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

Abstract Background and aim: Intrauterine growth restriction (IUGR) with fetal Doppler abnormalities can lead to persistent haemodynamic adaptations. We aimed to investigate the association between antenatal Doppler characteristics and transitional haemodynamic profiles in IUGR preterm infants. Methods: Infants <1500 g were enrolled in this prospective cohort study. Over the first 72 h of life, 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 were monitored combining near-infrared spectroscopy, pulse-oximetry and electrical velocimetry. Using multivariate linear models, these parameters were compared between neonates with normal antenatal Doppler and abnormal umbilical Doppler without brain-sparing (UAbs-), with brain-sparing (UAbs+) or with abnormal ductus venosus flow (UA+DV). Results: Ninety-two neonates (9 UAbs-, 12 UAbs+ , 6 UA+DV, 65 controls) were included. Compared to controls, UAbs+ had higher CO (p = 0.036), ICON (p < 0.001) and SVR (p = 0.012), whereas UA+DV showed lower SV (p = 0.038), CO (p = 0.018), PI (p = 0.006) and the highest SVR increase (p < 0.001). Impaired cerebrovascular reactivity was observed in UAbs+ (p < 0.001) and UA+DV neonates (p < 0.001). Conclusions: Antenatal Doppler abnormalities are associated with distinct transitional cardiovascular and cerebrovascular profiles in IUGR infants, with potential clinical implications. Impact: This study describes the association between specific antenatal Doppler abnormalities and distinct postnatal cardiovascular and cerebrovascular profiles in IUGR preterm infants. Knowledge of this association may aid to identify IUGR neonates at higher risk for complications and to develop individualised therapeutic approaches based on antenatal Doppler characteristics. Available literature investigating postnatal haemodynamics in IUGR infants is based on intrauterine growth or ponderal criteria that may underestimate the prevalence of fetal Doppler abnormalities and their hemodynamic consequences. This study provides a comprehensive haemodynamic overview across multiple districts, supporting the feasibility of non-invasive multimodal monitoring for neonatal hemodynamic assessment.