Respiratory outcome in preterm small for gestational age fetuses with or without abnormal umbilical artery Doppler and/or maternal hypertension.
OBJECTIVE
To study respiratory outcome in preterm small for gestational age (SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension.


METHODS
This was a retrospective study of 187 neonates with birth weight <10(th) percentile and gestational age <34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup.


RESULTS
No significant difference in respiratory outcome between SGA fetuses with normal (SGA-N) or abnormal (SGA-A) umbilical artery Doppler examination was found. Within the SGA-A group, the respiratory distress syndrome (RDS) incidence (OR 5.6, 95% CI 1.7-18.3), RDS grade (OR 6.7, 95% CI 1.2-38.5), and need for surfactant (OR 5.3, 95% CI 1.1-24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared to those of normotensive mothers.


CONCLUSIONS
Lung maturation is not accelerated with placental insufficiency. SGA-A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to 'oxidative stress' causing lung damage rather than lung maturation.
Perinatal Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. H.Torrance@umcutrecht.nl
Helen L
HL
Torrance
Eduard J H
EJ
Mulder
Hens A A
HA
Brouwers
Frank
F
van Bel
Gerard H A
GH
Visser
D001783:Blood Flow Velocity / Q000502:physiology; D004363:Drug Utilization; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D017359:HELLP Syndrome / Q000503:physiopathology*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
D005938:Glucocorticoids; D011663:Pulmonary Surfactants