Zusammenfassung
Klinische und epidemiologische Studien weisen auf eine wichtige Rolle perinataler Infektionen in der Genese fetaler und neonataler Schädigungen hin. Eine Chorioamnionitis ist nicht nur von wesentlicher Bedeutung für die Entwicklung einer Frühgeburt, sondern erhöht auch das Risiko perinataler Hirnschäden. Im Vordergrund stehen neben der peri- und intraventrikulären Hirnblutung, insbesondere Läsionen der weißen Hirnsubstanz, die so genannte periventrikuläre Leukomalazie. Diese wird heute als wesentliche Ursache für die spätere Ausbildung einer spastischen Zerebralparese angesehen. Bakterielle Endotoxine und im Körper freigesetzte proinflammatorische Zytokine spielen eine Schlüsselrolle in der Pathogenese der infektionsvermittelten perinatalen Hirnschädigung. Sie verursachen eine schwere Beeinträchtigung der fetalen Herz-Kreislauf-Regulation mit Abfall des zerebralen Sauerstofftransportes, führen zu einer direkten Schädigung der weißen Hirnsubstanz und scheinen das unreife Gehirn gegenüber einer Sauerstoffmangelsituation zu sensibilisieren. Die Aufklärung der pathophysiologischen Mechanismen im Rahmen einer intrauterinen Infektion des Feten könnte entscheidend dazu beitragen, die Inzidenz perinatal erworbener Hirnschäden und somit die Morbidität der betroffenen Kinder zu senken.
Abstract
There is a growing body of evidence from clinical and epidemiological studies that in utero exposure to infection plays an important role in the pathogenesis of fetal or neonatal morbidity leading to cerebral palsy. Thus, after chorioamnionitis the incidence of immature neonates suffering from periventricular white matter damage and peri- or intraventricular hemorrhage is significantly increased. Reports of elevated cytokine levels in both neonatal blood and amniotic fluid in children with cerebral palsy support the notion that cerebral palsy is preceded by a perinatal inflammatory disease. However, the mechanisms that link perinatal infection to cerebral palsy and hypoxic-ischemic encephalopathy have not been fully identified. A variety of studies support the view that proinflammatory cytokines released during intrauterine infection directly cause injury in the immature brain. On the other hand, the susceptibility of the fetus to infection and the type of neurologic sequelae change with gestational age and hence depend in part on the timing of the insult relative to the stage of maturation of both central nervous system and cardiovascular function. In this review article we provide evidence that in-utero exposure to bacterial infection may severely alter fetal cardiovascular function, resulting in dysregulation of cerebral blood flow and subsequent hypoxic-ischemic brain injury.
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Dr. med. PhD Yves Garnier
Universitätsklinikum Aachen · Frauenklinik für Gynäkologie und Geburtshilfe
Pauwelsstraße 30
52074 Aachen
Email: ygarnier@ukaachen.de
