Ultrasound Measurements of Intracranial Structures in Growth-Restricted Neonates with Fetal Blood Flow Redistribution: A Pilot Observational Study.

Background: Fetal growth restriction (FGR) is associated with neonatal and long-term neuro-morbidity. Preferential redistribution of blood flow to the brain is a common antenatal adaptation in FGR. The impact of this "brain sparing,"which may signify severity of FGR, on the growth of brain structures has not been studied. Aim(s): To compare corpus callosum (CC), cerebellar, and ventricular measurements of FGR neonates with evidence of fetal blood flow redistribution with those of gestation-matched appropriately grown (AGA) neonates. Method(s): This was a pilot, prospective observational study conducted at a tertiary level neonatal unit in Melbourne, Australia. Cranial ultrasound was done between days 1 and 3 of life in FGR and AGA neonates. Result(s): Cranial ultrasound on 20 FGR, gestation (mean +/- SD) 31.4 +/- 3.1 weeks, weight 1,205 +/- 463 g, and 20 AGA neonates, 31.1 +/- 3.0 weeks, 1,668 +/- 490 g, was performed. CC length was significantly decreased in FGR neonates as compared to AGA neonates (35.28 +/- 3.47 vs. 38.83 +/- 4.05 mm, p = 0.0002). CC was significantly thinner at genu (3.36 +/- 0.66 vs. 4.04 +/- 0.83 mm, p = 0.007), body (1.97 +/- 0.36 vs. 2.27 +/- 0.39 mm, p = 0.02), and splenium (4.07 +/- 0.76 vs. 4.72 +/- 0.75 mm, p = 0.003) in FGR vs. AGA neonates. CC-fastigium length was also significantly decreased (39.65 +/- 3.87 vs. 41.96 +/- 4.50 mm, p = 0.04). Similarly, FGR neonates showed decreased transverse cerebellar diameter (36.15 +/- 5.51 vs. 38.81 +/- 7.21 mm, p = 0.02), but ventricular measurements were comparable. In multivariate analysis, these differences were evident independent of the birth weight. Conclusion(s):CC and cerebellar measurements are significantly smaller in FGR neonates with fetal blood flow redistribution, which warrants further study.Copyright © 2020