Impaired Fetal Kidney Function And Neonates In Fetal Growth Are Inhibited

Understanding Intrauterine Growth Restriction (IUGR)

Intrauterine growth restriction (IUGR) is a condition where the fetus fails to achieve its normal growth potential due to genetic and environmental factors. According to the World Health Organization (WHO) standards, babies born at term with a body weight below 2500 grams are categorized as IUGR. However, there is often confusion between the terms "small for gestational age" (SGA) and IUGR, although about 70% of SGA babies are small but healthy babies. The most important assessment of fetal growth is to pay attention to weight gain as time goes by, which should follow the graph of normal growth. A decrease in growth rate indicates the presence of IUGR.

The Barker Hypothesis: A Strong Relationship Between IUGR and Adult Diseases

The Barker hypothesis explains the strong relationship between IUGR caused by suboptimal nutrition and placental insufficiency with the risk of hypertension, coronary heart disease, diabetes mellitus, and other vascular problems in adulthood. Research in experimental animals has shown a decrease in the number of glomeruli in cases of IUGR, followed by enlarged glomeruli as a form of compensation. This can lead to glomerulomegaly and proteinuria. Analysis of autopsy in the fetus born and babies who died in the first year has shown that the number of nephrons in infants with IUGR is fewer than those born with normal weight.

The Purpose of This Study: Measuring Fetal Kidney Volume and Urine Secretion

The purpose of this study was to measure the volume of fetal kidney at the age of 36 weeks, which is the end of nephrogenesis in the fetus IUGR, and compare it with normal fetus using 3D vocal ultrasonography techniques. In addition, this study also measures the urine secretion per hour based on the measurement of bladder delta conducted every 30 minutes, and the results are multiplied by two. After birth, on the seventh day, albumin and creatinine are taken by urine and Cystatin C levels in the blood.

Research Design and Participants

This research is quasi-experimental with pretest-posttest design and comparison. The case group consists of 20 fetuses with IUGR, while the control group consists of 20 normal fetuses. The average neonatal weight of IUGR was recorded at 2950 ± 330 grams, while the normal neonatal reached 3306 ± 194 grams. The neonate length of the IUGR is 49 cm ± 0.81, while the normal neonate has a length of 50 cm ± 0.88.

Results: Kidney Volume and Urine Secretion

The results of the measurement of kidney volume showed that the left kidney volume of the fetus IUGR was 6.47 ml ± 1.85, while in the normal fetus it reached 11.09 ml ± 2.91, with a significant difference. The right kidney volume of the fetus IUGR recorded 6.07 ml ± 1.90, compared to 10.74 ml ± 3.35 in the normal fetus, also with p = 0.001 which shows significant differences.

Measurement of fetal urine secretion IUGR is 8.21 ml ± 3.47 per hour, while the normal fetus has a secretion of 19.22 ml ± 5.78 per hour, showing a significant difference with p = 0.00. Urine production is closely related to the amount of amniotic fluid, and through semicuanitative measurements, an amniotic fluid index is obtained in the fetus of 6.57 ml ± 2.28, while in the normal fetus is 11.85 ml ± 2.53. Although this index is still within normal limits, there is a significant decrease between the fetal group IUGR and normal.

Postnatal Examination: Urine Albumin and Creatinine

After birth, on the 7th day, the examination of the urine albumin in the neonate of IUGR showed 15.8 mg/l ± 31.31, compared to 1.9 mg/l ± 0.19 in normal neonates. The creatinine level of neonatal urine IUGR recorded 17.1 mg/l ± 9.8, while normal neonates have a level of 8.2 mg/l ± 2.9, with significant differences between the two (p = 0.001).

Measurement of albumin and creatinine ratio shows the value of 198.0 μg/mg ± 627.6 in neonates of IUGR, while normal neonates indicate a value of 24.8 μg/mg ± 14.1. Although this value has not reached 200 μg/mg which indicates macroalbuminuria, there is a significant difference between neonates of IUGR and normal.

Conclusion: Implications for Future Neonatal Health

The conclusion of this study confirms that the fetus with stunted growth has experienced significant changes in kidney function and urine production, which can have implications for future neonatal health. Careful monitoring of fetal development and early handling of IUGR is very important to prevent long-term complications.

Recommendations for Future Research

Future research should focus on the long-term effects of IUGR on kidney function and urine production in neonates. Additionally, studies should investigate the relationship between IUGR and the development of adult diseases, such as hypertension, coronary heart disease, and diabetes mellitus.

Implications for Clinical Practice

The findings of this study have significant implications for clinical practice. Healthcare providers should be aware of the potential risks of IUGR and monitor fetal development closely. Early detection and management of IUGR can help prevent long-term complications and improve neonatal outcomes.

Limitations of the Study

This study has several limitations. The sample size was relatively small, and the study was conducted in a single hospital. Future studies should aim to recruit a larger sample size and conduct the study in multiple hospitals to increase the generalizability of the findings.

Future Directions

Future research should focus on the long-term effects of IUGR on kidney function and urine production in neonates. Additionally, studies should investigate the relationship between IUGR and the development of adult diseases, such as hypertension, coronary heart disease, and diabetes mellitus.

Q: What is intrauterine growth restriction (IUGR)?

A: Intrauterine growth restriction (IUGR) is a condition where the fetus fails to achieve its normal growth potential due to genetic and environmental factors. According to the World Health Organization (WHO) standards, babies born at term with a body weight below 2500 grams are categorized as IUGR.

Q: What are the causes of IUGR?

A: The causes of IUGR are multifactorial and include genetic factors, maternal health conditions, placental insufficiency, and environmental factors such as smoking and substance abuse.

Q: What are the effects of IUGR on fetal kidney function?

A: The effects of IUGR on fetal kidney function include decreased kidney volume, decreased urine production, and altered kidney function. These changes can have long-term implications for neonatal health.

Q: How is IUGR diagnosed?

A: IUGR is diagnosed through a combination of ultrasound measurements, fetal monitoring, and maternal health assessments. Healthcare providers use a variety of tools to assess fetal growth and development.

Q: What are the risks of IUGR?

A: The risks of IUGR include long-term complications such as hypertension, coronary heart disease, and diabetes mellitus. Additionally, IUGR can increase the risk of preterm birth, low birth weight, and neonatal mortality.

Q: How can IUGR be prevented?

A: IUGR can be prevented through a combination of prenatal care, healthy lifestyle choices, and early detection and management of maternal health conditions.

Q: What are the treatment options for IUGR?

A: The treatment options for IUGR include close monitoring of fetal growth and development, maternal health assessments, and interventions such as bed rest and oxygen therapy.

Q: What are the long-term effects of IUGR on neonatal health?

A: The long-term effects of IUGR on neonatal health include increased risk of hypertension, coronary heart disease, and diabetes mellitus. Additionally, IUGR can increase the risk of cognitive and behavioral problems.

Q: How can healthcare providers support families affected by IUGR?

A: Healthcare providers can support families affected by IUGR through education, counseling, and emotional support. Additionally, providers can work with families to develop a plan for managing IUGR and preventing long-term complications.

Q: What are the implications of IUGR for future research?

A: The implications of IUGR for future research include the need to investigate the long-term effects of IUGR on neonatal health, the development of adult diseases, and the relationship between IUGR and maternal health conditions.

Q: What are the implications of IUGR for clinical practice?

A: The implications of IUGR for clinical practice include the need for close monitoring of fetal growth and development, early detection and management of maternal health conditions, and interventions such as bed rest and oxygen therapy.

Q: What are the limitations of current research on IUGR?

A: The limitations of current research on IUGR include the small sample size, the lack of diversity in the study population, and the need for further investigation into the long-term effects of IUGR on neonatal health.

Q: What are the future directions for research on IUGR?

A: The future directions for research on IUGR include the need to investigate the long-term effects of IUGR on neonatal health, the development of adult diseases, and the relationship between IUGR and maternal health conditions. Additionally, researchers should aim to recruit a larger and more diverse sample size to increase the generalizability of the findings.