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Anämien des Früh- und Neugeborenen

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Pädiatrische Hämatologie und Onkologie

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Zusammenfassung

Im Kreißsaal herrscht konzentrierte Betriebsamkeit. In wenigen Minuten sollen Zwillinge mit pränatal diagnostiziertem fetofetalen Transfusionssyndrom durch Kaiserschnitt zur Welt kommen. Geburtshelfer, Neonatologen und Anästhesisten treffen ihre Vorbereitungen. Für die Kinder werden Intubationsbesteck, Nabelkatheterbesteck und eine Blutkonserve der Blutgruppe 0 Rhesus-negativ bereitgelegt. Da wird plötzlich eine andere Schwangere eingeliefert. Sie ist 12 Wochen vor dem errechneten Geburtstermin. Sie klagt über akut aufgetretene heftige Unterbauchschmerzen. Eine Hebamme versucht ein Kardiotokogramm abzuleiten, sie kann aber keine fetalen Herztöne erfassen.

Dann geht alles sehr schnell: Da das komplette Team für den anderen geplanten Kaiserschnitt vor Ort ist, kann sofort eine Notsectio erfolgen. Intraoperativ zeigt sich eine Uterusruptur mit großflächiger Plazentaablösung. In der Nabelarterie werden ein pH von 6,95 und ein BE von −15,8 mmol/l gemessen. Klinisch bietet das Kind das Bild der weißen Asphyxie: Es ist blass und leblos. Da alles schon für die angekü ndigten Zwillinge vorbereitet ist, kann schnell reagiert werden: Intubation, Beatmung, Herzdruckmassage, Nabelvenenkatheter. Der zentrale Venendruck ist negativ. Sukzessive werden 40 ml des bereit liegenden Erythrozytenkonzentrates und 20 ml Plasmalösung transfundiert bis der zentrale Venendruck positiv ist. Aus dem Volumenbedarf lässt sich hochrechnen, dass das Kind bei einem Geburtsgewicht von 1430 g etwa die Hälfte seines zirkulierenden Blutvolumens verloren hat. Unter der Transfusion wird die Hautfarbe rosig, Herzaktion und Kreislauf stabilisieren sich, erste spontane Bewegungen sind zu sehen.

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Author information

Authors and Affiliations

  1. Klinik für Neonatologie und Neuropädiatrie, Universitätsklinikum Marburg, Deutschhausstr. 12, 35037, Marburg

    Prof. Dr. Rolf F. Maier

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  1. Prof. Dr. Rolf F. Maier
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Editors and Affiliations

  1. Forschungsinstitut für krebskranke Kinder, St. Anna Kinderspital, Kinderspitalgasse 6, 1090, Wien, Österreich

    Helmut Gadner

  2. Klinik für Allgemeine Pädiatrie und Knochenmarktransplantation, Charité Campus Virchow-Klinikum Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Augustenburger Platz 1, 13353, Berlin

    Gerhard Gaedicke

  3. Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106, Freiburg

    Charlotte Niemeyer

  4. Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129, Münster

    Jörg Ritter

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Maier, R.F. (2006). Anämien des Früh- und Neugeborenen. In: Gadner, H., Gaedicke, G., Niemeyer, C., Ritter, J. (eds) Pädiatrische Hämatologie und Onkologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-29036-2_26

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  • DOI: https://doi.org/10.1007/3-540-29036-2_26

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  • Print ISBN: 978-3-540-03702-6

  • Online ISBN: 978-3-540-29036-0

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