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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017
36
AFRICA
Myocardial dysfunction in children with intrauterine
growth restriction: an echocardiographic study
Katarzyna Niewiadomska-Jarosik, Justyna Zamojska, Agata Zamecznik, Agnieszka Wosiak,
Piotr Jarosik, Jerzy Sta
ń
czyk
Abstract
Introduction:
The prevalence of intrauterine growth restric-
tion (IUGR) is about 3–10% of live-born newborns and can
be as high as 20% in developing countries. It may result in the
occurrence of cardiovascular diseases later in life.
Methods:
The aim of this study was echocardiographic
evaluation, with the use of conventional and tissue Doppler
parameters, of cardiac function in children born with IUGR,
and comparison with healthy peers born as normally grown
foetuses.
Results:
In the IUGR group, E wave and E/A ratio were
significantly lower compared to the control group. A wave,
isovolumetric relaxation time, deceleration time, myocardial
performance index as well as E/E
′
septal and E/E
′
lateral indi-
ces were significantly higher compared to healthy peers.
Conclusion:
Children with IUGR presented with subclinical
myocardial dysfunction.
Keywords:
echocardiography, intrauterine growth restriction,
myocardial dysfunction, children
Submitted 23/7/14, accepted 16/4/16
Published online 7/12/16
Cardiovasc J Afr
2017;
28
: 36–39
www.cvja.co.zaDOI: 10.5830/CVJA-2016-053
Intrauterine growth restriction (IUGR) is a major problem in
present-day medicine. It is defined as a birth weight below the
10th percentile for gestational age and involves about 5–10% of
neonates.
1
IUGR is one of the main causes of low birth weight
and directly affects perinatal morbidity and mortality rates.
It is well known that such pathology may be associated
with the later occurrence of cardiovascular diseases. Barker’s
hypothesis, published in 1989,
2
proved increased incidence of
cardiovascular diseases in adults born with IUGR, particularly
hypertension and hyperlipidaemia. It is explained by the ‘foetal
programming’ theory, which is the formation in the prenatal
period of adaptive mechanisms to prevent the long-term hypoxia
accompanying IUGR.
3
Currently, cardiovascular dysfunction
forming during the prenatal period is considered one of the
main pathophysiological features of this programming.
4-6
In
addition, Crispi
et al
. suggest that this dysfunction may be one
of the major mechanisms explaining increased cardiovascular
mortality rates in adults who were born with IUGR.
4
Due to the sparsity of reports, the increase in incidence of
myocardial dysfunction in children born with IUGR remains
unclear. The aim of our prospective study was echocardiographic
evaluation of cardiac function in children born with IUGR,
compared to children born at normal gestational age and birth
weight.
Methods
The analysis included 77 children (42 girls, 35 boys), aged from
5–11 years, who were randomly selected from the obstetrics and
gynecology out-patient clinic. We included those born at term
as small-for-gestational-age (SGA) babies (birth weight below
the 10th percentile according to gestational age) with IUGR
features, detected prenatally by foetal size measurements on
obstetric ultrasonography. All the children were single births.
The control group included 30 healthy subjects (16 girls, 14
boys), born with normal birth weight, gender and age matched
to the study group. Gestational age was calculated from the
mother’s last menstrual period.
All patients were hospitalised at the Pediatric Cardiology and
Rheumatology Department of the Medical University of Lodz
between 2010 and 2013. All demographic and anthropometric
datawere recorded during the examination, including information
about gestational age, birth weight and nutritional status [height,
weight, body mass index (BMI)
=
weight (kg)/height (m)
2
] (Table
1). All subjects were well at the time of the study, none had a
chronic illness or a history of medication taking.
The exclusion criteria were: evidence of chromosomal
or infectious aetiology for IUGR, gestational diabetes,
hypothyroidism, systemic or acute disease, and the mother
smoking cigarettes or using medication. This study was approved
by the medical ethics committee of the Health Sciences Faculty
of Lodz University (No: RNN/150/09/KB).
All patients underwent a full echocardiographic study, using
the Aloka Prosound
α
10 device, evaluating anatomy and cardiac
function. In standard projections, systolic and diastolic function
of the left ventricle was estimated.
•
Left ventricular diameter, ejection fraction (EF) and shorten-
ing fraction (SF) were calculated in the parasternal, long-axis
view, in M-mode presentation according to the Teichholz
formula.
Department of Pediatric Cardiology and Rheumatology,
2nd Chair of Pediatrics, Medical University of Lodz, Poland
Katarzyna Niewiadomska-Jarosik, MD, PhD,
kasiajarosik@wp.plJustyna Zamojska, MD, PhD
Agata Zamecznik, MD
Jerzy Sta
ń
czyk, MD, PhD
Institute of Information Technology, Technical University of
Lodz, Poland
Agnieszka Wosiak, PhD
Department of Pediatric Cardiosurgery, Polish Mother’s
Memorial Institute, Lodz, Poland
Piotr Jarosik, MD, PhD