Association between intracranial abnormalities in premature infants with intrauterine growth restriction compared to appropriately grown infants

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ESPR139
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Abstract: :

Background: Intrauterine growth restriction (IUGR) is a leading cause of neonatal morbidity and mortality. Although abnormal umbilical artery blood flow has been associated with poor outcomes, it is unclear if Doppler patterns are associated with a higher risk of intracranial abnormalities in the setting of immature cerebral autoregulation, cerebral hyper-perfusion and increased blood-brain barrier permeability in premature infants.


Objective: To assess the association between IUGR and outcomes of death, severe intraventricular hemorrhage (IVH) or cystic periventricular leukomalacia (PVL) in premature infants compared to appropriately grown for gestational age (AGA) infants.

 

Methods: This is a retrospective study including infants <32 weeks gestation born between 2016 and 2019. IUGR infants were stratified into: group 1: normal Dopplers and group 2: abnormal Dopplers including absent or reversed end diastolic flow in the umbilical artery (UA), or abnormal flow in the ductus venosus. The primary composite outcome was defined as death, severe IVH (grade III-IV) or cystic PVL on cranial ultrasound while further in-hospital outcomes were compared between the groups using univariate analyses and logistic or linear regression models.

 

Results: A total of 560 AGA and 168 IUGR infants met criteria with no significant difference in gestational age (29.6±2.5 weeks in AGA vs. 30.1±2.1 weeks in IUGR) but lower birth weight in the IUGR cohort (996±308 grams (g) vs 1344± 443 (g), p<0.01). IUGR infants were more likely to be small for gestational age with a female predominance, multiple gestation and born via Cesarean section. Mothers of IUGR infants had a higher incidence of hypertensive disease compared to mothers of AGA infants (62% vs 21%, p<0.01) with similar distribution across race and ethnicity. About 73% of IUGR infants had abnormal Dopplers and had a significantly higher incidence of the composite outcome compared to AGA infants (13% vs 7%, p<0.05) (Table 1). IUGR infants with abnormal Dopplers had a higher incidence of necrotizing enterocolitis, chronic lung disease, retinopathy of prematurity, and need for supplemental oxygen use at discharge (Table 1). In an adjusted model, lower gestational age (OR 0.60, 95% CI 0.52, 0.69; p<0.01), multiple gestation (OR 1.98, 95% CI 1.06, 3.67; p<0.05) and abnormal Dopplers (OR 4.07, 95% CI 1.57, 10.5; p<0.01) were associated with the primary composite outcome (Table 2). Lastly, in a Poisson linear regression model, IUGR infants with abnormal Dopplers had a 31% higher predicted length of stay (LOS) compared to AGA infants while those with normal Dopplers had a 14% higher predicted LOS compared to AGA infants.

 

Conclusions: In this cohort, abnormal Doppler patterns in IUGR infants were associated with an increased risk of death, cranial ultrasound findings and morbidities of prematurity compared to AGA infants while IUGR infants with normal Dopplers had similar incidences of morbidities but continued longer LOS. 

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Columbia University Medical Center
Columbia University Medical Center
Columbia University Medical Center
Columbia University Medical Center
Columbia University Medical Center

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