Cardiac Morphology and Function in Preterm Growth Restricted Infants: Relevance for Clinical Sequelae

Objectives To assess cardiac morphology and function in preterm infants with fetal growth restriction (FGR) compared with an appropriate for gestational age cohort, and to ascertain clinical correlation with neonatal sequelae. Study design With informed consent, 20 infants born between 28 and 32 weeks of gestational age and birthweight (BW) <10th percentile were compared using conventional and tissue Doppler echocardiography with 20 preterm appropriate for gestational age infants. Total duration of respiratory support was recorded. Results The gestational age and BW of the infants with FGR and appropriate for gestational age infants were 29.8 +/- 1.3 weeks vs 30 +/- 0.9 weeks (P = .78) and 923.4 +/- 168 g vs 1403 +/- 237 g (P < .001), respectively. Preterm infants with FGR had significantly greater interventricular septal hypertrophy, greater free wall thickening, and lower sphericity indices (1.53 +/- 0.15 vs 1.88 +/- 0.2; P < .001), signifying globular and hypertrophied hearts. The transmitral E/A ratio and isovolumic relaxation time, markers of diastolic function, were significantly increased in the FGR cohort (0.84 +/- 0.05 vs 0.78 +/- 0.03 [P < .001] and 61.4 +/- 4.1 ms vs 53.2 +/- 3.2 ms [P < .001], respectively). Ejection fraction, as measured by the rate corrected mean velocity of circumferential fiber shortening was reduced (1.93 +/- 0.4 circ/second vs 2.77 +/- 0.5 circ/second; P < .001) in the FGR cohort. On follow-up, the total duration of respiratory support was significantly longer in the FGR cohort, and correlated with tissue Doppler E/E' (r = 0.65; P = .001), mean velocity of circumferential fiber shortening (r = -0.64; P = .001) and mitral annular peak systolic excursion (r = -0.57; P = .008). Conclusions Preterm infants with FGR have altered cardiac function evident within days after birth, which is associated with respiratory sequelae.