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Neurodevelopmental outcome at three years of age after fetal 'brain-sparing'
S A Scherjon1, H Oosting, H Smolders-DeHaas
1Department of Obstetrics, University of Amsterdam, Academic Medical Centre, The Netherlands.
Insights
Preterm infants with intrauterine growth restriction (IUGR) face neurodevelopmental risks. Fetal brain-sparing, a blood flow adaptation, did not predict outcomes, suggesting it protects against severe brain damage.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Fetal Physiology
Background:
- Intrauterine growth restriction (IUGR) in preterm infants is linked to impaired neurodevelopmental outcomes.
- Fetal adaptation mechanisms, like 'brain-sparing,' are crucial for managing placental insufficiency.
Purpose of the Study:
- To investigate the relationship between fetal hemodynamic adaptation (U/C ratio) and neurodevelopmental outcomes in preterm IUGR infants.
- To assess the predictive value of fetal growth and Doppler ultrasound markers for long-term neurodevelopmental status.
Main Methods:
- A cohort of 106 preterm infants (26-33 weeks gestation) was studied.
- Neurodevelopmental outcome (Hempel examination) was assessed at three years.
- Fetal hemodynamics (umbilical/cerebral artery Pulsatility Index ratio - U/C ratio) and neonatal cranial ultrasound findings were analyzed.
Main Results:
- Adverse neurodevelopmental outcome was associated with neonatal cranial ultrasound abnormalities and smaller head circumference at three years.
- The U/C ratio and fetal growth ratio were not independently associated with Hempel outcome.
- Fetal brain-sparing did not predict adverse neurodevelopmental outcomes.
Conclusions:
- Neonatal brain injury, rather than fetal adaptation markers, predicts neurodevelopmental outcomes in preterm IUGR infants.
- Fetal 'brain-sparing' appears to be a protective mechanism, preventing severe brain damage in the context of IUGR.
Abstract:
Intrauterine growth restriction (IUGR), occurring preterm, may be related to impaired neurodevelopmental outcome. We measured neurodevelopmental outcome (Hempel examination) at the age of three years in a cohort of infants born between 26 and 33 weeks in 1989. Fetuses were studied haemodynamically, using Doppler ultrasound. The ratio between the umbilical and the cerebral artery Pulsatility Index (U/C ratio) was calculated. This is a measure of redistribution of fetal blood preferentially to the brain and this may be a marker of fetal adaptation to placental insufficiency. Impaired fetal growth was also measured by the fetal growth ratio. Neonatal cranial ultrasound was performed to document intracranial haemorrhages and/or ischaemia. From the original cohort of 106 infants, 96 (91%) infants were examined at three years. After adjustment for obstetric variables, adverse Hempel outcome was related to neonatal cranial ultrasound abnormality and low head circumference at three years. Neither the U/C ratio nor fetal growth were independently associated with Hempel outcome. Fetal 'brain-sparing' in IUGR appears to be a benign adaptive mechanism preventing severe brain damage.