E Hahn1, A Szwast2, J Cnota1, J C Levine3, C G Fifer4, E Jaeggi5, H Andrews6, I A Williams7. 1. The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 2. The Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, PA, USA. 3. Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. 4. The Congenital Heart Center at C.S. Mott Children's Hospital, Ann Arbor, MI, USA. 5. Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada. 6. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. 7. Division of Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
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). CONCLUSION: In univentricular fetuses, lower cerebrovascular resistance may be protective for ND. Decreased fetal somatic growth may predict developmental abnormalities.
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). CONCLUSION: In univentricular fetuses, lower cerebrovascular resistance may be protective for ND. Decreased fetal somatic growth may predict developmental abnormalities.
Authors: Mirthe J Mebius; Nathalie J E Oostdijk; Sara J Kuik; Arend F Bos; Rolf M F Berger; Caterina M Bilardo; Elisabeth M W Kooi; Hendrik J Ter Horst Journal: Pediatr Res Date: 2018-01-10 Impact factor: 3.756
Authors: Kriti Puri; Carri R Warshak; Mounira A Habli; Amy Yuan; Rashmi D Sahay; Eileen C King; Allison Divanovic; James F Cnota Journal: Pediatr Res Date: 2017-12-20 Impact factor: 3.756
Authors: A E L van Nisselrooij; F A R Jansen; N van Geloven; I H Linskens; E Pajkrt; S-A Clur; L A Rammeloo; L Rozendaal; J M M van Lith; N A Blom; M C Haak Journal: Ultrasound Obstet Gynecol Date: 2019-12-27 Impact factor: 7.299
Authors: Mirthe J Mebius; Catherina M Bilardo; Martin C J Kneyber; Marco Modestini; Tjark Ebels; Rolf M F Berger; Arend F Bos; Elisabeth M W Kooi Journal: PLoS One Date: 2020-03-25 Impact factor: 3.240