Die perinatale Therapie mit Glukokortikosteroiden: Zeit zum Umdenken[1]

Zusammenfassung

Glukokortikosteroide werden sowohl prä- als auch postnatal zur Senkung der pulmonalen Morbidität Frühgeborener eingesetzt. Ein einmaliger pränataler Steroidzyklus reduziert die Mortalität Frühgeborener sowie die Häufigkeit des Atemnotsyndroms und der Hirnblutung. Die Verabreichung repetitiver Behandlungszyklen kann jedoch möglicherweise einen ungünstigen Einfluss auf die Hirnentwicklung haben. Nachuntersuchungsstudien von Kindern mit mehrfachen pränatalen Steroidzyklen sind erforderlich. Die Art des verwendeten Steroids ist offenbar ebenfalls von Bedeutung für die zerebrale Morbidität von Frühgeborenen, die derzeitige Datenlage favorisiert Betamethason gegenüber Dexamethason. Postnatal werden Steroide zur Prophylaxe oder Therapie der bronchopulmonalen Dysplasie (BPD) verabreicht. Neuere Untersuchungen haben jedoch gezeigt, dass die Behandlung der BPD mit Dexamethason zu einer erhöhten Rate an Zerebralparesen führt. Die postnatale Behandlung der BPD mit Steroiden sollte auf lebensbedrohliche Situationen begrenzt werden.

Glucocorticosteroids are administered antenatally and postnatally to decrease pulmonary morbidity of preterm neonates. One course of antenatal corticosteroids decreases mortality, and the frequency of respiratory distress syndrome and intraventricular hemorrhage. However, multiple courses may be associated with impaired brain development. Follow-up studies are needed to assess long-term consequences. The use of betamethasone may be of advantage compared to dexamethasone. Postnatally, steroids are given to treat or prevent bronchopulmonary dysplasia (BPD). However, recent studies have shown that treatment with dexamethasone increases the rate of cerebral palsy in preterm infants. Postnatal treatment of BPD with steroids should be restricted to life-threatening situations.

Perinatale Steroidtherapie - Glukokortikoide - Dexamethason - Betamethason - bronchopulmonale Dysplasie

Perinatal corticosteroids - glucocorticosteroids - dexamethasone - betamethasone - bronchopulmonary dysplasia

Literatur

1 Eingang: 7. 3. 2001
Angenommen nach Revision: 9. 4. 2001

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