Intrauterine Inflammation und ihre Folgen: Spielt Chorioamnionitis eine Rolle für Organschäden bei sehr kleinen Frühgeborenen?

Zusammenfassung

Pränatale Infektion und die Chorioamnionitis sind wesentliche Risikofaktoren für spontane, meist sehr frühe Frühgeburt. Die Chorioamnionitis trägt auf diese Weise signifikant zu Frühgeburts-bedingter Morbidität und Letalität bei. Der Nachweis eines gestationsunabhängigen Effekts von Chorioamnionitis auf das Outcome sehr kleiner Frühgeborener ist unter anderem durch das Fehlen einer Vergleichsgruppe „gesunder Frühgeborener“ erschwert, da Frühgeburtlichkeit, wenn nicht mit Inflammation, meist mit anderen pränatalen Pathologien asssoziiert ist. Die Fortschritte der letzten Jahren im perinatologischen und neonatologischen Management verwischen zudem die Assoziation zwischen pränataler Entzündung und Morbidität und Letalität dieser Hochrisiko-Kinder. Eine histologische Chorioamnionitis ist assoziiert mit einer geringeren Inzidenz und Schwere des Atemnotsyndroms. Kurzfristige Maturations-induzierende Prozesse sind aber mit einer erhöhten Empfindlichkeit der unreifen Lunge für postnatale Noxen, wie mechanischer Beatmung, verbunden und begünstigen somit das Auftreten der Bronchopulmonalen Dysplasie. Die Datenlage zur Bedeutung der Chorioamnionitis für eine Hirnschädigung von sehr kleinen Frühgeborenen ist inkonsistent, wenn auch Metaanalysen die Entzündung der fetoplazentaren Einheit mit einem erhöhten Risiko für die zystische periventrikuläre Leukomalazie und die Cerebralparese in Verbindung bringen. Neueste epidemiologische Daten machen zudem eine Rolle der Chorioamnionitis in der Ätiopathogenese der Frühgeborenenretinopathie wahrscheinlich.

Abstract

Infections in utero and chorioamnionitis are major risk factors for spontaneous, very early premature birth. Thus chorioamnionitis contributes significantly to prematurity-associated morbidity and mortality. Evidence for a gestation-independent effect of chorioamnionitis on the outcome of very low birth weight infants is much more difficult to obtain as most of the studies addressing this issue lack a normal “control group”, as prematurity is mostly associated with some kind of prenatal pathology with a potential influence on neonatal outcome. Moreover, major advances in perinatal and neonatal care for this high-risk group have mitigated the impact of chorioamnionitis on morbidity and mortality of very low birth weight infants. Histological chorioamnionitis is associated with a lower incidence and severity of respiratory distress syndrome. However, short-term maturational effects on the lung are associated with a higher susceptibility for postnatal noxious events, such as mechanical ventilation, thus contributing to the risk of bronchopulmonary dysplasia. Data regarding the importance of chorioamnionitis for brain damage of the very premature infant are inconsistent although meta-analyses have shown an increased risk of cystic periventricular leukomalacia and cerebral palsy after exposure to inflammation in utero. Very recent epidemiological studies suggest a role of chorioamnionitis in the aetiology and pathogenesis of retinopathy of prematurity.

Schlüsselwörter

Bronchopulmonale Dysplasie - Atemnotsyndrom - Frühgeborenenretinopathie - Cerebralparese

Key words

bronchopulmonary dysplasia - respiratory distress syndrome - retinopathy of prematurity - cerebral palsy

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