Контроль за дітьми, народженими малими відповідно до гестаційного віку, до дорослого життя: положення консенсусу міжнародних товариств дитячої ендокринології і товариства дослідження гормону росту
Ключові слова:
-Анотація
Мета роботи. Низька маса тіла при народженні залишається основною причиною захворюваності та смертності серед немовлят та дітей. Це пов’язано з підвищеним ризиком проблем зі здоров’ям у подальшому житті, зокрема ризиком серцево-судинних захворювань та інсульту. Було скликано нараду, щоб визначити ключові проблеми, з якими стикаються діти, народжені малими щодо гестаційного віку (SGA), та запропонувати стратегії їх моніторингу.
Учасники. Відібрано 42 учасника за їх досвід роботи в акушерстві, пери- та неонатології, педіатрії, дитячій і дорослій ендокринології, епідеміології та фармакології.
Доказовість. Відбувався обмін письмовими матеріалами, вони були проаналізовані, переглянуті та в подальшому стали доступними всім. Це сформувало базу для дискусій на зустрічі. Якщо опубліковані дані не були доступними або адекватними, то дискусія ґрунтувалася на експертних думках.
Процес консенсусу. Кожен набір питань розглядали всі, а потім їх обговорювали на пленарних засіданнях з консенсусом та визначенням невирішених питань. Заяву консенсусу було підготовлено на пленарних засіданнях, а потім відредаговано головами груп та поширено серед учасників.
Висновки. Діагноз SGA має ґрунтуватися на точних антропометричних показниках (маса і довжина тіла та обвід голови). Рекомендовано раннє спостереження в клініках за тими, хто відстає у рості. Оцінка раннього неврологічного розвитку та втручання обґрунтовані для дітей з групи ризику. Ендокринні та метаболічні порушення у SGA-дитини мають місце, але нечасто. Для 10 % дітей з відставанням у рості лікування гормоном росту (ГР) може збільшити лінійний ріст. Раннє призначення ГР для осіб із вираженою затримкою росту (показник зросту <–2,5 SD; вік — 2—4 роки) слід проводити у дозі 35—70 мкг/кг маси тіла на добу. Необхідним є тривале спостереження за пацієнтами, котрі отримують лікування. В межах популяції визначається асоціація між низькою масою при народженні, зокрема SGA, і серцево-судинними захворюваннями та інсультом у подальшому житті, але недостатньо доказів, щоб рекомендувати планове спостереження за здоров’ям у всіх дорослих, які народилися SGA, поза нормальною клінічною практикою.
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