Suboptimal neurodevelopment in very preterm infants is related to fetal cardiovascular compromise in placental insufficiency.
OBJECTIVE
The purpose of this study was to determine the relationship between fetal cardiovascular hemodynamics and neurodevelopmental outcome in infants born before 32 gestational weeks with placental insufficiency.


METHODS
Seventeen fetuses that underwent Doppler ultrasonography within 24 hours before delivery were included in this prospective cross-sectional study. Placental histology was examined. Multiple inflammatory markers and vascular endothelial growth factor (VEGF) and its receptor were analyzed from umbilical cord serum. Neurodevelopmental outcome was assessed by Griffiths scales at 1 year of corrected age.


RESULTS
Infants with suboptimal outcome (n = 7) had higher umbilical artery, ductus venosus, and inferior vena cava pulsatility index values (P < .05) and lower weight-indexed cardiac outputs (P < .05) than infants with normal outcome (n = 10). Placental histology and serum revealed no inflammation. VEGF values were similar among all infants.


CONCLUSIONS
In placental insufficiency with delivery before 32 gestational weeks, suboptimal neurodevelopment was related to decreased fetal weight-indexed cardiac output and increased systemic venous pressure.
Kaukola
Tuula
T
Department of Pediatrics, University of Oulu, Oulu, Finland.
Räsänen
Juha
J
Herva
Riitta
R
Patel
Dhavalkumar D
DD
Hallman
Mikko
M
D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D005318:Fetal Heart / Q000503:physiopathology*; D005333:Fetus / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D009420:Nervous System / Q000254:growth & development*; D010927:Placental Insufficiency / Q000150:complications* / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D011673:Pulsatile Flow; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000502:physiology; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000097:blood
D042461:Vascular Endothelial Growth Factor A; D018799:Intercellular Adhesion Molecule-1; D040301:Vascular Endothelial Growth Factor Receptor-2