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Immunologische Konsequenzen bei frühgeborenen Kindern

The immune consequences of preterm birth

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Das Risiko für Frühgeburten konnte trotz des wachsenden medizinischen Fortschritts der vergangenen Jahrzehnte nicht nennenswert gesenkt werden und betrifft derzeit etwa 8–11 % aller Schwangerschaften. Eine Frühgeburt ist verbunden mit einer hohen Morbidität und Mortalität der Kinder. In diesem Zusammenhang haben die postnatal fortgesetzte Reifung des Immunsystems und die weitere Entwicklung von Organen in extrauteriner statt intrauteriner Umgebung eine besondere Bedeutung. Hierbei wird das neonatale, noch nicht an die extrauterine Umgebung angepasste Immunsystem mit der verfrühten postnatalen Mikrobiombesiedlung der noch nicht voll ausgereiften Organe konfrontiert. Auch besteht die Gefahr des Kontakts mit pathogenen Erregern und daraus resultierenden Infektionen. Zusammengenommen hat die Frühgeburt weitreichende gesundheitliche Konsequenzen für die Kinder, die bis ins Erwachsenenalter bestehen können. Der vorzeitig unterbrochene Transfer von mütterlichen Nährstoffen und Immunmarkern über die Plazenta kann diese Krankheitsrisiken noch verstärken. Wir diskutieren hier grundlegende Mechanismen der Immunantwort bei Frühgeborenen und stellen klinische Handlungsmaßnahmen vor.

Abstract

Despite growing medical progress in recent decades, the risk of preterm birth has not been significantly reduced and affects about 8–11% of all pregnancies. Preterm birth is associated with high infant morbidity and mortality. In this context, the continuous postnatal maturation of the immune system and the ongoing development of organs in an extrauterine, rather than intrauterine, environment is of pivotal significance. In this sítuation, the neonatal immune system, which is not yet adapted to the extrauterine environment, is confronted with the premature postnatal microbiome colonization of not yet fully matured organs. Also, there is the permanent threat of pathogen encounter and infections. Taken together, these influences have far-reaching health consequences that may persist into adulthood. The prematurely interrupted transfer of maternal nutrients and immune markers across the placenta can exacerbate these disease risks. This article discusses the basic mechanisms of immune response in preterm infants and proposes clinical measures for action.

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Authors and Affiliations

  1. Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland

    Josina M. Hofer, Dimitra E. Zazara, Anke Diemert & Petra Clara Arck

  2. Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland

    Dimitra E. Zazara

  3. Hamburg Center for Translational Immunology, University Medical Center of Hamburg-Eppendorf (UKE), Hamburg, Deutschland

    Petra Clara Arck

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  1. Josina M. Hofer
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Correspondence to Petra Clara Arck.

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J.M. Hofer, D.E. Zazara, A. Diemert und P.C. Arck geben an, dass kein Interessenkonflikt besteht.

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Hofer, J.M., Zazara, D.E., Diemert, A. et al. Immunologische Konsequenzen bei frühgeborenen Kindern. Gynäkologische Endokrinologie 21, 261–269 (2023). https://doi.org/10.1007/s10304-023-00538-x

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