Hypoxic ischemic encephalopathy: Do peripartum risk factors account for observed changes in incidence?

Minor, Kathleen; Liu, Jessica; El‐Sayed, Yasser Y.; Druzin, Maurice L.; Profit, Jochen; Hintz, Susan R.; Bonifacio, Sonia L.; Karakash, Scarlett

doi:10.1016/j.ajog.2021.11.359

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“…After birth, there is a greater risk of neurological and neurodevelopmental morbidity ( 4 ), and a 10-to-30-fold increase in the risk of developing cerebral palsy ( 5 ). In a multivariable analysis of the temporal trends (2010–2019) in hypoxic ischemic encephalopathy (HIE) and peripartum risk factors, small for gestational age neonates were found to be associated with increased odds of HIE ( 6 ). Recent studies conclude that the fetus with intrauterine growth retardation (IUGR) is at greater risk of abnormalities of cardiac size and shape ( 7 ), arterial and ventricular wall thickness and cardiac dilatation beyond neonatal period ( 8 ), metabolic abnormalities ( 9 ), and permanently altered autonomic cardiovascular control ( 10 ).…”

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confidence: 99%

Comparative evaluation of echocardiography indices during the transition to extrauterine life between small and appropriate for gestational age infants

et al. 2023

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ObjectivesTo study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts.DesignA hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery.ResultsEighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p < 0.05, respectively]. Maternal weight and body mass index was higher among non-affected pregnancies, 61% infants were born vaginally, and no differences in cord blood pH at birth were noted. SGA infants had higher systolic and mean blood pressure at both time points, lower indices of right ventricular (RV) performance [TAPSE (tricuspid annular peak systolic excursion) 7.4 ± 2.8 vs. 9.3 ± 0.7 on day 1, 7.2 ± 2.8 vs. 9.2 ± 0.5 on day 2, p = 0.001], lower pulmonary acceleration time (PAAT) suggestive of elevated pulmonary vascular resistance [56.4 ± 10.5 vs. 65.7 ± 13.2 on day 1, 61.4 ± 12.5 vs. 71.5 ± 15.7 on day 2, p = 0.01] and higher left ventricular (LV) ejection fraction [62.1 ± 7.8 vs. 54.9 ± 5.5 on day 1, 61.9 ± 7.6 vs. 55.8 ± 4.9 on day 2, p = 0.003].ConclusionsSGA infants had evidence of higher pulmonary vascular resistance, and lower RV performance during the postnatal transition. The relevance and impact of these changes to hemodynamic disease states during the postnatal transition requires prospective investigation.

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