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Z Geburtshilfe Neonatol 2001; 205(5): 167-173
DOI: 10.1055/s-2001-18502
ÜBERSICHT

Georg Thieme Verlag Stuttgart · New York

Hämatopoetische Wachstumsfaktoren in Prophylaxe und Therapie infektiöser Komplikationen bei Früh- und Neugeborenen[1]

Hematopoietic growth factors in prophylaxis and treatment of infectious complications in neonatesTh. Lehrnbecher
  • Kinderklinik der Universität Würzburg
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Publication History

Publication Date:
19 November 2001 (online)

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Zusammenfassung

Infektiöse Komplikationen sind auch heute noch ein großes Problem in der Betreuung von Früh- und Neugeborenen. Insbesondere bakterielle Infektionen und Pilzinfektionen haben bei diesen Patienten auch heute noch eine hohe Letalität, vor allem wenn sie mit einer Neutropenie einhergehen. Eine der Ursachen für die erhöhte Suszeptibilität von Früh- und Neugeborenen für Infektionen ist die verminderte Zahl von Vorläuferzellen der neutrophilen Granulozyten. Hämatopoetische Wachstumsfaktoren wie G-CSF (granulocyte colony stimulating factor) oder GM-CSF (granulocyte-macrophage colony stimulating factor) stimulieren Proliferation und Reifung der myeloischen Vorläuferzellen und expandieren so die Zahl zirkulierender neutrophiler Granulozyten. Mit dem Einsatz von gentechnologisch hergestellten G-CSF und GM-CSF versprach man sich einen großen Fortschritt in der Betreuung von Früh- und Neugeborenen. Zwar können beide Wachstumsfaktoren bei sehr kleinen Frühgeborenen als auch bei neutropenischen Kindern von Müttern mit Präeklampsie die Zahl der zirkulierenden neutrophilen Granulozyten erhöhen als auch deren Funktion verbessern, jedoch konnte in keiner größeren Studie gezeigt werden, dass G-CSF oder GM-CSF bei diesen Patienten die Inzidenz infektiöser Komplikationen reduzieren oder die Überlebenrate verbessern. Entsprechende Ergebnisse für G-CSF und GM-CSF wurden auch bei septischen Früh- und Neugeborenen berichtet. Aus diesem Grunde wird derzeit der routinemäßige Einsatz von hämatopoetischen Wachstumsfaktoren bei Früh- und Neugeborenen weder in der Prophylaxe noch in der Therapie infektiöser Komplikationen empfohlen. Zukünftige Studien müssen jedoch klären, ob spezielle Untergruppen von Früh- und Neugeborenen von der Gabe der Wachstumsfaktoren profitieren und G-CSF oder GM-CSF bei diesen Patienten die Inzidenz von Infektionen oder die Dauer von intravenösen Antibiotikagaben verringern, die Krankenhauszeit verkürzen oder zu einer Verbesserung der Überlebensrate führen können.

Bacterial sepsis continues to be an important cause of morbidity and mortality in neonates. Neutropenia in the newborn, as a result of decreased bone marrow neutrophil storage pool reserves and myeloid committed progenitor cells, increases the risk of sepsis and is associated with a poor prognosis. The hematopoietic colony-stimulating factors G-CSF (granulocyte colony stimulating factor) and GM-CSF (granulocyte-macrophage colony stimulating factor) increase the number of circulating neutrophil number by stimulating neutrophil precursors proliferation. In a number of clinical trials in very low birthweight neonates and in neonates with preeclampsia-associated neonatal neutropenia, both hematopoietic growth factors significantly increased the circulating absolute neutrophil count. However, no larger study showed that prophylactic G-CSF or GM-CSF treatment resulted in a reduction of infectious complications or in an improved overall survival. Similar results were seen in studies evaluating G-CSF and GM-CSF as intervention therapy in septic neonates. Therefore, experts do not recommend the routine use of the expensive growth factors in preterm and term neonates. However, prospective clinical trials are still needed to evaluate whether specific treatment groups will benefit from the use of G-CSF or GM-CSF. In this regard, efforts must be directed at better defining the endpoints and in particular assigning value to reduction in treatment of possible infectious complications, such as days in hospital, antibiotic usage and costs. In addition, randomized studies are required to evaluate the proper dosage and duration of therapy, which most likely will vary between groups of patients.

Schlüsselwörter

Neugeborene - Infektion - G-CSF (granulocyte colony stimulating factor) - GM-CSF (granulocyte-macrophage colony stimulating factor)

Key words

Neonate - infection - G-CSF (granulocyte colony stimulating factor) - GM-CSF (granulocyte-macrophage colony stimulating factor)

1 Eingang: 23. 2. 2001
Angenommen nach Revision: 2. 5. 2001

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PD Dr. med. Thomas Lehrnbecher

Klinik für Kinderheilkunde III
Hämatologie und Onkologie

Theodor-Stern-Kai 7

60596 Frankfurt/Main