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Erschienen in: Monatsschrift Kinderheilkunde 5/2014

01.05.2014 | Leitthema

Kolonisation oder Infektion bei Früh- und Neugeborenen

Warum sind sie so gefährdet?

verfasst von: C. Härtel, C. Gille, Prof. T.W. Orlikowsky

Erschienen in: Monatsschrift Kinderheilkunde | Ausgabe 5/2014

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Zusammenfassung

Sepsishäufigkeit

Von 650.000 Neugeborenen pro Jahr in Deutschland erkranken etwa 7000 am Termin geborene an einer Sepsis. Etwa 1,3 % der Neugeborenen kommen als sehr kleine (untergewichtige) Frühgeborene mit einem Geburtsgewicht < 1500 g (VLBW: „very low birth weight“) zur Welt und tragen ein bis zu 10-fach höheres Sepsisrisiko von 15 %.

Diskussion

Das komplexe Zusammenspiel von intrinsischen Faktoren (Adaptation des kindlichen und mütterlichen Immunsystems, funktionelle Unreife, anatomische Kleinheit, Wegfall von protektiven Faktoren) und exogenen Einflüssen (Invasivität intensivmedizinischer Maßnahmen) ist für die besondere Vulnerabilität von Früh- und Neugeborenen maßgeblich und steht im Fokus dieses Beitrags.
Literatur
1.
Zurück zum Zitat Andersen BM, Lindemann R, Bergh K et al (2002) Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 50:18–24PubMedCrossRef Andersen BM, Lindemann R, Bergh K et al (2002) Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 50:18–24PubMedCrossRef
2.
Zurück zum Zitat Bassler D, Stoll BJ, Schmidt B et al (2009) Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Pediatrics 123:313–318PubMedCentralPubMedCrossRef Bassler D, Stoll BJ, Schmidt B et al (2009) Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Pediatrics 123:313–318PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Bogaert D, Weinberger D, Thompson C et al (2009) Impaired innate and adaptive immunity to Streptococcus pneumoniae and its effect on colonization in an infant mouse model. Infect Immun 77:1613–1622PubMedCentralPubMedCrossRef Bogaert D, Weinberger D, Thompson C et al (2009) Impaired innate and adaptive immunity to Streptococcus pneumoniae and its effect on colonization in an infant mouse model. Infect Immun 77:1613–1622PubMedCentralPubMedCrossRef
4.
Zurück zum Zitat Bose C, Laughon M, Allred EN et al (2011) Blood protein concentrations in the first two postnatal weeks that predict bronchopulmonary dysplasia among infants born before the 28th week of gestation. Pediatr Res 69:347–353PubMedCentralPubMedCrossRef Bose C, Laughon M, Allred EN et al (2011) Blood protein concentrations in the first two postnatal weeks that predict bronchopulmonary dysplasia among infants born before the 28th week of gestation. Pediatr Res 69:347–353PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Carr R (2000) Neutrophil production and function in newborn infants. Br J Haematol 110:18–28PubMedCrossRef Carr R (2000) Neutrophil production and function in newborn infants. Br J Haematol 110:18–28PubMedCrossRef
6.
Zurück zum Zitat Carr R, Brocklehurst P, Dore CJ et al (2009) Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial. Lancet 373:226–233PubMedCrossRef Carr R, Brocklehurst P, Dore CJ et al (2009) Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial. Lancet 373:226–233PubMedCrossRef
7.
Zurück zum Zitat Cohen B, Saiman L, Cimiotti J, Larson E (2003) Factors associated with hand hygiene practices in two neonatal intensive care units. Pediatr Infect Dis J 22:494–499PubMedCentralPubMed Cohen B, Saiman L, Cimiotti J, Larson E (2003) Factors associated with hand hygiene practices in two neonatal intensive care units. Pediatr Infect Dis J 22:494–499PubMedCentralPubMed
8.
9.
Zurück zum Zitat Cotten CM, Taylor S, Stoll B et al (2009) Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 123:58–66PubMedCentralPubMedCrossRef Cotten CM, Taylor S, Stoll B et al (2009) Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 123:58–66PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Didier C, Streicher MP, Chognot D et al (2012) Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics. Eur J Pediatr 171:681–687PubMedCrossRef Didier C, Streicher MP, Chognot D et al (2012) Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics. Eur J Pediatr 171:681–687PubMedCrossRef
11.
Zurück zum Zitat Ghazal P, Dickinson P, Smith CL (2013) Early life response to infection. Curr Opin Infect Dis 26:213–218PubMedCrossRef Ghazal P, Dickinson P, Smith CL (2013) Early life response to infection. Curr Opin Infect Dis 26:213–218PubMedCrossRef
12.
Zurück zum Zitat Gille C, Orlikowsky TW, Spring B et al (2012) Monocytes derived from humanized neonatal NOD/SCID/IL2Rγ(null) mice are phenotypically immature and exhibit functional impairments. Hum Immunol 73:346–354PubMedCrossRef Gille C, Orlikowsky TW, Spring B et al (2012) Monocytes derived from humanized neonatal NOD/SCID/IL2Rγ(null) mice are phenotypically immature and exhibit functional impairments. Hum Immunol 73:346–354PubMedCrossRef
13.
Zurück zum Zitat Gille C, Dreschers S, Leiber A et al (2013) The CD95/CD95L pathway is involved in phagocytosis-induced cell death of monocytes and may account for sustained inflammation in neonates. Pediatr Res 73:402–408PubMedCrossRef Gille C, Dreschers S, Leiber A et al (2013) The CD95/CD95L pathway is involved in phagocytosis-induced cell death of monocytes and may account for sustained inflammation in neonates. Pediatr Res 73:402–408PubMedCrossRef
14.
Zurück zum Zitat Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8PubMedCrossRef Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8PubMedCrossRef
15.
Zurück zum Zitat Gortner L (2013) Nosocomial infections in very preterm neonates – improvements by further scientific research or discussions in talk shows? Klin Padiatr 225:55–56PubMedCrossRef Gortner L (2013) Nosocomial infections in very preterm neonates – improvements by further scientific research or discussions in talk shows? Klin Padiatr 225:55–56PubMedCrossRef
16.
Zurück zum Zitat Härtel C, Simon A, Geffers C et al (2013) Nosokomiale Infektionen bei Frühgeborenen. Umsetzung der KRINKO-Empfehlungen im Deutschen Frühgeborenennetzwerk. Monatsschr Kinderheilkd 161:27–33CrossRef Härtel C, Simon A, Geffers C et al (2013) Nosokomiale Infektionen bei Frühgeborenen. Umsetzung der KRINKO-Empfehlungen im Deutschen Frühgeborenennetzwerk. Monatsschr Kinderheilkd 161:27–33CrossRef
17.
Zurück zum Zitat INIS Collaborative Group, Brocklehurst P, Farrell B et al (2011) Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med 36:1201–1211 INIS Collaborative Group, Brocklehurst P, Farrell B et al (2011) Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med 36:1201–1211
18.
Zurück zum Zitat Isayama T, Lee SK, Mori R et al (2012) Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 130:e957–e965PubMedCrossRef Isayama T, Lee SK, Mori R et al (2012) Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 130:e957–e965PubMedCrossRef
19.
Zurück zum Zitat Kenzel S, Henneke P (2006) The innate immune system and its relevance to neonatal sepsis. Curr Opin Infect Dis 19:264–270PubMedCrossRef Kenzel S, Henneke P (2006) The innate immune system and its relevance to neonatal sepsis. Curr Opin Infect Dis 19:264–270PubMedCrossRef
20.
Zurück zum Zitat Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR (2011) Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 159:720–725PubMedCentralPubMedCrossRef Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR (2011) Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 159:720–725PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Laughon M, Bose C, Allred EN et al (2011) Patterns of blood protein concentrations of ELGANs classified by three patterns of respiratory disease in the first 2 postnatal weeks. Pediatr Res 70:292–296PubMedCentralPubMedCrossRef Laughon M, Bose C, Allred EN et al (2011) Patterns of blood protein concentrations of ELGANs classified by three patterns of respiratory disease in the first 2 postnatal weeks. Pediatr Res 70:292–296PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Lavoie PM, Huang Q, Jolette E et al (2010) Profound lack of interleukin (IL)-12/IL-23p40 in neonates born early in gestation is associated with an increased risk of sepsis. J Infect Dis 202:1754–1763PubMedCentralPubMedCrossRef Lavoie PM, Huang Q, Jolette E et al (2010) Profound lack of interleukin (IL)-12/IL-23p40 in neonates born early in gestation is associated with an increased risk of sepsis. J Infect Dis 202:1754–1763PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Levy O (2007) Innate immunity of the newborn: basic mechanisms and clinical correlates. Nature reviews. Immunology 7:379–390PubMed Levy O (2007) Innate immunity of the newborn: basic mechanisms and clinical correlates. Nature reviews. Immunology 7:379–390PubMed
24.
Zurück zum Zitat Löhr IH, Rettedal S, Natås OB et al (2013) Long-term faecal carriage in infants and intra-household transmission of CTX-M-15-producing Klebsiella pneumoniae following a nosocomial outbreak. J Antimicrob Chemother 68:1043–1048PubMedCrossRef Löhr IH, Rettedal S, Natås OB et al (2013) Long-term faecal carriage in infants and intra-household transmission of CTX-M-15-producing Klebsiella pneumoniae following a nosocomial outbreak. J Antimicrob Chemother 68:1043–1048PubMedCrossRef
25.
26.
Zurück zum Zitat Mancuso G, Midiri A, Beninati C et al (2004) Dual role of TLR2 and myeloid differentiation factor 88 in a mouse model of invasive group B streptococcal disease. J Immunol 172:6324–6329PubMedCrossRef Mancuso G, Midiri A, Beninati C et al (2004) Dual role of TLR2 and myeloid differentiation factor 88 in a mouse model of invasive group B streptococcal disease. J Immunol 172:6324–6329PubMedCrossRef
27.
Zurück zum Zitat Marchini G, Nelson A, Edner J et al (2005) Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant. Pediatr Res 58:613–616PubMedCrossRef Marchini G, Nelson A, Edner J et al (2005) Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant. Pediatr Res 58:613–616PubMedCrossRef
28.
Zurück zum Zitat Marcoe JP, Lim JR, Schaubert KL et al (2012) TGF-β is responsible for NK cell immaturity during ontogeny and increased susceptibility to infection during mouse infancy. Nat Immunol 13:843–850PubMedCentralPubMedCrossRef Marcoe JP, Lim JR, Schaubert KL et al (2012) TGF-β is responsible for NK cell immaturity during ontogeny and increased susceptibility to infection during mouse infancy. Nat Immunol 13:843–850PubMedCentralPubMedCrossRef
29.
Zurück zum Zitat Melville JM, Bischof RJ, Meeusen EN et al (2012) Changes in fetal thymic immune cell populations in a sheep model of intrauterine inflammation. Reprod Sci 19:740–747PubMedCrossRef Melville JM, Bischof RJ, Meeusen EN et al (2012) Changes in fetal thymic immune cell populations in a sheep model of intrauterine inflammation. Reprod Sci 19:740–747PubMedCrossRef
30.
Zurück zum Zitat Mönch N, Behnke M, Geffers C et al (2009) Compliance of alcoholic hand disinfection in pediatrics and neonatology. Klin Padiatr 221:254–255PubMedCrossRef Mönch N, Behnke M, Geffers C et al (2009) Compliance of alcoholic hand disinfection in pediatrics and neonatology. Klin Padiatr 221:254–255PubMedCrossRef
31.
Zurück zum Zitat Orlikowsky TW, Spring B, Dannecker GE et al (2003) Expression and regulation of B7 family molecules on macrophages (MPhi) in preterm and term neonatal cord blood and peripheral blood of adults. Cytometry B Clin Cytom 53:40–47PubMedCrossRef Orlikowsky TW, Spring B, Dannecker GE et al (2003) Expression and regulation of B7 family molecules on macrophages (MPhi) in preterm and term neonatal cord blood and peripheral blood of adults. Cytometry B Clin Cytom 53:40–47PubMedCrossRef
32.
Zurück zum Zitat Ortenstrand A, Westrup B, Broström EB et al (2010) The Stockholm neonatal family centered care study: effects on length of stay and infant morbidity. Pediatrics 125:e278–e285PubMedCrossRef Ortenstrand A, Westrup B, Broström EB et al (2010) The Stockholm neonatal family centered care study: effects on length of stay and infant morbidity. Pediatrics 125:e278–e285PubMedCrossRef
33.
Zurück zum Zitat Rieber N, Gille C, Köstlin N et al (2013) Neutrophilic myeloid-derived suppressor cells in cord blood modulate innate and adaptive immune responses. Clin Exp Immunol 174:45–52PubMedCrossRef Rieber N, Gille C, Köstlin N et al (2013) Neutrophilic myeloid-derived suppressor cells in cord blood modulate innate and adaptive immune responses. Clin Exp Immunol 174:45–52PubMedCrossRef
34.
Zurück zum Zitat Sadeghi K, Berger A, Langgartner M et al (2007) Immaturity of infection control in preterm and term newborns is associated with impaired toll-like receptor signaling. J Infect Dis 195:296–302PubMedCrossRef Sadeghi K, Berger A, Langgartner M et al (2007) Immaturity of infection control in preterm and term newborns is associated with impaired toll-like receptor signaling. J Infect Dis 195:296–302PubMedCrossRef
35.
Zurück zum Zitat Scheithauer S, Trepels-Kottek S, Häfner H et al (2013) Healthcare worker-related MRSA cluster in a German neonatology level III ICU: a true European story. Int J Hyg Environ Health 13:S1438–S4639 Scheithauer S, Trepels-Kottek S, Häfner H et al (2013) Healthcare worker-related MRSA cluster in a German neonatology level III ICU: a true European story. Int J Hyg Environ Health 13:S1438–S4639
36.
Zurück zum Zitat Schwab F, Gastmeier P, Piening B, Geffers C (2012) The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect. Antimicrob Resist Infect Control 1:24PubMedCentralPubMedCrossRef Schwab F, Gastmeier P, Piening B, Geffers C (2012) The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect. Antimicrob Resist Infect Control 1:24PubMedCentralPubMedCrossRef
37.
Zurück zum Zitat Simon A, Christoph J, Dame C et al (2013) Praktische Umsetzung sowie krankenhaushygienische und infektionspräventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Früh- und Neugeborenen. Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Epidemiol Bull 42:421–432 Simon A, Christoph J, Dame C et al (2013) Praktische Umsetzung sowie krankenhaushygienische und infektionspräventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Früh- und Neugeborenen. Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Epidemiol Bull 42:421–432
38.
Zurück zum Zitat Soraisham AS, Singhal N, McMillan DD et al (2009) A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol 200:372 e371–376PubMedCrossRef Soraisham AS, Singhal N, McMillan DD et al (2009) A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol 200:372 e371–376PubMedCrossRef
39.
Zurück zum Zitat Stoll BJ, Hansen NI, Adams-Chapman I et al (2004) Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 292:2357–2365PubMedCrossRef Stoll BJ, Hansen NI, Adams-Chapman I et al (2004) Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 292:2357–2365PubMedCrossRef
40.
Zurück zum Zitat Tröger B, Göpel W, Faust K et al (2014) Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multi-center study from the German Neonatal Network. Pediatr Infect Dis J 33:238–243PubMedCrossRef Tröger B, Göpel W, Faust K et al (2014) Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multi-center study from the German Neonatal Network. Pediatr Infect Dis J 33:238–243PubMedCrossRef
41.
Zurück zum Zitat Umlauf VN, Dreschers S, Orlikowsky TW (2013) Flow cytometry in the detection of neonatal sepsis. Int J Pediatr 763191 Umlauf VN, Dreschers S, Orlikowsky TW (2013) Flow cytometry in the detection of neonatal sepsis. Int J Pediatr 763191
42.
Zurück zum Zitat Watterberg KL, Demers LM, Scott SM, Murphy S (1996) Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 97:210–215PubMed Watterberg KL, Demers LM, Scott SM, Murphy S (1996) Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 97:210–215PubMed
43.
Zurück zum Zitat Wynn JL, Hansen NI, Das A et al (2013) Early sepsis does not increase the risk of late sepsis in very low birth weight neonates. J Pediatr 162:942–948.e1–3PubMedCentralPubMedCrossRef Wynn JL, Hansen NI, Das A et al (2013) Early sepsis does not increase the risk of late sepsis in very low birth weight neonates. J Pediatr 162:942–948.e1–3PubMedCentralPubMedCrossRef
Metadaten
Titel
Kolonisation oder Infektion bei Früh- und Neugeborenen
Warum sind sie so gefährdet?
verfasst von
C. Härtel
C. Gille
Prof. T.W. Orlikowsky
Publikationsdatum
01.05.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Monatsschrift Kinderheilkunde / Ausgabe 5/2014
Print ISSN: 0026-9298
Elektronische ISSN: 1433-0474
DOI
https://doi.org/10.1007/s00112-013-2973-9

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