Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital and Research Center, Pune, Maharashtra, India.
Department of Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
J Ultrasound. 2023 Mar;26(1):117-127. doi: 10.1007/s40477-022-00691-2. Epub 2022 May 26.
SGA infants with fetal growth restriction have reduced ability to adapt themselves to the postnatal life because of certain epigenetic changes in cardiac function. The aim of the present study is to assess and compare the cardiac functions of fetal growth restricted SGA newborns to the term stable AGA newborns, and evaluate any differences in the cardiac functions during the postnatal transitional circulation.
This observational study was conducted at a multispecialty tertiary care hospital in Western India from June to November 2021. The newborns were evaluated using bedside echocardiography at 24-48 h and repeat screening after 48 h. The echocardiographic assessment of the systolic function was done using EF, FS, FAC and TAPSE; diastolic function using E/A wave ratio and global functioning using LV MPI.
Twnety-four babies were included in cases and 30 in the control arm of the study. Maternal and newborn characteristics were comparable between the two groups. FS, EF for left ventricle and TAPSE, FAC for right ventricular systolic function were significantly lower in SGA group (p = 0.02, 0.02, 0.00 and 0.01; respectively). The current study revealed a lower tricuspid E/A ratio and higher mitral E/A ratio with a significant difference beyond 48 h in the first week of life (p value 0.00). Left ventricular MPI was significantly higher in SGA infants compared to AGA infants during two subsequent readings in immediate newborn period with p values 0.01 and 0.02 respectively. The subgroup analysis revealed that fetal growth-restricted neonates with absent end-diastolic flow had a greater impact on ventricular functions.
Present study showed a significant systolic and diastolic dysfunction during initial newborn period in growth restricted SGA infants.
由于心脏功能的某些表观遗传变化，胎儿生长受限的 SGA 婴儿在适应出生后生活的能力降低。本研究旨在评估和比较胎儿生长受限的 SGA 新生儿与足月稳定 AGA 新生儿的心脏功能，并评估出生后过渡循环期间心脏功能的任何差异。
本观察性研究于 2021 年 6 月至 11 月在印度西部的一家多专科三级保健医院进行。在 24-48 小时和 48 小时后重复筛查时，使用床边超声心动图对新生儿进行评估。使用 EF、FS、FAC 和 TAPSE 评估收缩功能；使用 E/A 波比评估舒张功能；使用 LV MPI 评估整体功能。
本研究共纳入 204 例病例组婴儿和 30 例对照组婴儿。两组的母婴特征相似。FS、左心室 EF 和 TAPSE、右心室收缩功能 FAC 在 SGA 组显著降低（p=0.02、0.02、0.00 和 0.01；分别）。本研究发现，在生命的第一周，三尖瓣 E/A 比值较低，二尖瓣 E/A 比值较高，且差异具有统计学意义（p 值均<0.001）。在新生儿期的后续两次读数中，SGA 婴儿的左心室 MPI 明显高于 AGA 婴儿，p 值分别为 0.01 和 0.02。亚组分析显示，舒张末期无血流的胎儿生长受限新生儿对心室功能的影响更大。
本研究显示，生长受限的 SGA 婴儿在新生儿早期存在明显的收缩和舒张功能障碍。
