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Elmakaty I, Amarah A, Henry M, Chhabra M, Hoang D, Suk D, Ron N, Dygulska B, Sy F, Gudavalli MB, Nadroo AM, Narula P, Gad A. Perinatal factors impacting echocardiographic left ventricular measurement in small for gestational age infants: a prospective cohort study. BMC Pediatr 2023; 23:393. [PMID: 37553638 PMCID: PMC10411023 DOI: 10.1186/s12887-023-04204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
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.
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Affiliation(s)
| | - Ahmed Amarah
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Manoj Chhabra
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Danthanh Hoang
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Debbie Suk
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Nitin Ron
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Beata Dygulska
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Farrah Sy
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Madhu B Gudavalli
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Ali M Nadroo
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Pramod Narula
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Ashraf Gad
- Division of neonatal-Prenatal Medicine, Women's Wellness and Research Centre, NICU, Hamad Medical Corporation, Doha, Qatar.
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Enzensberger C, Graupner O, Fischer S, Meister M, Reitz M, Götte M, Müller V, Wolter A, Herrmann J, Axt-Fliedner R. Evaluation of right ventricular myocardial deformation properties in fetal hypoplastic left heart by two-dimensional speckle tracking echocardiography. Arch Gynecol Obstet 2023; 307:699-708. [PMID: 36759358 PMCID: PMC9984504 DOI: 10.1007/s00404-022-06857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/10/2022] [Indexed: 02/11/2023]
Abstract
PURPOSE Right ventricular (RV) function influences the outcome of hypoplastic left heart (HLH) patients. This study aimed to confirm the assumption of prenatal RV remodeling and possible influencing factors of myocardial restructuring using two-dimensional speckle tracking echocardiography (2D STE). METHODS This is a retrospective cross-sectional cohort study including HLH fetuses and gestational age-matched controls. Based on a four-chamber view, cine loops were stored with 60 frames per second. Global longitudinal peak systolic strain (GLPSS) of the RV was retrospectively determined and compared to healthy controls. Furthermore, HLH subgroups were built according to the presence of left ventricular endocardial fibroelastosis (LV-EFE) and restrictive foramen ovale (FO) to investigate the effect of these compromising factors on myocardial deformation. RESULTS A total of 41 HLH fetuses and 101 controls were included. Gestational age at fetal assessment was similarly distributed in both groups (controls: 26.0 ± 5.6 weeks vs. HLH: 29.1 ± 5.6 weeks). Relating to RV-GLPSS values, fetuses with HLH demonstrated lower mean values than healthy control fetuses (- 15.65% vs. - 16.80%, p = 0.065). Cases with LV-EFE (n = 11) showed significantly lower mean values compared to such without LV-EFE (n = 30) (RV-GLPSS: - 12.12% vs. - 16.52%, p = 0.003). No significant differences were observed for cases with FO restriction (n = 10). CONCLUSIONS In HLH the RV undergoes prenatal remodeling, leading to an adaptation of myocardial function to LV conditions. Further explorations by STE should expand knowledge about RV contraction properties in HLH and its impact on surgical outcome.
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Affiliation(s)
- Christian Enzensberger
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH University, Pauwelsstraße 30, 52074, Aachen, Germany
- Departement of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University, Munich, Germany
| | - Stefanie Fischer
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
| | - Markus Meister
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Maleen Reitz
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
| | - Malena Götte
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
| | - Vera Müller
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
| | | | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, Justus Liebig University, Giessen, Germany
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Graupner O, Kuschel B, Axt-Fliedner R, Enzensberger C. New Markers for Placental Dysfunction at Term - Potential for More. Geburtshilfe Frauenheilkd 2022; 82:719-726. [PMID: 35815096 PMCID: PMC9262629 DOI: 10.1055/a-1761-1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
The remaining placental reserve capacity at term plays a decisive role in the perinatal morbidity of mother and child. Considering advances made in the field of fetal monitoring, the
routine examination methods currently used at term or late term may be insufficient to detect subclinical placental dysfunction (PD). The aim of this study is to offer an up-to-date,
narrative review of the literature in the context of detecting PD at term using complementary ultrasound markers and biomarkers. Parameters of fetomaternal Doppler ultrasound and fetal
cardiac function, as well as (anti-)angiogenic factors in maternal serum are potential PD markers. These may help identify patients that may benefit from an elective, early induction of
labor at term, thereby potentially reducing morbidity and mortality. However, their value in terms of the optimal date of delivery must first be determined in randomized controlled trials on
a large number of cases.
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Affiliation(s)
- Oliver Graupner
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, RWTH Aachen, Aachen.,Frauenklinik und Poliklinik, Universitätsklinikum rechts der Isar, Technische Universität München, München
| | - Bettina Kuschel
- Frauenklinik und Poliklinik, Universitätsklinikum rechts der Isar, Technische Universität München, München
| | - Roland Axt-Fliedner
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum UKGM, Justus-Liebig-Universität Gießen, Gießen
| | - Christian Enzensberger
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, RWTH Aachen, Aachen
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