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Dosadašnja istraživanja ukazuju na IUZR kao jedan od najčešćih poremećaja u trudnoći i ozbiljan problem suvremene perinatologije. Uzrokuje velik perinatalni morbiditet i mortalitet. U nerazvijenom svijetu najčešće nastaje zbog majčine pothranjenosti, dok u optimalnim životnim uvjetima prednjače uteroplacentarni čimbenici zastoja rasta. Uredan rast fetusa, dobra oksigenacija i primjerena maturacija preduvjeti su dobrog perinatalnog ishoda što upućuje na potrebu kontinuiranog nadzora svih trudnoća, poglavito rizičnih. Razvoj medicinske tehnologije omogućio je praćenje fetalnog rasta i razvoja ultrazvukom te ga učinio mjerljivim, a praćenje ugroženih trudnoća upotpunio kardiotokografijom, biofizikalnim profilom i doplerom. Kontinuiranim praćenjem trudnoće moguće je uočiti slabljenja nutritivne, a zatim i respiratorne funkcije posteljice, kao i aktivaciju kompenzacijskih mehanizama fetusa. Pogoršanje protoka kroz pupčane arterije vodi u hipoksiju što je osnovno patološkoanatomsko zbivanje. Progresija hipoksije može dovesti do sloma kompenzacijskih mehanizama fetusa. Intenzivnim perinatalnim nadzorom procjenjuje se uhranjenost fetusa i njegova oksigenacija kako bi se pravovremeno mogle uočiti naznake ozbiljnih poremećaja. Prioritet je spriječili neželjene posljedice hipoksije na nezreli mozak fetusa, fetalni metabolizam i na druge organe i organske sustave. U tom cilju razumno je donijeti odluku o dovršenju trudnoće prije nego nastupe nepovratna oštećenja. Former researches indicate IUGR as one of the most common disorders during the pregnancy and as a serious problem of modern perinatology. It causes great perinatal morbidity and mortality. In the underdeveloped word it often appears because of mother's malnutrition, while in optimal living conditions uteroplacental factors of intrauterine growth dominate. Normal fetal growth, good oxygenation and adequate maturation are preconditions for a good perinatal outcome, what indicates on the need for continuous supervision of all pregnancies, especially high risk ones. The development of modern technology enabled monitoring of fetal growth and development by ultrasound, it made it measurable, and completed the monitoring of endangared pregnancies with biophysical profile and doppler. Continuous monitoring makes it possible to notice the weakening of nutritional, and afterwards the respiratory function of the placenta, as well as the activation of compensatory mechanism of the fetus. Determination of the flow trough umbilical arteries leads to hypoxia, which is basic pathological process. Progression of hypoxia can lead to the breakdown of compensatory mechanisms. The nutrititional status of the fetus and its oxygenation is estimated by intensive perinatal surveillance, so that indications of serious disorders could be noticed on time. As the priority is to prevent undesirable consequences of hypoxia on immature brain of the fetus, fetal metabolism and other organs and organic systems, it is reasonable to make a decision about trmination of pregnancy before new irreversible damages appear.

Cilj rada. Izraditi tablice i analizirati standardne vrijednosti porodnih težina i duljina novorođenčadi u bolnici u Novoj Bili. Ispitanice i metode. Analizirani su retrogradno podatci za 5697 novorođenčadi iz jednoplodnih trudnoća, gestacijske dobi od 34. do 42. tjedna, za desetogodišnje razdoblje od 1998. do 2007. godine. Svoje rezultate smo usporedili s dosadašnjim mjerenjima i standardima. Iz analize su isključena djeca iz blizanačkih trudnoća, mrtvorođena djeca, malformirana djeca i djeca majki s nesigurnim trajanjem trudnoće. Rezultati. Prikazane su centilne vrijednosti porodnih težina i duljina novorođenčadi po navršenim tjednima trudnoće, paritetu majke i spolu novorođenčadi. Medijana vrijednost porodne težine i duljine sve novorođenčadi s navršenih 40 tjedana iznosi 3600 grama i 52 centimetra. Najnižu težinu i duljinu imale su djevojčice prvorotkinja (3450 g i 51 cm) a najvišu dječaci višerotkinja (3770 g i 53 cm). Ispitana novorođenčad težinski su najsličnija onima iz splitskog rodilišta, dok su, u usporedbi s europskim prosjekom i podacima iz ostalih velikih hrvatskih gradova, nešto veća. Zaključak. Potrebno je izraditi jedinstvene nacionalne antropometrijske standarde kao preduvjet za otkrivanje poremećaja fetalnog rasta., Aim of the study. To develop and analyze standard values for newborns’ birth weight and length in the hospital of Nova Bila. Sample and Method. Retrospective data for 5697 newborns from singleton pregnancies, with gestational age 34 to 42 weeks collected in ten year period from 1998 to 2007 were analyzed. We compared our results with previous measurements and standards. Newborns from multiple pregnancies, stillborn and malformed children and those born to mothers with uncertain pregnancy duration were excluded from the analysis. Results. Percentile values for birth weight and length are calculated by gestational age, mothers’ parity and neonatal gender. Median birth weight and length of all newborns for 40th gestational week was 3600 g and 52 cm. Lowest birth weight and length was for female newborns in primiparas (3450 g; 52 cm), and highest for male newborns in multiparas (3770 g; 53 cm). Investigated newborns are most similar to those in Split maternity hospital. Compared to European data and data from other large Croatian cities, our children are larger. Conclusion. It is necessary to develop unique national anthropometric standards as prerequisite for detection of fetal growth aberration.

U hrvatskim rodilištima su do sada učinjene četiri krivulje fetalnog rasta: Zagreb 1988, Zagreb 2005, Split 2005 i Rijeka 2007 godine. Cilj rada je bio međusobno usporediti postojeće četiri krivulje i njih s ostalim krivuljama indoeuropske populacije. Hrvatske krivulje rasta in toto, za svu mušku i žensku djecu prvorotkinja i višerotkinja, u Zagrebu 1982. i u Rijeci 1996–2005, se po 50-centilnim vrijednostima slažu s dvije krivulje na višemilijunskom broju novorođenčadi indoeuropske etničke skupine u USA. Među hrvatskim krivuljama, diferencirano po rodnosti majke i spolu djeteta, najviše su 50-centilne i 10-centilne vrijednosti u I- para s muškim djetetom u Splitu, a u I-para sa ženskim, M-para s muškim i M-para sa ženskim djetetom najviše su vrijednosti u Rijeci. Razlike 50-centilnih vrijednosti, između najviše i najniže, su u I-para-M 150 grama, u I-para-F 60, u M-para-M 90 i u M-para-F 60 grama. Razlike 10-centilnih vrijednosti po istom redoslijedu su 160 grama, 120, 100 i 160 grama. U odnosu na druge europske i USA krivulje, vrijed¬nosti hrvatskih krivulja su niže nego u skandinavskim krivuljama, a vrlo su blizu USA krivuljama učinjenim na milijunskim uzorcima živorođene djece indoeuropske etničke skupine. Date su smjernice za izradu krivulja fetalnog rasta te sugestija za izradu hrvatske nacionalne krivulje., In Croatian maternity hospitals exist four fetal growth-charts: Zagreb 1988, Zagreb 2005, Split 2005 and Rijeka 2007. The aim of the paper was to compare each other the existing four charts, and correlate them to the other Caucasian growth-charts, as well. Croatian growth charts in toto, for all male and female newborns in primigravida and plurigravidas, from Zagreb 1982 and Rijeka 1996–2005, correspond to two USA growth charts carried out on more millions of Caucasian newborns. Among Croatian charts in toto the highest 50-centiles and 10-centiles values are registered in Split. Differentiated according to parity and infant’s gender the highest values were at I-paras male, I-paras female, M-paras male and M-paras female in Rijeka. The differences between the highest and lowest 50-centiles values are at I-paras-M 150 grams, at I-paras-F 60, at M-paras-M male 90 and at M-paras-F 50 grams. The differences in 10-centiles according to the same succession are 160 grams, 120, 100 and 160 grams. In relation to other European and USA Caucasian growth-charts, the Croatian values are lower than in Scandinavian countries, they are very close to USA charts done on millions specimens of liveborn indoeuropean infants. The guidelines for construction of fetal growth-charts are presented and the suggestion for construction of Croatian national fetal growth-chart is done as well.

Cilj rada. Utvrditi indeks tjelesne težine (BMI) na početku trudnoće i prirast tjelesne težine u trudnica s gestacijskim dijabetesom (GDM) na dijeti te na dijeti i inzulinskoj terapiji, kao i njihov utjecaj na fetalni rast. Metode. Istraživanje je provedeno na 351 trudnici s GDM Odjela za dijabetes i fetalni rast Klinike za ženske bolesti i porode Kliničkog bolničkog centra u Zagrebu, na 278 trudnica na dijeti i 73 trudnice na dijeti i inzulinu iste životne dobi i pariteta majki, gestacijske dobi i spola novorođenčadi. U statističkoj je obradi uporabljena metoda univarijantne analize varijance (ANOVA), Studentov t-test, 2-test, Fisherov test programskog paketa SPSS software. Rezultati. U trudnica na inzulinu značajno su bile veće vrijednosti BMI i veća učestalost BMI 25, dok je kod trudnica na dijeti bio veći prirast tjelesne težine i veća učestalost njegova prekomjernog prirasta (p0,05). Vrijednost ponderalnog indeksa (PI) i učestalost PI >2,85 bila je značajno veća u trudnica na inzulinu (p0,05). Zaključak. Rad je ukazao na značajno više vrijednosti tjelesne težine i BMI trudnica s GDM na inzulinu i veći prirast tjelesne težine u trudnica na dijeti. Nisu nađene značajne razlike u vrijednostima porodnih težina, porodnih duljina i učestalosti makrosomne novorođenčadi između trudnica na dijeti i na inzulinu, kao ni značajan utjecaj BMI na početku trudnoće i prirasta tjelesne težine u trudnoći na veću učestalost fetalne makrosomije u trudnica na inzulinu., Objective. To determine the pregestational body mass index (BMI) and gestational weight gain for women with gestational diabetes mellitus (GDM) on the diet and on the insulin therapy, as well as determining the impact on fetal growth. Methods. In the study on 351 pregnant women with GDM in the Division of Diabetes and Fetal Growth of the University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, 279 pregnant women on the diet and 73 on the insulin therapy of the same mother’s age and parity, gestational age and newborn’s gender were included. Statistical evaluation was done by the method of univariate variance analysis (ANOVA), the Student’s t-test, the 2-test and the Fisher’s test of programme package SPSS. Results. Pregnant women with GDM on insulin had significantly higher body weight, BMI and more frequent excessive BMI (25 and 30) then pregnant women with GDM on diet, had greater body weight growth and more frequent excessive increase of body weight during pregnancy (p0,05). Newborns of mothers on insulin had higher values of PI (ponderal index) and were more frequently with PI0,05). Conclusion. The results of the study indicate significantly greater BMI in pregnant women with GDM on insulin and greater body weight growth in women with GDM on diet. There were no significant higher birth weight and birth length of newborns, increased frequency of fetal macrosomia and a significant impact of pregestational BMI and gestational weight gain on increased frequency of fetal macrosomia in mothers on insulin.

Antenatal tests determining fetal growth are performed in order to recognize intrauterine growth restriction (IUGR) and find early signs of fetal compensatory mechanisms failure. Cardiotocography (non-stress and stress test), doppler measurements of fetal and placentar circulation and the fetal biophysical profile are presently used for this purpose. They should scan fetuses with risk for a bad pregnancy outcome. A severe IUGR can occur due to several reasons, but it is most commonly caused by a deranged placenta function leading to a respiratory insufficiency and fetal hypoxemia. A delayed childbirth in such cases may lead to a deterioration of hypoxia, even of perinatal death. Apart from that, such children often show complications in their neurological development. This retrospective five-year study analyzed the application of antenatal tests and the pregnancy outcome in 18 patients with severe IUGR (fetal weight equal to or below the 5th percentile) who were hospitalized on the Pregnancy pathology ward of the Pula General hospital. In all the cases fetal monitoring was performed using a combination of tests (in most cases doppler measurements and a biophysical profile). The decision on a termination of pregnancy at 35-37 weeks of gestation was reached on the basis of one or more pathological tests (biophysical profile, Doppler or stress test), whereas the pathological test result of the biophysical profile was decisive for pregnancies of less than 35 weeks. The two groups of patients showed no differences in the Apgar score or the pH value of umbilical blood (Apgar 8/8,6- 7,4/8,6 pH 7,29- 7,31). The most newborns from the 35-37 weeks group had normal CNS ultrasound results, as well as normal neuromotoric clinical findings 6 months after birth. The CNS ultrasound performed in the group under 35 weeks detected in most cases an bilateral periventricular echogenicity of the first or second grade, two newborns showed periventricular cystic spaces. All patients from this group had to exercise continuously in order to eliminate the effect of a slower neuromotoric development. Several studies confirmed the biophysical profile to be the best way of guiding pregnancies with intrauterine growth restriction of the fetus. It is the starting point in the procedure of reaching the decision on premature childbirth, especially before the 35th week of gestation. The clinical procedure in our hospital is based on these findings.

Cilj rada. Izraditi tablice i analizirati standardne vrijednosti porodne težine i porodne duljine zdrave novorođenčadi. Ispitanici i metode. Retrospektivno su analizirani podatci o 19 996 novorođenčadi jednoplodnih trudnoća od 22. do 42. tjedna gestacije rođenih u Klinici za ginekologiju i porodništvo KBC Rijeka u razdoblju od deset godina. Iz analize su isključena novorođenčad s kongenitalnim malformacijama, mrtvorođeni, djeca majki s nesigurnim trajanjem trudnoće i majki s kroničnim bolestima. Rezultati su prikazani u tablicama i krivuljama centilnih vrijednosti prema navršenim tjednima trudnoće, paritetu majke i spolu novorođenčeta. Rezultati. Medijana vrijednost porodne težine u 40. tjednu trudnoće za analiziranu skupinu iznosila je 3580 g (c.10=3070 g; c.90=4140 g). Najnižu porodnu masu u 40. tjednu imala su ženska novorođenčad prvorotkinja, 3450 g (c.10=2980 g; c.90=3955 g). Slijede ženska djeca višerotkinja (3550 g) i muška djeca prvorotkinja (3590 g). Najteža su bila muška novorođenčad višerotkinja 3720 g. U 40. tjednu gestacije medijana vrijednost porodne duljine iznosila je 52 cm (c.10=49 cm; c.90=54 cm). Zaključak. Izrada antropometrijskih standarda na vlastitoj populaciji novorođenčadi preduvjet je za kvalitetnu skrb djeteta. Usporedba rezultata sa sličnim ¬studijama u zemlji otežena je zbog metodološki različitog pristupa u odabiru ispitanika. Zato je potrebno jedinstvenom metodologijom izraditi nacionalne standarde, kako bi se osigurao veći ispitivani uzorak, dobili objektivniji rezultati te omogućilo otkrivanje poremećaja fetalnog rasta., Aim. To present the obtained data as table records and to analyse standard values of birth weight and birth length in healthy newborns. Methods. Retrospective study of 19 996 singleton pregnancies' neonates with a gestational age between 22 to 42 weeks born at the University Hospital Rijeka, Department of Obstetrics and Gynecology, over the ¬period of ten years. Statistical evaluation of the hospital records data. Newborns with congenital disorders, stillborn ¬children, neonates born to mothers with uncertain pregnancy duration and those born to mothers with chronic diseases that may influence fetal growth (malignant and endocrine diseases, hypertension) were excluded. Obtained results have been presented in tables of percentiles, according to gestational age, mother's parity and neonatal gender. Results. Median birth weight value for the analysed group born at 40-th gestational week was 3580 gs (c10=3070 gs; c90=4140 gs). ¬Female neonates of primiparas, born at 40-th gestational week, had the lowest median birth weight, 3450 gs (c10=2980 gs; c90=3955 gs), followed by female neonates of multiparas (3550 gs) and male neonates of primiparas (3590 gs). Male newborns of multiparas had the greatest median birth weight, 3720 gs. Median birth length value at the 40-th gestational week for the analysed group was 52 cms (c10=49 cms; c90=54 cms). Conclusion. Construction of anthropometrical ¬standards in a certain population is essential condition for maintaining quality of antenatal and postnatal health care. ¬Eventual comparison of our results with similar studies in the country is difficult due to variant methodological ¬approaches considering the selection of examinees. It is essential to apply the unique methodology and create national standards, which would ensure greater examined sample and thus more objective results to enable further researches of fetal growth delays.

Cilj rada. Izraditi tablice i analizirati standardne vrijednosti porodne težine i porodne duljine zdrave novorođenčadi. Ispitanici i metode. Retrospektivno su analizirani podatci o 19 996 novorođenčadi jednoplodnih trudnoća od 22. do 42. tjedna gestacije rođenih u Klinici za ginekologiju i porodništvo KBC Rijeka u razdoblju od deset godina. Iz analize su isključena novorođenčad s kongenitalnim malformacijama, mrtvorođeni, djeca majki s nesigurnim trajanjem trudnoće i majki s kroničnim bolestima. Rezultati su prikazani u tablicama i krivuljama centilnih vrijednosti prema navršenim tjednima trudnoće, paritetu majke i spolu novorođenčeta. Rezultati. Medijana vrijednost porodne težine u 40. tjednu trudnoće za analiziranu skupinu iznosila je 3580 g (c.10=3070 g; c.90=4140 g). Najnižu porodnu masu u 40. tjednu imala su ženska novorođenčad prvorotkinja, 3450 g (c.10=2980 g; c.90=3955 g). Slijede ženska djeca višerotkinja (3550 g) i muška djeca prvorotkinja (3590 g). Najteža su bila muška novorođenčad višerotkinja 3720 g. U 40. tjednu gestacije medijana vrijednost porodne duljine iznosila je 52 cm (c.10=49 cm; c.90=54 cm). Zaključak. Izrada antropometrijskih standarda na vlastitoj populaciji novorođenčadi preduvjet je za kvalitetnu skrb djeteta. Usporedba rezultata sa sličnim ¬studijama u zemlji otežena je zbog metodološki različitog pristupa u odabiru ispitanika. Zato je potrebno jedinstvenom metodologijom izraditi nacionalne standarde, kako bi se osigurao veći ispitivani uzorak, dobili objektivniji rezultati te omogućilo otkrivanje poremećaja fetalnog rasta., Aim. To present the obtained data as table records and to analyse standard values of birth weight and birth length in healthy newborns. Methods. Retrospective study of 19 996 singleton pregnancies' neonates with a gestational age between 22 to 42 weeks born at the University Hospital Rijeka, Department of Obstetrics and Gynecology, over the ¬period of ten years. Statistical evaluation of the hospital records data. Newborns with congenital disorders, stillborn ¬children, neonates born to mothers with uncertain pregnancy duration and those born to mothers with chronic diseases that may influence fetal growth (malignant and endocrine diseases, hypertension) were excluded. Obtained results have been presented in tables of percentiles, according to gestational age, mother's parity and neonatal gender. Results. Median birth weight value for the analysed group born at 40-th gestational week was 3580 gs (c10=3070 gs; c90=4140 gs). ¬Female neonates of primiparas, born at 40-th gestational week, had the lowest median birth weight, 3450 gs (c10=2980 gs; c90=3955 gs), followed by female neonates of multiparas (3550 gs) and male neonates of primiparas (3590 gs). Male newborns of multiparas had the greatest median birth weight, 3720 gs. Median birth length value at the 40-th gestational week for the analysed group was 52 cms (c10=49 cms; c90=54 cms). Conclusion. Construction of anthropometrical ¬standards in a certain population is essential condition for maintaining quality of antenatal and postnatal health care. ¬Eventual comparison of our results with similar studies in the country is difficult due to variant methodological ¬approaches considering the selection of examinees. It is essential to apply the unique methodology and create national standards, which would ensure greater examined sample and thus more objective results to enable further researches of fetal growth delays.

Postnatalni rast praćen je povećanjem tjelesne mase kao i kompleksnim pojavama sazrijevanja funkcija organa, iza čega stoje složeni mehanizmi na organskoj i staničnoj razini. U biti rasta i razvoja stoje procesi maturacije i diferencijacije. Nedonščad ispod 2 kg ima posebne potrebe u tom pogledu jer ih možemo smatrati fetusima ex utero. Teoretski, njihova stopa rasta u tom bi slučaju trebala biti slična stopi rasta u fetusa. Majčino mlijeko pri prijevremenom porođaju ne zadovoljava u potpunosti povećane potrebe nedonoščeta za energijom, bjelančevinama i elektrolitima. Preporuča se majčinome mlijeku dodavati preparate koji povećavaju sadžaj tvari potrebnih za metabolizam. Time se postiže rast od 15 do 25 g/kg/dan, smanjuje se mogu}nost nastanka metaboličke bolesti kostiju, uz dobru podno{ljivost pripravka., The postnatal growth is followed by the body mass increase and complex phenomena of organ function maturation, behind which mechanisms on organic and cellular level can be recognized. Processes of maturation and differentiation are essential to the growth and development. Premature neonates below two kilograms, which can be recognized as fetuses ex utero, have specific needs in this regard. Theoretically, their growth rate should be similar to the fetal one. Human preterm milk is less than optimal to satisfy the preterm infant’s increased protein, energy and electrolyte requirements. Therefore, it is recommendable to fortify human milk to increase the metabolyte content. Herewith, the growth in wet weight of 15-25 g/kg/day has been achieved, the metabolic bone disease has been unlikely to emerge, and a fair preparation to tolerance has been recognized, too.