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Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Fetal growth restriction in preterm infants and cardiovascular function at five years of age
Kaija Mikkola1, Jaana Leipälä, Talvikki Boldt
1Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. kaija.mikkola@hus.fi
Insights
Cardiovascular changes persist in preterm infants at age 5, regardless of birth weight. Prematurity impacts cardiac function and blood vessel responses, suggesting increased afterload.
Area of Science:
- Pediatrics
- Cardiology
- Neonatology
Background:
- Previous studies indicated increased cardiac workload in preterm small for gestational age (SGA) infants.
- Cardiovascular changes in preterm infants were not previously assessed at school age.
Purpose of the Study:
- To investigate the persistence of cardiovascular changes in preterm infants at 5 years of age.
- To compare cardiovascular parameters between preterm small for gestational age (SGA) and appropriate for gestational age (AGA) infants and controls.
Main Methods:
- Blood pressure, echocardiography, and laser Doppler flowmetry were used to assess 22 SGA and 25 AGA preterm children at age 5.
- Laser Doppler flowmetry was also performed on 13 control children.
Main Results:
- Preterm SGA and AGA children exhibited higher systolic blood pressure, increased interventricular septum thickness, and smaller left ventricular end-diastolic diameter compared to reference values.
- AGA preterm infants showed enhanced endothelium-independent and faster endothelium-dependent vasodilation compared to controls.
Conclusions:
- Cardiovascular function may be impaired by prematurity independently of intrauterine growth restriction.
- Altered cardiac dimensions and perfusion responses in preterm children suggest increased cardiac afterload.
Objectives:
We have previously reported an increased cardiac workload in newborn preterm small (SGA) infants, but not in infants appropriate for gestational age (AGA). We hypothesized that these cardiovascular changes will persist at follow-up at 5 years of age.
Study Design:
We assessed blood pressure, echocardiography, and skin perfusion with laser Doppler flowmetry in 22 SGA (821 +/- 248 g, 28.5 +/- 2.5 gestational weeks) and in 25 AGA (1065 +/- 241 g, 27.6 +/- 0.8 weeks) preterm children at age 5 years. Laser Doppler flowmetry also was used in 13 control children (3982 +/- 425 g, 40.4 +/- 1.8 weeks).
Results:
The preterm children in both the SGA and AGA groups had similar higher systolic blood pressures, increased interventricular septum thicknesses, and smaller left ventricular end-diastolic diameters compared with population reference values. Maximal endothelium-independent perfusion to sodium nitroprusside was higher and maximal endothelium-dependent perfusion to acetylcholine reached a plateau earlier in the AGA preterm group than in the control group.
Conclusions:
Prematurity may impair cardiovascular function independently of intrauterine growth restriction. Altered cardiac dimensions and differences in perfusion responses may reflect increased cardiac afterload.
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