title: Brain sparing effect in growth-restricted fetuses is associated with decreased cardiac acceleration and deceleration capacities: a case-control study.
abstract: Phase rectified signal averaging (PRSA) is a new method of fetal heart rate variability (fHRV) analysis that quantifies the average acceleration (AC) and deceleration capacity (DC) of the heart. The aim of this study was to evaluate AC and DC of fHR [recorded by trans-abdominal fetal electrocardiogram (ta-fECG)] in relation to Doppler velocimetry characteristics of intrauterine growth restriction (IUGR).
  
  
  
  Prospective case-control study.
  
  
  
  Single third referral centre.
  
  
  
  IUGR (n = 66) between 25 and 40 gestational weeks and uncomplicated pregnancies (n = 79).
  
  
  
  In IUGR the nearest ta-fECG monitoring to delivery was used for PRSA analysis and Doppler velocimetry parameters obtained within 48 hours. AC and DC were computed at s = T = 9. The relation was evaluated between either AC or DC and Doppler velocimetry parameters adjusting for gestational age at monitoring, as well as the association between either AC or DC and IUGR with or without brain sparing.
  
  
  
  In IUGRs there was a significant association between either AC and DC and middle cerebral artery pulsatility index (PI; P = 0.01; P = 0.005), but the same was not true for uterine or umbilical artery PI (P > 0.05). Both IUGR fetuses with and without brain sparing had lower AC and DC than controls, but this association was stronger for IUGRs with brain sparing.
  
  
  
  Our study observed for the first time that AC and DC at PRSA analysis are associated with middle cerebral artery PI, but not with uterine or umbilical artery PI, and that there is a significant decrease of AC and DC in association with brain sparing in IUGR fetuses from 25 weeks of gestation to term.
  
  
  
  Brain sparing in IUGR fetuses is associated with decreased acceleration and deceleration capacities of the heart.
authors.affiliation: Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy. tamara.stampalija@burlo.trieste.it.
authors.forename: T
authors.initials: T
authors.lastname: Stampalija
authors.affiliation: Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Casati
authors.affiliation: Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Monasta
authors.affiliation: Department of Computer Science, Università degli Studi di Milano, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Sassi
authors.affiliation: Department of Computer Science, Università degli Studi di Milano, Milan, Italy.
authors.forename: M W
authors.initials: MW
authors.lastname: Rivolta
authors.affiliation: Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Muggiasca
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ferrazzi
mesh_terms: D000054:Acceleration; D000328:Adult; D001783:Blood Flow Velocity; D001921:Brain / Q000503:physiopathology*; D016022:Case-Control Studies; D003654:Deceleration; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005323:Fetal Monitoring / Q000379:methods; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D020768:Middle Cerebral Artery / Q000503:physiopathology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Doppler velocimetry; fetal heart rate variability; intrauterine growth restriction; phase rectified signal averaging