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Coronary flow in neonates with impaired intrauterine growth
Elhadi H Aburawi1, Peter Malcus, Ann Thuring
1Department of Pediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates. e.aburawi@uaeu.ac.ae
Insights
Neonates with intrauterine growth restriction show increased coronary flow (CF) and left ventricular mass index, despite normal cardiac function. This finding in fetal growth restriction may impact cardiac reserve.
Area of Science:
- Neonatal Cardiology
- Fetal Development
- Cardiovascular Physiology
Background:
- Subclinical myocardial injury is noted in neonates with fetal weights below the 2nd percentile for gestational age.
- Intrauterine growth restriction (IUGR) may impact cardiac function and coronary flow (CF).
Purpose of the Study:
- To investigate cardiac function and coronary flow in neonates with IUGR.
- To assess the relationship between IUGR and cardiovascular parameters in newborns.
Main Methods:
- Seventeen newborns with IUGR and 15 healthy controls underwent Doppler velocimetry for umbilical and uterine artery blood flow.
- Transthoracic Doppler echocardiography assessed cardiac function and left anterior descending coronary artery CF at 1 week of age.
Main Results:
- Newborns with IUGR exhibited a mean growth deviation of -2.5 SDs.
- Left ventricular mass index was significantly higher in IUGR neonates (86.6 g/m² vs 73.7 g/m²).
- Coronary flow (CF) was significantly increased in IUGR neonates (37 mL/min vs 8.2 mL/min), with increased diastolic peak flow velocity.
Conclusions:
- Neonates with impaired intrauterine growth demonstrate significantly increased coronary flow (CF).
- While left ventricular mass index is elevated, systolic and diastolic cardiac function remain within normal limits.
- The clinical implications of elevated CF in IUGR require further investigation, potentially indicating reduced CF reserve.
Background:
Subclinical myocardial injury has been reported in newborns with fetal weights < 2 SDs for gestational age. Intrauterine growth restriction might affect cardiac function and coronary flow (CF).
Methods:
Seventeen newborns with intrauterine growth restriction and 15 age-matched healthy controls were enrolled in the study. Blood flow in the umbilical artery and maternal uterine artery was assessed using Doppler velocimetry. Cardiac function and left anterior descending coronary artery CF were measured using transthoracic Doppler echocardiography at 1 week of age.
Results:
The mean growth deviation of the newborns from normal was -2.5 ± 0.2 SDs. Percentage left ventricular shortening fraction was 39 ± 4.3% in patients and 42 ± 4.1% in controls (P = .40), and the mean left ventricular mass index was 86.6 g/m(2) in patients and 73.7 g/m(2) in controls (P < .01). The mean left anterior descending coronary artery diameter was 0.99 ± 0.1 mm in patients and 0.8 ± 0.1 mm in controls (P = .002). The left anterior descending coronary artery flow velocity-time integral was correlated with left ventricular mass index (r = 0.31, P = .007) and with mitral peak E/A ratio (r = 0.74, P = .01). Intrauterine growth restriction was associated with increased peak flow velocity in diastole (34.5 ± 4 vs 19 ± 6 cm/sec in controls, P = .0001), as well as increased CF (37 ± 7.3 vs 8.2 ± 3.0 mL/min in controls, P = .001).
Conclusions:
CF is significantly increased in neonates with impaired intrauterine growth. Left ventricular mass index is increased, but systolic and diastolic function remains normal. The clinical significance of increased CF is unclear, but it might lead to decreased CF reserve.
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