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Published on: June 29, 2013
Transitional haemodynamic profiles of intrauterine growth-restricted preterm infants: correlation with antenatal
Silvia Martini1,2, Anna Nunzia Della Gatta3, Topun Austin4
1Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. silvia.martini9@unibo.it.
Insights
Antenatal Doppler abnormalities in intrauterine growth restriction (IUGR) preterm infants are linked to specific postnatal cardiovascular and cerebrovascular changes. This understanding can help identify high-risk neonates and guide individualized care.
Area of Science:
- Neonatal physiology
- Fetal medicine
- Cardiovascular research
Background:
- Intrauterine growth restriction (IUGR) with fetal Doppler abnormalities can cause lasting hemodynamic changes.
- Understanding these adaptations is crucial for managing high-risk preterm infants.
Purpose of the Study:
- To investigate the association between antenatal Doppler characteristics and transitional hemodynamic profiles in preterm infants with IUGR.
- To identify specific hemodynamic patterns linked to different types of fetal Doppler abnormalities.
Main Methods:
- A prospective cohort study monitored 92 preterm infants (<1500g) for 72 hours.
- Near-infrared spectroscopy, pulse-oximetry, and electrical velocimetry assessed stroke volume, cardiac output, systemic vascular resistance, and cerebral oxygenation.
- Multivariate linear models compared hemodynamic parameters based on antenatal Doppler findings (normal, abnormal umbilical artery without brain-sparing, abnormal umbilical artery with brain-sparing, abnormal ductus venosus).
Main Results:
- Infants with brain-sparing umbilical artery (UAbs+) showed higher cardiac output and contractility but impaired cerebrovascular reactivity.
- Infants with abnormal ductus venosus flow (UA+DV) exhibited lower stroke volume and cardiac output, with the highest systemic vascular resistance increase and impaired cerebrovascular reactivity.
- Abnormal antenatal Doppler findings were associated with distinct postnatal hemodynamic and cerebrovascular profiles.
Conclusions:
- Antenatal Doppler abnormalities correlate with specific transitional cardiovascular and cerebrovascular profiles in IUGR preterm infants.
- This knowledge can improve risk stratification and inform individualized therapeutic strategies.
- Non-invasive multimodal monitoring offers a feasible approach for neonatal hemodynamic assessment.
Background And Aim:
Intrauterine growth restriction (IUGR) with fetal Doppler abnormalities can lead to persistent haemodynamic adaptations. We aimed to investigate the association between antenatal Doppler characteristics and transitional haemodynamic profiles in IUGR preterm infants.
Methods:
Infants <1500 g were enrolled in this prospective cohort study. Over the first 72 h of life, stroke volume (SV), cardiac output (CO), cardiac contractility (ICON), heart rate, systemic vascular resistance (SVR), perfusion index (PI), peripheral oxygen saturation, cerebrovascular reactivity, cerebral oxygenation and oxygen extraction were monitored combining near-infrared spectroscopy, pulse-oximetry and electrical velocimetry. Using multivariate linear models, these parameters were compared between neonates with normal antenatal Doppler and abnormal umbilical Doppler without brain-sparing (UAbs-), with brain-sparing (UAbs+) or with abnormal ductus venosus flow (UA+DV).
Results:
Ninety-two neonates (9 UAbs-, 12 UAbs+ , 6 UA+DV, 65 controls) were included. Compared to controls, UAbs+ had higher CO (p = 0.036), ICON (p < 0.001) and SVR (p = 0.012), whereas UA+DV showed lower SV (p = 0.038), CO (p = 0.018), PI (p = 0.006) and the highest SVR increase (p < 0.001). Impaired cerebrovascular reactivity was observed in UAbs+ (p < 0.001) and UA+DV neonates (p < 0.001).
Conclusions:
Antenatal Doppler abnormalities are associated with distinct transitional cardiovascular and cerebrovascular profiles in IUGR infants, with potential clinical implications.
Impact:
This study describes the association between specific antenatal Doppler abnormalities and distinct postnatal cardiovascular and cerebrovascular profiles in IUGR preterm infants. Knowledge of this association may aid to identify IUGR neonates at higher risk for complications and to develop individualised therapeutic approaches based on antenatal Doppler characteristics. Available literature investigating postnatal haemodynamics in IUGR infants is based on intrauterine growth or ponderal criteria that may underestimate the prevalence of fetal Doppler abnormalities and their hemodynamic consequences. This study provides a comprehensive haemodynamic overview across multiple districts, supporting the feasibility of non-invasive multimodal monitoring for neonatal hemodynamic assessment.
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