Chorioamnionitis - Eine inflammatorische Multiorganerkrankung des Fetus?

Zusammenfassung

Die bakterielle Infektion von Chorion und Amnion (Chorioamnionitis) ist bei Frühgeborenen häufig nachweisbar. Dabei entwickelt die Mutter selten Symptome einer systemischen Inflammationsreaktion, sodass die Chorioamnionitis häufig asymptomatisch und chronisch verläuft. Hiervon ist die fetale Inflammationsreaktion (FIRS, fetal inflammatory response syndrome) mit dem Nachweis einer umbilikalen Entzündungsreaktion bzw. erhöhten Serumspiegeln von proinflammatorischen Zytokinen zu trennen. In klinischen und experimentellen Studien wurde die systemische fetale Inflammationsreaktion als wichtiger Risikofaktor für eine schlechte pulmonale und neurologische Entwicklung der überlebenden, extrem unreifen Frühgeborenen determiniert. Interessanterweise ist jedoch das Vorliegen einer Chorioamnionitis mit einer verminderten neonatalen Mortalität extrem unreifer Frühgeborener assoziiert. In dem vorliegenden Übersichtsreferat wird der aktuelle Kenntnisstand zur Pathogenese der inflammationsassoziierten perinatalen Morbidität mit besonderer Berücksichtigung von pulmonalen und neurologischen Krankheitsbildern dargestellt und das Konzept einer fetalen Multiorganerkrankung während intrauteriner Infektion diskutiert.

Abstract

Bacterial infection of the chorion and amniotic fluid (chorioamnionitis) is commonly found after preterm delivery. Clinical, epidemiological and experimental studies indicate that in-utero exposure to infection plays an important role in the pathogenesis of fetal bronchopulmonary dysplasia or neonatal brain injury leading to cerebral palsy. Fetal inflammatory response syndrome (FIRS) with increased proinflammatory cytokines is a distinct entity from chorioamnionitis with increased morbidity. Recent clinical and experimental data support the hypothesis that a fetal inflammatory response links antenatal infection with perinatal morbidity. In this review article we provide evidence from experimental animal models that in-utero exposure to bacterial infection may severely alter fetal cardiovascular function, resulting in dysregulation of pulmonary and cerebral blood flow and in an inflammatory response of the fetal lungs and brain.

Schlüsselwörter

perinatale Morbidität - Frühgeburtlichkeit - fetale Inflammationsantwort - periventrikuläre Leukomalazie - Zerebralparese - bronchopulmonale Dysplasie

Key words

perinatal morbidity - preterm delivery - fetal inflammatory response syndrome - periventricular leukomalacia - cerebral palsy - bronchopulmonary dysplasia

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