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Elmakaty I, Amarah A, Henry M, Chhabra M, Hoang D, Suk D, Ron N, Dygulska B, Sy F, Gudavalli MB, Nadroo AM, Narula P, Gad A. Perinatal factors impacting echocardiographic left ventricular measurement in small for gestational age infants: a prospective cohort study. BMC Pediatr 2023; 23:393. [PMID: 37553638 PMCID: PMC10411023 DOI: 10.1186/s12887-023-04204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Infants born small for gestational age (SGA) have an increased risk of developing various cardiovascular complications. While many influencing factors can be adjusted or adapt over time, congenital factors also have a significant role. This study, therefore, seeks to explore the effect of perinatal factors on the left ventricular (LV) parameters in SGA infants, as assessed immediately after birth. METHODS AND MATERIALS This single-center prospective cohort study, conducted between 2014 and 2018, involved healthy SGA newborns born > 35 weeks' gestation, delivered at New York-Presbyterian Brooklyn Methodist Hospital, and a gestational age (GA)-matched control group of appropriate for gestational age (AGA) infants. Data analysis was performed using multivariate linear regression in STATA. RESULTS The study enrolled 528 neonates, 114 SGA and 414 AGA. SGA infants exhibited a mean GA of 38.05 weeks (vs. 38.54), higher male representation (69.3% vs. 51.5%), lower birth weight (BW) (2318g vs 3381g), lower Apgar scores at birth, and a higher rate of neonatal intensive care unit admission compared to AGA infants (41.2% vs.18.9%; p<0.001). Furthermore, SGA infants were more likely to be born to nulliparous women (63.16% vs. 38.16%; p<0.001), with lower body mass index (BMI) (29.8 vs. 31.7; p=0.004), a lower prevalence of gestational maternal diabetes (GDM) (14.9 % vs. 35.5%; p<0.001), and a higher prevalence of preeclampsia (18.4 % vs. 6.52%; p<0.001). BW was identified as the most significant predictor affecting most LV parameters in this study (p<0.001), except shortening fraction, asymmetric interventricular septal hypertrophy and Inter-ventricular septal thickness/LV posterior wall ratio (IVS/LVPW). Lower GA (coefficient = -0.09, p=0.002), insulin use in GDM (coefficient = 0.39, p=0.014), and low APGAR scores at 1 minute (coefficient = -0.07, p<0.001) were significant predictors of IVS during diastole (R-squared [R2]=0.24). High maternal BMI is marginally associated with LVPW during systole (R2=0.27, coefficient = 0.01, p=0.050), while male sex was a significant predictor of LV internal dimension during diastole (R2=0.29, p=0.033). CONCLUSION This study highlights the significant influence of perinatal factors on LV parameters in SGA infants, with BW being the most influential factor. Although LV morphology alone may not predict future cardiovascular risk in the SGA population, further research is needed to develop effective strategies for long-term cardiovascular health management in this population.
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Affiliation(s)
| | - Ahmed Amarah
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Manoj Chhabra
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Danthanh Hoang
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Debbie Suk
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Nitin Ron
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Beata Dygulska
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Farrah Sy
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Madhu B Gudavalli
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Ali M Nadroo
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Pramod Narula
- Division of neonatal-Prenatal medicine, Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, 506 6th St, Brooklyn, New York, 11215, USA
| | - Ashraf Gad
- Division of neonatal-Prenatal Medicine, Women's Wellness and Research Centre, NICU, Hamad Medical Corporation, Doha, Qatar.
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Dani C, Luzzati M, Corsini I, Poggi C, Vangi V, Coviello C, Pratesi S. Cardiac Hypertrophy Associated with Insulin Therapy in Extremely Preterm Infants. Paediatr Drugs 2023:10.1007/s40272-023-00571-0. [PMID: 37204612 DOI: 10.1007/s40272-023-00571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND In the neonatal period, cardiac hypertrophy (CH) has been commonly associated with hyperinsulinemic pathologies, and the first case of CH in an extremely preterm infant treated with insulin infusion has recently been reported. To confirm this association, we report a case series of patients who developed CH after insulin therapy. METHODS Infants with gestational age < 30 weeks and birth weight < 1500 g, born from November 2017 to June 2022, were studied if they developed hyperglycemia requiring treatment with insulin and had echocardiographic diagnosis of CH. RESULTS We studied 10 extremely preterm infants (24.3 ± 1.4 weeks) who developed CH at a mean age of 124 ± 37 h of life, 98 ± 24 h after the initiation of insulin therapy. All surviving patients had resolution of CH at discharge, while three of four (75%) of the deceased patients had persistent CH. CONCLUSIONS Our case series supports the association between the development of CH and insulin therapy in extremely preterm infants and suggests further caution and the need for echocardiographic monitoring when treating these fragile patients with insulin.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Chiara Poggi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Venturella Vangi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
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