Журнал «Здоровье ребенка» Том 21, №7, 2026

Актуальність. Поєднання затримки внутрішньо­утробного розвитку плода з передчасними пологами підвищує ризик несприятливих перинатальних наслідків, однак систематизація патофізіологічних механізмів, що лежать в основі цього ефекту, та їх впровадження у клінічні рекомендації залишаються недостатніми. Метa: обґрунтувати диференційований підхід до клінічного ведення недоношених немовлят із затримкою внутрішньоутробного розвитку з урахуванням патогенетичних особливостей, що впливають на окремі системи органів. Матеріали та методи. Дослідження було проведено у формі описового огляду літератури в Медичному університеті м. Лодзь (Польща) з використанням 50 рецензованих джерел, індексованих у базах даних PubMed, Scopus, Web of Science та Google Scholar, що охоплюють період із 2003 до 2026 року. Результати. Аналіз літератури виявив, що порушення кровопостачання плаценти підтверджено в 51,2 % випадків затримки росту плода, причому частіше на ранніх стадіях (відношення шансів 1,89). Відмінності між стадіями були переважно кількісними щодо тяжкості уражень плаценти, але призводили до якісно різних наслідків для органогенезу. Поєднання передчасних пологів та затримки внутрішньоутробного розвитку плода мало синергічний ефект: ризик бронхолегеневої дисплазії середнього й тяжкого ступеня подвоювався (відношення шансів 2,5), частота некротизуючого ентероколіту зростала до 9,3 % порівняно з 4,1 %, а ризик тяжкої ретинопатії збільшувався у 4–5 разів. Висновки. Серед довгострокових наслідків було підтверджено збереження структурних змін судинної стінки в дорослому віці, а також підвищений у 8 разів ризик розвитку церебрального паралічу й епігенетичну активацію гена інсуліноподібного фактора росту 1 як механізм метаболічного програмування.

Background. The combination of foetal growth restriction with preterm birth increases the risk of adverse perinatal outcomes; however, systematisation of the pathophysiological mechanisms underlying this effect and their translation into clinical recommendations remains insufficient. The study aimed to substantiate a differentiated approach to the clinical management of preterm infants with foetal growth restriction, taking into account pathogenetic features affecting individual organ systems. Materials and methods. The study was conducted as a narrative literature review at the Medical University of Łódź (Poland), involving 50 peer-reviewed sources indexed in PubMed, Scopus, Web of Science, and Google Scholar and covering the period from 2003 to 2026. Results. Analysis of the literature indicated that placental vascular malperfusion was verified in 51.2 % of cases of foetal growth restriction, with a higher frequency in the early stages (odds ratio 1.89), and that differences between stages were predominantly quantitative in terms of the severity of placental lesions but resulted in qualitatively distinct consequences for organogenesis. The combination of prematurity and foetal growth restriction produced a synergistic effect: the risk of moderate-to-severe bronchopulmonary dysplasia doubled (odds ratio 2.5), the incidence of necrotising enterocolitis increased to 9.3 % compared with 4.1 %, and the risk of severe retinopathy increased fourfold to fivefold. Conclusions. Among long-term outcomes, persistence of structural changes in the vascular wall into adulthood was confirmed, alongside an eightfold increased risk of cerebral palsy and epigenetic activation of the insulin-like growth factor 1 gene as a mechanism of metabolic programming.

затримка внутрішньоутробного розвитку; недоношений новонароджений; плацентарна недостатність; централізація кровообігу; бронхолегенева дисплазія

foetal growth restriction; preterm newborn; placental insufficiency; centralisation of circulation; bronchopulmonary dysplasia

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