Zusammenfassung
Prolongierte Schmerzen beeinflussen bei frühgeborenen Kindern unter neonataler Intensivtherapie
das Verhalten und die physiologische Regulation. Aus unzureichender Schmerzbehandlung
resultieren erhöhte Morbidität und Mortalität. Langfristige Konsequenzen von Schmerz
und Stress für die spätere Entwicklung sind unklar, jedoch werden neurologische und
verhaltensbezogene Spätfolgen diskutiert. Zur Objektivierung kindlicher Schmerzreaktionen
stehen eine Anzahl von psychometrischen Konstrukten (Schmerzskalen) zur Verfügung,
auf deren Grundlage die Notwendigkeit einer Behandlung überprüft werden kann. Typische
Indikationsgruppen für eine Therapie sind schmerzhafte interventionelle Prozeduren,
eine Analgosedierung unter Beatmungstherapie sowie die Unterdrückung von Stressantwort
auf chirurgische Maßnahmen. Nichtmedikamentöse Ansätze zur Reduzierung von Schmerz
und Stress beziehen sich auf das Verhalten des Kindes, unterstützende Maßnahmen durch
das Personal und die Optimierung der Umgebungsbedingungen. Für die analgetische Pharmakotherapie
stehen bei leichten Schmerzen Acetaminophen, bei moderaten und schweren Schmerzen
hauptsächlich die Opioide Fentanyl und Morphin zur Verfügung. Unter weniger schmerzhaften
Bedingungen kann eine ausschließliche oder zusätzliche Sedierung die physiologische
Stabilität des Kindes verbessern. Individuelle Behandlung, engmaschige klinische Überwachung
und Dosisanpassung entsprechend einer standardisierten Schmerzbeurteilung sind erforderlich.
Die aktuelle Datenlage ermöglicht auch bei sehr unreifen Frühgeborenen eine effektive
Schmerzreduktion. Es bestehen jedoch eine Reihe von Unklarheiten über frühkindliche
Schmerz- und Stressreaktionen, so dass in jedem Fall eine sorgfältige Nutzen-Risiko-Abwägung
erforderlich ist.
Abstract
Prolonged pain influences behaviour and physiological regulation in preterm infants
undergoing intensive care. Insufficient pain treatment results in increased morbidity
and mortality. Long-term consequences of stress and pain yet are not clear, but associations
with neurobehavioral and developmental sequelae are discussed. A number of psychometric
constructs (pain scales) are available to identify pain indicators. These pain scales
represent the basis to consider treatment strategies. Mainindications are painful
interventional procedures, analgesia during mechanical ventilation and the reduction
of pain following surgery. Supporting approaches to reduce pain and stress relate
to infant’s behaviour, care of the professionals and improvement of „infant’s world”.
Pharmacologic interventions are practicable with acetaminophen in mild pain and with
opioid drugs (fentanyl and morphine) in moderate and severe pain. A pure or complementary
sedative agend can provide physiological stability in settings in which there are
less acutely painful stimuli. After standard pain evaluation it is necessary to individualize
treatment, to monitor clinical situation and to adjust dosage. Actual knowledge allows
an effective reduction of pain even in very premature infants. Because of lack of
clarity about early development of pain and stress reactivity at the time it is necessary
to estimate benefits against potential risks of therapy.
Schlüsselwörter
Frühgeborenes - Schmerz - Stress - Analgesie - Sedierung
Key words
Premature infant - pain - stress - analgesia - sedation
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Dr. med. Axel Hübler
Abteilung Neonatologie und Pädiatrische Intensivmedizin
Klinik für Kinder- und Jugendmedizin
Friedrich-Schiller-Universität Jena
Kochstraße 2
07740 Jena
Telefon: 03641-938259
Fax: 03641-938075
eMail: Axel.Huebler@med.uni-jena.de
