title: Early detection of prenatal cardiocirculatory compromise in small for gestational age infants.
abstract: BACKGROUND
  Impairment of gas and substrate exchange through the placenta leads to fetal hypoxia and growth restriction. Oxygenation of vital organs is maintained with preferential perfusion at the expense of less vital organs, challenging the fetal cardiovascular system.
  
  
  OBJECTIVE
  To identify cardiovascular compromise in preterm small for gestational age (SGA) infants using the cardiac biomarker B-type natriuretic peptide (BNP), which indicates the workload of the myocardium.
  
  
  METHODS
  In this retrospective case-control study, 26 SGA infants born at less than 32 weeks of gestation from October 2009 to October 2010 were matched for gestational age and month of birth with 26 appropriate for gestational age (AGA) infants. Antenatal Doppler ultrasound was used to identify fetal hemodynamic changes by determination of the pulsatility index (PI) of the middle cerebral artery (MCA-PI), umbilical artery (UA-PI) and veins of the ductus venosus (DV-PIV). These indices were compared with BNP levels obtained within 6 h after birth.
  
  
  RESULTS
  Antenatal PIs of MCA, UA and DV were significantly related to elevated BNP levels after birth in SGA infants, but not in AGA infants (SGA: MCA-PI = r(2) 0.23, p < 0.05; UA-PI = r(2) 0.46, p < 0.01; DV-PIV = r(2) 0.31, p < 0.05). Furthermore, signs of perinatal (chronic) asphyxia coincided with elevated levels of BNP. SGA was related to more postnatal cardiocirculatory complications. No significant relations between postnatal cardiac ultrasound measurements, placenta size and BNP were found.
  
  
  CONCLUSIONS
  BNP levels were elevated early after birth in SGA infants and corresponded positively with Doppler indices of circulatory compromise. This suggests an increased workload of the myocardium.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vijlbrief
authors.forename: Frank
authors.initials: F
authors.lastname: van Bel
authors.forename: Mirella C
authors.initials: MC
authors.lastname: Molenschot
authors.forename: Manon J N L
authors.initials: MJ
authors.lastname: Benders
authors.forename: Lou R
authors.initials: LR
authors.lastname: Pistorius
authors.forename: Hans
authors.initials: H
authors.lastname: Kemperman
authors.forename: Willem B
authors.initials: WB
authors.lastname: de Vries
mesh_terms: D015415:Biomarkers / Q000097:blood; D001724:Birth Weight; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D018608:Ultrasonography, Doppler; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain