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Geburtsasphyxie als Ursache kindlicher Hirnschäden?

  • 2. Hauptthema/deuxième thème principal Bedeutung der intrapartalen Asphyxie für Hirnschäden bei Termingeburten La signification de l'asphyxie périnatale lors de l'accouchement à terme comme origine de lésions cérébrales
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Zusammenfassung

Die Prävalenz der Zerebralparese (CP) zeigt in den meisten Ländern in den letzten 15 Jahren eine steigende Tendenz, die Folge der verbesserten Überlebenschancen der kleinen Frühgeburten ist. Bei Termingeburten ist die Geburtsasphyxie für die Entstehung einer CP von geringer Bedeutung und für weniger als 10% der Fälle wird eine Geburtsasphyxie als mögliche Ursache diskutiert. Bei Frühgeburten spielen Faktoren der Perinatalphase für die Entstehung einer CP eine deutlich größere Rolle. Nur die schwere Form des Sauerstoffmangels, die zu Gewebsschädigung im Gehirn sowie in anderen Organen führt und mit entsprechenden klinischen Symptomen einhergeht, ist für die Langzeitprognose bedeutungsvoll. Selbst bei Vorliegen einer Geburtsasphyxie ist die Kausalität für eine psychomotorische Entwicklungsstörung nicht bewiesen, da der Hirnschaden während der Schwangerschaft entstanden sein kann und Ursache der Geburtsasphyxie sein kann; oder Hirnschaden und Geburtsasphyxie sind Folge einer gemeinsamen Grundpathologie.

Summary

The prevalence of cerebral palsy (CP) has increased over the last 15 years in most countries. This is explained by an improved survival of very low birth weight prematures. In term infants birth asphyxia is of minor significance as a cause for CP. In only 10% of all CP cases following delivery at term, birth asphyxia must be discussed as a possible cause. In premature deliveries events during the perinatal period are of greater significance for the later development of a CP. Only severe forms of oxygen deficit, leading to tissue damage in the brain and other organs with clinical symptoms during the first days of life, are of significance for the long term prognosis. Even in the presence of severe birth asphyxia the causal relationship with a psychomotor handicap is not proven, since brain damage may have developed during pregnancy before the onset of labour and may be the cause of birth asphyxia. Brain damage and birth asphyxia may be the result of a common pathology of pregnancy.

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Literatur

  1. American College of Obstetricians and Gynecologists (1992) Fetal and neonatal neurologic injury. ACOG Technical Bulletin 163. Washington, DC: AGOG

    Google Scholar 

  2. American Academy of Pediatrics (1986) Use and abuse of the Apgarscore. Pediatrics 7:1148–1149

    Google Scholar 

  3. Béguin F (1995) Diagnostic de l'hypoxie foetale par surveillance pendant l'accouchement. Arch Gynecol Obstet 256 [Suppl]:S50-S60

    Article  PubMed  Google Scholar 

  4. Bejar R, Wozniak P, Allard M et al. (1988) Antenatal origin of neurologic damage in newborn infants I. Preterm infants. Am J Obstet Gynecol 159:357–363

    Article  CAS  PubMed  Google Scholar 

  5. Bhushan V Paneth N, Kieley JL (1993) Impact of improved survival of very low birth weight infants on recent secular trends in the prevalence of cerebral palsy. Pediatrics 91:1094–1100

    CAS  PubMed  Google Scholar 

  6. Blair E, Stanley FJ (1993) A research definition for “birth asphyxia”. Dev Med Child Neurol 35:449–455

    Article  CAS  PubMed  Google Scholar 

  7. Blair E, Stanley FJ (1982) An epidemiological study of cerebral palsy in Western Australia. III: Postnatal etiology. Dev. Med Child Neurol 24:575–585

    Article  CAS  PubMed  Google Scholar 

  8. Blair E, Stanley FJ (1988) Intrapartum asphyxia: a rare cause of cerebral palsy. J Pediatrics 122:575–579

    Google Scholar 

  9. Blair E, Stanley FJ (1990) Intrauterine growth and spastic cerebral palsy I. The association with birth weight for gestational age. Am J Obstet Gynecol 162:229–237

    Article  CAS  PubMed  Google Scholar 

  10. Blair E, Stanley FJ (1993) When can cerebral palsy be prevented? The generation of causal hypotheses by multivariate analysis of a case-controlled study. Pediatr Perinat Epidemiol 7:272–301

    Article  CAS  Google Scholar 

  11. Cummins SK, Nelson KB, Grether JK, Velie EM (1993) Cerebral palsy in four northern california counties, births 1983–85. J Pediatr 123:230–237

    Article  CAS  PubMed  Google Scholar 

  12. Dale A, Stanley FJ (1980) An epidemiologic study of cerebral palsy in Western Australia. 1956–1975 II:Spastic cerebral palsy and perinatal factors. Dev Med Child Neurol 22:13–25

    Article  CAS  PubMed  Google Scholar 

  13. Dawding VM, Barry C (1988) Cerebral palsy: Changing patterns of birth weight and gestational age (1976/81). Irish Med J 81:25–29

    Google Scholar 

  14. Dennis J (1985) The long-term effects of intrapartum cerebral damage. In: Crawford JW (ed) Risks of labour. Wiley & Sons, New York, pp 157–188

    Google Scholar 

  15. Dennis J, Johnson A, Mutch L, Yudkin P, Johnson P (1989) Acid-base status at birth and neurodevelopmental outcome at 41/2 years. Am J Obstet Gynecol 161:231–220

    Article  Google Scholar 

  16. Editorial (1989) Cerebral palsy, Intrapartum care and a shot in the foot. Lancet 25:1251–1252

  17. Ellenberg JH, Nelson KB (1979) Birth weight and gestational age in children with cerebral palsy or seizure disorders. Am J Dis Child 133:1044–1048

    CAS  PubMed  Google Scholar 

  18. Fauter W (1992) Geburtsschäden aus Sicht eines Haftpflichtversicherers. Frauenarzt 33:153–156

    Google Scholar 

  19. Fawer CL (1995) Asphyxie perinatal du nouveau-né à terme. Arch Obstet Gynecol 256 [Suppl]:S61-S70

    Google Scholar 

  20. Fawer CL, Calame A (1993) Neurodevelopmental outcome. In: Haddad J, Saliba E, (Hrsg) Perinatalasphyxia. Springer, Berlin Heidelberg New York Tokyo

    Google Scholar 

  21. Freeman JM, Nelson KB (1988) Intrapartum asphyxia and cerebral palsy. Pediatrics 82:240–249

    CAS  PubMed  Google Scholar 

  22. Gaffney G, Squier MV, Johnson A, Flavell V, Sellers S (1994) Clinical associations of prenatal ischemic white matter injury. Arch Dis Child 70:F101–106

    Article  Google Scholar 

  23. Haddad J, Messer J (1993) Magnetic resonance imaging and hypoxic ischemic brain injuries. In: Haddad J, Saliba E (Hrsg) Perinatal Asphyxia. Springer, Berlin Heidelberg New York Tokyo

    Chapter  Google Scholar 

  24. Hagberg B (1993) The origins of cerebral palsy. In: David TJ (ed) Recent advances in pediatrics. Churchill Livingston Edinburgh Vol 11

    Google Scholar 

  25. Hagberg B, Hagberg G, Olow I, Wendt L von (1989) The changing panorama of cerebral palsy in Sweden V. The birth year period 1979–1982. Acta Paetiatr Scand 17:283–290

    Article  Google Scholar 

  26. Hickl EJ (1994) Geburtshilfe aus forensischer Sicht am Beispiel der Beckenendlage. Gynäkologe 27:184–190

    CAS  PubMed  Google Scholar 

  27. Holmes LB (1985) Clinical indicators that time abnormal brain development. In: Freeman JM (ed) Prenatal and perinatal factors associated with brain disorder, NIH Publication 85-1149 Bethesda MD: National Institutes of Health.

    Google Scholar 

  28. Jorch G (1995) Ursachen frühkindlicher Hirnschäden. Zentralbl Gynäkol 117:175–181

    CAS  PubMed  Google Scholar 

  29. Judkin PL, Johnson A, Clover LM, Murphy KW (1994) Clustering of perinatal markers of birth asphyxia and outcome at age 5 years. Brit J Obstet Gynaecol 101:774–781

    Article  Google Scholar 

  30. Krägeloh-Mann J, Petersen D, Hagberg B, Michaelis R (1994) MRI in the timing of pathological events. A study in BS-CP children. In: Low HC (Hrsg) Alfred Benzon Symposium No. 37 “Brain lesions in the newborn”, Kopenhagen, Munksgaard

    Google Scholar 

  31. Kuban KCK, Leviton A (1994) Cerebal palsy. N Engl J Med 330:188–195

    Article  CAS  PubMed  Google Scholar 

  32. Levene MI (1990) Cerebral ultrasound and neurological impairment: Telling the future. Arch Dis Child 65:469–471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Little WJ (1843) Course of lectures on the deformities of the human frame. Lancet 1:318–322

    Article  Google Scholar 

  34. MacGillivray I, Campbell DM (1995) The changing pattern of cerebral palsy in Avon. Pediatr Perinat Epidemiol 9:146–155

    Article  CAS  Google Scholar 

  35. Naeye RL, Peters EC (1988) Anttepartum events and cerebral handicap. In: Kubli F, Patel N, Schmidt W, Linderkamp O (eds) Perinatal events and brain damage in surviving children. Springer, Berlin, S 83–91

    Chapter  Google Scholar 

  36. Naeye RL, Peters EC, Bartholomew M, Landis JR (1989) Origins of cerebral palsy. Am J Dis Child 143:1154–1161

    CAS  PubMed  Google Scholar 

  37. Nelson KB (1988) What proportion of cerebral palsy is related to birth asphyxia? J Pediatr 112:572–574

    Article  CAS  PubMed  Google Scholar 

  38. Nelson KB, Ellenberg JH (1986) Antecedents of cerebral palsy. Multivariate analysis of risk. N J Med 315:81–86

    Article  CAS  Google Scholar 

  39. Nelson KB, Ellenberg JH (1981) Apgarscores as predictors of chronic neurologic disability. Pediatr 68:36–44

    CAS  Google Scholar 

  40. Nelson KB, Emery ES (1993) Birth asphyxia and the neonatal brain: What do we know and when do we know it? Clin Perinat 20:327–344

    CAS  Google Scholar 

  41. Nelson KB, Grether JK (1995) Can magnesiumsulfate reduce the risk of cerebral palsy in very low birth weight infants? Pediatr 95:263–269

    CAS  Google Scholar 

  42. Oehlert G (1992) Entstehung und Bewertung von Schadensfällen in der Geburtshilfe. Frauenarzt 33:126–129

    Google Scholar 

  43. Ounsted M (1987) Causes, continua and other concepts. II Risks are not causes. Paediatr Perinat Epidem 1:130–135

    Article  CAS  Google Scholar 

  44. Palmer L, Blair E, Petterson B, Burton P (1995) Antenatal antecedents of moderate and severe cerebral palsy. Pediatr Epidemiol 9:171–184

    Article  CAS  Google Scholar 

  45. Paneth N (1986) Etiological factors in cerebral palsy. Pediatr Ann 15:191,194–195,197–201

    Article  CAS  PubMed  Google Scholar 

  46. Pharaoh POD (1985) CRIB and impairment after neonatal intensive care. Lancet 346:58

    Article  Google Scholar 

  47. Pharoah POD, Cooke T, Rosenblom L, Cooke RWI (1987) Effects of birth weight, gestational age, and maternal obstetric history on birth prevalence of cerebral palsy. Arch Dis Child 62:1035–1040

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Pharoah POD, Cooke T, Cooke RWI, Rosenblom L (1990) Birth weigth specific trends in cerebral palsy. Arch Dis Child 65:602–606

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Quilligan EJ, Paul RH (1975) Fetal monitoring: Is it worth it? Obstet Gynecol 45:96–100

    CAS  PubMed  Google Scholar 

  50. Rantakallio P, Von Wendt L, Koivu M (1987) Prognosis of perinatal brain damage: A prospective study of a one year birth cohort of 12000 children. Early Hum Dev 15:75–84

    Article  CAS  PubMed  Google Scholar 

  51. Riikonen RS, Raumavirta S, Sinivuori E, Seppala T (1989) Changing pattern of cerebral palsy in the South West region of Finnland. Acta Padiatr Scand 78:581–587

    Article  CAS  Google Scholar 

  52. Ruth VJ, Raivio KO (1988) Perinatal brain damage: Predictive value of metabolic acidosis and the Apgarscore. Br Med J 297:24–27

    Article  CAS  Google Scholar 

  53. Sarnat HB, Sarnat MS (1967) Neonatal encephalopathy following fetal distress. A clinical and electroencephalographical study. Arch Neurol 33:696–705

    Article  Google Scholar 

  54. Schneider H (1993) Bedeutung der intrapartalen Asphyxie für die Entstehung von kindlichen Hirnschäden. Geburtsh u Frauenheilk 53:369–378

    Article  CAS  Google Scholar 

  55. Schneider KTM (1994) Ueberwachung der Geburt aus forensischer Sicht. Gynäkologie 27:212–221

    CAS  Google Scholar 

  56. Silverman F, Suidan J, Wasserman J, Antoine C, Young BK (1985) The Apgarscore: Is it enought? Obstet Gynecol 66:331–336

    CAS  PubMed  Google Scholar 

  57. Skolnick A (1991) New ultrasound evidence appears to link prenatal brain damage to cerebral palsy. J Am Med Assoc 265:948–949

    Article  CAS  Google Scholar 

  58. Stanley FJ (1984) Prenatal risk factors in the study of the cerebral palsies. In: The Epidemiology of Cerebral Palsies. Clinics in developmental medicine 87. Editors: Stanley FJ, Alberman E. Oxford: Blackwell pp 87–97

    Google Scholar 

  59. Stanley FJ (1992) Survival and cerebral palsy in low birth weight infants: Implications for perinatal care. Pädiatr Perinat Epidemiol 6:298–310

    Article  CAS  Google Scholar 

  60. Stanley FJ, Blair E (1991) Why have we failed to reduce the frequency of cerebral palsy? Med J Austral 154:623–626

    CAS  PubMed  Google Scholar 

  61. Stanley FJ, English DR (1986) Prevalence of risk and risk factors for cerebral palsy in a total population cohort of low-birth weight (<2000 g) infants. Dev Med Child Neurol 28:559–568

    Article  CAS  PubMed  Google Scholar 

  62. Stanley FJ, Watson L (1988) The cerebral palsies in Western Australia: Trends 1968 to 1981. Am J Obstet Gynecol 158:89–93

    Article  CAS  PubMed  Google Scholar 

  63. Stanley FJ, Watson L (1992) Trends in perinatal mortality and cerebral palsy in Western Australia 1967–1985. Br Med J 304:1658–1663

    Article  CAS  Google Scholar 

  64. Sykes GS, Johnson P, Ashworth F, Molloy PM, Gu W, Stirrat GM, Turnbull AC (1982) Do Apgarscores indicate asphyxia? Lancet I:494–496

    Article  Google Scholar 

  65. Takeshita K, Ando Y, Ohtani K, Takashima S (1989) Cerebral palsy in Tottori, Japan. Neuroepidemiol 8:184–192

    Article  CAS  Google Scholar 

  66. Tarnow-Mordi W, Mutch L, Parry G, Cockburn F, McIntosh N (1995) CRIB and impairment after neonatal intensive care. Lancet 346:58–59

    Article  Google Scholar 

  67. Torfs CP, Van den Berg B, Oechsli FW, Cummins S (1990) Prenatal and perinatal factors in the etiology of cerebral palsy. J Pediatr 116:615–619

    Article  CAS  PubMed  Google Scholar 

  68. Truwit ChL, Barkowich AJ, Koch ThK, Ferriero DM (1993) Cerebral palsy: MRI findings in 40 patients. A J N R 13:67–78

    Google Scholar 

  69. Visser VJ, Fidler BCL, Touwen HJ, Huisyes (1986) Apgarscore, meconium and adidemia at birth. Relation to neonatal neurological morbidity in term infants. Br J Obstet Gynecol 93:217–222

    Article  Google Scholar 

  70. Volpe JJ (1989) Current concepts of brain injury in premature infants. Am J Radiol 153:243–251

    CAS  Google Scholar 

  71. Weindling M (1995) Periventricular hemorrhage and perventricular leucomalacia. Br J Obstet Gynaecol 102:278–281

    Article  CAS  PubMed  Google Scholar 

  72. Weindling AM, Wilkinson AR, Cooke J, Calvert SA, Vok TF, Rochfort MJ (1985) Perinatal events which precede periventricular hemorrhage and leucomalacia in the newborn. Br J Obstet Gynecol 92:1218–1223

    Article  CAS  Google Scholar 

  73. Wicklund L-M, Uvebrant P, Flodmark O (1991) Computed tomography as an adjunct in etiological analysis of hemiplegic cerebral palsy II. Children born at term. Neuropediatr 22:121–128

    Article  Google Scholar 

  74. Wicklund L-M, Uvebrant P, Flodmark O (1991) Computed tomography as an adjunct in etiological analysis of hemiplegic cerebral palsy I. Children born preterm. Neuropediatr 22:50–56

    Article  Google Scholar 

  75. Williams MC, O'Brien WF (1995) Asymmetric growth restriction is associated with cerebral palsy in term infants. J Soc Gyn Invest 95; 2:336

    Article  Google Scholar 

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  1. Universitäts-Frauenklinik, Schanzeneckstrasse 1, CH-3012, Bern, Switzerland

    H. Schneider

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Schneider, H. Geburtsasphyxie als Ursache kindlicher Hirnschäden?. Arch Gynecol Obstet 256 (Suppl 1), S32–S42 (1995). https://doi.org/10.1007/BF02201936

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