Stellenwert der Inhalation von Stickstoffmonoxid (NO) bei Frühgeborenen<34 Gestationswochen

Zusammenfassung

In Europa wurde inhalatives NO (iNO) Ende 2001 als Medikament zur Behandlung der pulmonalen Hypertension beim reifen Neugeborenen und älteren Frühgeborenen >34 Gestationswochen zugelassen. INO scheint auch bei einem Teil der Frühgeborenen <34 Gestationswochen eine Hypoxämie verbessern zu können. In insgesamt 21 randomisiert-kontrollierten Studien wurden 3 336 Frühgeborene <34 Gestationswochen eingeschlossen. Die Behandlung mit iNO reduziert jedoch weder die Sterblichkeit noch die Rate der bronchopulmonalen Dysplasie (BPD). Auch das kombinierte Risiko aus Tod und BPD wird durch die iNO-Behandlung in dieser Altersgruppe für Frühgeborene mit einem manifesten Lungenversagen oder einem erhöhten BPD-Risiko nicht verändert. Möglicherweise kann eine frühe prophylaktische iNO-Gabe bei Atemstörung die Rate der Frühgeborenen erhöhen, welche ohne BPD, intraventrikuläre Blutungen ≥ III. Grades oder periventrikuläre Leukomalazie überleben. Aufgrund der derzeitigen Datenlage kann die Behandlung Frühgeborener <34 Gestationswochen mit iNO außerhalb randomisiert-kontrollierter Studien nicht empfohlen werden.

Abstract

In 2001, NO was approved as a therapeutic agent in Europe for the treatment of persistent pulmonary hypertension in late preterm infants >34 weeks of gestational age and term newborns. Recent observational studies suggest, that preterm infants <34 weeks of gestation with acute hypoxic lung failure could benefit from inhaled NO (iNO) by improved oxygenation. To date, 21 randomised-controlled trials have enrolled 3 336 preterm infants <34 weeks of gestation for iNO treatment. Overall, iNO treatment does not reduce the rate of bronchopulmonary dysplasia (BPD) or death compared to controls. In addition, iNO treatment of preterm infants with hypoxic respiratory failure or increased risk of BPD does not affect the combined incidence of death and BPD. However, early prophylactic use of iNO in preterm infants with respiratory distress seems to improve survival without BPD or severe cerebral damage. Current data of long term neurological outcome of iNO-treated preterm infants do not seem to justify iNO administration. Outside of well designed clinical trials iNO-treatment of preterm infants can currently not be recommended.

Frühgeborene - inhalatives Stickstoffmonoxid - Atemnotsyndrom - bronchopulmonale Dysplasie

preterm infant - nitric oxide - respiratory distress syndrome - bronchopulmonary dysplasia

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