Mense Lars, Birdir Cahit, Reichert Jörg, Schleußner Ekkehard, Proquitté Hans, Schmitt Jochen, Müller Gabriele, Rüdiger Mario
Zentrum für Feto-Neonatale Gesundheit an der TU Dresden, TU Dresden, Dresden.
Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Universitätsklinikum Carl Gustav Carus, Dresden.
Z Geburtshilfe Neonatol. 2020 Feb;224(1):15-21. doi: 10.1055/a-0998-4532. Epub 2019 Sep 11.
Intrauterine growth restriction (IUGR) is present in fetuses that do not achieve their full in-utero growth potential. IUGR needs to be discriminated from small for gestational age (SGA) because IUGR newborns in particular experience long-term side effects from their small growth. IUGR fetuses have a significantly increased risk of prematurity and a distinct risk profile compared to adequate-for-gestational-age preterm newborns. Complications of prematurity are more frequent, including bronchopulmonary dysplasia, intraventricular hemorrhage, and meconium ileus. IUGR newborns are at risk of long-term health issues like cerebral palsy, impaired lung function, and delayed speech development. Interdisciplinary and interprofessional care of IUGR pregnancies in the context of a standardized health care research project is feasible: Pregnant women at risk are identified, early therapy with acetylsalicylic acid is started as indicated, risk-adapted care at level III centers is organized including psychosocial interventions and neonatal consultations. Postnatally, integrated neonatal care focusing on parent-child interaction and optimized nutrition is a hallmark. Afterwards, in-depth pediatric follow-up visits with local pediatricians help to identify growth and neurodevelopment problems early. The effects, acceptance. and cost efficiency of this approach are evaluated prospectively as part of an Innovationsfonds project.
宫内生长受限(IUGR)存在于未实现其完全宫内生长潜力的胎儿中。需要将IUGR与小于胎龄儿(SGA)区分开来,因为IUGR新生儿尤其会因生长过小而经历长期的副作用。与适于胎龄的早产新生儿相比,IUGR胎儿早产的风险显著增加,且有独特的风险特征。早产并发症更为常见,包括支气管肺发育不良、脑室内出血和胎粪性肠梗阻。IUGR新生儿有患脑瘫、肺功能受损和语言发育迟缓等长期健康问题的风险。在标准化医疗研究项目的背景下,对IUGR妊娠进行跨学科和跨专业护理是可行的:识别有风险的孕妇,根据指征开始使用乙酰水杨酸进行早期治疗,在三级中心组织风险适应性护理,包括心理社会干预和新生儿会诊。出生后,以亲子互动和优化营养为重点的综合新生儿护理是一大特色。之后,由当地儿科医生进行深入的儿科随访有助于早期发现生长和神经发育问题。作为创新基金项目的一部分,前瞻性地评估这种方法的效果、可接受性和成本效益。