Aktuelles in der Neonatologie

Der Beitrag stellt wichtige Aspekte der Entwicklung in der Neonatologie während der vergangenen 5 Jahre dar und skizziert, welche Änderungen sich für die medizinische Versorgung Frühgeborener und kranker Neugeborener ergeben.

Kernaussagen

• In der vergangenen Dekade hat sich der Versorgungsansatz der Erstversorgung reif- und frühgeborener Neugeborener drastisch verändert. International wird nun die v. a. Unterstützung physiologischer Umstellungsvorgänge des Neugeborenen propagiert. Eine stark interventionell geprägte Erstversorgung im Sinne einer Reanimation wurde abgelöst durch die sanfte Unterstützung der postnatalen Anpassung, mit verzögerter Abnabelung, schonender Atemunterstützung, kontrolliertem Temperaturmanagement und Stärkung eines frühzeitigen Bindungsaufbaus.

• Die auf politischer Ebene initiierte Zentralisierung der Versorgung von Müttern mit drohender Risikogeburt sowie die postnatale Versorgung von kindlichen Risikokollektiven haben zu einer Verringerung von Mortalität und Morbidität und einer Reduktion von chronisch kranken Kindern geführt.

• Verbesserungen der apparativen und medikamentösen Möglichkeiten für die Versorgung von kranken Früh- und Reifgeborenen ermöglichen heute die erfolgreiche Therapie vieler vormals mit schlechter Prognose behafteter perinataler Ereignisse, wie z. B. der perinatalen Hypoxie, einer frühkindlichen Atemnot oder entwicklungsbedingter Augenhintergrunderkrankungen.

• Der Teamaspekt in der perinatalen Versorgung und das frühzeitige Einbeziehen der Familien wurden zunehmend wahrgenommen. Spezifische Schulung der Teams in der Geburtshilfe und Neonatologie sowie deren erfolgreiches Zusammenspiel zum Wohle der zu versorgenden Familien sind nun vielerorts Standard, bedürfen aber oftmals noch weiterer Verbesserung.

• Die Besonderheiten der extrauterinen Umgebung während der Phase der fetalen Organentwicklung des Frühgeborenen werden zunehmend als Ursache der langfristigen Schädigung erkannt. Insbesondere der Einfluss auf die postnatale Reifung des Immunsystems und der endogenen Stammzellen scheint von besonderer Bedeutung zu sein.

• Die aus dieser Erkenntnis resultierenden regenerativen Therapieansätze für Erkrankungen, die ihren Ursprung in einer gestörten feto-neonatalen Entwicklung haben, zeigen in tierexperimentellen Untersuchungen vielversprechende Ergebnisse. Diese positiven Ergebnisse sind jetzt durch entsprechende klinische Studien zu bestätigen.

Schlüsselwörter

Neugeborenes - Überlebenschancen - Erstversorgung - Beatmung - verzögertes Abnabeln - Stammzellen

Key words

newborn - birth weight - stabilisation - ventilation - umbilical cord - stem cell

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