Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal day but not during infancy

Abstract

BackgroundFetal growth restriction (FGR) is associated with increased perinatal mortality and long-term cardiovascular and neurodevelopmental sequelae. We hypothesized that FGR impacts on the development of autonomic heart rate and blood pressure control, contributing to unfavorable short- and long-term outcomes following FGR.MethodsWe studied 25 preterm FGR and 22 preterm and 19 term appropriate for gestational age (AGA) infants. Preterm neonates were studied on postnatal day 1, and all infants were studied at 1 and 6 months post-term age. To investigate autonomic cardiovascular control, we examined heart rate variability (HRV) and baroreflex sensitivity using spectral power and transfer-function analyses.ResultsPreterm FGR neonates exhibited higher heart rates and reduced HRV compared with preterm AGA controls on postnatal day 1. No significant differences were found between the three groups at 1 or 6 months post-term age.ConclusionPreterm FGR neonates display compromised HRV on postnatal day 1, which may suggest increased vulnerability to circulatory instability. This may predispose these neonates to systemic and cerebral hypoperfusion and increase the risk of long-term neurodevelopmental sequelae. Differences were no longer found at 1 and 6 months post-term age, suggesting that the maturation of autonomic cardiovascular control may be preserved following FGR.

Cerebrovascular autoregulation in preterm fetal growth restricted neonates

“…However, we were unable to correct for other potentially confounding factors, such as hypocapnia or hypercapnia and hypoglycaemia or hyperglycaemia. Actually, FGR neonates and infants can present with altered acid base status36 and sympathetic tone,37 38 and they may have different cerebral metabolism 8. Moreover, there is evidence that vasoreactivity to some of these factors is altered in fetuses exposed to chronic hypoxia 30 31.…”

Effects of foetal growth restriction and preterm birth on cardiac morphology and function during infancy

“…p‐FGR and p‐AGA infants were studied on postnatal day 1 and all infants were studied at one‐and six‐months post‐term age. This study was part of a larger study and ethical considerations prevented us from performing a study in t‐AGA infants on day 1 of life. All echocardiographic studies were performed by a single, experienced paediatric cardiac sonographer (CW).…”

Noninvasive assessment of autonomic function in human neonates born at the extremes of fetal growth spectrum

“…Studies by the same authors in children born preterm combined with fetal growth restriction did not affect BPV or baroreflex function; however, children born preterm alone showed increased high‐frequency BPV and no differences in baroreflex function (Cohen et al. ). It is unclear whether prematurity or growth restriction accounts for these changes seen in these studies.…”

“…, ; Cohen et al. ). However, the methodology is technically challenging, and often investigators are unable to obtain adequate blood pressure signals in subjects.…”

“…Obtaining blood pressure waveform in the newborn noninvasively using photoplethysmography is a technique that offers potentially important advances in both research and clinical settings (Andriessen et al 2004;Polson et al 2006;Yiallourou et al 2012aYiallourou et al , 2013Cohen et al 2017). However, the methodology is technically challenging, and often investigators are unable to obtain adequate blood pressure signals in subjects.…”