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Prenatal hemodynamic disturbances -- pathophysiological background of intestinal motility disturbances in small for

E Robel-Tillig1, C Vogtmann, J Bennek

  • 1Department of Pediatrics, University of Leipzig, Leipzig, Germany. Eva_robel_tillig@web.de

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|July 9, 2002
PubMed

Insights

Prenatal hemodynamic disturbances in fetuses can lead to small for gestational age neonates with significant gastrointestinal issues. These issues are linked to altered superior mesenteric artery blood flow, impacting gut function.

Area of Science:

  • Neonatalogy
  • Fetal Medicine
  • Pediatric Surgery

Background:

  • Uteroplacental insufficiency is a primary cause of fetal growth restriction, leading to significant perinatal and postnatal complications.
  • Prenatal hemodynamic disturbances are indicative of compromised fetal well-being and can impact organ development.
  • Assessing fetal circulation patterns is crucial for predicting neonatal outcomes.

Purpose of the Study:

  • To investigate the relationship between prenatal hemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small for gestational age neonates.
  • To compare intestinal adaptation and superior mesenteric artery blood flow in neonates with and without prenatal hemodynamic disturbances.
  • To identify potential links between altered fetal blood flow and neonatal gastrointestinal problems.

Main Methods:

  • Prospective study of 124 preterm neonates (birth weight < 1500 g).
  • Group assignment based on prenatal Doppler sonography criteria for pathological fetal perfusion (uterine, umbilical, thoracic aorta PI > 90th percentile; middle cerebral artery PI < 10th percentile).
  • Postnatal assessment of intestinal adaptation, gastrointestinal function, and superior mesenteric artery blood flow velocity waveforms.

Main Results:

  • Neonates with prenatal hemodynamic disturbances were classified as small for gestational age and frequently experienced delayed meconium passage, abdominal distension, bilious vomiting, and feeding intolerance.
  • Five neonates with prenatal disturbances required surgical intervention, though none showed signs of necrotizing enterocolitis.
  • Neonates with normal prenatal perfusion were appropriate for gestational age, with fewer exhibiting postnatal intestinal disturbances.
  • Doppler sonography revealed significantly lower systolic, mean, and end-diastolic flow velocities and higher pulsatility indices in the superior mesenteric artery of neonates with prenatal hemodynamic disturbances.

Conclusions:

  • Prenatal hemodynamic disturbances are strongly associated with postnatal gastrointestinal problems in small for gestational age neonates.
  • Altered superior mesenteric artery blood flow postnatally may result from persistent fetal blood flow redistribution, impacting gut motility.
  • Doppler sonography is a valuable tool for identifying fetuses at risk for neonatal gastrointestinal complications.

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