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Prävention und Therapie der bronchopulmonalen Dysplasie

Prevention und treatment of bronchopulmonary dysplasia

  • Leitthema: Das kleine und sehr kleine Frühgeborene
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Zusammenfassung

Die bronchopulmonale Dysplasie (BPD) beinhaltet eine durch Exposition der unreifen Lungen gegenüber Noxen wie Barotrauma und Hyperoxie induzierte chronische Inflammation mit Arrest der Lungenentwicklung. Präventiv wirkt v. a. ein Vermeiden dieser Noxen, also ein Vermeiden bzw. Minimieren von Beatmung und Anstreben eher niedriger Sauerstoffwerte. Medikamentös ist Vitamin A die einzige Substanz mit nachgewiesener präventiver Wirksamkeit. Neue Ansätze stellen die Gabe von Koffein bzw. NO dar. Systemische Steroide sind sehr effektiv bei Verabreichung in der 2. Lebenswoche, kommen aber aufgrund schwerer Nebenwirkungen nur in Ausnahmefällen zum Einsatz. In der Therapie der etablierten BPD kommt einer Sauerstoffgabe sowie dem Vermeiden viraler Infektionen entscheidende Bedeutung zu, wobei der anzustrebende Zielbereich der O2-Sättigung unklar ist. Für die Gabe von monoklonalen Antikörpern gegen RS-Virus wurde bislang kein Effekt auf relevante Zielkriterien wie Beatmungspflichtigkeit oder Mortalität gezeigt. Insgesamt bleibt damit die Prävention der BPD oberstes Ziel.

Abstract

Bronchopulmonary dysplasia (BPD) involves a chronic inflammation of the airway with arrest of lung development and is triggered by exposure of the immature lung to such noxious stimuli as barotrauma and hyperoxia. Thus, primary prevention should take the form of avoidance of these noxious stimuli, which means minimizing mechanical ventilation and keeping oxygen levels low. Pharmacologically, vitamin A supplements are the only agents shown to be both effective and safe. New approaches such as caffeine or NO administration deserve further study. Systemic steroids given in the 2nd week of life are highly effective, but must be restricted to extreme cases because of their severe side effects. The main elements in the reatment of established BPD are additional inspired oxygen (though the optimum target range for arterial oxygen saturation is not known) and prevention of viral infections. Prevention of respiratory syncytial virus infections via monoclonal antibodies such as palivizumab is expensive, however, and has not yet been shown to influence clinically relevant outcome parameters, such as re-intubation or mortality. Given these limited treatment options, BPD prevention remains of paramount importance.

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  1. Abteilung Neonatologie und neonatologische Intensivmedizin, Universitätsklinik für Kinder- und Jugendmedizin, Tübingen

    C. F. Poets

  2. Abteilung Neonatologie und neonatologische Intensivmedizin, Universitätsklinik für Kinder- und Jugendmedizin, Calwerstraße 7, 72076, Tübingen

    C. F. Poets

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Poets, C.F. Prävention und Therapie der bronchopulmonalen Dysplasie. Monatsschr Kinderheilkd 153, 1140–1147 (2005). https://doi.org/10.1007/s00112-005-1259-2

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