Early feeding tolerance in small for gestational age infants with normal versus abnormal antenatal Doppler characteristics

Ahamed, Mohamed Farooq; Dar, P.; Vega, Mario; Kim, Mimi; Gao, Qi; Havranek, Thomas

doi:10.3233/npm-1682

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…It is likely that i n utero chronic fetal hypoxia and subsequent cardiovascular redistribution of blood flow away from the gastrointestinal tract contribute to immature gut development (49). FGR newborns, especially with abnormal flows in the umbilical artery prior to birth, are shown to have more feed intolerance when compared to their well-grown preterm counterparts (50). Superior mesenteric artery blood flows have been used as a marker for splanchnic perfusion in neonates and decreased flows correlate with feed intolerance (51).…”

Section: Perinatal Morbiditiesmentioning

confidence: 99%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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Being born small lays the foundation for short-term and long-term implications for life. Intrauterine or fetal growth restriction describes the pregnancy complication of pathological reduced fetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term deficits. Placental insufficiency is the principal cause of FGR, which in turn underlies a chronic undersupply of oxygen and nutrients to the fetus. The neonatal morbidities associated with FGR depend on the timing of onset of placental dysfunction and growth restriction, its severity, and the gestation at birth of the infant. In this review, we explore the pathophysiological mechanisms involved in the development of major neonatal morbidities in FGR, and their impact on the health of the infant. Fetal cardiovascular adaptation and altered organ development during gestation are principal contributors to postnatal consequences of FGR. Clinical presentation, diagnostic tools and management strategies of neonatal morbidities are presented. We also present information on the current status of targeted therapies. A better understanding of neonatal morbidities associated with FGR will enable early neonatal detection, monitoring and management of potential adverse outcomes in the newborn period and beyond.

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Section: Perinatal Morbiditiesmentioning

confidence: 99%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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“…A remarkable prevalence of FI in AREDF infants has also been reported by Aradhya et al, although they did not perform any comparisons between infants with or without Doppler abnormalities or with different Doppler features [ 25 ]. Ahamed et al compared FEF time among SGA infants with and without evidence of abnormal antenatal Doppler [ 26 ]; after adjustment for GA and BW, the impact of Doppler abnormalities on FEF achievement was no longer significant. However, it is possible that the inclusion of several covariates that may be strictly correlated to antenatal Doppler impairment (e.g., BW and head circumference and length at birth) may have underpowered the multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Association between Abnormal Antenatal Doppler Characteristics and Gastrointestinal Outcomes in Preterm Infants

et al. 2022

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Antenatal Doppler disturbances are associated with fetal hypoxia and may induce a brain-sparing vascular redistribution at the expense of splanchnic circulation, possibly predisposing to gut complications. We aimed to compare several gastrointestinal outcomes among very-low-birthweight (VLBW) preterm infants with different antenatal Doppler features. VLBW infants born between 2010–2022 were retrospectively included and stratified into the following clusters based on antenatal Doppler characteristics: normal Doppler (controls); absent or reversed end-diastolic flow in the umbilical artery (UA-AREDF) alone or also in the ductus venosus (UA+DV-AREDF); and abnormal Doppler with or without brain-sparing redistribution. The following outcomes were evaluated: time to reach full enteral feeds (FEF), feeding intolerance (FI), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP). Overall, 570 infants were included. Infants born following UA+DV-AREDF had significantly higher FI, NEC, and SIP rates and achieved FEF later compared to controls. Increased FI prevalence and a longer time to FEF compared to controls were also observed among UA-AREDF infants and in the presence of brain-sparing redistribution, which also increased NEC rates. Antenatal Doppler abnormalities exacerbate the gastrointestinal risks of preterm infants. Detailed knowledge of Doppler features can aid in identifying those at highest risk of intestinal complications who may benefit from tailored enteral feeding management.

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“…FGR has been associated with increased risk of perinatal and neonatal morbidities [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The conventional definition of FGR is based on estimated fetal weight < 10 th centile for gestation.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes of Fetal Growth Restriction, Classified According to the Delphi Consensus Definition: A Prospective Observational Study

Sainky¹,

Nayar²,

Sharma³

et al. 2022

Journal of Fetal Medicine

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Delphi Consensus criteria, early onset (D1) and late onset (D2), Non Delphi Conventional FGR as (C-D), early onset (C1-D1) and late onset (C2-D2). Rest of the fetuses were designated as Non FGR (> 10th% ile). The association of incidence along with perinatal outcomes in each group were compared. The incidence of FGR was as follows: conventional criteria: 35.8%, Delphi criteria: 22.7% and Non Delphi Conventional FGR: 13.1%. Delphi defined FGR had statistically significant increased incidence of PPHTN, hypoglycemia and NICU admission in comparison to Conventional FGR. Delphi defined FGR also had statistically significant increased frequency of Apgar < 7, PPHTN, hypoglycemia, seizures, NICU admissions and prolonged stay as compared to Non Delphi Conventional FGR group. Comparing Non FGR fetuses with Non Delphi Conventional FGR fetuses, neonatal outcomes were similar in both groups. Delphi defined FGR is associated with increased frequency of adverse perinatal outcomes as compared to conventionally defined FGR. Delphi defined criteria, should be routinely applied to a fetus who is small (AC/EFW < 10th% ile). This will timely identify a truly growth restricted fetus, who is at risk for adverse perinatal outcome and save the rest from unnecessary monitoring and intervention. The findings of our study call for larger studies validating the use of Delphi consensus in clinical practise.

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Early feeding tolerance in small for gestational age infants with normal versus abnormal antenatal Doppler characteristics

Abstract: Infants with AREDF are sicker at birth and have more feeding difficulties; after adjusting for BW and GA, Doppler flow was no longer a significant predictor of feeding intolerance.

Cited by 9 publications

References 19 publications

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Association between Abnormal Antenatal Doppler Characteristics and Gastrointestinal Outcomes in Preterm Infants

Perinatal Outcomes of Fetal Growth Restriction, Classified According to the Delphi Consensus Definition: A Prospective Observational Study

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