Related Experiment Videos
Prediction of impaired metabolic adaptation by antenatal Doppler studies in small for gestational age fetuses
J M Hawdon1, M P Ward Platt, S McPhail
1Princess Mary Maternity Hospital, Newcastle upon Tyne.
Insights
Infants small for gestational age (SGA) with absent umbilical artery end diastolic velocities (EDV) on antenatal Doppler scans show poorer early metabolic adaptation and are at higher risk for neonatal hypoglycemia.
Area of Science:
- Neonatal Medicine
- Perinatal Physiology
- Medical Imaging
Background:
- Infants small for gestational age (SGA) have an increased risk of neonatal hypoglycemia.
- Identifying SGA infants at high risk for hypoglycemia antenatally is crucial for management.
- Metabolic adaptation in SGA infants requires further investigation.
Purpose of the Study:
- To investigate metabolic differences between SGA infants based on antenatal umbilical artery Doppler findings.
- To determine if antenatal Doppler studies can predict neonatal metabolic adaptation and hypoglycemia risk.
Main Methods:
- Comparison of metabolic profiles (glucose, non-esterified fatty acids) in two groups of SGA infants.
- Groups were defined by the presence (n=14) or absence (n=11) of end diastolic velocities (EDV) in antenatal umbilical artery Doppler studies.
- Metabolic measurements were taken at birth and during the first six hours postpartum.
Main Results:
- The absent EDV group exhibited significantly lower NEFA concentrations at birth.
- Lower blood glucose and NEFA levels were observed in the absent EDV group within the first six hours postpartum.
- Metabolic differences between groups diminished after the first postnatal day.
Conclusions:
- Antenatal umbilical artery Doppler studies, specifically absent EDV, may identify SGA infants at risk for impaired neonatal metabolic adaptation.
- Absent EDV is associated with a higher risk of early neonatal hypoglycemia in SGA infants.
- This finding can aid in optimizing obstetric and neonatal management strategies for high-risk SGA infants.
Abstract:
The increased risk of hypoglycaemia for infants who are small for gestational age (SGA) is well known, and further information regarding metabolic adaptation can be gained by examining the profiles of glucose and other metabolic fuels in such infants. Not all SGA infants experience hypoglycaemia, however, and the ability to identify, antenatally, those at most risk would be helpful for obstetric and neonatal management. This study investigated metabolic differences between two groups of SGA infants who had antenatal umbilical artery Doppler studies. Fourteen had end diastolic velocities (EDV) present and 11 had absent EDV. The absent EDV group had significantly lower non-esterified fatty acid (NEFA) concentrations at birth, and lower blood glucose and NEFA concentrations in the first six hours after birth. After the first day, few metabolic differences were found between the two groups. Antenatal Doppler studies may identify those SGA infants who fail to achieve neonatal metabolic adaptation and are most at risk of early neonatal hypoglycaemia.