Ny publikation fra CBHS om højt blodtryk under graviditetens betydning for det nyfødte barn hjerte
Børn af mødre med svangerskabsforgiftning fødes med subkliniske morfologiske og funktionelle forandringer i det nyfødte barns hjerte, inklusive tykkere vægge af venstre pumpekammer og subkliniske systoliske og diastoliske forandringer. Derimod påvirker gestationel hypertension hos moder under graviditeten ikke det nyfødte barns ekkokardiografiske mål ved fødslen.
Studiet understreger vigtigheden af et øget fokus på svangerskabsforgiftning som en potent risikofaktor for hjertesygdom hos barnet. Der er dog behov for yderligere forskning til at afgøre om disse fund er permanente, samt hvorvidt denne gruppe børn burde tilbydes opfølgning igennem livet.
Maternal preeclampsia, but not gestational hypertension, was associated with subtle newborn cardiac morphological and functional alterations, including thickening of the left ventricular myocardium and altered systolic and diastolic function.
This study underlines the importance of preeclampsia as a potent factor affecting foetal cardiac development. Further research is needed to determine if these abnormalities are permanent and whether increased awareness and early management of these offspring should be provided.
Repeatability and Reproducibility of Neonatal Echocardiography: The Copenhagen Baby Heart Study.
by Sillesen AS, Iversen K
BACKGROUND: The Copenhagen Baby Heart Study (CBHS) is a population-based cohort study of neonates (N = 25,000), including echocardiography. Echocardiography in neonates is mainly focused on congenital heart disease (CHD), whereas general aspects of cardiac dimensions and function in neonates without CHD remain to be further addressed.
PURPOSE: This study was conducted to assess the reliability of neonatal echocardiography and validity of echocardiographic methods used in the CBHS.
METHODS: Reliability and agreement were tested for two-dimensional (2D), M-mode, spectral Doppler, and tissue velocity echocardiography for the following. (1) Measurements: seven sonographers independently performed two measurement rounds: (a) measurement of the same 50 echocardiograms (n = 350 echocardiograms measured) and (b) repeated measurement of 25 of the 50 echocardiograms (n = 175 echocardiograms measured). (2) Acquisition: four sonographers independently performed two rounds of echocardiographic acquisition and subsequent measurement of the same 22 neonates (n = 176 acquisitions and measures). Intra- and interobserver variabilities were assessed by determinations of coefficient of variation (CV), intraclass correlation coefficient (ICC), Bland-Altman plot, and 95% limits of agreement.
RESULTS: (1) Measurements: we found intra- and interobserver ICC ≥ 0.67 for 2D parameters, except for left ventricular (LV) wall thicknesses and LV diameter (interobserver); ICC ≥ 0.84 for tricuspid annular plane systolic excursion (TAPSE); ICC ≥ 0.93 for pulsed-wave Doppler (PW); ICC ≥ 0.84 for continuous-wave Doppler; and ICC ≥ 0.87 for tissue velocity parameters. We found CV < 15% for all parameters except LV wall thicknesses. (2) Acquisition: we found intra- and interobserver ICC ≥ 0.69 for 2D parameters, except for LV wall thicknesses, aortic valve annulus (interobserver), and LV end-systolic diameter (interobserver); ICC = 0.45-0.49 for TAPSE; ICC = 0.48-0.64 for PW; and ICC ≥ 0.70 for continuous wave. We found CV < 15% for all parameters. CONCLUSIONS: Reliability of echocardiographic measurements and acquisition of cardiac dimensions and function were good for most parameters but lower for TAPSE (acquisition) and PW Doppler (acquisition) and poor for LV wall thicknesses. In general, echocardiography of cardiac dimensions and function in the neonate is reliable. Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. KEYWORDS: Acquisition; Agreement; Echocardiography; Measurements; Neonate; Reliability
Copenhagen Baby Heart Study: a population study of newborns with prenatal inclusion.
Sillesen AS, Iversen K
Congenital heart diseases (CHDs) are reported in 0.8% of newborns. Numerous factors influence cardiovascular development and CHD prevalence, and possibly also development of cardiovascular disease later in life. However, known factors explain the probable etiology in only a fraction of patients. Past large-scale population-based studies have made invaluable contributions to the understanding of cardiac disease, but none recruited participants prenatally and focused on the neonatal period. The Copenhagen Baby Heart Study (CBHS) is a population-based study of the prevalence, spectrum, and prognosis of structural and functional cardiac abnormalities. The CBHS will also establish normal values for neonatal cardiac parameters and biomarkers, and study prenatal and early childhood factors potentially affecting later cardiovascular disease risk. The CBHS is an ongoing multicenter, prospective study recruiting from second trimester pregnancy (gestational weeks 18-20) (expected n = 25,000). Information on parents, pregnancy, and delivery are collected. After birth, umbilical cord blood is collected for biochemical analysis, DNA purification, and biobank storage. An echocardiographic examination, electrocardiography, and post-ductal pulse oximetry are performed shortly after birth. Infants diagnosed with significant CHD are referred to a specialist or admitted to hospital, depending on CHD severity. CBHS participants will be followed prospectively as part of specific research projects or regular clinical follow-up for CHD. CBHS design and methodology are described. The CBHS aims to identify new mechanisms underlying cardiovascular disease development and new targets for prevention, early detection, and management of CHD and other cardiac diseases presenting at birth or developing later in life.