Abstract
In very preterm neonates, bronchopulmonary dysplasia (BPD) complicates the course of respiratory distress syndrome, i.e., primary surfactant deficiency in a structural immature lung. In Germany, about 11 000 preterms having a gestational age below 32 weeks are born and treated in neonatal intensive care units per year. Within this high risk group, the rate of BPD is about 15%. Relevant prenatal risk factors include intrauterine inflammatory fetal reaction as a consequence of ascending maternal infections, intrauterine growth retardation apart from the main risk factor immaturity. Postnatal risk factors include genetic predisposition, mechanical ventilation, infections and hemodynamically relevant patent ductus arteriosus.
Preventive measures include intratracheal surfactant administration; new studies indicate preventive effects of caffeine, vitamin A and hydrocortisone in a subgroup of neonates with prenatal fetal inflammatory response.
Due to long-term detrimental effects of BPD on lung function and psychomotor development, further experimental and clinical studies are mandatory in order to continue to reduce the BPD rate.
Zusammenfassung
Die bronchopulmonale Dysplasie Frühgeborener ist eine chronische Lungenerkrankung, die häufig als Folgeerkrankung eines Atemnotsyndroms bei sehr unreifen Frühgeborenen, d. h. eines primären Surfactant-Mangels in einer strukturell unreifen Lunge, auftritt. In der Bundesrepublik Deutschland werden derzeit pro Jahr rund 11 000 Frühgeborene eines Gestationsalters von <32 Wochen geboren, innerhalb dieser Gruppe liegt die Rate der BPD bei rund 15%. Wesentliche pränatale Risikofaktoren sind die intrauterine inflammatorische Reaktion als Folge aszendierender Infektionen sowie die intrauterine Wachstumsretardierung neben dem Hauptrisikofaktor der Unreife. Die postnatalen Risikofaktoren sind neben genetischen Komponenten die der maschinellen Beatmung, postnatale Infektionen sowie ein behandlungsbedürftiger Ductus arteriosus.
Wesentliche präventive Maßnahmen sind die rechtzeitige intratracheale Surfactant-Applikation, neuere Studien belegen den Wert der intravenösen Gabe von Koffeinzitrat, Vitamin A sowie von Hydrocortison in einer Subgruppe von Frühgeborenen nach intrauterinen aszendierenden Infektionen.
Aufgrund der langfristigen Effekte der BPD auf die Lungen sowie die Gesamtentwicklung, sind weitere experimentelle und klinische Studien nötig, um die Häufigkeit der BPD noch weiter zu reduzieren.
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Respiratorisches Versagen im Früh- und Neugeborenenalter
Herausgegeben von L. Gortner (Homburg/Saar)
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Gortner, L., Meyer, S. Die bronchopulmonale Dysplasie Frühgeborener. Intensivmed 44, 475–485 (2007). https://doi.org/10.1007/s00390-007-0808-4
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DOI: https://doi.org/10.1007/s00390-007-0808-4
Key words
- bronchopulmonary dysplasia prematurity
- intrauterine growth retardation
- mechanical ventilation
- surfactant therapy