Ukuzalwa ngaphambi kwesikhathi, okusho ukuthi, ngaphambi kwamasonto angama-37 ubudala, kwenzeka ngezigameko eziguquguqukayo emhlabeni wonke.Kuzalwa izingane ezizalwa ngaphambi kwesikhathi ezingaba yizigidi ezingu-15 emhlabeni wonke unyaka ngamunye.
Ukuzalwa ngaphambi kwesikhathi kuka-60% kwenzeka emazweni anemithombo ephansi yezomnotho lapho ithuba lokunakekela owesifazane ngakho-ke okhulelwe lincane, njenge-Afrika neNingizimu Asia.Njengamanje eSpain kulinganiselwa ukuthi izingane ezizalwa ngaphambi kwesikhathi ziphakathi kuka-30 kanye neminyaka engama-40. izinkulungwane (7-8% wabo bonke abazalwa). Esikhathini esibi kakhulu sobhubhane lwe-Coronavirus, mhlawumbe hhayi nje ngenxa yezinkinga ezijwayelekile kamama noma zengane, kodwa nangenxa yezinkinga ezihlobene nokuphathwa kwe-Covid, ukukhula ngaphambi kwesikhathi kwafinyelela ku-11%.
Endabeni yokungakabi yisikhathi, kunezinganekwane ezingamanga zokuphikiswa kanye nezinto eziningi eziwusizo okufanele uzazi.
Ngokukhula kukamama nokwanda kwezinqubo zokuzala ezisizwayo, inani lamawele liye landa, futhi lokhu kungenye yezinto eziyingozi yokuzalwa ngaphambi kwesikhathi. Ezinye izimbangela kungase kube ukungenwa izifo zolwelwesi lwengane (chorioamnionitis), nazo ezinesibopho sokubeletha okungama-50% ngaphambi kwesikhathi ngoba zibangela ukwanda kokufinyela kwesibeletho. I-Pathologies ye-placenta nayo iyathinteka (isibonelo, izifo ze-vascular ezibangelwa isifo sikashukela somama esingalawulwa noma i-arterial hypertension), okubangela ukungasebenzi kahle kwe-placenta. Futhi ukwanda kwe-amniotic fluid, okubangela ukuphuka ngaphambi kwesikhathi kolwelwesi lwe-amniotic, noma ngisho nokuncipha kokukhula kwe-intrauterine ye-fetus (IUGR), okuvela kuzimbangela zikamama noma ze-placental,
Kungenzeka yini ukwenza ukuvimbela?
Hhayi kuzo zonke izimo, kodwa ngokwelapha ezinye izifo zomama ezifana nesifo sikashukela, umfutho wegazi ophakeme, i-chorioamnionitis noma ngokuvamile ngokushintsha indlela yokuphila, isibonelo ukunciphisa ukucindezeleka, ukulandela ukudla okufanele, ukugwema ukubhema, kungenzeka ukunciphisa ingozi yokugula. ukulethwa ngaphambi kwesikhathi. Kubalulekile ukunakekela abesifazane abasengcupheni yokuzalwa ngaphambi kwesikhathi (ikakhulukazi uma ukubeletha kulindelekile ngaphambi kwesikhathi eside) ezikhungweni zezibhedlela ezinezinsizakalo Zokubelethisa kanye Nezabesifazane Nezinsana ezinolwazi olufakazelwe ekulawuleni le nkinga”.
Ungenelela kanjani lapho umntwana ezalwa ngaphambi kwesikhathi?
“Izinkinga (i-cardio-respiratory, infectious, gastrointestinal, neurological, njll.) ngokuvamile ezihambisana nokukhula ngaphambi kwesikhathi (ngoba ukuzalwa ngaphambi kwesikhathi kusho ukungafinyeleli ekuvuthweni okuphelele kwezitho nezinhlelo eziningi), zinokubukeka nobukhulu obuhlukene kuye ngezinga lokukhula ngaphambi kwesikhathi. . Uma ukuzalwa ngaphambi kwamasonto angama-25 kuqhubeka nokuba yinselele enkulu ngenxa yokungavuthwa okuqinile, ikakhulukazi i-cardiorespiratory (edinga ukwamukelwa ePhikweni Lokunakekelwa Kwabagula Kakhulu abasanda kuzalwa ngokungenelela kosizo lokuphefumula, ukuphathwa kwe-surfactant nezinye izidakamizwa), nengozi enkulu yokufa nokugula, ukubeletha phakathi kwamasonto angama-25 kuya kwangu-32, nakuba kunzima, ngokuvamile kuba nomphumela ongcono kunomuhle. Futhi manje, ngo-2023, ukuzalwa phakathi kwamaviki angama-32 no-36,6 kuwumcimbi ojwayelekile ezandleni zezingane ezisanda kuzalwa.
Umntwana ozalwa ngaphambi kwesikhathi ululama nini?
“Ezimweni eziningi, ukululama kwe-auxological (isisindo nobude) kwenzeka phakathi neminyaka emibili yokuqala yokuphila. Kwenziwa okuhlukile kulezo zingane ezisanda kuzalwa ezithintwa i-IUGR ezingase zihlale ngaphansi kancane kwejwayelekile ngesisindo isikhathi eside, futhi eqinisweni ezidinga ukulawula ukudla okude futhi, ngezinye izikhathi, ngisho nokugadwa kwe-endocrinological eminyakeni yobudala yezingane. Ngokombono we-neurobehavioral (uma kungekho ukulimala kobuchopho be-anatomic ngesisekelo se-hypoxic-ischemic noma ukopha), kufanele kukhunjulwe ngaso sonke isikhathi ukuthi, ngokuzalwa ngaphambi kwesikhathi, izingane kufanele "zilindelwe" ekukwazini ukufinyelela izigaba ze-neurobehavioral. - ukuthuthukiswa kokuziphendukela kwemvelo, kucatshangelwa ukuthi c 'inkathi yangemva kokukhulelwa okufanele ihlonishwe. Lokhu kusho ukuthi amasonto asele ngaphambi kosuku olumisiwe azokwengezwa enkathini yokulandelana kwezikhathi,
Ingabe umntwana ozalwa ngaphambi kwesikhathi uzoba nemiphumela noma athuthukise ama-pathologies phakathi nokuphila?
"Kuyiqiniso ngokwengxenye mayelana nokukhula kwe-auxological kanye ne-neurodevelopmental, kodwa ngomthamo omkhulu wokululama osebenzayo. Ngaphezu kwalokho, izingane ezisanda kuzalwa zangaphambili ze-IUGR (eziveze ukukhubazeka kwe-intrauterine ukukhula) zisengozini ephakeme kancane yokuphathwa yizifo ezifana nesifo sikashukela kanye nomfutho wegazi ophakeme lapho sezikhulile, ngakho-ke kuzobaluleka ukwenza ngokuvumelana nendlela yazo yokuphila kusukela zisencane. Izingane ezazizalwe ngaphambi kwesikhathi, okuthi ngenxa yesifo esinzima sokuphefumula kwenhliziyo, zihlale ziyi-bronchodysplastic (okungukuthi, ezihlushwa ukulimala okungapheli kwamaphaphu) zingadinga ukwelashwa komoyampilo isikhathi esithile, okuhlanganisa nasekhaya, nokuqapha ukusebenza kwazo kokuphefumula ngokuhamba kwesikhathi. "
Kungenzeka yini ukuthi intombazane ezalwe ngaphambi kwesikhathi izale izingane ezizalwa ngaphambi kwesikhathi?
“Kukhona ukujwayelana okuthile, kodwa ukuvela kabusha kokukhula ngaphambi kwesikhathi kuvame ukuxhunyaniswa nokuphikelela kwezindlela zempilo kamama ezishintshile noma ukuvela kwezifo ezifanayo ezidalwe. ukusebenza ngaphambi kwesikhathi".
Ingabe ukukhula ngaphambi kwesikhathi kungaba yimbangela yokushoda ekukhuleni kwengqondo?
"Endabeni yezilonda ze-hypoxic-ischemic noma ze-hemorrhagic (kuzoxhomeka ngezinga), ukuntuleka kwemoto emaphethelweni kungenzeka, kodwa nge-physiotherapy kukhona umkhawulo obanzi wokuthuthukiswa noma ngisho nokuphila kahle okuphelele. Ezinsaneni ezizalwa ngaphambi kwesikhathi kakhulu (ikakhulukazi ngaphansi kwamaviki angu-25), ngisho nalapho kungekho izilonda zobuchopho be-anatomic, ezinye izinto ezingavamile ze-neurodevelopmental zibikwa enkulisa noma eminyakeni yesikole samabanga aphansi (ngokwesibonelo, ukungakwazi ukunaka, ukungahlaliseki, ukuphazamiseka kwenkulumo, njll. ), okufanele welashwe ngokushesha. Nakhu ukubaluleka kwenkonzo yokulandelela yalezi zingane ezisanda kuzalwa ngemva kokukhishwa esibhedlela ngamaPhiko Okunakekela Abagula Kakhulu, okuzohlala okungenani kuze kube yiminyaka engu-6-8 ubudala”.
Ingabe umntwana ozalwa ngaphambi kwesikhathi unezinkinga zempilo?
“Uma ingane ezalwe ngaphambi kwesikhathi isize yasizwa ngomshini wokuphefumula isikhathi eside ngenxa yokwehluleka kakhulu kwenhliziyo, futhi ikakhulukazi uma i-bronchodysplastic, isengozini enkulu yokulaliswa esibhedlela eminyakeni emithathu yokuqala yokuphila ngenxa yezinkinga zokuphefumula. Manje, nokho, imikhankaso yokugoma kanye ne-ad hoc immunoprophylaxis (njengaleyo ye-respiratory syncytial virus) iyinciphise kakhulu le ngozi. Uma usana olusanda kuzalwa luhlinzwe ngenxa yezinkinga zesisu ngokukhishwa kwamathumbu amakhulu, lungase ludinge ukuphathwa okukhethekile okunomsoco."