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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd
DOI: 10.1055/a-2593-0275
DOI: 10.1055/a-2593-0275
GebFra Science
Review
Perinatale Neuroprotektion bei Frühgeburt
Article in several languages: English | deutsch
Zusammenfassung
Eine der wesentlichen Ursachen der perinatalen Morbidität und Mortalität ist die Frühgeburt. Die Rate an Hirnblutungen Grad III und IV bei Kindern mit einem Geburtsgewicht unter 1500 g lag in Deutschland im Jahr 2022 bei 2,97% und die der periventrikulären Leukomalazie bei 1,07%. Neben diesen schweren Formen der Hirnschädigung, die sonografisch sichtbar sind, zeigen neuere MRT-Studien zum errechneten Termin der betroffenen Kinder auch diffuse Schädigungen der weißen und grauen Substanz, besonders auch der Basalganglien und des Zerebellums, als Zeichen von gestörter Hirnentwicklung und -funktion. Um diesen Kindern einen optimalen Start ins Leben zu bieten, ist es sehr entscheidend, sie von Anfang an in einem Perinatalzentrum LEVEL I zu betreuen. Darüber hinaus stehen uns eine Reihe perinatologischer Maßnahmen zur Verfügung, welche die neuronale Entwicklung von frühgeborenen Kindern entscheidend verbessern. Dazu gehören der Einsatz von antenatalen Kortikosteroiden, Magnesium, aber auch das späte Abnabeln. Die Hypothermiebehandlung eignet sich bei frühgeborenen Kindern, anders als bei reifgeborenen, nicht zur Neuroprotektion, wie jüngste Untersuchungen zeigen. Da auch Tage und Wochen nach dem primären Insult infolge persistierender Inflammation und mangelnder trophischer Stimulation sogenannte sekundäre und tertiäre Zellschäden entstehen können, ist es erforderlich, neben einer bestmöglichen Erstversorgung unreifer Kinder auch die anschließende Betreuung auf der Intensivstation im Sinne eines neuronal-positiv stimulierenden Umfeldes optimal zu gestalten. Eine besondere Bedeutung kommt dabei dem Stillen und der Muttermilchernährung zu.
Schlüsselwörter
Frühgeburt - peri-/intraventrikuläre Hirnblutung - Neuroprotektion - periventrikuläre LeukomalaziePublication History
Received: 23 January 2025
Accepted after revision: 12 March 2025
Article published online:
30 June 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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