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A prospective observational study comparing cardiac function of small for gestational age with appropriate for
Manish Kumar1, Sridhar Santhanam1, Niranjan Thomas1
1a Department of Neonatology , Christian Medical College , Vellore , India.
Insights
Small for gestational age (SGA) babies exhibit impaired cardiac function in the early neonatal period, with left and right ventricular myocardial performance index (MPI) significantly elevated compared to appropriate for gestational age (AGA) infants. Cardiac function shows spontaneous improvement over the first three days of life.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular research
- Fetal development and cardiac health
Background:
- Low birth weight (LBW) affects approximately 30% of Indian neonates, with 70% being small for gestational age (SGA).
- Limited data exists on postnatal cardiac function in SGA infants during the early neonatal period.
- Existing research primarily focuses on in utero cardiac function of intrauterine growth-restricted (IUGR) fetuses.
Purpose of the Study:
- To evaluate the cardiac functions of SGA babies using serial echocardiographic measurements.
- To compare the cardiac function of SGA infants with appropriate for gestational age (AGA) infants in the early postnatal period.
Main Methods:
- Prospective observational study involving 70 neonates (35 SGA, 35 AGA).
- Echocardiography performed on days 1, 2, and 3 of life.
- Myocardial Performance Index (MPI) calculated for both ventricles using pulse wave and tissue Doppler as the primary metric.
Main Results:
- Significantly higher left ventricular MPI in SGA versus AGA infants across all measurement days.
- Significantly higher right ventricular MPI in SGA infants on days 1 and 2, but not day 3.
- Increased left ventricular internal diameter (diastole and systole) and left atrium:aortic root ratio in SGA infants.
- Similar fractional shortening, ejection fraction, and area shortening between SGA and AGA groups.
Conclusions:
- SGA infants demonstrate compromised biventricular cardiac function during the first three days of life, indicated by elevated MPI.
- Right ventricular MPI in SGA infants showed improvement by day 3.
- Cardiac performance in SGA neonates shows spontaneous improvement over the initial postnatal days, suggesting adaptive changes.
Background:
Approximately 30% of babies born in India are low birth weight (LBW) and about 70% of LBW babies are small for gestational age (SGA). Though there are several trials that have evaluated cardiac function of intrauterine growth restricted (IUGR) babies in utero, there is limited data about postnatal cardiac function in SGA babies during early neonatal period. This study was conducted to evaluate the cardiac functions of SGA babies by serial echocardiographic measurements and compare this with appropriate for gestational age (AGA) babies during the early postnatal period.
Material And Methods:
Seventy babies were enrolled in this prospective observational study with 35 each in the SGA and AGA groups. Echocardiography was performed for all babies on days 1, 2, and 3 of life. Myocardial performance index (MPI) was used as the primary measure to compare cardiac function. MPI was calculated for both ventricles using pulse wave Doppler and tissue Doppler.
Results:
MPI of the left ventricle was significantly higher in the SGA group as compared to AGA babies during all the three measurement periods with SGA babies having significantly higher MPI of right ventricle on day 1 and day 2 but not on day 3. Left ventricular internal diameter index during diastole and systole (LVIDD index and LVIDS index), left atrium: aortic root ratio (LA:AO ratio) were significantly increased in SGA babies on all the occasions. Fractional shortening, ejection fraction, and area shortening were similar in two groups.
Conclusions:
Myocardial performance index of left and right ventricle, which evaluates both systolic and diastolic function of ventricles, was significantly increased in SGA babies in comparison to AGA babies during the first 3 days of life except MPI of the right ventricle on day 3. Thus, SGA babies have compromised cardiac function through all phases of the cardiac cycle with the performance improving spontaneously over time.
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