Frühgeborene unter 1500 g Geburtsgewicht

Zusammenfassung

In Deutschland kommen rund 1,4 % aller Neugeborenen mit einem Gewicht unter 1500 g zur Welt. Im Jahr 2015 waren das 9484 Kinder, von denen 87 % lebend nach Hause entlassen werden konnten. Seit 2006 schreibt der Gemeinsame Bundesausschuss eine Nachuntersuchung dieser Kinder im Alter von 2 Jahren vor, etwa mit den Bayley Scales of Infant Development. In diesem Alter lassen sich Zerebralparesen relativ sicher diagnostizieren, Aussagen zur kognitiven Entwicklung sind aber erst mit etwa 4–5 Jahren einigermaßen verlässlich. Längsschnittdaten aus Niedersachsen der Jahrgänge 2004–2008 weisen nur in 73 % eine übereinstimmende Klassifizierung der gleichen Frühgeborenen (FG) im Alter von 2 und 5 Jahren auf. Die landesweiten Berliner Einschulungsuntersuchungen im Alter von 5–6 Jahren weisen bei 36 % der Kinder unter 750 g Geburtsgewicht und bei 22 % der Kinder zwischen 750 und 1500 g Geburtsgewicht auf einen sonderpädagogischen Förderbedarf hin (gegenüber 5 % bei normalgewichtigen Neugeborenen). Im Alter von 26 Jahren hatten ehemalige Frühgeborene der Bayerischen Entwicklungsstudie (Jahrgänge 1985/86) einen um 7–15 Punkte verringerten Intelligenzquotienten gegenüber Reifgeborenen (RG), sie neigten mehr zu sozialen Ängsten, hatten Schwierigkeiten, einen Partner bzw. eine Part-nerin zu finden und waren häufiger von ihren Eltern abhängig als Kontrollpersonen.

Summary

Preterm infants with a birth weight below 1,500 g comprise approximately 1.4 % of all live-born infants in Germany, amounting to 9484 infants in 2015. Their calculated survival-to-discharge estimate was of 87 %. Follow-up examinations at 2 years of age using the Bayley Scales of Infant Development or similar standardized tests are mandatory since 2006. This time point allows for a robust diagnosis of cerebral palsy but not of cognitive impairment. When preterm infants born 2004–2008 in Lower Saxony were examined both at 2 and 5 years of age, only 73 % were in the same diagnostic categories at both occasions. State-wide school readiness examinations at 5–6 years of age, conducted 2007–2011 in Berlin, diagnosed special educational needs in 36 % of children with a birth weight <750 g, and in 22 % of children with a birth weight of 750–1,500 g, as compared to 5 % of normal birth weight children. Adults born preterm with a birth weight <1,500 g in Bavaria 1985/86 had 7–15 points lower IQ score, displayed more anxiety, complained more about difficulties finding an intimate partner, and had less self-sustained living than controls.

Schlüsselwörter

Frühgeborene - Langzeitprognose - Deutsch-land

Keywords

Preterm infants - outcome - Germany

• Literatur

• 1 Allen MC, Cristofalo E, Kim C. Preterm birth: Transition to adulthood. Dev Disabil Res Rev 2010; 16: 323-335.
• 2 Aylward GP. Cognitive function in preterm infants: no simple answers. JAMA 2003; 289: 752-753.
• 3 Beinder E. Fetalzeit und spätere Gesundheit. Dtsch Ärztebl 2007; 104: 644-650.
• 4 Bettge S, Oberwöhrmann S, Brockstedt M, Bührer C. Birth weight and special educational needs: results of a population-based study in Berlin. Dtsch Arztebl Int 2014; 111: 337-344.
• 5 Botellero VL, Skranes J, Bjuland KJ. et al A longitudinal study of associations between psychiatric symptoms and disorders and cerebral gray matter volumes in adolescents born very preterm. BMC Pediatr 2017; 17: 45
• 6 Breeman LD, Jaekel J, Baumann N. et al Preterm Cognitive Function Into Adulthood. Pediatrics 2015; 136: 415-423.
• 7 Cristobal R, Oghalai JS. Hearing loss in children with very low birth weight: current review of epidemiology and pathophysiology. Arch Dis Child Fetal Neonatal Ed 2008; 93: F462-468.
• 8 Fazzi E, Bova S, Giovenzana A. et al Cognitive visual dysfunctions in preterm children with periventricular leukomalacia. Dev Med Child Neurol 2009; 51: 974-981.
• 9 Ford RM, Griffiths S, Neulinger K. et al Impaired prospective memory but intact episodic memory in intellectually average 7- to 9-year-olds born very preterm and/or very low birth weight. Child Neuropsychol 2016; 1-26.
• 10 Goddeeris JH, Saigal S, Boyle MH. et al Economic outcomes in young adulthood for extremely low birth weight survivors. Pediatrics 2010; 126: e1102-1108.
• 11 Grunewaldt KH, Fjortoft T, Bjuland KJ. et al Follow-up at age 10 years in ELBW children - functional outcome, brain morphology and results from motor assessments in infancy. Early Hum Dev 2014; 90: 571-578.
• 12 Hack M. Young adult outcomes of very-low-birth-weight children. Semin Fetal Neonatal Med 2006; 11: 127-137.
• 13 Hack M, Flannery DJ, Schluchter M. et al Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med 2002; 346: 149-157.
• 14 Hack M, Youngstrom EA, Cartar L. et al Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years. Pediatrics 2004; 114: 932-940.
• 15 Holling H, Schlack R, Kamtsiuris P. et al Die KiGGS-Studie. Bundesweit repräsentative Längs- und Querschnittstudie zur Gesundheit von Kindern und Jugendlichen im Rahmen des Gesundheitsmonitorings am Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 836-842.
• 16 Indredavik MS, Vik T, Evensen KA. et al Perinatal risk and psychiatric outcome in adolescents born preterm with very low birth weight or term small for gestational age. J Dev Behav Pediatr 2010; 31: 286-294.
• 17 Jaekel J, Bartmann P, Schneider W, Wolke D. Neurodevelopmental pathways to preterm children‘s specific and general mathematic abilities. Early Hum Dev 2014; 90: 639-644.
• 18 Jaekel J, Wolke D. Preterm birth and dyscalculia. J Pediatr 2014; 164: 1327-1332.
• 19 Jeschke E, Biermann A, Günster C. et al Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008-2012; A Report Based on Administrative Data. Front Pediatr 2016; 4: 23
• 20 Johnson S, Fawke J, Hennessy E. et al Neurodevelopmental disability through 11 years of age in children born before 26 weeks of gestation. Pediatrics 2009; 124: e249-257.
• 21 Johnson S, Hollis C, Kochhar P. et al Autism spectrum disorders in extremely preterm children. J Pediatr 2010; 156: 525-531. e2
• 22 Jornayvaz FR, Vollenweider P, Bochud M. et al Low birth weight leads to obesity, diabetes and increased leptin levels in adults: the CoLaus study. Cardiovasc Diabetol 2016; 15: 73
• 23 Krägeloh-Mann I, Cans C. Cerebral palsy update. Brain Dev 2009; 31: 537-544.
• 24 Linsell L, Malouf R, Morris J. et al Prognostic Factors for Poor Cognitive Development in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review. JAMA Pediatr 2015; 169: 1162-1172.
• 25 Moreno-De-Luca A, Ledbetter DH, Martin CL. Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol 2012; 11: 283-292.
• 26 Murray AL, Scratch SE, Thompson DK. et al Neonatal brain pathology predicts adverse attention and processing speed outcomes in very preterm and/or very low birth weight children. Neuropsychology 2014; 28: 552-562.
• 27 Natalucci G, Schneider M, Werner H. et al Development of neuromotor functions in very low birth weight children from six to 10 years of age: patterns of change. Acta Paediat 2013; 102: 809-814.
• 28 O‘Callaghan ME, MacLennan AH, Haan EA, Dekker G. South Australian Cerebral Palsy Research G The genomic basis of cerebral palsy: a HuGE systematic literature review. Hum Gene 2009; 126: 149-172.
• 29 Ochiai M, Ichiyama M, Iwayama M. et al Longitudinal study of very low birth weight infants until 9years of age; attention deficit hyperactivity and autistic features are correlated with their cognitive functions. Early Hum Dev 2015; 91: 783-786.
• 30 Oliveira A, de Lauzon-Guillain B, Jones L. et al Birth weight and eating behaviors of young children. J Pediatr 2015; 166: 59-65.
• 31 Reidy N, Morgan A, Thompson DK. et al Impaired language abilities and white matter abnormalities in children born very preterm and/or very low birth weight. J Pediatr 2013; 162: 719-724.
• 32 Sellier E, Platt MJ, Andersen GL. et al Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol 2016; 58: 85-92.
• 33 Stahlmann N, Rapp M, Herting E, Thyen U. Outcome of extremely premature infants at early school age: health-related quality of life and neurosensory, cognitive, and behavioral outcomes in a population-based sample in northern Germany. Neuropediatrics 2009; 40: 112-119.
• 34 Stoinska B, Gadzinowski J. Neurological and developmental disabilities in ELBW and VLBW: follow-up at 2 years of age. J Perinatol 2011; 31: 137-142.
• 35 Strassburg HM, Leimer S, Platz A. et al Langzeitprognose sehr kleiner Frühgeborener in Deutschland. Klin Padiatr 2008; 220: 61-65.
• 36 Tettamanti G, Altman D, Cnattingius S. et al Does urinary incontinence have fetal origins? Results from a nationwide twin study. Int Urogynecol J 2014; 25: 1471-1477.
• 37 Tyson JE, Saigal S. Outcomes for extremely low-birth-weight infants: disappointing news. JAMA 2005; 294: 371-373.
• 38 van der Pal-de Bruin KM, van der Pal SM, Verloove-Vanhorick SP, Walther FJ. Profiling the preterm or VLBW born adolescent; implications of the Dutch POPS cohort follow-up studies. Early Hum Dev 2015; 91: 97-102.
• 39 Voss W, Hobbiebrunken E, Ungermann U. et al The Development of Extremely Premature Infants. Dtsch Arztebl Int 2016; 113: 871-878.
• 40 Voss W, Jungmann T, Wachtendorf M, Neubauer AP. Long-term cognitive outcomes of extremely low-birth-weight infants: the influence of the maternal educational background. Acta Paediatr 2012; 101: 569-573.
• 41 Wang CJ, McGlynn EA, Brook RH. et al Quality-of-care indicators for the neurodevelopmental follow-up of very low birth weight children: results of an expert panel process. Pediatrics 2006; 117: 2080-2092.
• 42 Weindrich D, Jennen-Steinmetz C, Laucht M, Schmidt MH. Late sequelae of low birthweight: mediators of poor school performance at 11 years. Dev Med Child Neurol 2003; 45: 463-469.
• 43 Wolke D, Jaekel J. Langzeitüberlebensqualität ehemaliger kleiner Frühgeborener. Monatsschr Kinderheilkd 2016; 164: 673-684.