Article

Abnormal antenatal Doppler velocimetry and cognitive outcome in very-low-birth-weight infants at 2 years of age.

Department of Pediatrics, Turku University Hospital, Turku, Finland.
Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.56). 08/2010; 36(2):178-85. DOI: 10.1002/uog.7694
Source: PubMed

ABSTRACT To study neurodevelopmental outcome at 2 years of corrected age in very-low-birth-weight (VLBW) (< or = 1500 g) preterm infants with abnormal fetoplacental flow.
A total of 258 VLBW infants were born at Turku University Hospital between 2001 and 2006. Of these, 99 had undergone, within 1 week of delivery, antenatal Doppler assessment of blood flow in the umbilical artery (UA), fetal middle cerebral artery (MCA), descending aorta (DAo), aortic isthmus and ductus venosus and were eligible for inclusion in the study. Postnatally brain pathology was assessed by serial ultrasound and magnetic resonance imaging in 86 of the neonates and brain volume was measured in 80. Cognitive development was evaluated at 2 years of corrected age in 83 infants using the Bayley Scales of Infant Development-II. Motor development was assessed using the Hammersmith Infant Neurological Examination.
On univariate analysis, abnormal pulsatility index (PI) in the UA and an abnormal UA-PI/MCA-PI ratio (P = 0.04 and P = 0.003, respectively) as well as increases in both the DAo-PI and in the DAo-PI/MCA-PI ratio (P = 0.03 and P = 0.02, respectively), were associated with adverse cognitive outcome at 2 years of age. However, when controlling for cerebral volume using multivariate analysis, the association between abnormal antenatal Doppler characteristics and cognitive outcome became statistically non-significant, which indicated the determinant role of the volume reduction. Motor development was not associated with antenatal Doppler indices.
Abnormal antenatal Doppler indices are associated with adverse cognitive outcome at 2 years in VLBW infants. Our findings suggest that this association may be mediated through brain volume.

0 Bookmarks
 · 
221 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE OF REVIEW: To provide evidence that fetal brain vasodilatation can be related with postnatal cerebral structural and functional complications. RECENT FINDINGS: Most early-onset intrauterine growth restricted (IUGR) fetuses show signs of brain vasodilatation. As most of them are born prematurely, a high prevalence of short-term and long-term neurological complications is expected. However, the clinical significance of brain vasodilatation might be different. In the early stage of fetal deterioration, the risk of structural brain damage is low, but at advanced stages there is an increased risk of periventricular leukomalacia and intraventricular hemorrhage. The presence of brain vasodilatation in fetuses with an estimated fetal weight below the 10th centile but normal umbilical artery Doppler can be used to identify late-onset IUGR fetuses with latent placental insufficiency. These fetuses have an increased risk of abnormal neurological performance at birth and at 2 years of age. SUMMARY: Changes in cerebral brain blood perfusion in IUGR fetuses can be detected by Doppler ultrasound techniques. Despite its association with structural and functional neurological damage after birth, fetal brain vasodilatation is usually not considered in the decision to deliver, with the only exception of the 'return' to normal middle cerebral artery pulsatility index, which is highly associated with an increased risk for perinatal mortality.
    Current opinion in obstetrics & gynecology 01/2013; · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow. Methods Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination. Results The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children. Conclusion Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.
    Early human development 01/2013; · 2.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Normal intrauterine conditions are essential to normal brain growth and development; premature birth and growth restriction can interrupt brain maturation. Maturation processes can be studied using diffusion tensor imaging. Objective The aim of this study was to use tract-based spatial statistics to assess the effect that early postnatal growth from birth to 40 gestational weeks has on brain white matter maturation. Materials and methods A total of 36 preterm infants were accepted in the study. Postnatal growth was assessed by weight, length and head circumference. Birth weight z-score and gestational age were used as confounding covariates. Results Head circumference catch-up growth was associated with less mature diffusion parameters (P < 0.05). No significant associations were observed between weight or length growth and diffusion parameters. Conclusion Growth-restricted infants seem to have delayed brain maturation that is not fully compensated at term, despite catch-up growth.
    Pediatric Radiology 01/2013; · 1.65 Impact Factor

Full-text

Download
68 Downloads
Available from
Jun 4, 2014