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Myocardial perfusion and function dichotomy in growth restricted preterm infants
Arvind Sehgal1,2, Beth J Allison3,4, Suzanne L Miller3,4
1Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia.
Journal of Developmental Origins of Health and Disease
|November 21, 2022
Summary
Preterm infants with fetal growth restriction (FGR) show increased coronary artery blood flow (CABF) but impaired cardiac function postnatally. This suggests fetal programming or altered cardiac structure, not improved heart health, in FGR infants.
Area of Science:
- Neonatal cardiology
- Fetal medicine
- Pediatric cardiovascular research
Background:
- Fetal growth restriction (FGR) is associated with altered fetal circulation.
- Postnatal cardiovascular adaptation in FGR infants remains poorly understood.
- Previous studies suggest dichotomy between coronary artery blood flow (CABF) and cardiac function in utero.
Purpose of the Study:
- To compare postnatal coronary artery blood flow (CABF) and cardiac function in preterm FGR infants versus appropriate for gestational age (AGA) infants.
- To investigate the relationship between CABF and cardiac function in the early postnatal period.
- To explore potential mechanisms underlying observed cardiovascular differences in FGR.
Main Methods:
- Prospective comparative study of preterm FGR and AGA infants.
- Defined FGR by birthweight <10th centile and absent/reversed umbilical artery Doppler.
- Assessed diastolic CABF and cardiac function (systolic and diastolic) via echocardiography in the second week of life.
Main Results:
- FGR infants exhibited significantly higher CABF (velocity time integral) compared to AGA infants.
- Impaired diastolic function (increased trans-mitral E/A ratio) and affected systolic function (reduced mean velocity of circumferential fibre shortening) were observed in FGR infants.
- Despite higher CABF, FGR infants showed poorer cardiac function indices when CABF was indexed to cardiac function parameters.
Conclusions:
- Increased postnatal CABF in preterm FGR infants does not correlate with improved cardiac function.
- The observed cardiovascular dichotomy may represent a persistent response to fetal hypoxemia (fetal programming).
- Altered cardiac architecture in FGR infants could also contribute to the observed functional differences.
