Differential association of prenatal blood flow patterns with death and neurodevelopmental retardation in preterm infants with intrauterine growth restriction
20 September 2018 (online)
To evaluate the association between fetal Doppler velocities with death and neurodevelopment in intrauterine growth restricted (IUGR) preterm infants (birth weight < 10th percentile, umbilical artery (UA) pulsatility index (PI) > 95th percentile).
Retrospective single-center cohort study, including 176 live born IUGR infants 24 – 34 weeks of gestation. We assessed the association between UA (n = 156), middle cerebral artery (MCA, n = 146) and ductus venosus (DV, n = 106) blood flow measured within 48h before birth and death and neurodevelopmental retardation at one and two years' corrected age (Griffiths or Bayley scores one standard deviation below mean).
Twenty-one of 176 IUGR infants died (median [range] gestational age 25.6 [24.0 – 33.4] vs. 29.6 [24.6 – 34.0] weeks in survivors, p < 0.01). Death was associated with absent/reversed end-diastolic UA flow (11/16 nonsurvivors vs. 47/140 survivors, p = 0.0116) and absent/negative DV a wave (3/11 vs. 4/95, p = 0.02335), but these associations did not remain significant after controlling for gestational age. Neurodevelopmental retardation, observed in 38/101 infants examined, was not associated with gestational age but increased UA PI (2.21 [1.16 – 3.85] vs. 1.71 [0.82 – 5.73], p = 0.04) and decreased MCA PI (1.21 [0.9 – 1.82] vs. 1.39 [0.87 – 2.19], p = 0.01). After logistic regression analysis, the association was maintained for MCA PI (p = 0.019) but not for UA PI. Receiver operator characteristics curve analysis yielded an area of 0.685 (95% confidence interval 0.545 – 0.771) but no useful operational threshold.
The associations between compromised UA and DV flow and extrauterine death are mediated by gestational age while an MCA brain sparing-like pattern is independently linked to neurodevelopmental retardation.