IVH-Prävention bei ELBW-Frühgeborenen in zwei Perinatalzentren

Zusammenfassung

Hintergrund Im Rahmen eines Projekts zur konsequenten Vermeidung zahlreicher bekannter Risikoindikatoren sank die Inzidenz von intraventrikulären Hämorrhagien (IVH) am Ulmer Perinatalzentrum. Ein Vergleich mit dem Leipziger Zentrum sollte Hinweise liefern, an welchen Stellen es an beiden Zentren noch Verbesserungsmöglichkeiten gibt.

Methoden Eine retrospektive Datenerhebung wurde für 189 Leipziger und 89 Ulmer Frühgeborene mit einem Geburtsgewicht von unter 1000 g durchgeführt. Für diese Daten wurde ein Vergleich zwischen den beiden Zentren durchgeführt.

Ergebnisse Eine IVH aller Schweregrade wurde in Leipzig (56/197, 28,4%) häufiger (p=0,01) als in Ulm (13/89, 14,6%) gefunden. Der Unterschied betraf nur die leichten IVH Grade 1–2; die Inzidenz der schweren IVH (Grad 3–4) unterschied sich nicht zwischen den beiden Zentren (p=0,59, Leipzig 12/197, 6,1%; Ulm 4/89, 4,5%). Weiterhin zeigte sich bei einzelnen IVH-Risikoindikatoren eine unterschiedliche Verteilung zwischen den beiden Zentren. So trat eine postnatale Hypokapnie in Leipzig (42/197, 21,3%) häufiger auf (p<0,01) als in Ulm (3/86, 3,5%). Auch eine postnatale Hypothermie ereignete sich häufiger (p<0,01) in Leipzig (53/197, 26,9%) als in Ulm (10/89, 11,2%). In Ulm wurde hingegen eine rasche postnatale Surfactantapplikation seltener (p<0,01) durchgeführt (32/60, 53,3%) als in Leipzig (136/158, 86,1%) und Bikarbonat wurde in Ulm häufiger gegeben (48/89, 46,1% gegenüber 183/197, 7,1%, p<0,01).

Schlussfolgerung Potenziell vermeidbare Risikofaktoren traten in beiden Zentren in unterschiedlicher Häufigkeit auf. Diese Ergebnisse ermöglichen es beiden Zentren, die jeweils mit erhöhte Häufigkeit aufgetretenen Risikofaktoren gezielt zu vermeiden und so die IVH-Rate weiter abzusenken.

Abstract

Background In a project to carefully observe and minimize risk factors of intraventricular hemorrhages (IVH) in preterm infants, the incidence decreased markedly at the perinatal Center in Ulm, Germany. By comparing its data with the perinatal center in Leipzig, Germany, we sought to identify what improvements could still be made.

Methods A retrospective survey was performed, including 189 infants from Leipzig and 89 from Ulm, all of whom weighed less than 1000 grams. A comparison between both perinatal centers was made.

Results IVH was more frequently detected in Leipzig (28.4%) than in Ulm (14.6%, p=0.011), yet only the incidence of mild IVH (grade 1–2) was affected since the incidence of severe IVH did not differ between the 2 centers (p=0.59, Leipzig 6.1%, Ulm 4.5%). Furthermore, several potentially avoidable risk factors of IVH were differentially distributed between the 2 centers. For example, postnatal hypocapnia and postnatal hypothermia occurred with higher frequency in Leipzig than in Ulm. Conversely, rapid postnatal application of surfactant was the rule in Leipzig but not in Ulm. Furthermore, sodium bicarbonate application occurred more frequently in Ulm.

Conclusion Both centers avoided certain risk factors for IVH with varying success. These results allow both centers to specifically target the risk factors that occurred with greater frequency to further reduce the incidence of IVH.

Schlüsselwörter

Frühgeborene - intrakranielle Blutung - Neonatalperiode - Perinatal Zentren - Prävention - Risikofaktoren

Key words

preterm infants - intracranial haemorrhage - perinatal centre - prevention - risk factors - neonates

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