Hypothermie bei hypoxisch-ischämischer Enzephalopathie nach perinataler Asphyxie

Einleitung

Ein Sauerstoffmangel unter der Geburt kann zu einer zerebralen Minderversorgung und einer daraus resultierenden hypoxisch-ischämischen Enzephalopathie (HIE) führen, welche sich in einer langfristigen neurologischen Schädigung manifestiert. Die dieser Schädigung zugrunde liegende Pathophysiologie bietet verschiedene Ansätze für therapeutische Interventionen.

Die Hypothermiebehandlung ist die bisher einzige Intervention, welche zum therapeutischen Standard bei der Behandlung Neugeborener mit HIE gehört.

• Literatur

• 1 Blair E, Stanley F. Intrapartum asphyxia: A rare cause of cerebral palsy. J Pediatr 1988; 112: 515-519
• 2 De Lee JB. Asphyxia Neonatorum: Causation and treatment. Medicine 1897; 3: 643-660
• 3 Rüdiger M, Braun N, Gurth H et al. Preterm resuscitation I: Clinical approaches to improve management in delivery room. Early Hum Dev 2011; 87: 749-753
• 4 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol 1976; 33: 696-705
• 5 Thompson CM et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelomental outcome. Acta Paediatr 1997; 86: 757-761
• 6 Hellström-Westas L et al. Amplitude-integrated EEG: Classification and interpretation in preterm and term infants. NeoReviews 2006; 7: e76-e86
• 7 Spitzmiller RE et al. Amplitude-integrated EEG is usefull in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy: A meta-analysis. J Child Neurol 2007; 22: 1078
• 8 van Bel F, Hirasing RA, Grimberg MTh. Can perinatal asphyxia cause cerebral edema and effect cerebral blood flow velocity?. Eur J Pediatr 1984; 142: 29-32
• 9 Shankaran S et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353: 1574-1584
• 10 Gluckman PD et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663-670
• 11 Marlow N et al. Neuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2005; 90: F380-F387
• 12 van Handel M et al. Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr 2007; 166: 645-654
• 13 Kintzel HW. Der Energiestoffwechsel Frühgeborener bei langanhaltender Hypothermie. Monatsschr Kinderheilkd 1966; 114: 544-550
• 14 Kintzel HW. Die Blutzuckerregulation und der Säurebasenhaushalt Frühgeborener während langanhaltender Hypothermie. Monatsschr Kinderheilkd 1967; 115: 477-479
• 15 Rutherford MA et al. Mild hypothermia and the distribution of cerebral lesions in neonates with hypoxic-ischemic encephalopathy. Pediatrics 2005; 116: 1001-1006
• 16 Thoresen M. Supportive care during neuroprotective hypothermia in the term newborn: Adverse effects and their prevention. Clin Perinatol 2008; 35: 749-763
• 17 Schulzke SM, Rao VS, Patole SK. A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy – are we there yet?. BMC Pediatrics 2007; 7: 30
• 18 Shankaran S et al. Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic ischemic encephalopathy. Pediatrics 2008; 122: e791-e798
• 19 Azzopardi D et al. Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is managed in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed 2009; 94: F260-F264
• 20 Wyatt JS et al. Determinants of outcome after head cooling for neonatal encephalopathy. Pediatrics 2007; 119: 912-921
• 21 Roka A et al. Elevated morphine concentrations in neonates treated with morphine and prolonged hypothermia for hypoxic ischemic encephalopathy. Pediatrics 2008; 121: e844-e849