophawu lwazo lokuqala ngaphambi kokuba kuvele izimpawu zakudala ezifana nomkhuhlane noma ukukhwehlela.

1. I-Laryngospasm kanye ne-Laryngeal Chemoreflex (LCR) kusuka ku-reflux¶

Ezinganeni ezindala nakubantu abadala, uma iconsi le-asidi esiswini noma amathe lithinta izintambo zezwi (larynx), i-brainstem ibangela ukukhwehlela okunamandla ukuze kususwe umoya. Ezinsaneni ezisanda kuzalwa nezinsana ezingaphansi kwezinyanga ezi-4 kuya kweziyisi-6 ubudala, nokho, inzwa ephakeme ye-laryngeal ibangela indlela yokusinda yengane ebizwa ngokuthi Laryngeal Chemoreflex (LCR) (eklanyelwe ukuvimba umbungu ekuhogeleni uketshezi lwe-amniotic esibelethweni). Lapho ithonsi elincane lobisi olushintshiwe noma i-asidi yesisu ehlanzekile ifika buthule ngemuva komphimbo wosana, izintambo zezwi zibophana ngokuqinile ku-laryngospasm, ukuphefumula kobuchopho obumaphakathi kuyama, futhi inzwa ye-vagus ibambezela ukushaya kwenhliziyo (bradycardia).

• Okubonwa abazali ngesikhathi somcimbi LCR ukupela: Isiqephu sivamise ukwenzeka lapho umntwana elele phansi ngomhlane imizuzu eyi-15 kuya kwengama-60 ngemva kokuncela (noma ngemva nje kokubhodla okumanzi). Ingane ivele iqine, igobise iqolo, ivule amehlo ivuleke ngokwethuka, ikhiphe umlomo ithule noma inyakaze isifuba inyakaze nge **zero sound **, iphenduke ibebomvu ngokubomvu bese izungeza izindebe ezindebeni zibe luhlaza okwesibhakabhaka, bese ekugcineni ikhipha umsindo omkhulu (inspiratory stridor) ngemva kwemizuzwana engu-20 ukuya kwengama-45 njengoba izintambo zezwi ziphumula.
• Ukungenelela okusheshayo okuseceleni kombhede: Jikisela usana ulubeke eceleni lwalo noma ulubambe luqonde esifubeni sakho nge-engeli engu-45-degree, uncele kancane ubisi olubonakalayo emakhaleni ngesirinji sebulb ethambile (ngoba izingane ezingaphansi kwezinyanga ezi-4 zibophezele ukuphefumula emakhaleni), futhi zifuthe umoya opholile esihlathini sazo. Ungalokothi uphoqe umunwe wehle emphinjeni.

2. I-Apneic pertussis (ukukhwehlela) kanye ne-RSV bronchiolitis¶

Abazali balindele umntwana one-pertussis (Bordetella pertussis) noma I-Respiratory Syncytial Virus (RSV) ukuba nomsindo omkhulu, ukukhwehlela noma umkhuhlane. Ezinganeni ezingaphansi kwezinyanga ezi-3 ubudala, lokho kucabangela kungase kubulale:

• I-apnea ngaphambi kokukhwehlela: Kufika kumaphesenti angama-50 wezingane ezisanda kuzalwa nezinsana ezincane ezingaphansi kwamasonto angu-8 ezithola inkontileka RSV noma i-pertussis evela kungane yakini endala noma umuntu omdala “onomkhuhlane ocasulayo” omnene, i-apnea emaphakathi ngokuzumayo (ukumisa ukuphefumula imizuzwana engama-20 kuya kwengama-60 bese kuba luhlaza okwesibhakabhaka) kuwuphawu lokuqala lomtholampilo, okwenzeka amahora angu-24 kuya kwangu-48 ngaphambi kokuba noma yikuphi ukukhwehlela, ukuminyana, noma imfiva.
• Ukungabikho kwe-"whoop": Izingane ezincane ezisanda kuzalwa azinawo amandla odonga lwesifuba ukudala umsindo okhuthazayo othi "whoop" wokukhwehlela. Esikhundleni salokho, babambe umlomo buthule kufinyila olunamathelayo oluncanyana, baphelelwe amandla, bamise ukuphefumula, futhi babe ne-bradycardia ejulile. Ngoba ingane ene-apneic pertussis yokuqala noma RSV ingabukeka ijwayelekile ngokuphelele phakathi kweziphonso zokuqala bese iyeka ukuphefumula unomphela phakathi nokulala okujulile amahora angu-6 kamuva, iminyango yezimo eziphuthumayo yenza i-nasopharyngeal PCR ama-swabs for Pertussis kanye RSV futhi ugcine izingane ezincane kuma-pulse oximetry nama-apnea monitors aqhubekayo.

3. I-Channelopathies yenhliziyo (i-Long QT Syndrome, i-WPW, nokukhubazeka okuncike embotsheni)¶

Isiqephu esingazelelwe lapho usana luphenduka mhlophe njengesipoki, impunga, noma umlotha (pallor) futhi uyaxhuga njenge ragdoll ngokuvamile inhliziyo noma vagal esikhundleni sokuphefumula. Lonke usana luhlolelwa a BRUE (kokubili Ubungozi obuphansi kanye Nengozi Ephezulu) kufanele bathole 12-lead electrocardiogram (ECG):

• I-Congenital Long QT Syndrome (LQTS) kanye ne-Brugada Syndrome: Ukukhubazeka kwe-ion-channel yofuzo ohlelweni lukagesi lwenhliziyo kungabangela ukugijima okufushane, okuziqedayo kwe-polymorphic ventricular tachycardia (torsades de pointes). Phakathi nokugijima kwemizuzwana engu-20 kwe-arrhythmia, ukuphuma kwenhliziyo kuyehla kuye ku-zero, kuguqule ingane ibe mnyama futhi ixhugele; uma isigqi sibuyela ngokuzenzakalelayo kusigqi esivamile se-sinus, ingane ivuka ibukeka kahle, kuze kube yilapho ukugijima okulandelayo kubangela ukuboshwa kwenhliziyo kungazelelwe (SIDS).
• Wolff-Parkinson-White (WPWkanye ne-Tachycardia ye-Supraventricular (SVT): Izinsana ezinesesekeli somzila kagesi enhliziyweni zingagxuma kungazelelwe zifinyelele ekushayeni kwenhliziyo okungu-240 kuya ku-300 ukushaya ngomzuzu*, okubangele ukuphaphatheka okungazelelwe, isikhumba esinamabala, ukungondleki kahle, noma i-syncope emfushane.
• Isifo senhliziyo esizalwa ngemuva kwesikhathi esincike ku-ductal noma ALCAPA: Izimo ezinjengokuqina kwe-aorta noma umthambo wegazi wesokunxele ongajwayelekile osuka kumthambo wamaphaphu ( pulmonary artery )ALCAPA) kungabangela ukukhala kungazelelwe, ukujuluka, ukuphaphatheka, nokuxhuga ngesikhathi sokuncelisa.

4. Ukuquleka okucashile kwezingane ezisanda kuzalwa nezinsana (kuhlanganise ne-Infantile Spasms)¶

Ngokungafani nezingane ezindala ezinokudlikizeka okujwayelekile okujwayelekile ngokungangabazeki, izinsana ezingaphansi kwezinyanga eziyisi-6 zine-myelination engaphelele yemizila yazo ye-cerebral cortex. Ngenxa yalokho, ukuquleka okuqala endaweni yesikhashana noma ye-brainstem kuvame ukuveza njengokuthi izenzakalo ezizimele noma ezicashile:

• I-Apneic seizures: Usana luyeka ukuphefumula kungazelelwe, lugqolozele lubheke ohlangothini olulodwa namehlo ayingilazi, lwenza imilenze eshaya ngezindebe ezinesigqi, isunduze ulimi, noma ihambe ngebhayisikili, bese iphenduka ibe luhlaza okwesibhakabhaka imizuzwana engama-30 ukuya kwangu-60.
• I-Infantile Spasms (I-West Syndrome): Iqala ngokuvamile phakathi kwe-3 nezinyanga ezingu-8 ubudala, ngokuvamile lapho ingane ivuka noma ilele, usana luba nokuguquguquka okufushane, okungazelelwe kwesekhondi elingu-1 kuya kwangu-2 noma ukuqina kwentamo, isiqu, nezingalo, ngokuvamile imizuzwana emi-5 kuye ku-5. "i-reflux cramps" noma iziphonso zokwethuka. Ukuqoshwa kwevidiyo kusenesikhathi ngabazali kanye ne-electroencephalogram ye-neurology yezingane (EEG) zibalulekile ukuvimbela ukuhlehla kwentuthuko okungapheli.

5. Amaphutha azalwa nawo e-metabolism kanye ne-hypoglycemia¶

Ukuphazamiseka kwe-metabolic kokuzalwa okungajwayelekile (okufana nokuthi Medium-Chain Acyl-CoA Dehydrogenase Deficiency [MCADD], ukonakala kwe-fatty acid oxidation, ukuphazamiseka komjikelezo we-urea, kanye ne-organic acidemias) kuvimbela usana ekuguquleni amafutha agciniwe abe ushukela lapho izila ukudla phakathi kokuphakelayo. Uma usana lulala isikhathi eside kunokuvamile noma lungadli kahle, ushukela wegazi walo uyancipha noma i-ammonia enobuthi iyanqwabelana, okubangele ukukhathala okungazelelwe, ukuxhuga, ukuphefumula umoya, noma ukungaphenduli okuphaphathekile. Ukuhlola umbhede osheshayo i-capillary blood glucose, igesi yegazi, ama-electrolyte, ne-lactate emnyangweni wezimo eziphuthumayo ngokushesha kukhomba izinkinga ze-metabolic.

6. I-bacterium yemimoya, i-meningitis, ukutheleleka komgudu womchamo, kanye ne-botulism yezingane¶

Ezinsaneni ezingaphansi kwezinsuku ezingu-60 ubudala, ukutheleleka kwebhaktheriya okubi kakhulu (okufana nesifo somzila womchamo, i-Streptococcus ye-Group B noma E. coli bacteremia, noma i-meningitis yangaphambi kwesikhathi) kuvame ukubangela i-hypothermia (izinga lokushisa le-rectal elingaphansi kuka-36.0 degrees Celsius / 96.8 degrees Fahrenheit) noma ukupela ngaphandle kokuphaphama. Ngokufanayo, ekuqaleni i-botulism yengane kusukela ekugwinyweni kwezinhlamvu zothuli lwendawo kubangela ukwehla kwamandla emisipha ye-cranial, i-gag reflex engalungile, amathe ahlangene, kanye neziphonso zokuphefumula okuzumayo.

7. Ukuhlukumezeka okungeyona ingozi (Ukuhlukumezeka Kwekhanda Okuhlukumezayo) kanye noshevu ungahlosile¶

Izifundo zomtholampilo ezibuyekezwe ngabakwa AAP bonisa ukuthi phakathi kwephesenti elingu-1 no-3 lezinsana ezethula Ubungozi Obuphezulu noma obuvelayo BRUE babe nesisekelo ukuhlukumezeka kwekhanda okuhlukumezayo (i-shaken baby syndrome) ene-occult subdural hematomas ebangela i-central brainstem apnea, ngisho nalapho ingekho imihuzuko yangaphandle ekhanda. Ngakho-ke odokotela bahlola ngokucophelela isikhumba sekhanda kuya ozwaneni, bahlole i-fontanelle yangaphambili (indawo ethambile) ukuthi iqhubukile yini, bahlole ingaphakathi lodebe olungenhla ukuze babone i-labial frenulum edabukile, futhi bahlole ukuchayeka ngephutha emithini epholisayo (njengamaconsi abandayo abantu abadala, i-diphenhydramine, i-topical lidocaine/benzocaine metonicemia, i-benzocaine noma i-benzocaine methemoglobinemia. i-opioids/ insangu).

Ukuhlolwa kokulala okuphephile kanye ne-positional asphyxiation ngemva kwe-BRUE¶

Ukuma kwesikhashana kokuphefumula kwezinsana eziningi kanye neziphonso ze-cyanotic kubangelwa i-positional obstructive asphyxiation, okwenzeka lapho ikhanda elisindayo lomntwana litshekela phambili (neck flexion) ngakho isilevu sawo sicindezela esifubeni sawo, sinyakazisa uqhoqhoqho othambile, noqwanga (trachea) zivaliwe, noma lapho izicupho zokulala ezithambile zikhipha isikhutha emakhaleni abo. Ngenkathi ulinde ezokuthutha eziphuthumayo noma ngemva nje kokubuyela ekhaya uvela esibhedlela, yenza lokhu okuphelele Ukulala Okuphephile kanye Nokuhlolwa Kwendlela Yomoya:

• Hlola Izihlalo Zemoto, Izinqola, Amabhawunsi, Nokujika Kwezingane: Ungalokothi uvumele usana ukuthi luhlale lulele esihlalweni semoto uma lukhishwe emotweni, futhi ungalokothi usebenzise isihlalo esigobileyo, ukushwiba, noma umcamelo wokuncelisa njengendawo yokulala evamile. Uma isihlalo semoto sichofozwa esisekelweni saso esimile ngaphakathi emotweni, sihlala endaweni ephephile yokuhlehla; lapho ibekwe endaweni eyisicaba yekamelo lokuhlala, isihlalo sibheke phambili, okubangela ukuthi ikhanda losana olusanda kuzalwa lixegazelele esilevini bese livala indlela yokuphefumula buthule (positional asphyxia).
• Hlola izihlilingi zezingane kanye nokugoqa kwendwangu ethambile: Ezinganeni ezingaphansi kwezinyanga ezi-4 ubudala ezithwelwe ngesihlilingi noma ukugoqa, landela njalo T.I.C.K.S. umthetho: gcina ophethe Tight, ngingibuka ngaso sonke isikhathi (ungalokothi umboze ubuso bengane ngendwangu), Cukulahlekelwa ngokwanele ukuqabula phezulu kwekhanda lomntwana, gcina isilevu sengane Ksisuse esifubeni (okungenani isikhala esisodwa somunwe womuntu omdala ngaphansi kwesilevu), futhi ugcine umhlane wengane ubheke S
• Hlola i-Crib noma i-Bassinet (ABCs Yokulala Okuphephile): Sonke isikhathi sokulala (ubusuku nemini) kumelwe sibe Ayodwa, sibekwe flat ku-Back (supine), kumatilasi aqinile, ayisicaba Crib noma i-bassinet embozwe kuphela ishidi elifakwe ngokuqinile. Susa yonke imicamelo, obhampa abafakwe ama-quilted, amasaka okulala anesisindo, amalounge anesitayela se-DockATot, izilwane ezigxishiwe, nezingubo zokulala ezixegayo.
• Izinga Lokushisa Legumbi Lokucwaninga Nokunqwabelanisa Kakhulu: Ukushisa ngokweqile kufiphaza ingqondo yosana olusanda kuzalwa oluvusa amadlingozi ngesikhathi se-hypoxia. Gcina igumbi lokulala liphakathi kuka-20 no-22.2 degrees Celsius (68 kanye no-72 degrees Fahrenheit)* futhi ugqokise ingane okungenani ungqimba olulodwa oluncane oluncane kunolomuntu omdala angalugqoka ngokunethezeka (njenge-onesie kakotini ephefumulayo engaphakathi kwesaka lokulala eligqokekayo elingasindwa isisindo, ikhanda lingamboziwe).
• Hlola Ukuchayeka Kwentuthu Yesandla Sesibili Sekhaya kanye Ne-Vape Aerosol: Ukuchayeka ku-nicotine, intuthu kagwayi, noma ama-aerosols afuthayo engutsheni yomnakekeli kulimaza ama-autonomic brainstem chemoreceptors, kukhinyabeze kakhulu ikhono lengane lokuhefuzela nokuvuka lapho umoya mpilo wehla (auto-resuscitation).

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

Uma usana lwakho lunekhefu lokuphefumula elingachazwanga, ukushintsha kombala, noma ukuxhuga, shayela isevisi yakho ye-ambulensi yesimo esiphuthumayo kazwelonke ngokushesha futhi wazise umthumeli ngeminyaka eqondile yomntwana emavikini noma ezinyangeni:

• I-United States ne-Canada: Shayela u-911* ngokushesha ukuze uthole izinsizakalo zezokwelapha eziphuthumayo (EMS) ezokuthutha eziyiswa emnyangweni wezimo eziphuthumayo okwazi ukuphatha izingane. Ukuhlolwa kwesibhedlela kulandela ** I-American Academy of Pediatrics (AAP)** kanye ne-Canadian Pediatric Society (CPS)* BRUE imihlahlandlela yokusebenza kwemitholampilo. Uma usola ukungenisa ngephutha into yasendlini noma imithi, shayela futhi Ukulawula Ubuthi ku-1-800-222-1222 (US) noma 1-844-764-7669 (Canada).
• E-United Kingdom: Shayela u-999* ngokushesha ukuze uthole i-ambulensi ephuthumayo uma usana luyeka ukuphefumula, luba luhlaza okwesibhakabhaka noma luphaphathekile, noma luxhuga, bese luyisa usana eliseduzane Ingozi Nesimo Esiphuthumayo Sezingane (A&E) umnyango. Ukuhlolwa komtholampilo kulandela Isikhungo Sikazwelonke Sezempilo Nokunakekelwa Okuncomekayo (NICE) kanye I-Royal College of Paediatrics and Child Health (RCPCH) ukuwa kokubeletha okungalindelekile okungalindelekile (SUPC) kanye BRUE imihlahlandlela. Ngemibuzo yokulandelela ngemva kokukhishwa, shayela ku-NHS 111.
• I-European Union: Shayela u-112* kuwo wonke amazwe angamalungu e-EU ukuze uthole ukuthunyelwa okuphuthumayo kwe-ambulensi yezingane. Izivumelwano zomtholampilo zilandela European Resuscitation Council (ERC) Iziqondiso eziyisisekelo zokusekela impilo yezingane (ezicacisa ukuphefumula kokuqala okungu-5 ngaphambi kokuqala ukucindezelwa kwesifuba nge-15:2 isilinganiso kubahlinzeki abaqeqeshiwe) kanye nodokotela bezingane kazwelonke. BRUE izindinganiso.
• I-Australia ne-New Zealand: Shayela u-000* e-Australia noma 111 eNew Zealand ukuze uthole impendulo esheshayo ye-ambulensi. Iminyango yezimo eziphuthumayo yezingane ilandela Ucwaningo Lwezingane eminyangweni yezimo eziphuthumayo International Collaborative (PREDICT) kanye Isibhedlela Sezingane Sasebukhosini (RCH) Melbourne imihlahlandlela yokuzijwayeza yomtholampilo ye BRUE.
• I-India ne-Asia-Pacific: Shayela ku-112* (inombolo kazwelonke yezimo eziphuthumayo yase-India), 995 (Singapore), 119 (e-Japan ne-South Korea), noma inombolo yakho yasendaweni yezimo eziphuthumayo (bona konke izinombolo eziphuthumayo) bese udlulela esibhedlela semfundo ephakeme esinoPhiko Lwezingane Ezisanda kuzalwa noma Zokunakekelwa Kakhulu Kwezingane (NICU/PICU).

Imibuzo ejwayelekile ukubuzwa¶

Kungani ubuso bengane yami esanda kuzalwa buphenduke baba bomvu ngokugqamile futhi ime isikhashana ukuphefumula imizuzwana eyi-10 kuyilapho ikhala ukuze ikhiphe amathumbu? Ingabe lokho kuyi-BRUE?¶

Cha. Lapho usana olunempilo ludonsa kanzima ukuze ludlule indle noma igesi (isimo sokukhula esingesihle esibizwa ngokuthi i-infant dyschezia), luthwala kanzima endleleni yomoya evaliwe (i-Valsalva maneuver), evame ukuguqula ubuso balo bube bomvu noma bubebomvu futhi ime isikhashana ukuphefumula kwayo imizuzwana emi-5 kuya kweyi-10 kuyilapho imilenze yalo ikhuphuka. Ngenxa yokuthi imbangela kuwumzamo osobala ovamile wokuzikhandla ngokomzimba futhi izindebe zomntwana ezimaphakathi nolimi akulokothi kuguquke kube luhlaza okwesibhakabhaka noma kube mhlophe njengesipoki, i-American Academy of Pediatrics ibubalula ngokusobala ububomvu obuvamile bokukhala kanye nokuqiniswa kwendle encazelweni ye-BRUE.

Izandla nezinyawo zengane yami zibukeka ziluhlaza kancane lapho ngiqaqa indwangu yazo, nakuba iphefumula ngendlela evamile. Ingabe kufanele ngishayele i-ambulensi?¶

Ukushintsha umbala oluhlaza okotshani okulinganiselwe kuphela ezandleni, eminweni, ezinyaweni nasezinzwaneni kusana olusanda kuzalwa noma olusanda kuzalwa kubizwa ngokuthi i-acrocyanosis, futhi kuwukusabela okungenangozi, okuvamile kwemithambo emoyeni opholile njengoba imithambo yegazi emincane ejikelezayo ibopha ukugcina umgogodla wengane ufudumele. Njalo hlola ulwelwesi oluphakathi lwengane: bheka izindebe, ulimi, izinsini, nesifuba esimaphakathi ngaphansi kokukhanya okuhle. Uma ulimi nezindebe zipinki ezifudumele futhi ezikhanyayo futhi ingane iphefumula kahle futhi iqaphile, i-acrocyanosis engenabungozi; uma izindebe, ulimi, noma ubuso buphenduka okwesibhakabhaka, onsomi, dusky, noma mhlophe ngokuphaphathekile, kuyi-cyanosis emaphakathi futhi kudinga ucingo oluphuthumayo oluphuthumayo.

Ingabe ukuba ne-BRUE Enobungozi obuncane kusho ukuthi ingane yami izobulawa yi-SIDS (Sudden Infant Death Syndrome)?¶

Ucwaningo olukhulu lwezingane olugxile ezintweni eziningi lubonisa ukuthi izinsana ezihlangabezana nazo zonke izinqubo ze-BRUE Enengozi Ephansi (ezindala kunezinsuku ezingu-60, ezizalwa emasontweni angama-32 zikhulelwe noma kamuva, umcimbi omfushane owodwa ongaphansi komzuzu ongu-1, i-CPR edingekayo, nokuhlolwa komzimba okuvamile kanye ne-ECG) zisengozini ephansi kakhulu yokufa ngokuzumayo okufana nenani lezingane ezisanda kuzalwa ezivamile. Ukuzijwayeza imikhuba eqinile yokulala ngokuphephile (uyedwa, ngemuva, embhedeni ongenalutho oqinile) kuhlala kubalulekile kuyo yonke ingane.

Kungani udokotela wegumbi lezimo eziphuthumayo encome ngokumelene noku-oda ukuhlolwa kwegazi, ukucofa umgogodla, nokuskena kobuchopho kwengane yami ye-BRUE Enobungozi obuphansi?¶

Lapho usana olungaphezu kwezinsuku ezingu-60 lunelisa ngokuqinile zonke izici ze-BRUE Eyengozi Ephansi futhi luhlolwa ngokomzimba okuvamile, ukuhlolwa okubanzi kwemitholampilo okuhilela izinkulungwane zezingane kufakazela ukuthi igazi elihlaselayo lidonsa, ama-lumbar puncture, ama-X-ray esifuba, nama-CT scans anesivuno sokuxilonga ngaphansi kwephesenti elingu-1, imiphumela yobuhlungu, eveza amanga futhi eveza amanga. izifo ezitholwa esibhedlela. Esikhundleni salokho, imihlahlandlela esemthethweni ye-AAP incoma ihora eli-1 kuye kwayi-4 lokubonwa kwe-pulse oximetry eqhubekayo, i-ECG engahlaseli engu-12 eholayo, i-nasopharyngeal swab uma kusolwa i-pertussis, kanye nokulandelela eduze nodokotela wakho wezingane phakathi namahora angu-24.

Ingabe kufanele ngithenge i-smart-sock yomthengi noma i-clip-on breathing monitor ngemva kokuba ingane yami ine-BRUE?¶

I-American Academy of Pediatrics kanye ne-US Food and Drug Administration yeluleka abazali ukuthi bangathembeli kubathengi bamasokisi ahlakaniphile, omaka bekhamera, noma iziqeshana zamanabukeni ukuze bavimbele i-SIDS noma baqaphe usana olungemuva kwe-BRUE, ngoba amadivayisi abathengi avame ukuphuthelwa yi-hypoxemia kuyilapho ecupha ama-alamu angamanga. Uma usana lwakho kutholakala ukuthi line-BRUE Enobungozi Ephezulu, ukukhula ngaphambi kwesikhathi ngokwedlulele, noma ukuphazamiseka kwenhliziyo/umoya okudinga ukuqashwa ekhaya, uchwepheshe wakho uzokunikeza umqaphi we-cardiorespiratory osulwe yi-FDA kanye nokuqeqeshwa okusemthethweni komzali kwe-CPR.

Uyini umehluko phakathi kwe-BRUE yezinyanga ezi-2 ubudala kanye nesipelingi sokubamba umoya kwengane enezinyanga eziyi-14?¶

I-BRUE yenzeka ezinsaneni ezingaphansi kwezinyanga ezingu-12 futhi azichazwa, ngokuvamile zenzeka ngesikhathi sokulala, ukuphumula, noma ukudla. Ngokuphambene, ukupela okubamba umoya kuvame ukwenzeka ezinganeni ezisacathula ezineminyaka eyizinyanga eziyisi-6 kuye kweyisi-6 ngemva nje kokuqalisa okucacile: noma ukukhala ngenxa yokukhungatheka (i-cyanotic blue spell) noma ukungqubuzana okuncane okungazelelwe noma ukwesaba (ukupeleta okumhlophe okuphaphathekile). Zombili zidinga ukuhlolwa kwezokwelapha lapho zivela okokuqala, okuhlanganisa ne-ECG yeziphonso eziphaphathekile.

Iziqondiso ezihlobene¶

• Iziphonso zokubamba umoya (okuluhlaza okwesibhakabhaka vs. i-syncope ephaphathekile) kanye nokuhlolwa kwe-apnea yezingane
• I-CPR yezingane nezinsana kanye nokuklinywa
• I-botulism yezingane, ukumunca uju olungaphekiwe, i-floppy baby syndrome, nokuqunjelwa
• I-jaundice esanda kuzalwa, i-kernicterus, i-lethargy, nesibalo sokuphelelwa amanzi kwe-diaper emanzi
• Izinombolo eziphuthumayo

Imithombo neziqondiso ezisemthethweni¶

• ** I-American Academy of Pediatrics (AAP, United States):** Isiqondiso Sokusebenza Komtholampilo: Izehlakalo Ezingachazwa Kafushane Ezixazululwe Kafushane (BRUE) (Izehlakalo Zangaphambili Ezazibonakala Zisongela Ukuphila) kanye Nokuhlolwa Kwezinsana Ezisengozini Ephansi (Tieder et al., Pediatrics) kanye Ne-Task Force on Sudden Infant Death Syndrome Izincomo Zokulala Okuphephile.
• ** Inhlangano Yezingane YaseCanada (CPS, Canada):** Iphuzu Lokuzilolonga Lekomidi Lokunakekelwa Okubukhali: Ukuphatha Isehlakalo Esifingqiwe Esixazululiwe Esingachazwanga Esifushane (BRUE) Ezinsaneni.
• Isikhungo Sikazwelonke Sezempilo Nokunakekelwa Okuphambili (NICE) kanye neRoyal College of Paediatrics and Child Health (RCPCH, United Kingdom): Imihlahlandlela Yophenyo Lokugoqa Kungazelelwe Ngemva Kokubeletha (SUPC) kanye Nezehlakalo Ezibonakala Zisongela Impilo Ebuntwaneni.
• Izikhungo Zokulawula Nokuvimbela Izifo (CDC, United States): Izici Zomtholampilo Ze-Pertussis (I-Whooping Cough) kanye ne-RSV Apnea Ezinsaneni Ezingaphansi Kwezinyanga Eziyisi-6.
• I-World Health Organization (WHO) kanye neKomidi Lokuxhumanisa Lamazwe Ngamazwe mayelana Nokuvuselela (ILCOR): Ukwesekwa Kwempilo Yezingane (PBLS) Ukuvumelana Ngesayensi Nezincomo Zokwelashwa.