The impact of foetal growth restriction on neonatal outcomes in preterm infants

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.