Intrauterine Wachstumsrestriktion: Transsektorale, interdisziplinäre und multiprofessionelle Betreuung von Schwangeren und Neugeborenen im Feto-Neonat-Pfad: Ein Projekt des Innovationsfonds

Zusammenfassung

Eine intrauterine Wachstumsrestriktion (IUGR) betrifft Feten, die ihr intrauterines Wachstumspotenzial nicht nutzen können. Überschneidungen bestehen dabei zur Gruppe der small-for-gestational age (SGA) Kinder, doch sind speziell IUGR-Kinder von kurz- und langfristigen Folgen betroffen. IUGR-Feten haben ein deutlich erhöhtes Frühgeburtlichkeits-Risiko und ein spezielles Risikoprofil im Vergleich zu altersentsprechend gewachsenen Frühgeborenen. Dies umfasst das häufigere Auftreten typischer Komplikationen wie Bronchopulmonale Dysplasie, intraventrikuläre Hämorrhagie und Mekonium-Ileus. Neugeborene mit IUGR scheinen langfristig ein erhöhtes Risiko für Folgeprobleme, wie Zerebralparesen, eingeschränkte Lungenfunktion und Sprachentwicklungsverzögerungen zu haben. Eine transsektorale, interdisziplinäre und multiprofessionelle Betreuung der Schwangeren, Neugeborenen und Säuglinge im Rahmen eines Versorgungspfades ist eine aussichtsreiche neue Versorgungsform. Sie umfasst die frühe Identifizierung von Schwangeren mit einem erhöhten Risiko für eine fetale Wachstumsrestriktion, ggf. die Therapie mit Acetylsalicylsäure, die Risiko-adaptierte Anbindung an die Perinatalzentren mit psychologischen Interventionen und neonatologischen Gesprächen. Ziel des Pfades ist die Vermeidung von Verlegungen in die Perinatologie und Totgeburten. Postnatal steht eine umfassende Betreuung mit besonderem Augenmerk auf die Eltern-Kind-Bindung und Ernährungsoptimierung im Mittelpunkt. Vertiefende Vorsorgeuntersuchungen der ambulanten Kinderärzte dienen dem frühen Aufdecken von Entwicklungsproblemen. Die Wirkungen, Akzeptanz und Kosteneffizienz dieses Pfades werden im Rahmen eines Projektes des Innovationsfonds getestet.

Abstract

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.

Schlüsselwörter

evidenzbasierte Schwangerenvorsorge - intrauterine Wachstumsrestriktion - intrauterine Wachstumsretardierung - IUGR - Perinatale Mortalität - Präeklampsie

Key words

evidence based antenatal care - intrauterine growth restriction - IUGR - mortality - perinatal Mortality - preeclampsia

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