Treatment of growth-restricted human fetuses with amino acids and glucose supplementation through a chronic fetal intravascular perinatal port system.
OBJECTIVE
Intrauterine growth restriction (IUGR) carries an increased risk of mortality and morbidity. The accepted procedure to treat IUGR fetuses is premature delivery, which may increase neonatal mortality and morbidity and retards neonatal brain development.


METHODS
We report here on intravascular supplementation with amino acids and glucose of an IUGR human fetus at 33 weeks of gestation with oligohydramnios and placental insufficiency using the port system (Norfolk Medical Products, Skokie, Ill., USA). The catheter was implanted into the umbilical vein (UV) by cordocentesis, and was then connected to a subcutaneously implanted port system. The treatment course included daily infusions of amino acid solution and 10% glucose into the UV.


RESULTS
Daily intravascular fetal nutrition significantly improved both fetal condition and fetal weight gain. No complications were seen. The patient was delivered by cesarean section in the 38th week of gestation. The female newborn weighed 2,130 g and was 47 cm long. Blood sampling from the UV after delivery showed no deviations of amino acids in comparison to standardized curves. In one-year follow-up the child's development and weight gain was like that of children without IUGR in the anamnesis.


CONCLUSIONS
This is the first report of the successful use of a subcutaneously implanted intravascular perinatal port system in IUGR human fetuses for long-term administration of nutriments into the UV of a fetus.
Tchirikov
M
M
Clinic of Obstetrics and Gynecology, University Medical Center Mainz, Mainz, Germany. tchirikov@uni-mainz.de
Kharkevich
O
O
Steetskamp
J
J
Beluga
M
M
Strohner
M
M
D000279:Administration, Cutaneous; D000596:Amino Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D002404:Catheterization / Q000379:methods; D002585:Cesarean Section; D002657:Child Development; D005260:Female; D005317:Fetal Growth Retardation / Q000188:drug therapy*; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D011168:Portal System / Q000196:embryology; D011247:Pregnancy; D014471:Umbilical Veins; D015430:Weight Gain
D000596:Amino Acids; D005947:Glucose