Prenatal Hemodynamic Disturbances - Pathophysiological Background of Intestinal Motility Disturbances in Small for Gestational Age Infants

Abstract

Uteroplacental insufficiency leads to fetal growth retardation which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal hemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small for gestational age neonates. Prospectively, 124 preterm neonates with a birth weight below 1500 g were assigned to one of two groups according to the prenatal Doppler sonographic measurements: neonates with or without prenatal hemodynamic disturbances. We defined a pathological fetal perfusion using a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and a pulsatility index of the middle cerebral artery below the 10th percentile of a normal group. We compared intestinal adaptation in both groups as well as the blood flow velocity wave forms of the superior mesenteric artery in all neonates. Postnatally, all 42 neonates with prenatal hemodynamic disturbances were classified to be small for gestational age. Thirty-seven of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating enteral feeding within the first days of life. Five of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates born after normal prenatal perfusion were classified as appropriate for gestational age. Only 19 of 82 neonates of this group showed signs of intestinal disturbances postnatally. Doppler sonography demonstrated significantly lower systolic, mean and END-diastolic flow velocities, and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal hemodynamic disturbances. This may occur as a result of a postnatally persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.

Feeding infants below 29 weeks’ gestation with abnormal antenatal Doppler: analysis from a randomised trial

“…Similar findings to our own were documented by Robel-Tillig et al ,10 who found a very high incidence of intestinal dysmotility and delayed feed tolerance in babies with abnormal antenatal umbilical artery pulsatility index. However, this was not found by Mihatsch et al 11 with similar fetal Doppler findings or by Adiotomre et al 12 following fetal absent end-diastolic flow in the umbilical artery.…”

Structure and Function of Enterocyte in Intrauterine Growth Retarded Pig Neonates

“…Moreover, significant differences in the muscularis of the small intestine were shown (Table 2). Thinner muscularis, notably in the IUGR jejunum, compared to NBW piglets helps to explain altered motility of IUGR intestine [23]. …”

Minimal enteral feeding, fetal blood flow pulsatility, and postnatal intestinal permeability in preterm infants with intrauterine growth retardation

“…A few studies have investigated the relation between fetal blood flow pulsatility and gastrointestinal disturbances. [7][8][9][10][11][12] As enteral feeding may increase the risk of NEC, its initiation is often postponed. Minimal enteral feeding (MEF) has recently been introduced as a strategy to improve feeding tolerance and to prevent complications of prolonged parenteral nutrition, such as gut mucosa atrophy.…”