胎儿生长受限新生儿早期的 M 型和组织多普勒超声心动图心功能。
Heart function by M-mode and tissue Doppler in the early neonatal period in neonates with fetal growth restriction.
机构信息
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Clinic of Paediatrics and Adolescence, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
出版信息
Early Hum Dev. 2023 Aug;183:105809. doi: 10.1016/j.earlhumdev.2023.105809. Epub 2023 Jun 14.
BACKGROUND
Fetal growth restricted (FGR) neonates have increased risk of circulatory compromise due to failure of normal transition of circulation after birth.
AIM
Echocardiographic assessment of heart function in FGR neonates first three days after birth.
STUDY DESIGN
Prospective observational study.
SUBJECTS
FGR- and non-FGR neonates.
OUTCOME MEASURES
M-mode excursions and pulsed-wave tissue Doppler velocities normalised for heart size and E/e' of the atrioventricular plane day one, two and three after birth.
RESULTS
Compared with controls (non-FGR of comparable gestational age, n = 41), late-FGR (gestational age ≥ 32 weeks, n = 21) exhibited higher septal excursion (15.9 (0.6) vs. 14.0 (0.4) %, p = 0.021) (mean (SEM)) and left E/e' (17.3 (1.9) vs.11.5 (1.3), p = 0.019). Relative to day three, indexes on day one were higher for left excursion (21 (6) % higher on day one, p = 0.002), right excursion (12 (5) %, p = 0.025), left e' (15 (7) %, p = 0.049), right a' (18 (6) %, p = 0.001), left E/e' (25 (10) %, p = 0.015) and right E/e' (17 (7) %, p = 0.013), whereas no index changed from day two to day three. Late-FGR had no impact on changes from day one and two to day three. No measurements differed between early-FGR (n = 7) and late-FGR.
CONCLUSIONS
FGR impacted neonatal heart function the early transitional days after birth. Late-FGR hearts had increased septal contraction and reduced left diastolic function compared with controls. The dynamic changes in heart function between first three days were most evident in lateral walls, with similar pattern in late-FGR and non-FGR. Early-FGR and late-FGR exhibited similar heart function.
背景
由于出生后循环的正常过渡失败，胎儿生长受限（FGR）新生儿发生循环衰竭的风险增加。
目的
在出生后三天内对 FGR 新生儿进行心脏功能的超声心动图评估。
研究设计
前瞻性观察研究。
受试者
FGR 和非 FGR 新生儿。
观察指标
出生后第一天、第二天和第三天，通过 M 模式测量心腔大小和房室平面 E/e'校正的心肌运动速度。
结果
与对照组（非 FGR，胎龄相当，n=41）相比，晚期 FGR（胎龄≥32 周，n=21）的室间隔活动度更高（15.9（0.6）%比 14.0（0.4）%，p=0.021）（均值（SEM））和左室 E/e'更高（17.3（1.9）比 11.5（1.3），p=0.019）。与第三天相比，第一天的左室活动度（高 21%，p=0.002）、右室活动度（高 12%，p=0.025）、左室 e'（高 15%，p=0.049）、右室 a'（高 18%，p=0.001）、左室 E/e'（高 25%，p=0.015）和右室 E/e'（高 17%，p=0.013）均升高。从第二天到第三天，没有指标发生变化。晚期 FGR 对从第一天到第三天的变化没有影响。早期 FGR（n=7）和晚期 FGR 之间的测量值没有差异。
结论
FGR 对新生儿出生后早期过渡阶段的心脏功能有影响。与对照组相比，晚期 FGR 的心功能表现为室间隔收缩增强和左室舒张功能降低。出生后三天内心功能的动态变化在侧壁最为明显，晚期 FGR 和非 FGR 的变化模式相似。早期 FGR 和晚期 FGR 的心脏功能相似。
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