Medikamentöse Prophylaxe und Therapie der bronchopulmonalen Dysplasie

Zusammenfassung

Die wichtigsten Maßnahmen zur Prävention der bronchopulmonalen Dysplasie (BPD) erfolgen prä- und unmittelbar postnatal und bestehen in der Behandlung mit pränatalen Steroiden, der prophylaktischen oder frühen Surfactantgabe, einem frühen Einsatz von nasalem CPAP mit weitestgehender Vermeidung der maschinellen Beatmung, einem frühen PDA-Verschluss und der Vermeidung nosokomialer Infektionen.

Neben diesen unspezifischen lungenprotektiven Maßnahmen sind eine Fülle von medikamentösen Interventionen zur Prophylaxe und Therapie der BPD untersucht worden.

Eine eindeutige Evidenz für eine nachhaltige Effektivität besteht bei den prophylaktischen medikamentösen Maßnahmen nur für eine Behandlung mit Vitamin A sowie für die Impfungen. Therapeutisch ist die Verabreichung von Sauerstoff die einzige nachweislich effektive, routinemäßig empfohlene Maßnahme, ohne dass sichere Angaben über die anzustrebenden Grenzwerte exsistieren. Ein passagerer, zeitlich begrenzter Effekt ist für Kinder mit drohender oder etablierter BPD durch die Behandlung mit Diuretika, inhalativen Steroiden und inhalativen Bronchodilatatoren zu erwarten. Diese Therapiemaßnahmen haben keine nachgewiesene Langzeitwirkung. Nur als Notfallbehandlung kommt die Therapie mit systemischen Steroiden bei schwerer respiratorischer Insuffizienz in Betracht. Die Behandlung mit inhalativen oder systemischen pulmonalen Vasodilatantien ist bei Vorliegen einer pulmonalen Hypertension die einzige therapeutische Möglichkeit, ohne dass derzeit ausreichende Langzeiterfahrungen vorliegen.

Abstract

Treatment with prenatal steroids, prophylactic or early therapeutic surfactant substitution, application of early nasal CPAP, minimizing of mechanical ventilation, early treatment of PDA and avoiding nosocomial infections are the main measures to prevent the development of bronchopulmonary dysplasia (BPD) in high-risk pre-term neonates. Beside these strategies, several pharmacologic interventions to prevent or to treat BPD have been investigated. So far, clear evidence for effective prevention has only been demonstrated for the administration of vitamin A and vaccinations. The administration of oxygen is the only effective treatment modality. Unfortunately, the upper and lower limits for the dosage of oxygen are still not clear. In patients with established BPD, a transient therapeutic effect is observerved following treatment with systemic diuretics, inhaled steroids, and inhaled bronchodilators. However, treatment with these drugs has no documented long-term effect on the course of the disease. Systemic steroids only play a role as rescue treatment in life-threatening situations. Treatment with inhaled or systemic pulmonary vasodilatative may have a place in the treatment of pulmonary hypertension in severely affected infants. However, long-term experience in this treatment modality is still lacking.

Schlüsselwörter

Bronchopulmonale Dysplasie - Prophylaxe - Therapie - Vitamin A - Impfungen

Key words

Bronchopulmonary dysplasia - prophylaxis - therapy - vitamin A - immunization

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