Chronische Erkrankungen des Atemwegstraktes und der Lunge im Neugeborenenalter

Zusammenfassung

Erkrankungen des Atemwegstraktes und der Lunge, die in der Neonatalperiode ihren Ursprung haben, sind häufig mit einer lebenslangen Belastung für den Patienten und dessen Familie behaftet. Dabei sind im Bereich der Atemwege vor allem angeborene Fehlbildungen und Entzündungen ursächlich für eine langfristige Beeinträchtigung der Kinder. Eine frühzeitige, möglichst pränatale Diagnose für die optimale Planung der peri- und postnatalen Versorgung, insbesondere bei vermuteter Enge der oberen Atemwege, ist für die spätere Prognose entscheidend. Bei pränatalem Verdacht auf eine Atemwegsenge ist eine Entbindung in einem spezialisierten Zentrum mit interdisziplinärer Geburtsplanung erforderlich.

Im Bereich des Lungenparenchyms ist die chronische Lungenerkrankung in der Folge einer Frühgeburtlichkeit, die bronchopulmonale Dysplasie (BPD), die häufigste Ursache für eine dauerhafte Beeinträchtigung der Patienten. Sie wird ausgelöst durch die Frühgeburtlichkeit, aber auch durch Infektionen, Surfactantmangel und mechanische Beatmung.

Im Folgenden sollen exemplarisch Erkrankungen der Atemwege und ausführlicher besondere Aspekte der bronchopulmonalen Dysplasie des Frühgeborenen diskutiert werden. Insbesondere verschiedene Ansätze der differenzierten Prophylaxe und Therapie der BPD in Hinblick auf evidente Daten werden diskutiert.

Summary

Diseases of the respiratory tract and the lung that initially presenting in the neonatal period often result in severe long term impairment with a significant burden for both the patient and the family. The etiologies of chronic airway diseases are often congenital malformations and inflammatory diseases. Thus, early, preferentially prenatal diagnosis of congenital airway disease is required for adequate intrapartum or postnatal emergency treatment. When upper airway obstruction is suspected, delivery should be planned in a specialized perinatal center after counseling of all involved subspecialties.

The most common cause of chronic lung disease in the neonatal period, the bronchopulmonary dysplasia of the premature (BPD), is induced by premature birth as well as by a combination of inflammatory disease of the immature lung, surfactant deficiency and mechanical ventilation.

This review will discuss some examples of upper airway obstruction and neonatal management. A special focus of the paper will be on the discussion of prevention as well as evidence based therapy of bronchopulmonary dysplasia in prematures.

Schlüsselwörter

Atemwegsobstruktion - neonatal - chronische Lungenerkrankung - BPD

Keywords

Airway obstruction - neonatal - chronic lung disease - BPD

• Literatur

• 1 Wiatrak BJ. Congenital anomalies of the larynx and trachea. Otolaryngol Clin North Am 2000; 33: 91-110.
• 2 Kern C, Ange M. Morales et al. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. Swiss Med Wkly 2007; 137: 279-285.
• 3 Hirose S, Harrison MR. The ex utero intrapartum treatment (EXIT) procedure. Semin Neonatol 2003; 8: 207-214.
• 4 Pereira KD, Smith SL, Henry M. Failed extubation in the neonatal intensive care unit. Int J Pediatr Otorhinolaryngol 2007; 71: 1763-1766.
• 5 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723-1729.
• 6 Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline membrane disease: bronchopulmonary dysplasia. N Engl J Med 1967; 276: 357-368.
• 7 Marshall DD, Kotelchuck M, Young TE. et al. Pediatrics risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologists Association 1999; 104: 1345-1350.
• 8 Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol 2001; 18: 1-9.
• 9 Tredano M, De Blic J, Griese M. et al. Clinical biological and genetic heterogeneity of the inborn errors of pulmonary surfactant metabolism. Clin Chem Lab Med 2001; 39: 90-108.
• 10 Wells LR, Papile LA, Gardner MO. et al. Impact of antenatal corticosteroid therapy in very low birth weight infants on chronic lung disease and other morbidities of prematurity. Perinatol 1999; 19: 578-581.
• 11 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; 3: CD004454.
• 12 Bancalari E, Moral T. Bronchopulmonary dysplasia and surfactant. Biol Neonate 2001; 80 (01) 7-13.
• 13 Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2007 CD003063.
• 14 Groneck P, Schmale J, Soditt V. et al. Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease. Pediatr Pulmonol 2001; 31: 331-338.
• 15 Agarwal P, Rajadurai VS, Pradeepkumar VK, Tan KW. Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates. J Paediatr Child Health 2000; 36: 487-490.
• 16 Lyon AJ, McColm J, Middlemist L. et al. Randomised trial of erythromycin on the development of chronic lung disease in preterm infants. Arch Dis Child Fetal Neonatal Ed 1998; 78: F10-14.
• 17 Fowlie PW. Intravenous indomethacin for preventing mortality and morbidity in very low birth weight infants. Cochrane Database Syst Rev. 2000 CD000174.
• 18 Schmidt B, Davis P, Moddemann D. et al. Longterm effects of indomethacin prophylaxis in extremely- low-birth-weight infants. N Engl J Med 2001; 344: 1966-1972.
• 19 Stark AR, Carlo WA, Tyson JE. et al. Adverse effects of early dexamethasone in extremely-low-birthweight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 2001; 344: 95-101.
• 20 Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG. Continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. 2000 CD002271.
• 21 Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev. 2000 CD001243.
• 22 te Pas AB, and Walther FJ. A randomized, controlled trial of delivery-room respiratory management in very preterm infants. Pediatrics 2007; 120: 322-329.
• 23 Morley CJ, Davis PG, Doyle LW. et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358: 700-708.
• 24 Ambalavanan N, Carlo WA. Ventilatory strategies in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol 2006; 30: 192-199.
• 25 Schmidt B, Roberts RS, Davis P. et al. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med 2007; 357: 1893-1902.
• 26 Schmidt B, Roberts RS, Davis P. et al. Caffeine therapy for apnea of prematurity. N Engl J Med 2006; 354: 2112-2121.
• 27 Speer CP. New insights into the pathogenesis of pulmonary inflammation in preterm infants. Biol Neonate 2001; 79: 205-209.
• 28 Poets CF. When do infants need additional inspired oxygen? A review of the current literature. Pediatr Pulmonol 1998; 26: 424-428.
• 29 Tammela OK. Appropriate fluid regimens to prevent bronchopulmonary dysplasia. Eur J Pediatr 1995; 154: 15-18.
• 30 Darlow BA, Graham PJ. Vitamin A supple - mentation for preventing morbidity and mortality in very low birthweight infants. Cochrane Database Syst Rev. 2000 CD000501.
• 31 Johnson L, Bowen FW, Abbasi S. Relationship of prolonged pharmacologic serum levels of vitamin E to incidence of sepsis and necrotizing enterocolitis in infants with birth weight 1,500 grams or less. Cochrane Database Syst Rev 1985; 75: 619-638.
• 32 Barrington KJ, Finer NN. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev. 2007 CD000509.
• 33 Schreiber MD, Gin-Mestan K, Marks JD. et al. Inhaled nitric oxide in premature infants with the respiratory distress syndrome. N Engl J Med 2003; 349: 2099-2107.
• 34 Halliday HL, Ehrenkranz RA. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants (Cochrane Review). Cochrane Database Syst Rev 2001; 1: CD001146.
• 35 Halliday HL, Ehrenkranz RA. Moderately early (7–14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants (Cochrane Review). Cochrane Database Syst Rev 2001; 1: CD001144.
• 36 Doyle LW, Halliday HL, Ehrenkranz RA. et al. Impact of postnatal systemic corticosteroids on mortality and cerebral palsy in preterm infants: effect modification by risk for chronic lung disease. Pediatrics 2005; 115: 655-661.
• 37 Frank L, Sosenko IR. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis 1988; 138: 725-729.
• 38 Ehrenkranz RA. Early, aggressive nutritional management for very low birth weight infants: what is the evidence?. Semin Perinatol 2007; 31: 48-55.
• 39 Frakaloss G, Burke G, Sanders MR. Impact of gastroesophageal reflux on growth and hospital stay in premature infants. J Pediatr Gastroenterol Nutr 1998; 26: 146-150.
• 40 Sedin G, Bogner P, Berenyi E. et al. Res Lung water and proton magnetic resonance relaxation in preterm and term rabbit pups: their relation to tissue hyaluronan. Pediatr 2000; 48: 554-559.
• 41 Brion LP, Soll RF. Diuretics for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. 2000 CD001454.
• 42 Brion LP, Primhak RA, Yong W. Aerosolized diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2000 CD001694.
• 43 Ng GY, da Silva O, Ohlsson A. Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants (Cochrane Review). Cochrane Database Syst Rev 2001; 3: CD003214.
• 44 Kennedy JD. Lung function outcome in children of premature birth. Paediatr Child Health 1999; 35: 516-521.
• 45 Greenough A. Long-term pulmonary outcome in the preterm infant. Neonatology 2008; 93: 324-327.