Bagci Soyhan, Brosens Erwin, Tibboel Dick, De Klein Annelies, Ijsselstijn Hanneke, Wijers Charlotte H W, Roeleveld Nel, de Blaauw Ivo, Broens Paul M, van Rooij Iris A L M, Hölscher Alice, Boemers Thomas M, Pauly Marcus, Münsterer Oliver J, Schmiedeke Eberhard, Schäfer Mattias, Ure Benno E, Lacher Martin, Choinitzki Vera, Schumacher Johannes, Zwink Nadine, Jenetzky Ekkehart, Katzer David, Arand Joerg, Bartmann Peter, Reutter Heiko M
Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands.
Eur J Pediatr. 2016 Jun;175(6):825-31. doi: 10.1007/s00431-016-2713-y. Epub 2016 Mar 16.
The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = -0.185, p < 0.001).
Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation.
• Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy. • Amniotic fluid (AF) comprises large amounts of hormones and growth regulators. What is New: • A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia. • These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation.
我们研究的目的是使用食管闭锁（EA）患者作为模型，探讨妊娠晚期羊水（AF）对胎儿生长的重要性。在这项回顾性队列研究中，我们将517例患有先天性胃前肠闭锁（即EA）的欧洲新生儿的出生体重适配z评分（BW z评分）与欧洲参考人群进行了比较。为了考虑肠闭锁本身对胎儿生长的影响，我们将504例患有结肠后肠闭锁（肛门闭锁合并肛门直肠畸形（ARM））的欧洲新生儿的适配出生体重与同一欧洲参考人群进行了比较。对整个队列的分析显示：（i）与ARM新生儿相比，EA新生儿中小于胎龄儿的发生率显著更高（p<0.001）；（ii）与ARM新生儿相比，EA新生儿的BW z评分显著更低（p<0.001）。与早产新生儿相比，足月儿EA新生儿的BW z评分显著更低，且与胎龄（GA）呈负相关（Spearman相关系数，r = -0.185，p<0.001）。
羊水的肠内摄取似乎在妊娠晚期胎儿生长中起关键作用。
• 胎儿体重增加的峰值速度出现在妊娠33周，并持续到出生。在此期间，胎儿生长主要以细胞肥大为主。• 羊水（AF）包含大量激素和生长调节因子。新发现：• 在患有先天性胃前肠闭锁的新生儿中，观察到小于胎龄儿的发生率显著更高，出生体重和z评分更低。• 这些发现表明，羊水的肠内摄取是妊娠晚期胎儿生长的主要预测指标。
