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Perinatal factors impacting echocardiographic left ventricular measurement in small for gestational age infants: a
Ibrahim Elmakaty1, Ahmed Amarah1, Michael Henry2
1College of Medicine, QU Health, Qatar University, Doha, Qatar.
Insights
Birth weight is the key factor influencing left ventricular (LV) parameters in infants born small for gestational age (SGA). Understanding these perinatal influences is crucial for assessing cardiovascular risk in SGA newborns.
Area of Science:
- Neonatal Cardiology
- Perinatal Medicine
- Pediatric Cardiovascular Research
Background:
- Infants born small for gestational age (SGA) face elevated risks for cardiovascular complications.
- Congenital and perinatal factors significantly impact cardiovascular health in SGA infants.
- Early assessment of left ventricular (LV) parameters is vital for SGA neonates.
Purpose of the Study:
- To investigate the impact of perinatal factors on left ventricular (LV) parameters in small for gestational age (SGA) infants immediately after birth.
- To identify key predictors of LV morphology and function in SGA neonates.
Main Methods:
- Prospective cohort study involving SGA and appropriate for gestational age (AGA) newborns.
- Data collected from 528 neonates (114 SGA, 414 AGA) between 2014-2018.
- Multivariate linear regression analysis used to assess the relationship between perinatal factors and LV parameters.
Main Results:
- Birth weight (BW) was the most significant predictor for most LV parameters in SGA infants.
- Lower gestational age (GA), insulin use in gestational diabetes, and low Apgar scores predicted interventricular septal (IVS) dimensions.
- Maternal BMI and male sex were associated with LV posterior wall (LVPW) and LV internal dimension, respectively.
Conclusions:
- Perinatal factors, particularly birth weight, significantly influence LV parameters in SGA infants.
- While LV morphology is affected, its direct prediction of future cardiovascular risk in SGA requires further investigation.
- Developing strategies for long-term cardiovascular health management in SGA infants is essential.
Introduction:
Infants born small for gestational age (SGA) have an increased risk of developing various cardiovascular complications. While many influencing factors can be adjusted or adapt over time, congenital factors also have a significant role. This study, therefore, seeks to explore the effect of perinatal factors on the left ventricular (LV) parameters in SGA infants, as assessed immediately after birth.
Methods And Materials:
This single-center prospective cohort study, conducted between 2014 and 2018, involved healthy SGA newborns born > 35 weeks' gestation, delivered at New York-Presbyterian Brooklyn Methodist Hospital, and a gestational age (GA)-matched control group of appropriate for gestational age (AGA) infants. Data analysis was performed using multivariate linear regression in STATA.
Results:
The study enrolled 528 neonates, 114 SGA and 414 AGA. SGA infants exhibited a mean GA of 38.05 weeks (vs. 38.54), higher male representation (69.3% vs. 51.5%), lower birth weight (BW) (2318g vs 3381g), lower Apgar scores at birth, and a higher rate of neonatal intensive care unit admission compared to AGA infants (41.2% vs.18.9%; p<0.001). Furthermore, SGA infants were more likely to be born to nulliparous women (63.16% vs. 38.16%; p<0.001), with lower body mass index (BMI) (29.8 vs. 31.7; p=0.004), a lower prevalence of gestational maternal diabetes (GDM) (14.9 % vs. 35.5%; p<0.001), and a higher prevalence of preeclampsia (18.4 % vs. 6.52%; p<0.001). BW was identified as the most significant predictor affecting most LV parameters in this study (p<0.001), except shortening fraction, asymmetric interventricular septal hypertrophy and Inter-ventricular septal thickness/LV posterior wall ratio (IVS/LVPW). Lower GA (coefficient = -0.09, p=0.002), insulin use in GDM (coefficient = 0.39, p=0.014), and low APGAR scores at 1 minute (coefficient = -0.07, p<0.001) were significant predictors of IVS during diastole (R-squared [R2]=0.24). High maternal BMI is marginally associated with LVPW during systole (R2=0.27, coefficient = 0.01, p=0.050), while male sex was a significant predictor of LV internal dimension during diastole (R2=0.29, p=0.033).
Conclusion:
This study highlights the significant influence of perinatal factors on LV parameters in SGA infants, with BW being the most influential factor. Although LV morphology alone may not predict future cardiovascular risk in the SGA population, further research is needed to develop effective strategies for long-term cardiovascular health management in this population.
