Perinatale Palliativbetreuung im zeitlichen Wandel: eine longitudinale Beobachtungsstudie

Zusammenfassung

Neonatale Todesfälle treten großteils auf, nachdem eine Entscheidung, lebensunterstützende Maßnahmen zu beenden, getroffen wurde [1–7]. Neugeborene sterben selten unerwartet sondern überwiegend nach einer Entscheidung zur Therapiezieländerung. Der Entscheidungsweg dazu hat sich über die Jahre deutlich gewandelt und die praktische Umsetzung variiert stark zwischen den einzelnen Neugeborenenintensivstationen [1, 8]. Ziel der Studie war es, die näheren Umstände neonataler Todesfälle einer universitären Neonatologie in einem definierten Zeitraum zu evaluieren und Veränderungen im Laufe der Zeit festzuhalten. Während des 10-jährigen Beobachtungszeitraumes wurden am LMU Klinikum München 41 543 Kinder entbunden, von diesen sind 348 Kinder peri- oder postnatal verstorben. Im Kreißsaal verstarben 248 Kinder. Auf der Neugeborenenintensivstation verstarben von den 10 908 im Beobachtungszeitraum versorgten Kindern insgesamt 97. Ein zunehmend proaktiverer Ansatz hat in den letzten Jahren dazu geführt, dass dieprimäre Palliativversorgung Extremfrühgeborener häufiger abgelöst wurde durch einen Therapieversuch an der Grenze der Lebensfähigkeit. Da keine Änderung der Leitlinie zum Vorgehen bei Frühgeburtlichkeit an der Grenze der Lebensfähigkeit während des Datenerhebungszeitraumes vorgenommen wurde, ist diese Veränderung eher dem Zusammenwirken elterlicher Wunsch- und Erwartungshaltung und ärztlichem Handeln zuzuschreiben.

Abstract

Advances in perinatal medicine have contributed to significantly improved survival of newborns. While some infants die despite extensive medical treatment, a larger proportion dies after a decision to withdraw life-sustaining therapy is made. The approaches to these decisions have significantly changed over the years, and their practical implementation still varies greatly between different neonatal intensive care units. The aim of this study was to evaluate the circumstances surrounding all neonatal deaths in a university neonatal setting in Germany over a ten-year period and to document changes over time. During the 10-year study period, 41,543 children were born at the LMU university hospital Munich, while 348 children died during this time. Of these, 248 children passed away in the delivery room. A total of 10,908 children received medical care in the neonatal wards (two level III NICUs and two intermediate care units). Of these, more than half (56%) were term infants, and only about 1% wereat the border of viability. On the neonatal intensive care unit, a total of 97 newborns died. A more proactive approach has led to primary palliative care for extremely preterm infants being increasingly replaced by attempts at therapy at the threshold of viability. Since there was no change in the guidelines for the management of preterm infants at the border of viability during the data collection period, this shift could be attributed more likely to the interaction of parental preferences and expectations and medical decision-making.

Schlüsselwörter

Palliativmedizin - Grenze der Lebensfähigkeit - Zurückhalten lebensverlängernder Therapie

Keywords

palliative care - withholding life sustaining therapy - border of viability

Publication History

Received: 13 December 2024

Accepted after revision: 12 June 2025

Article published online:
24 September 2025

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