Die Inhalation von Stickstoffmonoxid in der Neonatologie: Stellenwert dieser Therapie im Jahre 2004

Zusammenfassung

Ende der 1970er Jahre konnte nachgewiesen werden, dass Stickstoffmonoxid (NO) an der Kontrolle des Blutgefäßtonus beteiligt ist. In Europa wurde inhalatives NO (iNO) Ende 2001 als Medikament zur Behandlung der pulmonalen Hypertension beim Neugeborenen und älteren Frühgeborenen > 34 Gestationswochen zugelassen. Die Therapie mit iNO reduziert hauptsächlich den Bedarf an Behandlungen mittels extrakorporaler Membranoxygenierung. Die Letalität der zugrunde liegenden Erkrankung wird jedoch nicht beeinflusst. Die iNO-Therapie bei Neugeborenen und älteren Frühgeborenen > 34 Gestationswochen stellt nach derzeitigen Erkenntnissen keinen zusätzlichen Risikofaktor für die neurologische Entwicklung dar.

Die iNO-Behandlung gilt heute als der Goldstandard zur Therapie der pulmonalen Hypertension des Neugeborenen. Die etwa 30 % Therapieversager geben jedoch Anlass, auch weiterhin nach alternativen Behandlungskonzepten zu suchen. Eine prophylaktische Therapie nach einem Risikoprofil hat sich bisher als nicht sinnvoll erwiesen.

Eine Behandlungsindikation Frühgeborener < 34 Gestationswochen mit iNO konnte bisher nicht gesichert werden.

Abkürzungen

NO:Stickstoffmonoxid

iNO:inhalatives Stickstoffmonoxid

OI:Oxygenierungsindex: dimensionslose Größe ausAtemwegsmitteldruck (MAP), Sauerstoffkonzentrationin der Inspirationsluft (O₂-Konz.) und arteriellemSauerstoffpartialdruck (PaO₂).OI = MAP [mbar] × O₂-Konz. [%]PaO₂ [mmHg]

ECMO:Extracorporale Membranoxygenierung

SSW:Schwangerschaftswochen

RDS:Atemnotsyndrom (engl. Respiratory distress syndrome

BPD:bronchopulmonale Dysplasie

IVH:intraventrikuläre Hämorrhagie

PVL:periventrikuläre Leukomalazie

HFOV:Hochfrequenz-Oszillationsbeatmung(engl. High frequency oscillatory ventilation)

PaO₂:arterieller Sauerstoffpartialdruck

Abstract

In the late 1970 s it was demonstrated that nitric oxide (NO) was involved in the regulation of vasomotor tone. In Europe inhaled NO (iNO) was approved as a therapy option for the treatment of pulmonary hypertension in term and slightly preterm (> 34 weeks of gestation) neonates. Therapy by iNO mainly reduces the necessity for treatment by extracorporeal membrane oxygenation. However, the mortality of the underlying disease is not affected. According to our current knowledge iNO therapy for term and slightly preterm (> 34 weeks of gestation) neonates does not represent an additional risk factor for the neurological development. Today, iNO therapy constitutes the gold standard for pulmonary hypertension in new-born babies. However, the 30 % non-responders warrant a continued search for alternative treatment concepts. Prophylactic therapy according to a risk profile has not yet proved to be meaningful. An indication for the treatment of preterm neonates of less than 34 weeks of gestation has not yet been confirmed.

Schlüsselwörter

Reifes Neugeborenes - Frühgeborenes - Pulmonale Hypertonie - inhalatives Stickstoffmonoxid

Key words

Full-term neonates - preterm neonates - pulmonary hypertension - inhaled nitric oxide

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