Acceleration Time-to-Ejection Time Ratio in Fetal Pulmonary Artery Predicts the Development of Neonatal Respiratory Distress Syndrome: A Prospective Cohort Study

Sun Min Kim; Joong Shin Park; Errol R. Norwitz; Eun Ju Hwang; Hye Sim Kang; Chan-Wook Park; Jong Kwan Jun

doi:10.1055/s-0032-1333132

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(10): 805-812
DOI: 10.1055/s-0032-1333132

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acceleration Time-to-Ejection Time Ratio in Fetal Pulmonary Artery Predicts the Development of Neonatal Respiratory Distress Syndrome: A Prospective Cohort Study

Sun Min Kim

¹Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

,

Joong Shin Park

¹Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

,

Errol R. Norwitz

²Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts

,

Eun Ju Hwang

¹Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

,

Hye Sim Kang

³Department of Obstetrics and Gynecology, Jeju National University College of Medicine, Jeju, Korea

,

Chan-Wook Park

¹Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

,

Jong Kwan Jun

¹Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

› Author Affiliations

Abstract

Objective This study investigates whether fetal pulmonary artery Doppler waveforms can predict the subsequent development of respiratory distress syndrome (RDS).

Study Design A prospective cohort study was performed in women with impending preterm birth. Pulsatility index, resistance index, systolic-to-diastolic ratio, peak systolic velocity, and acceleration time-to-ejection time (At/Et) ratio were measured in the main pulmonary artery of fetus just before delivery.

Results Neonates who developed RDS (n = 11) had significantly lower gestational age at birth than those without RDS (n = 31; median: 28.7 [range: 24.7 to 34.9] versus 32.9 [range: 25.7 to 36.0] weeks; p = 0.003); there was no difference in antenatal corticosteroid administration. Pulmonary artery At/Et ratio was significantly higher in fetuses that developed RDS compared with those that did not (median: 0.37 [range: 0.26 to 0.41] versus median: 0.30 [range: 0.21 to 0.44]; p = 0.008). RDS prediction score (=a hundredfold At/Et ratio) is significantly associated with the subsequent development of RDS after controlling for gestational age by logistic regression analysis (odds ratio = 1.31, 95% confidence interval 1.05 to 1.63, p = 0.017).

Conclusion An elevated At/Et ratio in the fetal pulmonary artery is independently associated with the development of RDS in preterm infants. These data suggest that fetal pulmonary artery Doppler velocimetry may provide a reliable noninvasive technique to evaluate fetal lung maturity, similar to the way in which middle cerebral artery Doppler has replaced amniocentesis for the assessment of fetal anemia.

Keywords

fetal pulmonary artery - Doppler - respiratory distress syndrome - prematurity - preterm birth

Full Text

References

References
1 Hjalmarson O. Epidemiology and classification of acute, neonatal respiratory disorders. A prospective study. Acta Paediatr Scand 1981; 70: 773-783
2 Robertson PA, Sniderman SH, Laros Jr RK , et al. Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States, 1983 through 1986. Am J Obstet Gynecol 1992; 166 (6 Pt 1) 1629-1641 ; discussion 1641–1645
3 Copper RL, Goldenberg RL, Creasy RK , et al. A multicenter study of preterm birth weight and gestational age-specific neonatal mortality. Am J Obstet Gynecol 1993; 168 (1 Pt 1) 78-84
4 Angus DC, Linde-Zwirble WT, Clermont G, Griffin MF, Clark RH. Epidemiology of neonatal respiratory failure in the United States: projections from California and New York. Am J Respir Crit Care Med 2001; 164: 1154-1160
5 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; 3: CD004454
6 Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics 2011; 127: 1139-1146
7 Practice Bulletin No ACOG. ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007; 109: 1007-1019
8 ACOG Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin. Management of preterm labor. Number 43, May 2003. Int J Gynaecol Obstet 2003; 82: 127-135
9 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111: 35-41
10 Hibbard JU, Wilkins I, Sun L , et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304: 419-425
11 Gluck L, Kulovich MV, Borer Jr RC, Keidel WN. The interpretation and significance of the lecithin-sphingomyelin ratio in amniotic fluid. Am J Obstet Gynecol 1974; 120: 142-155
12 Hallman M, Kulovich M, Kirkpatrick E, Sugarman RG, Gluck L. Phosphatidylinositol and phosphatidylglycerol in amniotic fluid: indices of lung maturity. Am J Obstet Gynecol 1976; 125: 613-617
13 Elrad H, Beydoun SN, Hagen JH, Cabalum MT, Aubry RH, Smith C. Fetal pulmonary maturity as determined by fluorescent polarization of amniotic fluid. Am J Obstet Gynecol 1978; 132: 681-685
14 Dalence CR, Bowie LJ, Dohnal JC, Farrell EE, Neerhof MG. Amniotic fluid lamellar body count: a rapid and reliable fetal lung maturity test. Obstet Gynecol 1995; 86: 235-239
15 Chaoui R, Kalache K, Tennstedt C, Lenz F, Vogel M. Pulmonary arterial Doppler velocimetry in fetuses with lung hypoplasia. Eur J Obstet Gynecol Reprod Biol 1999; 84: 179-185
16 Yoshimura S, Masuzaki H, Miura K, Muta K, Gotoh H, Ishimaru T. Diagnosis of fetal pulmonary hypoplasia by measurement of blood flow velocity waveforms of pulmonary arteries with Doppler ultrasonography. Am J Obstet Gynecol 1999; 180 (2 Pt 1) 441-446
17 Rizzo G, Capponi A, Angelini E, Mazzoleni A, Romanini C. Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia. Ultrasound Obstet Gynecol 2000; 15: 98-103
18 Fuke S, Kanzaki T, Mu J , et al. Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry. Am J Obstet Gynecol 2003; 188: 228-233
19 Moreno-Alvarez O, Hernandez-Andrade E, Oros D, Jani J, Deprest J, Gratacos E. Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung-to-head ratio in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2008; 31: 164-170
20 Azpurua H, Norwitz ER, Campbell KH , et al. Acceleration/ejection time ratio in the fetal pulmonary artery predicts fetal lung maturity. Am J Obstet Gynecol 2010; 203: e1-e8
21 Yoon BH, Romero R, Park JS , et al. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol 2000; 182: 675-681
22 Mitchell JM, Roberts AB, Lee A. Doppler waveforms from the pulmonary arterial system in normal fetuses and those with pulmonary hypoplasia. Ultrasound Obstet Gynecol 1998; 11: 167-172
23 McElrath TF, Colon I, Hecht J, Tanasijevic MJ, Norwitz ER. Neonatal respiratory distress syndrome as a function of gestational age and an assay for surfactant-to-albumin ratio. Obstet Gynecol 2004; 103: 463-468
24 Mari G, Adrignolo A, Abuhamad AZ , et al. Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization. Ultrasound Obstet Gynecol 1995; 5: 400-405
25 Mari G, Deter RL, Carpenter RL , et al; Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med 2000; 342: 9-14
26 Schenone M, Samson J, Suhag A, Jenkins L, Mari G. A non-invasive method to predict fetal lung maturity using fetal pulmonary artery Doppler wave acceleration time/ejection time ratio. Am J Obstet Gynecol 2012; 206 (Suppl): S170
27 Chaoui R, Taddei F, Rizzo G, Bast C, Lenz F, Bollmann R. Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus. Ultrasound Obstet Gynecol 1998; 11: 173-179