Alisjahbana Bachti, Rivami Dwi Savitri, Octavia Lestari, Susilawati Nopi, Pangaribuan Mathilda, Alisjahbana Anna, Diana Aly
Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia.
Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Indonesia.
Asia Pac J Clin Nutr. 2019;28(Suppl 1):S17-S31. doi: 10.6133/apjcn.201901_28(S1).0002.
Intrauterine growth retardation (IUGR) is related to mortality and morbidity. However, defining IUGR by suitable field methods remains a challenge. A maternal-child Risk-Approach- Strategy (during 1988-1989) and follow-on Tanjungsari Cohort Study (TCS) (1989-1990), aimed to generate a practical classification of IUGR and explore its usage in predicting growth, mortality and morbidity of infants in the cohort.
Some 3892 singleton live-birth infants were followed. IUGR was defined by birth weight (BW) and length (BL) classified as: acute, chronic, non-IUGR or 'probably preterm'. Growth, mortality, and survival curve were calculated to prove that the classification identified the most vulnerable infants. Fever >3 days and diarrhoea were assessed based on IUGR classification, sex, exclusive breastfeeding, and environmental factors.
IUGR infant weight and length did not catch-up with the non-IUGR in the first year. Infant mortality rate was 44.7 per 1000 where some 61% died within 90 days. Using age specific mortality by BW, 23.6% of all deaths occurred when it was <2500 g compared to 66.2% from IUGR and preterm groups. Fever and diarrhoea rates increased over 12 months. Diarrhoea was associated with poor source-of-drinking-water and latrine.
The IUGR classification predicted one-year growth curves and survival, besides age and sex. IUGR based on BW and BL identified a larger group of at-risk infants than did low BW. High morbidity rates were partly explained by poor environmental conditions. IUGR inclusive of BL has value in optimizing nutritional status in the first 1000 days of life.
宫内生长受限（IUGR）与死亡率和发病率相关。然而，采用合适的现场方法定义IUGR仍然是一项挑战。一项母婴风险评估策略（1988 - 1989年）及后续的丹戎萨里队列研究（TCS）（1989 - 1990年），旨在生成IUGR的实用分类，并探索其在预测队列中婴儿生长、死亡率和发病率方面的应用。
对约3892名单胎活产婴儿进行了随访。IUGR根据出生体重（BW）和身长（BL）定义为：急性、慢性、非IUGR或“可能早产”。计算生长、死亡率和生存曲线，以证明该分类可识别出最脆弱的婴儿。根据IUGR分类、性别、纯母乳喂养和环境因素评估发热超过3天及腹泻情况。
IUGR婴儿的体重和身长在第一年未赶上非IUGR婴儿。婴儿死亡率为每1000例中有44.7例，其中约61%在90天内死亡。按BW计算特定年龄死亡率，所有死亡病例中23.6%发生在体重<2500 g时，而IUGR组和早产组为66.2%。发热和腹泻率在12个月内有所上升。腹泻与饮用水源和厕所条件差有关。
IUGR分类除了能预测年龄和性别外，还能预测一岁时的生长曲线和生存率。基于BW和BL的IUGR识别出的高危婴儿群体比低BW识别出的更大。高发病率部分归因于恶劣的环境条件。包含BL的IUGR在优化生命最初1000天的营养状况方面具有价值。
