Früherkennung der Infantilen Zerebralparese

Die Infantile Zerebralparese ist die häufigste motorische Behinderung im Kindesalter. Die Frühgeburtlichkeit ist gesicherter Hauptrisikofaktor und erfordert angesichts der steigenden Überlebensrate extremer Frühgeborener eine strukturierte und langfristige interdisziplinäre Nachsorge der motorischen und kognitiven Entwicklung. Die frühzeitige Identifikation von Risikopatienten und die therapeutische Intervention können die Entwicklungsprognose positiv beeinflussen.

Kernaussagen

• Jedes Kind, das in der Schwangerschaft und Perinatalzeit einem nachgewiesenem Risikofaktor ausgesetzt war, sollte mit zuverlässigen Methoden frühzeitig auf sein ICP-Risiko untersucht werden.

• Die prognostische Validität der klinischen Untersuchung alleine reicht dazu insbesondere in den ersten Lebensmonaten nicht aus. Die Kombination mehrerer Verfahren und der Einsatz longitudinaler Untersuchungen erhöhen die prognostische Sicherheit.

• Eine hohe prognostische Sicherheit kann auch durch die Kombination der frühen MRT oder zerebralen Sonografie mit den Befunden der klinischen Untersuchung und des General Movement Assessments erreicht werden.

• In der Nachsorge von Neugeborenen mit relevanten Risikofaktoren in Deutschland bildet die klinisch-neurologische Untersuchung zusammen mit bildgebenden Verfahren die Grundlage für eine Vorhersage der ICP.

• Entwicklungsneurologische Untersuchungen im Alter von korrigiert 2 Jahren dienen der Diagnosesicherung.

• Während die Nachsorge von sehr unreifen Frühgeborenen durch strukturelle Vorgaben und Leitlinien reguliert ist, existieren keine verbindlichen Qualitätsstandards für die Nachsorge später Frühgeborener und Reifgeborener mit anamnestischen ICP-Risikofaktoren. Diese sind aber von mehr als der Hälfte der ICP-Erkrankungen betroffen.

• Literatur

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