Kinder- und Jugendmedizin 2012; 12(03): 157-160
DOI: 10.1055/s-0038-1629193
Säuglinge
Schattauer GmbH

Nachsorge bei Frühgeborenen

Welche Konzepte tragen zur langfristigen Prognoseverbesserung bei?Follow up of preterm infantsWhich developmental programs improve long-term outcome?
U. Lindner
1   Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg/Saar
,
L. Gortner
1   Universitätsklinikum des Saarlandes, Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg/Saar
› Author Affiliations
Further Information

Publication History

Eingereicht am:06 February 2012

angenommen am:13 February 2012

Publication Date:
31 January 2018 (online)

Zusammenfassung

Steigende Frühgeburten- sowie steigende Überlebensraten sehr unreifer Frühgeborener in den letzten Dekaden haben zu einem Anstieg der Anzahl von Kindern mit einem Risiko für psychoneurologische Entwicklungsauffälligkeiten geführt, welche Auffälligkeiten in der motorischen und kognitiven Entwicklung, Seh- und Hörstörungen, Teilleistungsstörungen und Verhaltensauffälligkeiten umfassen. Die hohe Rate an Entwicklungsauffälligkeiten macht eine über das Kleinkindesalter hinausgehende Nachbetreuung erforderlich. Zur Nachbetreuung der Kinder wurden verschiedene Nachsorgekonzepte entwickelt, welche physiotherapeutische, psychologische, soziale und/oder pädagogische Ansätze beinhalten. In einer Metaanalyse verschiedener Nachsorgekonzepte konnten teilweise signifikante Effekte auf die kognitive Entwicklung im Kleinkindesalter gezeigt werden, ein Effekt auf die motorische Entwicklung wurde nicht beobachtet. Dem Ansatz der psycho-sozialen Unterstützung der Familien scheint eine Bedeutung in der Verbesserung des kognitiven Outcomes und in der Reduktion von Verhaltensauffälligkeiten zuzukommen.

Summary

Increasing rates of premature birth as well as increasing survival rates of very preterm infants during the last decades have led to an increase of children with a high risk of neurobehavioural impairments such as cognitive impairment, motor dysfunction, sensory deficits (blindness/deafness), learning disabilities and behavioural problems. The high rate of neurobehavioural impairments requires special follow up beyond early childhood. Early developmental intervention programs including physiotherapeutic, psychological, social and/or educational approaches have been developed for preterm infants. Significant effects on cognitive development during early childhood could be shown in a meta-analysis of different early developmental intervention programs; an effect on motor development could not be found. The approach of psychosocial support of families seems to play an important role in improving cognitive outcome and reducing behavioural problems.

 
  • Literatur

  • 1 Martin RJ, Fanaroff AA, Walsh MC. Neonatal-Perinatal Medicine, Diseases of the Fetus and Infant. Aufl.. St. Louis, Missouri: Elsevier; 2009
  • 2 Balchin I, Whittaker JC, Lamont RF. et al The effect of exclusion of cases with unrecorded best estimate of gestational age on the estimates of preterm birth rate. BJOG 2009; 116: 1218-1224.
  • 3 Doyle LW. and the Victorian Infant Collaborative Study Group. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades. I. Effectiveness. Pediatrics 2004; 113: 505-509.
  • 4 Field DJ, Dorling JS, Manktelow BN. et al Survival of extremly premature babies in a geographically defined population: prospective cohort study of 1994-1999 compared with 2000-2005. BMJ 2008; 336: 1221-1223.
  • 5 Vohr B, Wright LL, Dusick AM. et al Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research network, 1993-1994. Pediatrics 2000; 105: 1216-1226.
  • 6 Hogan DP, Park JM. Family factors and social support in the developmental outcomes of very lowbirth weight children. Clin Perinatol 2000; 27: 433-459.
  • 7 Laucht M, Esser G, Schmidt MH. Developmental outcome of infants born with biological and psychosocial risks. J Child Psychol Psychiatry 1997; 38: 843-853.
  • 8 Voss W, Wachtendorf M, Jungmann T. et al Hannoversche Frühgeborenen-Langzeitstudie - Die Bedeutung soziodemografischer Faktoren für das entwicklungsneurologische Outcome von Frühgeborenen mit einem Geburtsgewicht <1000 g. Z Geburtshilfe Neonatol 2009; 213 FV_N_10_02 (Abstract)
  • 9 Himpens E, van den Broeck C, Oostra A. et al Prevalence, type, distribution and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008; 50: 334-340.
  • 10 Larroque B, Ancel PY, Marret S. et al Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE Study): a longitudinal cohort study. Lancet 2008; 371: 813-820.
  • 11 Arpino C, Compagnone E, Montanaro ML. et al Preterm birth and neurodevelopmental outcome: a review. Childs Nerv Syst 2010; 26: 1139-1149.
  • 12 Doyle LW, Anderson PJ. Victorian Infant Collaborative Study Group. Improved neurosensory outcome at 8 years of age of extremely low birth weight children born in Victoria over three distinct eras. Arch Dis Child Fetal Neonatal Ed 2005; 90: F484-488.
  • 13 Bhutta AT, Cleves MA, Casey PH. et al Cognitive and behavioural outcomes of school-aged children who were born preterm. A meta-analysis. JAMA 2002; 288: 728-737.
  • 14 Chyi LJ, Lee HC, Hintz SR. et al School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation. J Pediatr 2008; 153: 25-31.
  • 15 Huddy CL, Johnson A, Hope PL. Educational and behavioural problems in babies of 32-35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001; 85: F23-28.
  • 16 Kirkegaard I, Obel C, Hedegaard M. et al Gestational age and birth weight in relation to school performance of 10-year-old children: a follow up study of children born after 32 completed weeks. Pediatrics 2006; 118: 1600-1606.
  • 17 Ramey CT, Bryant DM, Wasik BH. et al Infant health and development program for low birth weight, premature infants: program elements, familiy participation, and child intelligence. Pediatrics 1992; 89: 454-465.
  • 18 Brooks-Gunn J, McCarton CM, Casey PH. et al Early intervention in low-birth-weight premature infants: results through age 5 years from the Infant health and Development Program. JAMA 1994; 272: 1257-1262.
  • 19 McCarton CM, Brooks-Gunn J, Wallace IF. et al Results at age 8 years of early intervention for lowbirth- weight premature infants. The Infant Health and Development Program. JAMA 1997; 277: 126-132.
  • 20 McCormick MC, Brooks-Gunn J, Buka SL. et al Early Intervention in Low Birth Weight Premature Infants: results at 18 Years of Age for the Infant Health and Development Program. Pediatrics 2011; 117: 771-780.
  • 21 Spittle AJ, Ferretti C, Anderson PJ. et al Improving the outcome of infants born at <30 weeks` gestation - a randomized controlled trial of preventative care at home. BMC Pediatr 2009; 9: 73-86.
  • 22 Spittle AJ, Anderson PJ, Lee KJ. et al Preventive Care at Home for Very Preterm Infants Improves Infant and Caregiver Outcomes at 2 Years. Pediatrics 2010; 126: e171-178.
  • 23 Rauh VA, Nurcombe B, Achenbach T. et al The Mother-Infant Transaction Program: The content and implications of an intervention for the mothers of low-birthweight infants. Clin Perinatol 1990; 17: 31-45.
  • 24 Nordhov SM, Ronning JA, Dahl LB. et al Early Intervention Improves Cogitive Outcomes for Preterm Infants: Randomized Controlled Trial. Pediatrics 2010; 126: e1088-1094.
  • 25 Porz F. Prospektive randomisierte Implementierung des Modellprojektes Augsburg (PRIMA-Studie): Evaluation der individuellen familienorientierten Nachsorge für Früh- und Risikogeborene des Modellprojektes BUNTER KREIS Augsburg, Zusammenfassung des Endberichts, Juli 2008. www.beta-institut.de/downlowd/prima-ergebnisse-zusammenfassung.pdf
  • 26 Spittle A, Orton J, Doyle LW. et al Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2007; CD005495
  • 27 Vanderveen JA, Bassler D, Robertson CMT. et al Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis. J Perinatol 2009; 29: 343-351.
  • 28 Orton J, Spittle A, Doyle L. et al Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review. Dev Med Child Neurol 2009; 51: 851-859.
  • 29 Der gemeinsame Bundesausschuss. Vereinbarung über Maßnahmen zur Qualitätssicherung der Versorgung von Früh- und Neugeborenen vom 20.08.2009. Bundesanzeiger. 2009; 195: 4450