Predictors of Cranial Ultrasound Abnormalities in Intrauterine Growth-Restricted Fetuses Born between 28 and 34 Weeks of Gestation: A Prospective Cohort Study

Abstract

Background: Doppler parameters have been commonly used for the prediction of neonatal outcomes. However, controversies exist with regard to the value of Doppler parameters in predicting the risk of neurological outcomes among neonates. Objective: This prospective cohort study attempted to assess the value of Doppler parameters in predict ing cranial ultrasound abnormalities (CUAs) in intrauterine growth restriction (IUGR) among fetuses at 28–34 weeks of gestation. Methods: This was a prospective cohort study of 83 delivered IUGR fetuses and 75 control fetuses matched for gestational age (GA). The value of mentioned Doppler parameters and GA in predicting the risk of CUAs, including periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and basal ganglia lesions (BGLs), was analyzed. Results: The incidence of CUAs among IUGR fetuses (66.3%) was significantly higher (p < 0.001) than in the control group (40%). The incidence of neonatal mortality among IUGR fetuses was significantly higher (p < 0.001) than in the control group. Absent or reversed end-diastolic velocity (AREDV) in the umbilical artery (UA) and the ductus venosus (DV) after adjustment for GA was associated with increased odds of IVH, PVL, BGLs, and any CUA. Conclusions: GA at birth and AREDV in the UA and the DV within 1 week before childbirth were reliable predictors of CUAs during the neonatal period.

Cranial Ultrasound Abnormalities in Small for Gestational Age or Growth-Restricted Infants Born over 32 Weeks Gestation: A Systematic Review and Meta-Analysis

“…CURs ≤ 1 are an important marker of fetal compromise and have been linked to adverse perinatal outcomes with strongest association in low birthweight babies [ 53 ]. Khazardoost also found that absent or reversed end-diastolic velocity in the UA and DV was associated with an increased rate of CUAs [ 54 ]. Although it is not possible to fully ascertain the benefit of cranial ultrasonography screening upon all growth-restricted infants, risk stratification may be a useful tool in the development of screening guidelines.…”

Blood-Brain Barrier Disintegration in Growth-Restricted Fetuses with Brain Sparing Effect

“…The post-mortem studies revealed a decreased neuronal cortex density [ 22 ]. The disturbed neuronal migration and proliferation, observed in the hippocampus and in the septo-hippocampal circuit in FGR, are supposed to be responsible for learning and memory dysfunction [ 9 , 23 , 24 , 25 ]. Moreover, the impaired neuronal connectivity and myelination were described in animal models of placental insufficiency [ 23 , 26 ], and in human prematurely born FGR infants [ 9 , 27 , 28 ].…”

“…The disturbed neuronal migration and proliferation, observed in the hippocampus and in the septo-hippocampal circuit in FGR, are supposed to be responsible for learning and memory dysfunction [ 9 , 23 , 24 , 25 ]. Moreover, the impaired neuronal connectivity and myelination were described in animal models of placental insufficiency [ 23 , 26 ], and in human prematurely born FGR infants [ 9 , 27 , 28 ]. Ramenghi et al noticed a significant reduction in the myelination in neonates with FGR and BS during pregnancy, as compared to neonates with FGR and normal middle cerebral artery flows [ 29 ].…”