Das späte Frühgeborene – unterschätzte Morbidität

Von späten Frühgeborenen nahm man bisher an, dass ihr Morbiditäts- und Mortalitätsrisiko aufgrund ihrer schon fortgeschrittenen Organreife dem reifgeborener Kinder ähnlich sei. Es zeigte sich aber, dass auch die Gruppe der späten Frühgeborenen im Vergleich zu reifen Neugeborenen von einer deutlich erhöhten Morbidität und auch Mortalität betroffen ist. Erst in letzter Zeit werden auch sie als eine eigene Gruppe wahrgenommen und genauer untersucht.

Kernaussagen

• Laut Definition gelten Kinder, die in der 38. SSW geboren sind, als reif. Daher unterschätzen wir noch heute die Morbidität später Frühgeborener. Wie Studien zeigen, ist ihre Fähigkeit zur Regulation und Transition noch nicht ausgereift.

• Ein großer Anteil der späten Frühgeborenen sind für ihr Geburtsalter zu klein und zeigen eine große Diversität der Verläufe in der 1. Lebenswoche und unterschiedliche Risikomuster, denen ganz unterschiedliche fetale Morbiditäten zugrunde liegen. Diese Besonderheiten gilt es, in der Versorgung zu berücksichtigen.

• Aufgrund der erhöhten Morbidität und Mortalität muss gerade bei iatrogener Frühgeburt in der 35. – 38. SSW das perinatale Management gemeinsam mit der Geburtshilfe optimiert werden. Nicht indizierte Geburten in diesem Zeitraum dürfen nicht bagatellisiert werden.

• Es ist eine Herausforderung, die späten Frühgeborenen in ihrer Transition und in der Neonatalzeit bestmöglich zu unterstützen, damit sie die Ressourcen, die sie aufgrund ihrer relativen Reife besitzen, optimal nutzen können.

• Hierbei geht es oft weniger um den Ausgleich von Defiziten als um den Erhalt und die Förderung einer empfindlichen Homöostase.

• Entscheidend ist es, den engen Kontakt von Mutter und Kind zu fördern. Auch das Stillen und die Muttermilchfütterung sind entwicklungsfördernde und schützende Faktoren.

• Die generelle Möglichkeit zum Rooming-in, auch für die kränkeren unter den späten Frühgeborenen, wäre wünschenswert.

• Das Einbinden der Familie in die Pflege und die Entlassvorbereitungen des Kindes und die oft notwendige Stillförderung sind sehr zeit- und personalintensiv. Dies könnte bei einem geeigneten Konzept zur poststationären Unterstützung durch kompetente Personen auch zu Hause erfolgen – und so die Krankenhausaufenthaltsdauer für manches Kind verkürzen.

Schlüsselwörter

late preterm infants - neonatale Morbidität - neonatale Mortalität - Transition - Langzeitoutcome

• Literatur

• 1 Blencowe H, Cousens S, Chou D. et al. The Born Too Soon Preterm Birth Action Group. Born Too Soon: The global epidemiology of 15 million preterm births. Reproduct Health 2013; 10: 2
• 2 American Academy of Pediatrics, Committee on Fetus and Newborn. „Late-preterm“ infants: a population at risk. Pediatrics 2007; 120: 1390-1401
• 3 Institut für Qualitätssicherung und Transparenz im Gesundheitswesen IQTIG. Qualitätsreport des gemeinsamen Bundesausschusses 2009–2015. Zahlen des Statistischen Bundesamtes.. Im Internet: https://www.iqtig.org/ Stand: 28.03.2018
• 4 Weichert A, Weichert TM, Bergmann RL. et al. Factors for Preterm Births in Germany – An Analysis of Representative German Data (KiGGS). Geburtsh Frauenheilk 2015; 75: 819-826
• 5 Carter MF, Fowler S, Holden A. et al. The late preterm birth rate and its association with comorbidities in a population-based study. Am J Perinatol 2011; 28: 703-707
• 6 Machado LC, Passini R, Rodrigues Machado IR. Late prematurity: a systematic review. J Ped Rio de J 2014; 90: 221-231
• 7 Herz K, Wohlmut P, Liedtke B. et al. Late preterms: Auswirkungen des fetalen Geschlechts auf das neonatologische Outcome. Z Geburtsh Neonatol 2012; 216: 141-146
• 8 Iams JD, Donovan EF. Spontaneous late preterm births: what can be done to improve outcomes?. Semin Perinatol 2011; 35: 309-313
• 9 Carreno CA, Constantine MM, Holland MG. et al. Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction. Am J Obstet Gynecol 2011; 204: 263.e1-263.4
• 10 Lubow MJ, How HY, Habli M. et al. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol 2009; 200: e30-e33
• 11 Parker LA, Sulliva S, Krueger C. et al. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med 2015; 10: 84-91
• 12 Gyamfi-Bannermann C. The scope of the problem: the epidemiology of late preterm birth and early-term birth. Semin Perinatol 2011; 35: 246-248
• 13 Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med 2012; 17: 120-125
• 14 Grubinger E, Scheier M. Mehrlingsschwangerschaften. Epidemiologie, Entwicklung und Morbidität. J Gyn Endokrinol 2011; 21: 14-19
• 15 Melamed N, Klinger G, Tennebaum-Gavish K. et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114: 253-260
• 16 Hibbard JU, Wilkins I, Sun L. et al. Respiratory morbidity in late preterm births. JAMA 2010; 304: 419-425
• 17 Scheuchenegger A, Lechner E, Wiesinger-Eidenberger G. et al. Short-term morbidities in moderate and late preterm infants. Klin Padiatr 2014; 226: 216-220
• 18 Jakiel G, Wilinska M, Binkowska M. et al. Late preterm infants-impact of perinatal factors on neonatal results. A clinical study. Ann Agricult Environm Med 2015; 22: 536-541
• 19 Rojas Feria P, Pavón Delgado A, Rosso Gonzáles M. et al. [Short-term complications of late preterm infants]. An Pediatr (Barc) 2011; 75: 169-174
• 20 Celik IH, Demirel G, Canpolat FE. et al. A common problem for neonatal intensive care units: late preterm infants, a prospective study with term controls in a large perinatal center. J Matern Fetal Neonatal Med 2013; 26: 459-462
• 21 Joshi S, Kotecha S. Lung growth and development. Early Hum Devel 2007; 83: 789-794
• 22 Steurer MA, Jeliffe-Pawlowski LL, Baer RJ. et al. Persistent pulmonary hypertension of the newborn in late preterm and term infants in California. Pediatrics 2017; 139: e20161165
• 23 Medoff-Cooper B, Holditch-Davis Diane. Verklan MT. et al. Newborn clinical outcomes of the AWHONN late preterm infant research-based practice project. J Obstet Gynecol Neonatal Nurs 2012; 41: 774-785
• 24 De Carolis MP, Pinna G, Cocca C. et al. The transition from intra to extra-uterine life in late preterm infant: a single-center study. Ital J Pediatr 2016; 42: 87
• 25 Gouyon JB, Iacobelli S, Ferdynus C. et al. Neonatal problems of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17: 146-152
• 26 Kim SA, Lee SM, Kim BJ. et al. The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery. J Perinatal Med 2017; 45: 129-134 doi:10.1515/jpm2015-0191
• 27 Celebi MY, Alan S, Kahvecioglu D. et al. Impact of Prophylactic Continuous Positive Airway Pressure on Transient Tachypnea of the Newborn and Neonatal Intensive Care Admission in Newborns Delivered by Elective Cesarean section. Am J Perinatol 2016; 33: 99-106
• 28 Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Data Syst Rev 2006; (03) CD004454
• 29 Saccone G, Berghella V. Antenatal corticosteroids for maturaty of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ 2016; 355: i5044
• 30 Laptook AR, Jackson GL. Cold stress and hypoglycemia in the late preterm (“near-term”) infant: impact on nursery of admission. Semin Perinatol 2006; 30: 24-27
• 31 Boyle EM, Johnson S, Manktelow B. et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100: 479-485
• 32 Pope M, Budge H, Symonds ME. The developmental transition of ovine adipose tissue through early life. Acta Physiol 2014; 210: 20-30
• 33 Laptook AR, Watkinson M. Temperature management in the delivery room. Semin Fetal Neonatal Med 2008; 13: 383-391
• 34 Bulut C, Gürsoy T, Ovali F. Short-term outcomes and mortality of late preterm infants. Balkan Med J 2016; 33: 198-203
• 35 Bastek JA, Sammel MD, Pare E. et al. Adverse neonatal outcomes: examining the risk between preterm, late preterm, and term infants. Am J Obstet Gynecol 2008; 199: 367.e1-367.e8
• 36 Teune MJ, Bakhuizen S, Gyamfi Bannerman C. et al. A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol 2011; 205: 374.e1-374.e9
• 37 Duvanel CB, Fawer CL, Cotting J. et al. Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants. J Pediatr 1999; 134: 492-498
• 38 Kalyoncu O, Aygün C, Cetinoglu E. et al. Neonatal morbidity and mortality of late-preterm babies. J Maternal Fetal Neonatal Med 2010; 23: 607-612
• 39 Marrochella S, Sestilli V, Indraccolo U. et al. Late preterm births: a retrospective analysis of the morbidity risk stratified for gestational age. Springer Plus 2014; 3: 114
• 40 AWMF-Leitlinie: Betreuung von Neugeborenen diabetischer Mütter. Registernummer 024-006. In Überarbeitung.. Im Internet: http://www.awmf.org/leitlinien/aktuelle-leitlinien.html Stand: 28.03.2018
• 41 Weston PJ, Harris DL, Battin M. et al. Oral dextrose gel for the treatment of hypoglycemia in newborn infants. Cochrane Database Syst Rev 2016; (05) CD011027
• 42 Clarke L, Heasman L, Symonds ME. Influence of maternal dexamethasone administration on thermoregulation in lambs delivered by cesarean section. J Endocrinol 1998; 156: 307-314
• 43 Contreras C, Gonzales F, Fernø J. et al. The brain and brown fat. Ann Med 2015; 47: 150-168
• 44 Sarici SÜ, Serdar MA, Korkmaz A. et al. Incidence, course and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics 2004; 113: 775-780
• 45 AWMF-Leitlinie: Hyperbilirubinämie bei neugeborenen. Diagnostik und Therapie. Registernummer 024-007.. Im Internet: http://www.awmf.org/leitlinien/aktuelle-leitlinien.html Stand: 28.03.2018
• 46 Shapiro-Mendoza CK, Tomashek KM, Kotelchuk M. et al. Risk factors for neonatal morbidity and mortality among “healthy”, late preterm newborns. Semin Perinatol 2006; 30: 54-60
• 47 Lee SM, Park JW, Kim BJ. et al. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes. PLoS One 2013; 8: e79941
• 48 Melville JM, Moss TJM. The immune consequences of preterm birth. Front Neurosci 2013; 7: 79
• 49 Cohen-Wolkowiez M, Moran C, Benjamin DK. et al. Early and late onset sepsis in late preterm infants. Ped Infect Dis J 2009; 28: 1052-1056
• 50 Lu Q, Cheng S, Zhou M. et al. Risk factors for necrotizing enterocolitis in neonates: a retrospective case-control study. Pediatr Neonatol 2017; 58: 165-170
• 51 Olivier F, Nadeau S, Caouette G. et al. Association between apnea of prematurity and respiratory distress syndrome in late preterm infants: an observational study. Front Pediatr 2016; 4: 105
• 52 Gianni ML, Roggero P, Piemontese P. et al. Is nutritional support needed in late preterm infants?. BMC Ped 2015; 15: 194
• 53 Siggers RH, Thymann T, Boye M. et al. Nutritional modulation of the gut microbiota and immune system in preterm neonates susceptible to necrotizing enterocolitis. J Nutr Biochem 2011; 22: 511-521
• 54 Offermann H, Gebauer C, Pulzer F. et al. Cesarean section increases the risk of respiratory adaptive disorders in healthy late preterm and two groups of mature newborns. Z Geburtshilfe Neonatol 2015; 259-265
• 55 Collado MC, Cernada M, Neu J. et al. Factors influencing gastrointestinal tract and microbiota immune interaction in preterm infants. Pediatr Res 2015; 77: 726-731
• 56 Collado MC, Cernada M, Bäuerl C. et al. Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes 2012; 3: 352-365
• 57 Lee N, Kim WU. Microbiota in T-cell homeostasis and inflammatory disease. Exp Mol Med 2017; 49: e340
• 58 Gülden E, Wong FS, Wen L. The gut microbiota and Type 1 Diabetes. Clin Immunol 2015; 159: 143-153
• 59 Korpela K, de Vos WM. Antibiotic use in childhood alters the gut microbiota and predisposes to overweight. Microb Cell 2016; 3: 296-298
• 60 Sherman MP, Zaghouani H, Niklas V. Gut microbiota, the immune system, and diet influence the neonatal gut-brain axis. Pediatr Res 2015; 77: 127-134
• 61 Meier PP, Furman LM, Degenhardt M. Increased lactation risk for late preterm infants and mothers: evidence and management strategies to protect breastfeeding. J Midwifery Womens Health 2007; 52: 579-587
• 62 Cleaveland K. Feeding challenges in the late preterm infant. Neonatal Netw 2010; 29: 37-41
• 63 Johnson S, Matthews R, Draper ES. et al. Eating difficulties in children born late and moderately preterm at 2 years of age: a prospective population-based cohort study. Am J Clin Nutr 2015; 103: 406-414
• 64 Santos IS, Matijasevich A, Domingues MR. et al. Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study. BMC Pediatrics 2009; 9: 71
• 65 Roze JC, Darmaun D, Boquien CY. et al. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open 2012; 2: e000834
• 66 Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol 2006; 30: 81-88
• 67 Honein MA, Kirby RS, Meyer RE. et al. National Birth Defects Prevention Network. The association between major birth defects and preterm birth. Matern Child Health J 2009; 13: 164-175
• 68 Natarajan G, Anne SR, Aggarwal S. Outcomes of congenital heart disease in late preterm infants: double jeopardy?. Acta Paediatr 2011; 100: 1104-1107
• 69 Escobar GJ, Clarke RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol 2006; 30: 28-33
• 70 Whyte RK. Neonatal management and safe discharge of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17: 153-158
• 71 Tomashek KM, Shapiro-Medoza K, Davidoff MJ. et al. Differences in Mortality between Late-Preterm and Term-Singleton Infants in the United States. J Pediatrics 2007; 151: 450-456
• 72 Gouyon JB, Vintejoux A, Sagot P. et al. Burgundy Perinatal Network. Neonatal outcome associated with singleton birth at 34-41 weeks of gestation. Int J Epidemiol 2010; 39: 769-776
• 73 King JP, Gazmararian JA, Shapiro-Mendoza CK. Disparities in mortality rates among US infants born late preterm or early term, 2003-2005. Matern Child Health J 2014; 18: 233-241
• 74 Condò V, Colaghi M, Vanzatiz M. et al. [Respiratory failure in “late preterm” infants: a retrospective cohort study]. Pediatr Med Chir 2009; 31: 241-245
• 75 Kotecha SJ, Watkins WJ, Paranjothy S. et al. Effect of late preterm birth on longitudinal lung spirometry in school age children and adolescents. Thorax 2012; 67: 54-61
• 76 Lanari M, Adorni F, Silvestri M. et al. Italian Study Group on Risk Factors for RSV-related Hospitalization. The multicenter Italian birth cohort study on incidence and determinants of lower respiratory tract infection hospitalization in infants at 33 weeks GA or more: preliminary results. Early Hum Dev 2011; 87: S43-S46
• 77 Law BJ, Langley JM, Allen U. et al. The Pediatric Investors Collaborative Network on Infections in Canada study of predictors of hospitalisation for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J 2004; 23: 806-814
• 78 Boyce TG, Mellen BG, Mitchel jr. EF. et al. Rates of hospitalization for respiratory syncytial virus among children in medicaid. J Pediatr 2000; 137: 865-870
• 79 Goyal NK, Fiks AG, Lorch SA. Association of late-preterm birth with asthma in young children: practice-based study. Pediatrics 2011; 128: e830-e838
• 80 Abe K, Shapiro-Mendoza CK, Hall LR. et al. Late preterm birth and risk of developing asthma. J Pediatr 2010; 157: 74-78
• 81 Voge GA, Katusic SK, Qin R. et al. Risk of asthma in late preterm infants: a propensity score approach. J Allergy Clin Immunol Pract 2015; 3: 905-910
• 82 Crump C, Winkley MA, Sundquist J. et al. Risk of asthma in young adults who were born preterm: a swedish national cohort study. Pediatrics 2011; 127: 913-920
• 83 Romeo DM, Di Stefano A, Conversano M. et al. Neurodevelopmental outcome at 12 and 18 months in late preterm infants. Eur J Paediatr Neurol 2010; 14: 503-507
• 84 Stene-Larsen K, Brandlistuen RE, Lang AM. et al. Communication impairments in early term and late preterm children: a prospective cohort study following children to age 36 months. J Pediatr 2014; 165: 1123-1128
• 85 Richards JL, Drews-Botsch C, Sales JM. et al. Describing the shape of the relationship between gestational age at birth and cognitive development in a nationally representative U.S. cohort. Paediatr Perinat Epidemiol 2016; 30: 571-582
• 86 Baron IS, Erickson K, Ahronovich MD. et al. Cognitive deficit in preschoolers born late-preterm. Early Hum Dev 2011; 87: 115-119
• 87 Talge NM, Holzman C, Wang J. et al. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age. Pediatrics 2010; 126: 1124-1131
• 88 Chan E, Leong P, Malouf R. et al. Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review. Child Care Health Dev 2016; 42: 297-312
• 89 Petrini JR, Dias T, McCormick MC. et al. Increased risk of adverse neurological development for late preterm infants. J Pediatr 2009; 154: 169-176
• 90 Boylan J, Alderdice FA, McGowan JE. et al. Behavioural outcomes at 3 years of age among late preterm infants admitted to neonatal intensive care: a cohort study. Arch Dis Child Fetal Neonatal Ed 2014; 99: 359-365
• 91 Talge NM, Holzman C, van Egeren LA. et al. Late-preterm birth a delivery circumstance and its association with parent reported attention problems in childhood. J Dev Behav Pediatr 2012; 33: 405-415
• 92 Guy A, Seaton SE, Boyke EM. et al. Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age. J Pediatr 2015; 166: 269-275
• 93 Baron IS, Litman FR, Ahronovich MD. et al. Late preterm birth: a review of medical and neuropsychological childhood outcomes. Neuropsychol Rev 2012; 22: 438-450
• 94 Kelly JR, Minuto C, Cryan CF. et al. Cross Talk: The Microbiota and Neurodevelopmental Disorders. Front Neurosci 2017; 11: 490
• 95 Matsuoka K, Kanai T. The gut microbiota and inflammatory bowel disease. Semin Immunopathol 2015; 37: 47-55