Fetoplacental Doppler abnormalities have been associated with increased neonatal mortality and morbidity. This study evaluated the associations between prenatal Doppler assessments and neonatal mortality and morbidity in premature infants born small for gestational age or after pre-eclampsia.

Methods

This was a population-based study of infants born alive at 22⁰–33⁶ weeks of gestation, a birthweight <10th percentile for gestational age and/or maternal pre-eclampsia. Doppler assessments of the umbilical artery, middle cerebral artery and ductus venosus were evaluated in 127, 125 and 95 cases, respectively. Circulatory compromise was defined as absent or reversed end-diastolic velocity in the umbilical artery (AREDF), middle cerebral artery pulsatility index <2.5 percentile for gestational age and ductus venosus pulsatility index for veins >97.5 percentile.

Results

AREDF was present in 28% of the infants. This was associated with increased frequencies of neonatal sepsis and necrotising enterocolitis after adjusting for gestational age. Abnormal ductus venosus pulsatility index for veins was associated with increased risk of neonatal sepsis, but only in combination with AREDF. These associations were only present when gestational age was <28 weeks.

Conclusion

AREDF was associated with increased neonatal morbidity in premature infants born small for gestational age or after pre-eclampsia.

References

1Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Goland A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. Am J Obstet Gynecol 2000; 182: 198–206.
10.1016/S0002-9378(00)70513-8
CAS PubMed Web of Science® Google Scholar
2Markestad T, Kaaresen PI, Rønnestad A, Reigstad H, Lossius K, Medbø S, et al. Norwegian extreme prematurity study group. Early morbidity, and need of treatment among extremely premature infants. Pediatrics 2005; 115: 1289–98.
10.1542/peds.2004-1482
PubMed Web of Science® Google Scholar
3Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M, GRIT study group. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet 2004; 364: 513–20.
10.1016/S0140-6736(04)16809-8
CAS PubMed Web of Science® Google Scholar
4Alfirevic Z, Neilson JP. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2010; 1: CD000073.
PubMed Web of Science® Google Scholar
5Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol 2006; 28: 126–36.
10.1002/uog.2832
CAS PubMed Web of Science® Google Scholar
6Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch U, et al. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 32: 160–7.
10.1002/uog.5386
CAS PubMed Web of Science® Google Scholar
7Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelöer BJ, Kok HJ, et al. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564–70.
10.1046/j.0960-7692.2001.00590.x
CAS PubMed Web of Science® Google Scholar
8Neerhof MG, Thaete LG. The fetal response to chronic placental insuffiency. Semin Perinatol 2008; 32: 201–5.
10.1053/j.semperi.2007.11.002
PubMed Web of Science® Google Scholar
9Kessler J, Rasmussen S, Godfrey KM, Hanson MA, Kiserud T. Fetal growth-restriction is associated with prioritization of umbilical blood flow to the left hepatic lobe, at the expense of the right lobe. Pediatr Res 2009; 66: 113–7.
10.1203/PDR.0b013e3181a29077
PubMed Web of Science® Google Scholar
10Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR, Simensen B. Ductus venosus blood velocity and the umbilical circulation in the seriously growth-retarded foetus. Ultrasound Obstet Gynecol 1994; 4: 109–14.
10.1046/j.1469-0705.1994.04020109.x
CAS PubMed Web of Science® Google Scholar
11Thiebaugeorges O, Ancel PY, Goffinet F, Breart G, EPIPAGE group. A population-based study of 518 very preterm neonates from high-risk pregnancies: prognostic value of umbilical and cerebral artery Doppler velocimetry for mortality before discharge and severe neurological morbidity. Eur J Obstet Gynecol Reprod Bioll 2006; 128: 69–76.
10.1016/j.ejogrb.2006.03.015
PubMed Web of Science® Google Scholar
12Kamoji VM, Dorling JS, Manktelow B, Draper ES, Field DJ. Antenatal umbilical Doppler abnormalities: an independent risk factor for early onset neonatal necrotizing enterocolitis in premature infants. Acta Paediatr 2008; 97: 327–31.
10.1111/j.1651-2227.2008.00671.x
CAS PubMed Web of Science® Google Scholar
13Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, et al. Predictors of neonatal outcome in early-onset placental dysfunction. Am J Obstet Gynecol 2007; 109: 253–61.
10.1097/01.AOG.0000253215.79121.75
PubMed Web of Science® Google Scholar
14Voßbeck S, de Camargo OK, Grab D, Bode H, Pohlandt F. Neonatal and neurodevelopmental outcome in infants born before 30 weeks of gestation with absent or reversed end-diastolic flow velocities in the umbilical artery. Eur J Pediatr 2001; 160: 128–35.
10.1007/s004310000680
CAS PubMed Web of Science® Google Scholar
15Ebbing C, Rasmussen S, Kiserud T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol 2007; 30: 287–96.
10.1002/uog.4088
CAS PubMed Web of Science® Google Scholar
16Kessler J, Rasmussen S, Hanson M, Kiserud T. Longitudinal reference ranges for ductus venosus flow velocities and waveform indices. Ultrasound Obstet Gynecol 2006; 28: 890–8.
10.1002/uog.3857
CAS PubMed Web of Science® Google Scholar
17Melamed N, Ben-Haroush A, Pardo J, Chen R, Hadar E, Hod Met al. Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gynecol 2011; 204: 48e1–8.
Google Scholar
18Skjærven R, Gjessing HK, Bakketeig LS. Birthweight by gestational age in Norway. Acta Obstet Gynecol Scand 2000; 79: 440–9.
10.1034/j.1600-0412.2000.079006440.x
CAS PubMed Web of Science® Google Scholar
19Papile LA, Burstein J, Burstein AR, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 1978; 92: 529–34.
10.1016/S0022-3476(78)80282-0
CAS PubMed Web of Science® Google Scholar
20 Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol 1984; 102: 1130–4.
10.1001/archopht.1984.01040030908011
PubMed Google Scholar
21Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg H. Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatr 2002; 91: 946–51.
10.1111/j.1651-2227.2002.tb02860.x
CAS PubMed Web of Science® Google Scholar
22Spinillo A, Montanari L, Bergante C, Gaia G, Chiara A, Fazzi E. Prognostic value of umbilical artery Doppler studies in unselected preterm deliveries. Obstet Gynecol 2005; 105: 613–20.
10.1097/01.AOG.0000152382.13490.18
PubMed Web of Science® Google Scholar
23Karsdorp VH, van Vugt JM, van Geijn HP, Konstense PJ, Arduini D, Montenegro N, et al. Clinical significance of absent or reversed end diastolic velocity waveforms in the umbilical artery. Lancet 1994; 344: 1664–8.
10.1016/S0140-6736(94)90457-X
CAS PubMed Web of Science® Google Scholar
24Sezik M, Tuncay G, Yapar EG. Predictors of adverse neonatal outcomes in preeclampsia by absent or reversed end-diastolic flow velocity in the umbilical artery. Gynecol Obstet Invest 2004; 57: 109–13.
10.1159/000075675
PubMed Web of Science® Google Scholar
25Brodszky J, Morsing E, Malcus P, Thuring A, Ley D, Marsal K. Early intervention in management of very preterm growth-restricted foetuses: 2-year outcome of infants delivered on fetal indication before 30 gestational weeks. Ultrasound Obstet Gynecol 2009; 34: 288–96.
10.1002/uog.7321
PubMed Web of Science® Google Scholar
26Gephart S, McGrath J, Effken J, Halpern MD. Necrotizing enterocolitis risk: State of the science. Adv Neonatal Care 2012; 12: 77–89.
10.1097/ANC.0b013e31824cee94
PubMed Web of Science® Google Scholar
27Tröger B, Müller T, Faust K, Bendiks M, Bohlmann MK, Thonnisen S, et al. Intrauterine growth restriction and the innate immune system in preterm infants of ≤32 weeks gestation. Neonatology 2013; 103: 199–204.
10.1159/000343260
CAS PubMed Web of Science® Google Scholar
28Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Longitudinal study of umbilical and portal venous blood flow to the fetal liver: low pregnancy weight gain is associated with preferential supply to the fetal left liver lobe. Pediatr Res 2008; 63: 315–20.
10.1203/PDR.0b013e318163a1de
PubMed Web of Science® Google Scholar
29Briana D, Gougiotis D, Baka S, Boutsikou M, Vraila VM, Boutsikou T, et al. The effect of intrauterine growth restriction on circulation surfactant Protein D concentrations in the perinatal period. Reprod Sci 2010; 17: 653–8.
10.1177/1933719110366165
CAS PubMed Web of Science® Google Scholar
30Adiotomre P, Johnstone F, Laing I. Effect of absent end diastolic flow velocity in the fetal umbilical artery on subsequent outcome. Arch Dis Child Fetal Neonatal Ed 1997; 76: 35–8.
10.1136/fn.76.1.F35
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume104, Issue4

April 2015

Pages 368-376

Foetal Doppler abnormality is associated with increased risk of sepsis and necrotising enterocolitis in preterm infants

Abstract

Aim

Methods

Results

Conclusion

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Foetal Doppler abnormality is associated with increased risk of sepsis and necrotising enterocolitis in preterm infants

Abstract

Aim

Methods

Results

Conclusion

References

Citing Literature

References

Related

Information