Ultraschall Med 2016; 37 - PS9_10
DOI: 10.1055/s-0036-1587914

Response of severe IUGR human fetuses with brain sparing to amino acids supplementation via subcutaneously implanted port system with and without hyperbaric oxygenation

M Tchirikov 1, G Bapaeva 2, M Entezami 3
  • 1Martin-Luther-Universität Halle-Wittenberg, Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Halle, Germany
  • 2Nazarbayev University, Obstetrics and Gynecology, Astana, Kazakhstan
  • 3Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany

Objective: This study aims to treat severe placental insufficiency with amino acid and glucose intraumbilical supplementation via a port system and hyperbaric oxygenation (HBO).

Study design: A prospective clinical study of 6 IUGR very preterm human fetuses with cerebroplacental ratio < 1 with long-term intraumbilical amino acid and glucose supplementation, using subcutaneously implanted port system (10% of feto-placental blood volume/day, n = 6) and HBO (1.4 Bar, n = 1).

Results: Fetal nutrition significantly reduced the pulsatility index in the umbilical artery after first week from 2.44 ± 1.35 to 1.47 ± 0.53 and after two weeks in the non-placentar uterine artery (1.7 ± 0.56 vs. 0.97 ± 0.47) but did not affect Dopper profile of cerebral arteries and ductus venosus. The mean weight gain remained under the third percentile. However, the fetuses between 22 and 28 week of gestation did not have any sufficient benefit from infused commercial amino acids. The brain sparing to delivery interval could be prolonged to 24 [14; 33] days (median; rage). The port system was successfully used in one case for fetal blood transfusion. The method was successfully improved by hyperbaric oxygenation without any adverse effects to the mother and her baby.

Conclusion: The subcutaneously implanted perinatal port system can be used for a long-term intraumbilical administration of nutrients, blood and other medicine in humans. The intravascular treatment of growth restriction with fetal nutrition and HBO could prolong pregnancies with severe placental insufficiency and brain sparing for many weeks. The intraumbilical infusion seems to improve the placental blood perfusion. The commercial amino acid nutrition formulas cannot be safely recommended for the prenatal supplementation of extreme preterm IUGR fetuses because of lack of some amino acids combined with extreme deviations to this in similar fetuses under physiologic conditions.