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DOI: 10.1055/s-2006-931552
Die Langzeitprognose von Frühgeborenen: Was sich hinter den Statistiken verbirgt
Long-Term Outcome of Preterm Neonates: The Message behind the StatisticsPublication History
Eingereicht: 19.12.2005
Angenommen nach Überarbeitung: 22.12.2005
Publication Date:
27 March 2006 (online)
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Zusammenfassung
Wegen der Therapiefortschritte in der Neonatologie gibt die heute feststellbare Langzeitprognose ehemaliger Frühgeborener nicht zwingend das künftige Outcome heutiger Frühgeborener wieder. Unabhängig von dieser statistischen Unsicherheit lassen Langzeitstudien der vergangenen Jahre aber erkennen, dass sich die Folgen einer Frühgeburt weit über das Säuglingsalter hinaus erstrecken und sich in späteren Lebensphasen nicht selten in gewandelter Form manifestieren. Dementsprechend wird in dem vorliegenden Beitrag eine Chronologie der Folgeprobleme aufgezeigt, die sich angefangen von der perinatalen Mortalität und Frühmorbidität über das Kleinkindes-, Vorschul- und Adoleszentenalter bis hin zum Erwachsenenalter ergeben können. Dabei wird auch ein doppelter Paradigmenwechsel in der Neonatologie erkennbar, dem zufolge das Outcome von Frühgeborenen zum einen nicht von der Unreife allein abhängt, sondern wesentlich durch die Ursachen der Frühgeburtlichkeit (Infektion, intrauterine Mangelversorgung) mitbestimmt wird, und zum anderen auch nicht am Ende der Klinikaufenthaltes unveränderlich feststeht, sondern vielmehr im weiteren Verlauf erheblich von familiären Faktoren moduliert wird. Diese Erkenntnisse bilden, auch wenn die statistische Datenlage im Einzelnen noch im Fluss ist, die Grundlage für eine qualifizierte Langzeitbetreuung von Frühgeborenen, die nach der zunehmenden Etablierung der Akutbehandlungsstrategien eine immer wichtigere Zukunftsaufgabe der Neonatologie innerhalb der Pädiatrie darstellen wird.
Abstract
In view of the current progress in neonatal intensive care, the present outcome of former preterm neonates does not necessarily reflect the future outcome of today’s preterm neonates. In spite of this statistical uncertainty, long-term follow-up studies performed in the past few years point to the fact that the sequelae of prematurity may appear well beyond infancy and may be revealed in varying manners with increasing age. Therefore, a chronological account of the consequences of prematurity is given in this paper, ranging from perinatal mortality/morbidity to the problems to be observed during early childhood, preschool age, and adolescence right up to the long-term sequelae arising in later adulthood. Within this context, a two-fold paradigm shift in neonatology becomes apparent in that, first, the outcome of preterm neonates is not a result of immaturity per se, yet is significantly influenced by the factors leading to preterm birth (inflammation, intrauterine growth restriction), and, second, the sequelae of prematurity do not end with the end of neonatal intensive care, but are greatly modulated by familial conditions in their further course. Even though the statistical data are still subject to changes, these insights form the basis of a structured long-term follow-up of preterm neonates which, after the progressive establishment of acute treatment strategies, will become an increasingly important challenge to neonatology within the framework of paediatrics.
Schlüsselwörter
Frühgeburt - Ursachen - Prognose - Nachsorge
Key words
Prematurity - causes - outcome - follow-up
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PD Dr. med. D. Singer
Perinatalzentrum
Universitäts-Kinderklinik
Josef-Schneider-Straße 2
97080 Würzburg
Phone: 0931/201-27484
Fax: 0931/201-61805
Email: d.singer@mail.uni-wuerzburg.de