Abstract
Objectives
The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH).
Methods
A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome.
Results
The rate of Grade I–II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III–IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32 weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome.
Conclusions
Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
References
1. Obstetricians ACo, Gynecologists. ACOG Practice Bulletin No. 204: fetal growth restriction. Obstet Gynecol 2019;133:e97–e109, https://doi.org/10.1097/AOG.0000000000003070.Search in Google Scholar PubMed
2. Flood, K, Unterscheider, J, Daly, S, Geary, MP, Kennelly, MM, McAuliffe, FM, et al.. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study. Am J Obstet Gynecol 2014;211:288 e1–5, https://doi.org/10.1016/j.ajog.2014.05.008.Search in Google Scholar PubMed
3. Moreta, D, Vo, S, Eslick, GD, Benzie, R. Re-evaluating the role of cerebro placental ratio in predicting adverse perinatal outcome. Eur J Obstet Gynecol Reprod Biol 2019;242:17–28, https://doi.org/10.1016/j.ejogrb.2019.06.033.Search in Google Scholar PubMed
4. Conde-Agudelo, A, Villar, J, Kennedy, SH, Papageorghiou, AT. Predictive accuracy of cerebro placental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;52:430–41, https://doi.org/10.1002/uog.19117.Search in Google Scholar PubMed
5. Monteith, C, Flood, K, Mullers, S, Unterscheider, J, Breathnach, F, Daly, S, et al.. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol 2017;216:285.e1–6. https://doi.org/10.1016/j.ajog.2016.11.1008.Search in Google Scholar PubMed
6. Reubsaet, P, Brouwer, AJ, van Haastert, IC, Brouwer, MJ, Koopman, C, Groenendaal, F, et al.. The impact of low-grade germinal matrix-intraventricular hemorrhage on neurodevelopmental outcome of very preterm infants. Neonatology 2017;112:203–10, https://doi.org/10.1159/000472246.Search in Google Scholar PubMed
7. Bassan, H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol 2009;36:737–62, https://doi.org/10.1016/j.clp.2009.07.014.Search in Google Scholar PubMed
8. Inder, TE, Perlman, JM, Volpe, JJ. Chapter 24 - preterm intraventricular hemorrhage/posthemorrhagic hydrocephalus. In: Volpe’s neurology of the newborn. Philadelphia, PA: Elsevier; 2018:637–98.e21 pp.10.1016/B978-0-323-42876-7.00024-7Search in Google Scholar
9. Gordijn, S, Beune, I, Thilaganathan, B, Papageorghiou, A, Baschat, A, Baker, P, et al.. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016;48:333–9, https://doi.org/10.1002/uog.15884.Search in Google Scholar PubMed
10. Flood, K, Unterscheider, J, Daly, S, Geary, MP, Kennelly, MM, McAuliffe, FM, et al.. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study. Am J Obstet Gynecol 2014;211:288.el–5. https://doi.org/10.1016/j.ajog.2014.05.008.Search in Google Scholar
11. Magee, L, Sawchuck, D, Synnes, A, von Dadelszen, P. Magnesium sulphate for fetal neuroprotection consensus C, maternal fetal medicine C: SOGC clinical practice guideline. Magnesium sulphate for fetal neuroprotection. J Obstet Gynaecol Can 2011;33:516–29, https://doi.org/10.1016/S1701-2163(16)34886-1.Search in Google Scholar PubMed
12. Perlman, JM, editor. The relationship between systemic hemodynamic perturbations and periventricular-intraventricular hemorrhage – a historical perspective. Semin Pediatr Neurol 2009;16:191–9. https://doi.org/10.1016/j.spen.2009.09.006.Search in Google Scholar PubMed
13. O’Leary, H, Gregas, MC, Limperopoulos, C, Zaretskaya, I, Bassan, H, Soul, JS, et al.. Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatrics 2009;124:302–9, https://doi.org/10.1542/peds.2008-2004.Search in Google Scholar PubMed PubMed Central
14. Tsuji, M, Saul, JP, du Plessis, A, Eichenwald, E, Sobh, J, Crocker, R, et al.. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics 2000;106:625–32, https://doi.org/10.1542/peds.106.4.625.Search in Google Scholar PubMed
15. Soul, JS, Hammer, PE, Tsuji, M, Saul, JP, Bassan, H, Limperopoulos, C, et al.. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res 2007;61:467–73, https://doi.org/10.1203/pdr.0b013e31803237f6.Search in Google Scholar PubMed
16. Noori, S, Seri, I, editors. Hemodynamic antecedents of peri/intraventricular hemorrhage in very preterm neonates. Semin Fetal Neonatal Med 2015;20:232–7, https://doi.org/10.1016/j.siny.2015.02.004.Search in Google Scholar PubMed
17. Alderliesten, T, Lemmers, PM, Smarius, JJ, van de Vosse, RE, Baerts, W, van Bel, F. Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J Pediatr 2013;162:698–704.e2, https://doi.org/10.1016/j.jpeds.2012.09.038.Search in Google Scholar PubMed
18. DeVore, GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213:5–15, https://doi.org/10.1016/j.ajog.2015.05.024.Search in Google Scholar PubMed
19. Stoll, BJ, Hansen, NI, Bell, EF, Walsh, MC, Carlo, WA, Shankaran, S, et al.. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA 2015;314:1039–51.10.1001/jama.2015.10244Search in Google Scholar PubMed PubMed Central
20. Handley, SC, Passarella, M, Lee, HC, Lorch, SA. Incidence trends and risk factor variation in severe intraventricular hemorrhage across a population based cohort. J Pediatr 2018;200:24–9.e3, https://doi.org/10.1016/j.jpeds.2018.04.020.Search in Google Scholar PubMed PubMed Central
21. Roberge, S, Nicolaides, K, Demers, S, Hyett, J, Chaillet, N, Bujold, E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017;216:110–20.e6, https://doi.org/10.1016/j.ajog.2016.09.076.Search in Google Scholar PubMed
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