Cardiac left heart morphology and function in newborns with intrauterine growth restriction: relevance for long-term assessment

Gabriela Corina Zaharie, Monica Hasmasanu, Ligia Blaga, Melinda Matyas, Daniel Muresan, Sorana Daniela Bolboaca

Abstract


Aim: To asses the cardiac morphology and functional changes specific for newborns from intrauterine growth restriction (IUGR) pregnancies.

Material and method: A cohort of IUGR infants were evaluated by serial echocardiographies at delivery and at the first and six months follow-ups. IUGR newborn delivery status was compared to that of newborns in the control group according to gestational age (AGA).

Results: Left heart measurements were significantly lower in IUGR newborns compared to AGA babies. Left ventricular size increased at follow-up inthe IUGR group (p<0.05). Systolic dysfunction (the myocardial performance index (MPI)> 0.47) was identified in 40% of the neonates in the IUGR group (16/40), respectively 4.76% in the control group. IUGR neonates had a significantly increased proportion of systolic malfunction (p=0.004).

Conclusion: IUGR patients had reduced left ventricle dimensions compared to AGA babies. The MPI stands out as a marker of left
heart function in newborns. Systolic dysfunction was a hallmark of the cardiac adaptation in IUGR neonates. 


Keywords


: birth weight; intrauterine growth restriction (IUGR); left ventricular morphology; myocardial performance index (MPI)

Full Text:

PDF

References


Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med. 2016; 29(24): 3977-3987.

Sharma D, Farahbakhsh N, Shastri S, Sharma P. Intrauterine growth restriction - part 2. J Matern Fetal Neonatal Med. 2016; 29(24): 4037-4048.

Easter SR, Eckert LO, Boghossian N, et al. Fetal growth restriction: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2017; 35(48 Pt A): 6546-6554.

Vayssière C, Sentilhes L, Ego A, et al. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2015; 193: 10-18.

Crispi F, Hernandez-Andrade E, Pelsers MM, et al. Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol 2008; 199: 254.e1-e8.

Comas M, Crispi F, Cruz-Martinez R, Figueras F, Gratacos E. Tissue Doppler echocardiographic markers of cardiac dysfunction in small-for-gestational age fetuses. Am J Obstet Gynecol 2011; 205 (1): 57.e1-6.

Comas M, Crispi F, Cruz-Martinez R, Martinez JM, Figueras F, Gratacós E. Usefulness of myocardial tissue Doppler vs. conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction. J Obstet Gynecol 2010; 203(1): 45.e1-7.

Verburg BO, Jaddoe VW, Wladimiroff JW, Hofman A, Witteman JC, Steegers EA .Fetal hemodynamic adaptive changes related to intrauterine growth: the Generation R Study. Circulation 2008; 117(5): 649-659.

Niewiadomska-Jarosik K, Zamojska J, Zamecznik A, Wosiak A, Jarosik P, Stańczyk J. Myocardial dysfunction in children with intrauterine growth restriction: an echocardiographic study. Cardiovasc J Afr 2017; 28(1): 36-39.

Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, et al. A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction. Am J Obstet Gynecol 2014; 210(6): 552.e1-e22.

Crispi F, Bijnens B, Figueras F, et al. Fetal growth restriction results in remodeled and less efficient hearts in children. Circulation 2010; 121(22): 2427-2436.

Crispi F, Figueras F, Cruz-Lemini M, Bartrons J, Bijnens B, Gratacos E. Cardiovascular programming in children born small for gestational age and relationship with prenatal signs of severity. Am J Obstet Gynecol 2012; 207:121.e1-9.

Fouzas S, Karatza AA, Davlouros PA, et al. Neonatal cardiac dysfunction in intrauterine growth restriction. Pediatr Res 2014; 75(5): 651-657.

Akazawa Y, Hachiya A, Yamazaki S, et al. Cardiovascular Remodeling and Dysfunction Across a Range of Growth Restriction Severity in Small for Gestational Age Infants- Implications for Fetal Programming Circ J 2016; 80(10): 2212-2220.

Breatnach CR, Levy PT, James AT, Franklin O, El-Khuffash A. Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart. Neonatology 2016; 110(4): 248-260.

Bokiniec R, Własienko P, Borszewska-Kornacka MK, Madajczak D, Szymkiewicz-Dangel J. Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period. Kardiol Pol. 2016; 74(9): 1002-1009.

Kumar M, Santhanam S, Thomas N, Jana AK. A prospective observational study comparing cardiac function of small for gestational age with appropriate for gestational age babies using serial echocardiographic studies. J Matern Fetal Neonatal Med 2018; 31: 1-6.

Gravett C, Eckert LO, Gravett MG, et al. Non-reassuring fetal status: Case definition &guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34(49): 6084-6092.

Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013; 208(4): 290.e1-6.

Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59. doi: 10.1186/1471-2431-13-59

Kampmann C, Wiethoff CM, Wenzel A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667-672.

Mertens L, Seri I, Marek J et al. Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 2011; 12(10): 715-736.

Cantinotti M, Scalese M, Murzi B, et al. Echocardiographic nomograms for ventricular, valvular and arterial dimensions in caucasian children with a special focus on neonates, infants and toddlers. J Am Soc Echocardiogr 2014; 27(2): 179-191.e2

Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465-495.

Hăşmăşanu MG, Bolboacă SD, Baizat MI, Drugan TC, Zaharie GC. Neonatal short-term outcomes in infants with intrauterine growth restriction. Saudi Med J 2015; 36(8): 947-953.

Baschat AA, Odibo AO. Timing of delivery in fetal growth restriction and childhood development: Some uncertainties remain. Am J Obstet Gynecol 2011; 204: 2-3.

Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev. 2013; 12 (9):CD000078. doi: 10.1002/14651858.CD000078.pub3.

Meyer K, Lubo Zhang. Fetal programming of cardiac function and disease. Reprod Sci. 2007; 14(3): 209-216.

Cosmi E, Fanelli T, Visentin S, Trevisanuto D, Zanardo V. Consequences in infants that were intrauterine growth restricted. J Pregnancy. 2011; 2011: 364381

Melamed N, Yogev Y, Glezerman M. Fetal Gender and Pregnancy outcome. J Matern Fetal Neonatal Med. 2010; 23: 338-344.

Cinar B, Sert A, Gokmen Z, Aypar E, Aslan E, Odabas D. Left ventricular dimensions, systolic functions, and mass in term neonates with symmetric and asymmetric intrauterine growth restriction. Cardiol Young 2015; 25(2): 301-307.

Mikkola K, Leipälä J, Boldt T, Fellman V. Fetal growth restriction in preterm infants and cardiovascular function at five years of age. J Pediatr 2007; 151(5): 494-499, 499.e1-2.

Morsing E, Liuba P, Fellman V, Maršál K, Brodszki J. Cardiovascular function in children born very preterm after intrauterine growth restriction with severely abnormal umbilical artery blood flow. Eur J Prev Cardiol 2014; 21(10): 1257-1266.

Ishii M, Eto G, Tei C et al. Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: A right ventricular myocardial performance index. Pediatr Cardiol 2000; 21(5): 416-421.

Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Changes in myocardial performance index and aortic isthmus and ductus venosus Doppler in term, small for gestational age fetuses with normal umbilical artery pulsatility index. Ultrasound Obstet Gynecol 2011; 38: 400-405.

Altın H, Karaarslan S, Karataş Z, Alp H, Şap F, Baysal T. Evaluation of cardiac functions in term small for gestational age newborns with mild growth retardation: a serial conventional and tissue Doppler imaging echocardiographic study. Early Hum Dev 2012; 88: 757-764.

Bjarnegård N, Morsing E, Cinthio M, Länne T, Brodszki J. Cardiovascular function in adulthood following intrauterine growth restriction with abnormal fetal blood flow. Ultrasound Obstet Gynecol 2013; 41: 177-184.




DOI: http://dx.doi.org/10.11152/mu-1667

Refbacks

  • There are currently no refbacks.