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Z Geburtshilfe Neonatol 2011; 215(04): 145-151
DOI: 10.1055/s-0031-1285835
Übersicht
George Thieme Verlag KG Stuttgart · New York

Respiratorische Erkrankungen bei Früh- und Neugeborenen – Aktuelle Diagnostik und Therapie

Respiratory Disorders in Preterm and Term Neonates – An Update on Diagnostics and Therapy
L. Gortner
1   Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg/Saar
,
E. Tutdibi
1   Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg/Saar
› Author Affiliations
Further Information

Publication History

eingereicht15 May 2011

angenommen nach Überarbeitung06 June 2011

Publication Date:
23 August 2011 (online)

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Zusammenfassung

Störungen des Gasaustauschs sind weiterhin eine Hauptkomplikation der postnatalen Adaptation. Bei reifen Neugeborenen wurde während der vergangenen Dekade ein gehäuftes Auftreten der transienten Tachypnoe des Neugeborenen berichtet, die mit hoher Wahrscheinlichkeit bedingt durch eine steigende Anzahl von primären Sectiones caesareae erklärlich ist. Die Erkrankung ist im Wesentlichen geprägt durch eine verzögerte Resorption der fetalen Lungenflüssigkeit, die bei ausbleibender Wehentätigkeit weiter aggraviert werden kann. Weitere kritische Atemstörungen bei reifen Neugeborenen können durch ein Mekoniumaspirationssyndrom sowie die angeborene Zwerchfellhernie bedingt sein, welche in schweren Fällen der Lungenhypoplasie zu einer ausgeprägten Gasaustauschstörung und pulmonalen Hypertension führt. Bei sehr unreifen Frühgeborenen bleibt das Atemnotsyndrom bedingt durch einen primären Surfactant-Mangel die wesentliche pulmonale Akutkomplikation, welche in langfristige Atemstörungen übergehen kann. Die pränatale Gabe von Glukokortikoiden kombiniert mit der postnatalen Surfactanttherapie ist eine der wesentlichen Meilensteine in der perinatalen Medizin mit erhöhter Überlebensrate sehr unreifer Frühgeborener. Die zuvor angesprochene langfristige Komplikation, bronchopulmonale Dysplasie, wird gegenwärtig bei rund 15% der Frühgeborenen unter 32 Schwangerschaftswochen in Europa beobachtet und ist mit zum Teil schwerwiegenden pulmonalen  −  meist obstruktiven Atemwegserkrankungen  −  sowie extrapulmonalen Störungen assoziiert. Bedingt durch eine Verbesserung der perinatalen Versorgung ist die Sterblichkeit an schwerem respiratorischem Versagen zwar zurückgegangen, ist jedoch weiterhin eine der hauptpostnatalen Komplikationen. Die Verbesserung wurde durch verschiedene Strategien sowohl in der pränatalen Medizin als auch in der Neonatologie erreicht.

Abstract

Respiratory disorders remain a major problem in postnatal adaptation. In term neonates, an increased incidence of the risk for transient tachypnoea of the neonate has been observed during the past decade, most likely secondary to an increased usage of primary Caesarean section. The disorder is mainly caused by a delayed resorption of foetal lung fluid. Further disorders in term neonates include meconium aspiration syndrome and congenital diaphragmatic hernia leading to impaired gas exchange and pulmonary hypertension. In preterm neonates, respiratory distress syndrome is the main disorder leading to severe acute and long-term impaired gas exchange. Prenatal administration of glucocorticoids and postnatal surfactant therapy remains an established principle in perinatal care for very preterm neonates. The most relevant long-term sequelae, bronchopulmonary dysplasia, is currently being observed in about 15% of preterms with less than 32 weeks of gestation and is associated with severe pulmonary and extrapulmonary consequences. Due to the overall improvement in perinatal care, respiratory disorders still remain a major problem in pulmonary adaptation. However, mortality secondary to neonatal lung failure has been decreased substantially by the improvements in the whole field of perinatal medicine.

Schlüsselwörter

Neugeborene - transiente Tachypnoe des Neugeborenen - Atemnotsyndrom - bronchopulmonale ­Dysplasie

Key words

neonates - transient tachypnoea of the neonate - respiratory distress ­syndrome - bronchopulmonary ­dysplasia
 

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