General movements after fetal growth restriction in relation to prenatal Doppler flow patterns
Aim To investigate whether in fetal growth restriction (FGR) Doppler PI measurements of the fetal circulation are associated with neonatal general movements (GMs) Method FGR diagnosis was based on abdominal circumference or estimated fetal weight <P10 or delecting fetal growth. Fetal Doppler parameters of the umbilical artery (UA) middle cerebral artery (MCA) and ductus venosus (DV) were measured maximally 1 week prior to delivery. Cerebroplacental ratio (CPR) was calculated as MCA divided by UA PI. We assessed the quality of GMs on day 7 after birth, around the due date if cases were born preterm, and at three months post term. Additionally, we performed a detailed analysis of the motor repertoire by calculating a motor optimality score (MOS) Results Forty eight FGR cases were included with a median GA of 35 (range 26 40) weeks. UA PI, MCA PI, and CPR correlated strongly (rho .374 .472, p<.01) with MOS on day 7 after birth, DV did not. Doppler PI measurements did not correlate with MOS at three months post term. Conclusion Fetal arterial Doppler measurements are associated with the quality of neonatal GMs one week after birth, but this association is no longer evident at three months post term age. Brain sparing in particular associated strongly with abnormal quality of GMs. Prenatal predictors of neonatal outcome in FGR 57 4 Introductory section Fetal growth restriction (FGR) is one of the leading causes of perinatal and long term adverse outcomes.(1) FGR occurs in both early and late stages of pregnancy, each with its own pathofysiological mechanism. During fetal life, Doppler pulsatility index (PI) measurements of arterial and venous vessels are used for fetal monitoring. Previous studies suggest that abnormal PI values of the umbilical artery (UA) middle cerebral artery (MCA) and ductus venosus (DV) are predictive of perinatal outcome including long term neurodevelopment.(2 4) Speciically, absent or reversed end diastolic low (AREDF) of the UA is associated with long term neurodevelopmental delay.(3) It is unknown, however, whether the entire range of Doppler measurements are associated with neurodevelopmental delay, and how abnormal PI of the UA, MCA, and DV affect neurologic development shortly after birth. Previous studies report a higher incidence of abnormal general movements (representative of neurological functioning) in growth restricted infants when compared to controls.(5,6) However, they did not compare these results with fetal Doppler measurements. Therefore, it remains unknown whether fetal Doppler measurements are associated with short term neurological functioning of the newborn in FGR, and if so, which Doppler measurements. A reliable method to determine neurological functioning, is Prechtl's method of assessing quality of general movements (GMs)(7,8) Chronologically, two types of GMs can be distinguished. Up to term age, GMs are normally characterized by variability, complexity, and luency. At three months post term, idgety GMs (FMs) emerge, deined as continuous small, circular movements of moderate speed in all directions. The quality of GMs and FMs are predictive of abnormal neurological development.(8) Therefore, abnormal GMs in FGR infants may be a relection of possible brain damage. To gain insight into the relationship between prenatal Doppler PI measurements and short term postnatal neurology in FGR, we aimed to determine associations between Doppler PI of the UA, MCA, and DV and the qualitative and quantitative assessment of GMs and FMs. Since preterm and term born FGR infants might have different underlying pathofysiological mechanisms, we also aimed to study associations for both groups separately.