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Postnatal intestinal disturbances in small-for-gestational-age premature infants after prenatal haemodynamic
E Robel-Tillig1, C Vogtmann, R Faber
1Department of Pediatrics, University of Leipzig, Germany.
Insights
Prenatal hemodynamic disturbances in fetuses can lead to small-for-gestational-age neonates experiencing significant postnatal gastrointestinal issues and impaired intestinal perfusion, impacting gut motility.
Area of Science:
- Neonatal Medicine
- Fetal Medicine
- Pediatric Gastroenterology
Background:
- Uteroplacental insufficiency is a primary cause of fetal growth retardation and associated perinatal/postnatal morbidity.
- Investigating the link between prenatal circulatory issues and infant gut health is crucial for improving outcomes.
Purpose of the Study:
- To examine the relationship between prenatal hemodynamic disturbances and postnatal intestinal perfusion and function in small-for-gestational-age neonates.
- To compare the adaptation and superior mesenteric artery blood flow in neonates with and without prenatal circulatory abnormalities.
Main Methods:
- Prospective study of 114 preterm neonates (<1500g birthweight) categorized by prenatal Doppler sonography findings.
- Pathological fetal perfusion defined by elevated pulsatility index in uterine/umbilical arteries/aorta and low pulsatility index in the middle cerebral artery.
- Postnatal assessment included respiratory/intestinal adaptation and superior mesenteric artery Doppler velocimetry.
Main Results:
- Neonates with prenatal hemodynamic disturbances (n=36) were small-for-gestational-age and frequently experienced delayed meconium, distension, vomiting, and feeding intolerance.
- Superior mesenteric artery Doppler showed significantly lower flow velocities and higher pulsatility indices in neonates with prenatal disturbances.
- Neonates with normal prenatal perfusion (n=78) were appropriate-for-gestational-age, with fewer postnatal intestinal issues.
Conclusions:
- Prenatal hemodynamic disturbances are strongly associated with impaired postnatal intestinal perfusion and gastrointestinal dysfunction in small-for-gestational-age neonates.
- These circulatory changes may lead to persistent regional blood flow redistribution, affecting gut motility and contributing to feeding difficulties.
- Doppler sonography is valuable in identifying fetuses at risk for these adverse postnatal outcomes.
Abstract:
Uteroplacental insufficiency leads to fetal growth retardation, which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal haemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small-for-gestational-age neonates. Prospectively, 114 preterm neonates with a birthweight below 1500 g were assigned to one of two groups according to their prenatal Doppler sonographic measurements: neonates with or without prenatal haemodynamic disturbances. We defined a pathological fetal perfusion by a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and by a pulsatility index of middle cerebral artery below the 10th percentile of a normal group. We compared the postnatal respiratory and intestinal adaptation in both groups as well as the blood flow velocity waveforms of the superior mesenteric artery in all neonates. Postnatally, all 36 neonates with prenatal haemodynamic disturbances were classified to be small for gestational age. Thirty-one of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating in enteral feeding within the first days of life. Six of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates after normal prenatal perfusion were classified to be appropriate for gestational age. Only 19 of 78 neonates of this group showed signs of intestinal disturbances postnatally. By Doppler sonographic investigations we found significant lower systolic, mean and end-diastolic flow velocities and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal haemodynamic disturbances. This may occur as a result of postnatal persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.