Transitional haemodynamic profiles of intrauterine growth-restricted preterm infants: correlation with antenatal Doppler characteristics – Nature

Report on Transitional Haemodynamic Profiles in Intrauterine Growth-Restricted Preterm Infants and Their Correlation with Antenatal Doppler Characteristics

Background and Aim

Intrauterine growth restriction (IUGR) accompanied by fetal Doppler abnormalities can result in persistent haemodynamic adaptations postnatally. This study aimed to investigate the association between antenatal Doppler characteristics and transitional haemodynamic profiles in preterm infants with IUGR. Understanding these associations aligns with the Sustainable Development Goal (SDG) 3: Good Health and Well-being, by improving neonatal health outcomes through targeted interventions.

Methods

A prospective cohort study was conducted involving infants weighing less than 1500 grams. Over the first 72 hours of life, multiple haemodynamic parameters were monitored, including stroke volume (SV), cardiac output (CO), cardiac contractility (ICON), heart rate, systemic vascular resistance (SVR), perfusion index (PI), peripheral oxygen saturation, cerebrovascular reactivity, cerebral oxygenation, and oxygen extraction. These parameters were assessed using a combination of near-infrared spectroscopy, pulse oximetry, and electrical velocimetry.

Multivariate linear models compared these parameters among neonates categorized by antenatal Doppler status:

1. Normal antenatal Doppler (controls)
2. Abnormal umbilical Doppler without brain-sparing (UAbs-)
3. Abnormal umbilical Doppler with brain-sparing (UAbs+)
4. Abnormal umbilical Doppler with abnormal ductus venosus flow (UA+DV)

This methodological approach supports SDG 9: Industry, Innovation, and Infrastructure, by utilizing advanced non-invasive monitoring technologies to enhance neonatal care.

Results

A total of 92 neonates were included: 65 controls, 9 UAbs-, 12 UAbs+, and 6 UA+DV. Key findings include:

• UAbs+ neonates exhibited significantly higher cardiac output (p = 0.036), cardiac contractility (p < 0.001), and systemic vascular resistance (p = 0.012) compared to controls.
• UA+DV neonates showed lower stroke volume (p = 0.038), cardiac output (p = 0.018), perfusion index (p = 0.006), and the highest increase in systemic vascular resistance (p < 0.001).
• Impaired cerebrovascular reactivity was observed in both UAbs+ and UA+DV groups (p < 0.001 for both), indicating potential risks for neurodevelopmental complications.

These findings contribute to SDG 3 by identifying specific cardiovascular and cerebrovascular profiles linked to antenatal Doppler abnormalities, facilitating early risk stratification and management.

Conclusions

Antenatal Doppler abnormalities are associated with distinct transitional cardiovascular and cerebrovascular profiles in IUGR preterm infants. Recognizing these profiles has potential clinical implications for personalized neonatal care, which is integral to achieving SDG 3: Good Health and Well-being.

Impact and Relevance to Sustainable Development Goals

• This study elucidates the relationship between specific antenatal Doppler abnormalities and unique postnatal haemodynamic profiles in IUGR preterm infants, enhancing clinical understanding and care strategies.
• Knowledge of these associations aids in identifying neonates at higher risk of complications, promoting individualized therapeutic approaches based on antenatal Doppler characteristics, thereby supporting SDG 3.
• Previous literature relying on intrauterine growth or ponderal criteria may underestimate the prevalence and impact of fetal Doppler abnormalities; this study addresses this gap, contributing to improved neonatal outcomes.
• The research demonstrates the feasibility of comprehensive, non-invasive multimodal haemodynamic monitoring, aligning with SDG 9 by fostering innovation in healthcare technologies.

Data Availability

The study dataset and statistical analyses are available upon reasonable request from the corresponding author, promoting transparency and collaboration in research, which supports SDG 17: Partnerships for the Goals.

Funding and Ethical Considerations

• The study was funded by the European Society for Paediatric Research (ESPR) and supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and Brain Injury MedTech Co-operative.
• Ethical approval was obtained from the S. Orsola University Hospital Ethics Committee, and informed consent was secured from parents or legal guardians, ensuring adherence to ethical standards in research.

Author Contributions

The study was conceived, conducted, analyzed, and reported by a multidisciplinary team of experts, ensuring comprehensive expertise and accountability, which reflects the collaborative spirit emphasized in SDG 17.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article focuses on intrauterine growth restriction (IUGR) in preterm infants, a critical health issue affecting neonatal survival and long-term health outcomes.
   • It addresses antenatal Doppler abnormalities and their impact on cardiovascular and cerebrovascular profiles, which are essential for improving neonatal care and reducing infant mortality and morbidity.
2. SDG 9: Industry, Innovation, and Infrastructure
   • The study employs advanced non-invasive multimodal monitoring technologies (near-infrared spectroscopy, pulse-oximetry, electrical velocimetry) for neonatal hemodynamic assessment, reflecting innovation in healthcare technology.
3. SDG 17: Partnerships for the Goals
   • The research is supported by international collaborations and funding bodies such as the European Society for Paediatric Research and the NIHR Cambridge Biomedical Research Centre, highlighting partnerships to advance health research.

2. Specific Targets under the Identified SDGs

1. SDG 3: Good Health and Well-being
   • Target 3.2: End preventable deaths of newborns and children under 5 years of age.
   • Target 3.8: Achieve universal health coverage, including access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines.
   • Target 3.b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries.
2. SDG 9: Industry, Innovation, and Infrastructure
   • Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors, including health technologies.
3. SDG 17: Partnerships for the Goals
   • Target 17.6: Enhance North-South, South-South, and triangular regional and international cooperation on and access to science, technology, and innovation.

3. Indicators Mentioned or Implied to Measure Progress

1. Health Outcome Indicators
   • Incidence and prevalence of intrauterine growth restriction (IUGR) in preterm infants.
   • Neonatal mortality and morbidity rates associated with IUGR and fetal Doppler abnormalities.
2. Clinical and Physiological Indicators
   • Stroke volume (SV), cardiac output (CO), cardiac contractility (ICON), heart rate, systemic vascular resistance (SVR), perfusion index (PI).
   • Cerebrovascular reactivity, cerebral oxygenation, and oxygen extraction measured by near-infrared spectroscopy, pulse-oximetry, and electrical velocimetry.
   • Presence and classification of antenatal Doppler abnormalities (normal, abnormal umbilical Doppler without brain-sparing, with brain-sparing, abnormal ductus venosus flow).
3. Research and Innovation Indicators
   • Use and development of non-invasive multimodal monitoring technologies in neonatal care.
   • Number and impact of research collaborations and funding supporting neonatal health research.

4. Table of SDGs, Targets, and Indicators

Source: nature.com