Cardiac Morphology in Neonates with Intrauterine Growth Restriction

Abstract

Background: Intrauterine growth restriction (IUGR) affects cardiac development. We hypothesized that IUGR impacts early cardiac modelling. Aim: To assess the impact of IUGR on cardiac morphology in premature and term neonates. Study design: Prospective, observational cohort study Subjects: Pregnant women and their neonates with early (week 30+0 -31+6, n=9) and late (week 32+0 -42+0, n=19) IUGR with centralized fetal circulation. A gestational age matched control group (n=41) of non-IUGR neonates with normal prenatal growth and circulation. Outcome measures: Heart size measured by echocardiography. Results: Adjusted for gestational age, birth weight, sex and twin/singleton, IUGR neonates had significantly shorter mean (SEM) left ventricular septum length than non-IUGR neonates (27.8 mm (0.4) vs 29.7 (0.3)), shorter diameter of left atrium (9.4 (0.2) vs 10.8 (0.2)), left ventricle (15.0 (0.3) vs 17.3 (0.2)) and right ventricle (8.3 (0.3) vs 9.9 (0.3)) (p<0.01). In unadjusted estimates, IUGR had more impact on atrial cavities and right ventricle areas and diameters than on longitudinal dimensions, but less impact on atrioventricular valve orifices and left ventricle cavity diameters. This indicated a globular shape of the left ventricle and a symmetrical-to-oblong shape of right ventricle in IUGR. In adjusted estimates, the right ventricle dimensions exhibited an oblong shape whereas left ventricle dimensions were symmetrical. Conclusion: IUGR neonates had smaller hearts compared with non-IUGR neonates. In unadjusted estimates, IUGR hearts portrayed a symmetrical-to-oblong shape of the right ventricle and a globular shape of the left ventricle. In adjusted estimates, right ventricle shape remained oblong, whereas left ventricle shape was symmetrical. Funding Information: The research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sector. Declaration of Interests: None declared. Ethics Approval Statement: The Hospital’s Data Protection Officer and The Regional Ethics Committee of Research, South East, Norway approved the study (2016/923D). The parents gave written informed consent.