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Klin Padiatr 2000; 212(2): 47-52
DOI: 10.1055/s-2000-9651
ÜBERSICHT

Georg Thieme Verlag Stuttgart ·New York

Inhalative Stickstoffmonoxidtherapie bei Frühgeborenen

Inhaled nitric oxide in preterm neonates:T.  Hoehn1 , M.  F.  Krause2 , C.  Bührer1
  • 1Klinik für Neonatologie, Charité, Virchow-Klinikum, Humboldt-Universität, Berlin
  • 2Neugeborenen-Intensivstation, Universitäts-Kinderklinik, Freiburg
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Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

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Zusammenfassung:

Die Therapie der persistierenden pulmonalen Hypertension des Neugeborenen (PPHN) mit inhalativem Stickstoffmonoxid (iNO) zählt nach Veröffentlichung einer Reihe von randomisierten und kontrollierten Studien mittlerweile zu einem etablierten Verfahren in der neonatologischen Intensivmedizin. Ganz anders ist die Situation beim Frühgeborenen, da infolge der Interferenz von Stickstoffmonoxid mit der Thrombozytenaggregation das Risiko von intraventrikulären Blutungen bzw. deren Ausprägungsgrad unter dieser Therapie als risikoreicher eingeschätzt wird. Die bisher vorliegenden Studien bei Frühgeborenen beantworten die Frage nach der Inzidenz von intraventrikulären Blutungen (IVH) nur unzureichend, Endpunkte sind in den meisten Fällen Veränderungen der Oxygenierungsparameter. Mittlerweile konnten zwei größere Studien von iNO bei Frühgeborenen zeigen, dass diese Therapieform nicht mit einer erhöhten Hirnblutungsrate im iNO-Kollektiv assoziiert ist. Weitere randomisierte, kontrollierte Studien zum Einsatz von Stickstoffmonoxid bei Frühgeborenen sind dringend erforderlich um den künftigen Stellenwert dieser Therapieform und deren Indikationen zu determinieren.

According to a number of recently published, randomized controlled trials, treatment of persistent pulmonary hypertension of the newborn (PPHN) by the use of inhaled nitric oxide (iNO) has emerged as an established procedure in neonatology. The situation in premature infants appears to be more complicated than in the term infant. Due to the fact that nitric oxide interferes with platelet aggregation, the risk of intraventricular hemorrhage or its aggravation during iNO therapy is being discussed in a controversial manner. Since most studies are aimed at endpoints like oxygenation parameters, the presently available studies report extremely variable incidences of intraventricular hemorrhages (IVH). Meanwhile two large studies could demonstrate that clinical application of iNO in preterm infants is not associated with an increased incidence of IVH. Further randomized controlled trials of iNO in preterm neonates are highly desirable in order to establish the future role of this therapy and its indications.

Abkürzungen:

BPD Bronchopulmonale Dysplasie

CLD Chronische Lungenerkrankung

ECMO Extrakorporale Membranoxygenierung

FiO2Inspiratorische Sauerstoffkonzentration

iNO Inhalatives Stickstoffmonoxid

IVH Intraventrikuläre Blutung

MAP Mittlerer Atemwegsdruck

OI Oxygenierungsindex

PaO2/PAO2 Arterio-alveolärer Sauerstoffgradient

PPHN Persistierende pulmonale Hypertension des Neugeborenen

ppm Teile per Million

Schlüsselwörter:

Pulmonale Hypertension - inhalatives Stickstoffmonoxid - Frühgeborenes - intraventrikuläre Blutung - Thrombozytenaggregationshemmung - extrakorporale Membranoxygenierung

Key words:

Pulmonary hypertension - inhaled nitric oxide - premature infant - intraventricular hemorrhage - inhibition of platelet aggregation - extracorporeal membrane oxygenation

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Dr. med. Thomas Hoehn

Klinik für Neonatologie Charité, Campus Virchow-Klinikum

Augustenburger Platz 1

13344 Berlin

Telefon: Tel. 030-450 66413

Fax: Fax 030-450 66922

eMail: E-mail: thomas.hoehn@charité.de