胎儿生长受限新生儿出生后的早期过渡性循环

Early postnatal transitional circulation in fetal growth restricted neonates.

作者信息

Bjarkø Lisa, Fugelseth Drude, Haugen Guttorm, Nestaas Eirik

机构信息

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.

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.

出版信息

Early Hum Dev. 2025 Feb;201:106170. doi: 10.1016/j.earlhumdev.2024.106170. Epub 2024 Dec 5.

DOI:10.1016/j.earlhumdev.2024.106170

PMID:39662237

Abstract

BACKGROUND

Fetal growth restriction (FGR) may impact early postnatal transitional circulation.

AIM

Echocardiographic assessment of left ventricular cardiac output, superior vena cava (SVC) and ductus venosus (DV) blood flow in FGR neonates first three days after birth.

STUDY DESIGN

Prospective observational study.

SUBJECTS

FGR and Non-FGR neonates.

OUTCOME MEASURES

Left ventricular cardiac output, SVC and DV blood flow day one, two, and three.

RESULTS

Adjusting for gestational age (GA), birth weight, sex, and twin/singleton, flow measurements were similar between Late-FGR (GA ≥ 32 weeks, n = 23) and Non-FGR (GA ≥ 32 weeks, n = 39). On day three, Late-FGR had significantly lower left ventricular stroke volume (Estimated Marginal Means (Standard Error) 0.99 (0.08) vs 1.22 (0.06) mL/kg, p = 0.027) and higher heart rate (134 (5) vs 119 (4) beats/min, p = 0.032). Left ventricular cardiac output and left ventricular stroke volume decreased significantly from day one to three in both groups; Late-FGR 170 (8) to 149 (8) mL/min/kg, p = 0.007, and 1.34 (0.07) to 1.17 (0.07) mL/kg, p = 0.015, and Non-FGR 161 (6) to 144 (6) mL/min/kg, p = 0.002, and 1.27 (0.06) to 1.16 (0.06) mL/kg, p = 0.021. SVC flow remained unchanged from day one to three in Late-FGR (92 (6) to 83 (6) mL/min/kg, p = 0.161) and decreased significantly in Non-FGR (83 (5) to 71 (5) mL/min/kg, p = 0.021). DV blood flow remained unchanged. No measurements differed between Early-FGR (GA 30-31 weeks) and Late-FGR.

CONCLUSIONS

Late-FGR had limited impact on left ventricular cardiac output, SVC and DV blood flow in early neonatal period. Most adaptive circulatory changes occurred early during transition.

摘要

背景

胎儿生长受限（FGR）可能会影响出生后早期的过渡循环。

目的

对FGR新生儿出生后前三天的左心室心输出量、上腔静脉（SVC）和静脉导管（DV）血流进行超声心动图评估。

研究设计

前瞻性观察研究。

研究对象

FGR和非FGR新生儿。

观察指标

出生后第1、2、3天的左心室心输出量、SVC和DV血流。

结果

校正胎龄（GA）、出生体重、性别及双胎/单胎情况后，晚期FGR（GA≥32周，n = 23）与非FGR（GA≥32周，n = 39）之间的血流测量值相似。在第3天，晚期FGR的左心室每搏输出量显著降低（估计边际均值（标准误）0.99（0.08）对1.22（0.06）mL/kg，p = 0.027），心率较高（134（5）对119（4）次/分钟，p = 0.032）。两组的左心室心输出量和左心室每搏输出量从第1天到第3天均显著下降；晚期FGR从170（8）降至149（8）mL/min/kg，p = 0.007，从1.34（0.07）降至1.17（0.07）mL/kg，p = 0.015，非FGR从161（6）降至144（6）mL/min/kg，p = 0.002，从1.27（0.06）降至1.16（0.06）mL/kg，p = 0.021。晚期FGR的SVC血流从第1天到第3天保持不变（92（6）至83（6）mL/min/kg，p = 0.161），而非FGR则显著下降（83（5）至71（5）mL/min/kg，p = 0.021）。DV血流保持不变。早期FGR（GA 30 - 31周）与晚期FGR之间的测量值无差异。