title: Association between fetal growth, cerebral blood flow and neurodevelopmental outcome in univentricular fetuses.
abstract: OBJECTIVE
  To investigate the association of fetal growth and cerebrovascular resistance at different periods in gestation with neurodevelopment (ND) at 14 months in the univentricular subject.
  
  
  METHODS
  We reviewed serial prenatal ultrasound (US) examinations from 133 infants enrolled in the Pediatric Heart Network's Single Ventricle Reconstruction or Infants with Single Ventricle trials, including a subset of 82 infants in whom ND was assessed at 14 months using mental (MDI) and psychomotor (PDI) developmental indices. US examinations were assigned to one of four gestational time periods: (1) 20-23 weeks, (2) 24-29 weeks, (3) 30-33 weeks and (4) ≥ 34 weeks. Middle cerebral artery (MCA) flow velocity was measured and pulsatility index (PI), a measure of downstream resistance, was calculated. Data on fetal head circumference (HC), femur length, abdominal circumference (AC) and estimated fetal weight (EFW) were collected and their Z-scores were calculated. We evaluated the rate of change of these parameters over time within individuals, tested correlations between fetal growth and ND and assessed predictors of ND using linear regression.
  
  
  RESULTS
  The mean prenatal HC Z-score was < 0 at each gestational-age period and became more negative later in pregnancy. There was less growth in HC from time period 3 to period 4 compared with from period 2 to 3 (Δ HC Z-score, -0.07 ± 0.1 vs 0.11 ± 0.22, P = 0.03). Though ND did not correlate with HC, HC Z-score or MCA-PI Z-score, HC growth from period 2 to period 3 correlated with MDI (r = 0.45, P = 0.047). AC Z-score in period 4 predicted MDI (β = 4.02, P = 0.04). EFW Z-score and AC Z-score in period 2 predicted PDI (β = 10.6, P = 0.04 and β = 3.29, P = 0.047, respectively). Lower MCA-PI at initial US predicted higher PDI (β = -14.7, P = 0.03).
  
  
  CONCLUSIONS
  In univentricular fetuses, lower cerebrovascular resistance may be protective for ND. Decreased fetal somatic growth may predict developmental abnormalities. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: E
authors.initials: E
authors.lastname: Hahn
authors.affiliation: The Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Szwast
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cnota
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Levine
authors.affiliation: The Congenital Heart Center at C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Fifer
authors.affiliation: Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Jaeggi
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: H
authors.initials: H
authors.lastname: Andrews
authors.affiliation: Division of Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Williams
mesh_terms: D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005333:Fetus / Q000503:physiopathology*; D005865:Gestational Age; D006352:Heart Ventricles / Q000002:abnormalities* / Q000503:physiopathology; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000503:physiopathology; D065886:Neurodevelopmental Disorders / Q000209:etiology* / Q000503:physiopathology; D011247:Pregnancy; D011673:Pulsatile Flow / Q000502:physiology; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: cerebral blood flow; fetuses; growth; neurodevelopment; single ventricle