Fetale Mangelernährung und Unterernährung bei Kindern – Ursachen, Therapie, Ernährung

Fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR), represents one of the most critical challenges in contemporary perinatal medicine, as its consequences may pose substantial threats to both the health and survival of the unborn child. The diagnosis is established through serial ultrasonographic assessments that, on at least two occasions separated by a minimum of two weeks, demonstrate a significant deceleration in fetal biometric parameters—such as head circumference, abdominal circumference, or femur length—or when the estimated fetal weight falls below the 10th percentile for the corresponding gestational age, as defined by current reference charts [2]. Notably, this developmental impairment may manifest at any stage of pregnancy, ranging from the early weeks of the first trimester to the immediate pre-delivery period, rendering it particularly complex from both diagnostic and therapeutic perspectives. Clinically, two primary variants are distinguished: **symmetric growth restriction** and **asymmetric growth restriction**, which differ not only in their timing of onset but also in underlying etiologies, fetal morphological presentation, and neonatal outcomes.

Historical medical observations dating back to the Hippocratic era posited that the highest viability in newborns typically occurs when delivery takes place toward the end of the ninth gestational month. A Finnish pediatric specialist proposed that the appropriate birth weight for a mature, full-term infant should approximate 2500 grams. Any substantial deviation below this benchmark is associated with elevated risks of physiological immaturity and health complications (refer to Table 1), thereby necessitating specialized neonatal intensive care interventions [citation 5]. A newborn is considered full-term—or *at term*—when born between the completion of the 37th and 42nd weeks of gestation. The following classification outlines the severity gradations of suboptimal birth weight based on body mass: **Table 1.** *Categorization of newborn underweight by body mass thresholds* - **low birth weight (LBW)**: < 2500 g - **very low birth weight (VLBW)**: < 1500 g - **extremely low birth weight (ELBW)**: < 1000 g - **profoundly low birth weight (ILBW)**: < 750 g

Pinpointing a solitary, predominant factor responsible for the onset of prenatal growth disturbances presents a substantial diagnostic challenge, as the pathogenesis of this condition is inherently multifactorial. Among the primary determinants are genetic predispositions—including hereditary tendencies toward diminished stature observed in both parents—as well as chromosomal aberrations and congenital malformations that coexist with hypotrophy. Equally critical are placental dysfunctions, such as premature aging, umbilical vessel thrombosis, structural anomalies of the umbilical cord, or cardiopulmonary insufficiency of the fetoplacental unit. Furthermore, exogenous factors—including maternal malnutrition, toxin exposure (alcohol, nicotine, psychoactive substances), and chronic oxidative stress—significantly amplify the risk of this disorder. In accordance with current perinatal medicine guidelines, fetal hypotrophy may arise as a consequence of any high-risk pregnancy in which destabilization of homeostasis within the maternal-placental-fetal system occurs, ultimately culminating in placental insufficiency [as per reference 4].

A critical component of prenatal care involves the prompt detection of fetal growth delay indicators, achieved through systematic ultrasonographic surveillance supplemented by Doppler assessment of uteroplacental circulation. Despite advancements in medical science, definitive preventive strategies and universally effective treatments for newborns diagnosed with intrauterine growth restriction (IUGR) remain elusive clinical challenges. Current obstetric practice typically advises expectant mothers to adopt a regimen of restricted physical activity, designed to enhance uterine perfusion while facilitating comprehensive diagnostic evaluation and therapeutic intervention for any concurrent maternal pathologies [2]. The identification of progressive growth inhibition beyond the 37th week of gestation warrants consideration for preterm delivery, as the intrauterine environment—when it has become a limiting factor for fetal development—may no longer provide optimal conditions for continued healthy maturation. In such scenarios, it is posited that earlier birth, combined with immediate initiation of breastfeeding as the most nutritionally complete source of infant nourishment, may confer greater developmental advantages to the fetus than prolonged gestation under suboptimal conditions.

There is overwhelming consensus that human breast milk represents the gold standard of infant nutrition during the first six months of life, fulfilling all energy requirements and providing essential nutrients that support optimal physical and psychomotor development. In the case of preterm infants and newborns with low birth weight, nutritional management is critically dependent on the maturity of the gastrointestinal tract, which dictates feeding tolerance and absorption capacity. Notably, the colostrum and early milk produced by mothers of preterm infants exhibit elevated concentrations of calories, proteins, lipids, electrolytes, and trace elements compared to the milk of mothers who deliver at term—a biologically advantageous adaptation that enhances survival outcomes [3]. Neonates with extremely low birth weight (ELBW) initially require total parenteral nutrition within neonatal intensive care units, supplemented by minimal trophic enteral feeding to stimulate gut maturation and facilitate the transition to full enteral nutrition. Human milk—whether from the infant’s own mother or pasteurized donor milk—is strongly preferred in this context due to its superior digestibility and beneficial effects on gut microbiota composition relative to artificial formula. For infants with growth restrictions, the use of *human milk fortifiers* (protein-mineral concentrates) is recommended to ensure adequate weight gain trajectories and prevent metabolic complications such as osteopenia of prematurity [3]. Discharge criteria extend beyond clinical stability to include the infant’s ability to coordinate sucking, swallowing, and breathing, as well as parental competency in feeding techniques under professional guidance, with assured access to neonatal follow-up services as needed [6]. Ongoing developmental assessments are essential, with particular emphasis on nutritional status and psychomotor milestones. Intrauterine growth restriction remains a significant challenge in contemporary perinatology, with growing recognition of the role played by socioeconomic and environmental determinants in shaping fetal development. Emerging evidence indicates that modifiable risk factors—such as maternal malnutrition, chronic stress, or tobacco exposure—can profoundly impair in utero growth trajectories. Consequently, promoting routine gynecological care, high-resolution ultrasonography, and the mitigation of preventable risks constitutes a public health priority.