Efficacy of intravenous propranolol for life-threatening diffuse neonatal hemangiomatosis.

Oral propranolol is recommended as the first-line agent for infantile hemangioma requiring systemic treatment. Life-threatening complications such as obstructive infantile hemangioma of the airway or infantile hepatic hemangioma associated with high-output congestive heart failure are major indications for the consideration of early treatment. We present the case of an infant with life-threatening diffuse neonatal hemangiomatosis, including airway obstruction due to subglottic hemangioma, heart failure due to multiple hepatic hemangiomas with portohepatic venous shunts, and severe anemia due to continuous gastrointestinal bleeding, in which treatment with intravenous propranolol proved successful.

Case Report: Structural Changes in the Coronary Vessel Wall in a Patient With Incomplete Kawasaki Disease.

Background: Kawasaki disease (KD) is an acute systemic vasculitis of infants and young children that affects medium-sized vessels. Conventional cardiac imaging techniques, such as cardiac catheterization, are useful for characterizing the coronary arterial lesion (CAL) size and luminal diameter of the diseased coronary artery segment in patients with KD, but there are limitations to the visualization of the detailed vascular anatomy. Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality that can distinguish the three layers of the coronary arterial wall. Several studies have reported coronary artery wall abnormalities in KD patients with coronary arterial aneurysm or regressed aneurysm. However, there have been no reports on changes in the coronary artery wall in cases of incomplete KD without CAL. Case Presentation: We herein report an 11-year-old girl with a history of incomplete KD without coronary arterial aneurysms. She had been diagnosed with perimembranous ventricular septal defect (VSD) after birth and had experienced incomplete KD at 1 year old. During her hospitalization for KD, she did not receive intravenous immunoglobulin (IVIG), because she did not meet the Harada score or criteria for treatment in patients with incomplete KD established by the American Heart Association. No dilatation or coronary artery aneurysm were observed on transthoracic echocardiography in the acute or follow-up period. At 11 years old, she received cardiac catheterization and coronary angiography (CAG) for the evaluation of a VSD and follow-up of KD. CAG demonstrated no aneurysm, dilatation, or significant stenosis of the coronary arteries. We performed an OCT study, which revealed the presence of intimal thickening, disruption of the media, and neovascularization in the left anterior descending artery. Conclusion: OCT demonstrates the structural changes of CA even in the patient with incomplete KD who have not been treated with IVIG.

Diagnostic and prognostic significance of serum angiopoietin-1 and -2 concentrations in patients with pulmonary hypertension.

Several biomarkers for detecting pulmonary hypertension (PH) have been reported. However, these biomarkers are deemed insufficient to detect PH in its early stages. We evaluated the utility of serum angiopoietin (ANGP), a glycoprotein related to angiogenesis, as a diagnostic and prognostic biomarker of PH. Patients with PH who underwent right-heart catheterization, were retrospectively studied. Serum concentrations of ANGP-1 and ANGP-2 were measured using an enzyme-linked immunosorbent assay in patients with PH (n = 32), those with idiopathic pulmonary fibrosis (IPF) without PH (as a disease control, n = 75), and age-matched healthy controls (HC, n = 60). Nineteen patients (59.4%) with PH had World Health Organization group 3 PH. Serum ANGP-2 concentration, but not ANGP-1, in patients with PH was significantly higher compared with that in HC (p = 0.025) and in patients with IPF without PH (p = 0.008). Serum ANGP-2 concentration in patients with PH positively and significantly correlated with N-terminal pro-B-type natriuretic peptide (r = 0.769, p < 0.001), right ventricular diameter on echocardiography (r = 0.565, p = 0.035), and mean pulmonary arterial pressure (r = 0.449, p = 0.032) and pulmonary vascular resistance (r = 0.451, p = 0.031) on right-heart catheterization. ANGP-1 and ANGP-2 were expressed on lung vascular endothelial cells, as shown by immunohistochemistry. Patients with PH with higher ANGP-2 concentration (≥ 2.48 ng/mL) had significantly worse survival (p = 0.022). Higher ANGP-2 concentration was a significant worse prognostic factor (hazard ratio = 6.063, p = 0.037), while serum ANGP-1 concentration was not. In conclusion, serum ANGP-2 may be a useful diagnostic and prognostic biomarker in patients with PH, especially in patients with group 3 PH.

Hemodynamic changes in neonates born to mothers with Graves' disease.

PURPOSE: Cardiac insufficiency is a major morbidity in neonatal hyperthyroidism. It is important to assess the hemodynamics in neonates born to mothers with Graves' disease (GD). This study prospectively evaluated the hemodynamic changes in neonates born to mothers with GD. METHODS: Overall, 80 newborns were enrolled. Thirty-six neonates were born to mothers with GD who were positive for thyroid-stimulating hormone (TSH) receptor antibody (TRAb), and 44 were born to mother negative for TRAb. The serum levels of TSH, free triiodothyronine (FT3), free thyroxine (FT4), and N-terminal-pro-B-type natriuretic peptide (NT-proBNP), the cardiac output, and cardiac index (CI) evaluated by echocardiography were compared between the two groups at several postnatal points (day of delivery and 5, 10, and 30 days of life). RESULTS: The TRAb-positive newborns had higher FT4 levels and CI on Day 5 (both p < 0.05) and higher FT3 (p < 0.05) and FT4 levels (p < 0.01) and CI (p < 0.01) but lower TSH levels (p < 0.05) on Day 10 than the TRAb-negative newborns. The TRAb-positive newborns had significantly higher NT-proBNP levels on Days 5 (median 752 vs. 563 pg/mL, p = 0.034) and 10 (median 789 vs. 552 pg/mL, p = 0.002) than the TRAb-negative newborns. CONCLUSIONS: Hemodynamic changes in neonates born to TRAb-positive mothers with GD resulted in a higher CI and NT-proBNP levels than in those with TRAb-negative mothers from postnatal days 5 to 10.

The association between congenital heart disease and small for gestational age with regard to the prevalence and outcomes.

AIM: To evaluate the association between small for gestational age (SGA) and the prevalence of congenital heart disease (CHD) and the association of the SGA status with the outcomes among infants with CHD. METHODS: Echocardiography was performed within the first 5 days of life in 5664 consecutive infants. Infants were classified into four groups according to the presence or absence of SGA and CHD. All CHD infants were followed up until either spontaneous resolution of all cardiac lesions, invasive intervention or death. All newborns without CHD were followed for mortality until the final follow-up date. RESULTS: A total of 303 infants were diagnosed with CHD, while 610 were diagnosed with SGA. Among the CHD infants, 56 were SGA, and 247 were not. A multivariable logistic regression analysis showed that the adjusted odds ratio of SGA (9.71, P < .001) was significantly higher than that of other parameters concerning predictors of invasive intervention or death. The mortality rate in the presence of both SGA and CHD (hazard ratio: 33.6, P < .001) was markedly higher than in the absence of both. CONCLUSION: SGA was a significant predictor of invasive intervention for CHD. The combination of CHD and SGA carried a high risk of death beyond that of either alone.

TSC1 intragenic deletion transmitted from a mosaic father to two siblings with cardiac rhabdomyomas: Identification of two aberrant transcripts.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder characterized by non-cancerous tumors in multiple organs including the brain, kidney, lung, heart, and skin. We encountered a Japanese family consisting of two siblings (a four-year-old boy and a one-year-old girl) with multiple cardiac rhabdomyomas conveying a high risk of TSC and apparently unaffected sibling (a two-year-old girl) and parents. Whole exome sequencing and application of Integrative Genomic Viewer revealed an identical intragenic TSC1 deletion with the breakpoints on intron 15 and exon 19 in the affected siblings, but not in the apparently unaffected sibling and parents. Subsequently, PCR-based analyses were performed using primers flanking the deletion, showing that the deletion was also present in the father and that the deletion occurred between chr9:135,777,038 (bp) and chr9:135,780,540 (bp) in association with a one bp overlap. Furthermore, RT-PCR analyses were carried out using lymphoblastoid cell lines, revealing a major in-frame insertion/deletion transcript produced by aberrant splicing using a cryptic ″ag″ splice acceptor motif at intron 15 (r.1998_2438delinsTTCATTAGGTGG) and a minor frameshift transcript generated by aberrant splicing between exon 15 and exon 20 (r.1998_2502del, p.Lys666Asnfs*15) in the affected siblings. These findings imply that the intragenic deletion producing two aberrant transcripts was generated as a somatic pathogenic variant involving the germline in the father and was transmitted to the affected siblings.

Successful Management of Pulmonary Arterial Hypertension by Monitoring N-Terminal Pro-B-Type Natriuretic Peptide Serum Levels in a Preterm Infant with Chronic Lung Disease: A Case Report.

We measured the serial changes in N-terminal probrain natriuretic peptide (NT-proBNP) levels in a 6-month-old male infant with chronic lung disease (CLD) complicated by pulmonary arterial hypertension (PAH). The patient was born at the 24th week of gestation weighing 695 g. At 1 month after birth, an echocardiogram confirmed the diagnosis of CLD with PAH. He was treated with inhaled nitric oxide (iNO) and oral sildenafil and discharged from the hospital. At 190 days of age, the patient was readmitted to our department because of a viral upper respiratory infection. At 195 days of age, his respiratory condition worsened with pulmonary edema and his NT-proBNP level was determined to be 10,117 pg/mL. The patient was immediately administered iNO, and his respiratory condition improved, and NT-proBNP levels decreased. However, he experienced repeated severe cyanosis attacks. Before the attacks, his NT-proBNP level was > 1,000 pg/mL. Therefore, we continuously administered iNO until his NT-proBNP level decreased to < 1,000 pg/mL. We safely discontinued iNO administration at 473 days of age. In conclusion, serial change in NT-proBNP is a surrogate marker with prognostic value in patients with PAH associated with CLD.

Closure time of ductus arteriosus after birth based on survival analysis.

OBJECTIVES: The correct ductus arteriosus (DA) closure time is somewhere between the opening and closing time confirmed on echo, not on examination. We investigated DA closure time and factors affecting DA closure time using interval censoring analysis. METHODS: This was an observational, retrospective study including 2611 healthy neonates. Echo was performed every 12-24 h after birth until DA closure. We investigated the DA closure time using interval censoring analysis. If the DA was closed on echo, we assumed that the DA was open at birth. We evaluated clinical factors affecting DA closure time. RESULTS: Median DA closure time was 13.5 h (range, 7.7-18.7 h) after birth. DA closure time was associated with primipara status, maternal prostaglandin E2 (PGE2) administration, <2500 g birth weight, and diagnosis of congenital ductus arteriosus aneurysm (DAA). Using proportional hazards regression models, the interval-censored data (primipara, hazard ratio [HR] = 1.099, P = 0.04; PGE2, HR = 0.823, P = 0.03; <2500 g, HR = 1.413, P < 0.01; DAA, HR = 0.570, P < 0.01) were found to be significantly associated with DA closure time. CONCLUSIONS: Estimation of DA closure time by interval censoring analysis is helpful to determine the optimal time to perform echo and to predict risk factors for patent DA.

The association between oxidative stress and endothelial dysfunction in early childhood patients with Kawasaki disease.

BACKGROUND: Oxidative stress has recently been shown to play an important role in the development of arteriosclerosis in patients with Kawasaki disease (KD); however, no study has investigated this association in early childhood patients with KD. In this study, we evaluated prospectively the association between the levels of oxidative stress and the endothelial function in early childhood patients with KD. METHODS: We compared the derivatives of reactive oxygen metabolites (ROM), flow-mediated dilatation (FMD), and biological characteristics in a population of 50 children: 10 patients with KD and coronary artery lesions (CAL) (group 1), 15 KD patients without CAL (group 2), and 25 healthy age- and sex-matched children (group 3). RESULTS: The median age of all KD children at study enrollment was 6.8 (IQR 4.4-8.2) years. ROM levels were significantly higher in group 1 (p <  0.001) and group 2 (p = 0.004) than in group 3. The %FMD of group 1 (p <  0.001) and group 2 (p = 0.026) was significantly lower than that of group 3. There was a significant negative correlation between ROM and %FMD (r = - 0.60, p <  0.001). A multiple linear regression analysis identified ln-ROM (standardized coefficient = - 0.403, p = 0.043) and total fever duration (standardized coefficient = - 0.413, p = 0.038) as significant determinants of %FMD in the patients with KD. CONCLUSIONS: Our study suggests that oxidative stress is strongly associated with endothelial dysfunction in early childhood patients with KD. Furthermore, we found that the longer the fever duration, the higher the risk of oxidative stress-induced endothelial dysfunction in these children.

Measurement of Aortic Valve Coaptation and Effective Height Using Echocardiography in Patients with Ventricular Septal Defects and Aortic Valve Prolapse.

Decreased coaptation height in adults has been identified as a marker of early valve failure. We evaluated aortic valve coaptation and effective height in healthy children and in children with a ventricular septal defect (VSD) with aortic cusp prolapse (ACP), using echocardiography. We included 45 subjects with VSD with ACP, 27 did not develop aortic regurgitation (AR) by ACP and 18 developed AR by ACP, and 83 healthy children as controls. Aortic root anatomy was estimated using the parasternal long-axis view. We measured the diameter of aortic valve (AV), coaptation height (CH), and effective height (EH) of the aortic valve. We defined the ACH (CH/AV ratio) and AEH (EH/AV ratio) indices as follows: [Formula: see text]. There were significant differences in ACH and AEH between the groups (control vs VSD with ACP vs VSD with ACP and AR, median ACH [%], 35.1 vs 32.0 vs 22.1; median AEH [%], 52.0 vs 48.0 vs 34.4, respectively; P < 0.01]). Intra-cardiac repair (ICR) was performed in 15 cases. Significant increases were observed in ACH and AEH before and after ICR (median ACH [%], before: 27.0, after: 32.7, P < 0.05; median AEH (%), before 38.5, after 45.8, P < 0.05). Measurement of ACH and AEH may allow direct and non-invasive assessment of the severity of VSD with ACP, which could aid clinicians in determining the need and timing for surgical intervention.

Reproductive technologies and the risk of congenital heart defects.

Assisted reproductive technology (ART) has become widespread, accounting for ∼2% of all births worldwide, with a similar proportion in Japan. Our goal was to determine whether ART is associated with an increased risk of congenital heart defect (CHD). The study subjects were 2716 pregnant women (2317 in a spontaneous conception [SC] group and 399 in an assisted conception [AC] group). Of patients in the AC group, 142 were treated with ovulation-inducing agents (OIAs), 56 with artificial insemination by the husband (AIH), 159 with in vitro fertilization (IVF), and 42 with intracytoplasmic sperm injection (ICSI). CHD screening on the fetus or newborn was performed using two-dimensional echocardiography. Severe CHD was defined as requiring surgical treatment, or leading to death within one year. There were 2746 births (one of 31 twins was a still birth), 410 resulted from AC and within this group, 111 cases of CHD were found (AC group, 17 [4.1%]; SC group, 94 [4.0%]). Five cases of severe CHD were found in the AC group and 19 in the SC group, with no significant difference between the groups (p = 0.892). In conclusion, there was no evidence of increased CHD risk associated with ART treatment.

Quantitative, Noninvasive Assessment of Patent Ductus Arteriosus Shunt Flow by Measuring Proximal Isovelocity Surface Area on Color Doppler Mapping in Very Low-Birth-Weight Infants.

Background Our goal was to evaluate the hemodynamic status of very low-birth-weight infants (VLBWIs) with patent ductus arteriosus (PDA) by measuring the vena contracta width (VCW) and effective shunt orifice area (ESOA) using the proximal isovelocity surface area (PISA) on color Doppler imaging. Method and Results In this study, 34 VLBWIs with PDA (median weight: 949 g) were studied. We measured VCW and ESOA using the PISA on echocardiography. PDA-VCW was measured at the narrowest PDA flow region. ESOA determined using PISA (PDA-ESOA) was defined as the hemispheric area of laminar flow with aliased velocities on color Doppler flow imaging: PDA-ESOA = 2π (PDA radius) 2 × aligning velocity/PDA velocity. Of the 34 VLBWIs, 26 received indomethacin (IND) for symptomatic PDA. Comparing echocardiographic parameters between infants who did versus did not receive IND, significant differences were seen in the left atrial-to-aortic root ratio (LA/AO), PDA-VCW, and PDA-ESOA. Receiver operating characteristic curve analysis to differentiate between IND usage status produced statistically significant results for PDA-VCW (area under the curve [AUC] = 0.880), PDA-ESOA (AUC = 0.813), and LA/AO (AUC = 0.769). Conclusion PDA-VCW and PDA-ESOA may allow noninvasive assessment of PDA severity, and are useful when determining the timing of clinical decision making for IND administration.

Hemodynamic assessment in a child with renovascular hypertension using time-resolved three-dimensional cine phase-contrast MRI.

Renovascular hypertension (RVH) is an important cause of hypertension in children. It is essential to assess the hemodynamics of RVH lesions in detail. We herein report the case of a 9-year-old female with RVH caused by left renal artery stenosis in which the hemodynamics of the lesions were assessed with time-resolved three-dimensional cine phase-contrast MRI (3D cine PC MRI) with a vastly undersampled 3D radial projection imaging trajectory before and after percutaneous transluminal renal angioplasty (PTRA). The utility of 3D cine PC MRA for diagnosing RVH and evaluating the renal blood flow pre- and post-PTRA is presented.

Quantitative, noninvasive assessment of patent ductus arteriosus shunt flow by measuring proximal isovelocity surface area on color Doppler imaging.

BACKGROUND: We evaluated the hemodynamic status of patent ductus arteriosus (PDA) by measuring vena contracta width (VCW) and effective shunt orifice area (ESOA) using proximal isovelocity surface area (PISA) on color Doppler imaging. METHODS AND RESULTS: Study subjects were 21 patients with PDA (mean age, 3.6 years). We measured VCW (mm/m(2)) and ESOA (cm(2)) by the PISA method using echocardiography. Color images were obtained from parasternal long-axis views. VCW (mm/m(2)) was measured at the narrowest region of PDA flow. ESOA by PISA (PDA-ESOA) was defined on color Doppler flow imaging as a hemispheric area of laminar flow with aliased velocities [PDA-ESOA (cm(2))=2π[PDA radius (cm)]^2×aligning velocity (cm/s)/PDA peak velocity (cm/s)]. Upon examining the relationships with catheterization parameters by univariate analysis, VCW correlated with diastolic blood pressure (DBP), % left ventricular end-diastolic volume (%LVEDV), pulmonary blood flow index, pulmonary blood flow/systemic blood flow ratio (Qp/Qs), left-right (LR) shunt ratio, left atrial to aortic root ratio (LA/AO), chest-thoracic ratio and N-terminal pro-brain natriuretic peptide (NTproBNP); and PDA-ESOA correlated with DBP, Qp/Qs, average pulmonary artery pressure, pulmonary/systemic pressure ratio, %LVEDV, LR shunt ratio, LA/AO and NTproBNP. When stepwise multiple linear regression analysis was performed with the correlations that were significant on univariate analysis, significant correlations with Qp/Qs were noted (VCW; R(2)=0.836, ß=0.914, P<0.001, PDA-ESOA; R(2)=0.621, ß=0.788, P<0.001). CONCLUSIONS: Measurement of VCW and PDA-ESOA by the PISA method can noninvasively evaluate the hemodynamic status of PDA.

Endothelial dysfunction in children within 5 years after onset of Kawasaki disease.

OBJECTIVE: To evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). STUDY DESIGN: A total of 46 children were enrolled prospectively as follows: 9 patients with KD and coronary artery lesions composed group 1, 15 patients with KD but without coronary artery lesions composed group 2, and 22 healthy age- and sex-matched children composed group 3. Flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery, and biologic characteristics were compared among the 3 groups. Differences in the factors associated with endothelial function after KD were examined as well. RESULTS: The mean age of the study group was 6.5 ± 1.7 years. The patients with KD were studied at a median interval of 3.3 years (IQR, 2.0-4.4 years) from the onset of disease. The percent FMD (%FMD) was significantly lower in group 1 patients (median, 4.4%; IQR, 2.6%-5.7%) compared with both group 2 (median, 9.1%; IQR 6.6%-10.7%; P < .01) and group 3 (median, 11.1%; IQR, 10.1%-13.9%, P < .01). The %FMD was statistically significantly lower in group 2 compared with group 3 (P < .05). There were no significant differences in the intima-media thickness among the 3 groups. There was a significant negative correlation between %FMD and the total duration of fever (r = -0.50; P = .013). CONCLUSION: The children with KD already had arterial endothelial dysfunction within 5 years after the onset of illness. The longer the duration of fever, the greater the risk of inflammation-induced endothelial dysfunction.

Serial change in myocardial tissue Doppler imaging from fetus to neonate.

BACKGROUND: Our goal was to evaluate the serial change in myocardial performance from fetus to neonate using tissue Doppler imaging (TDI). METHOD AND RESULTS: There were 37 term infants in the present study. The TDI sensor was placed at the level of the lateral mitral annulus (M-TDI), inter-ventricular septum (IVS-TDI) and the lateral tricuspid annulus (T-TDI). We measured TDI parameters from fetus to neonate. On univariate analysis, E' (cm/s), A' (cm/s), and S' (cm/s) of three ventricular walls of TDI parameters excluding E' IVS-TDI significantly decreased during the transition from fetal to neonatal circulation. E'/A' ratio, E/E' ratio and myocardial performance index (MPI) of three ventricular walls of TDI parameters excluding T-TDI MPI significantly increased during the transition from fetal to neonatal circulation. When multiple linear regression analysis with a step-wise procedure during the transition from fetus to neonate for TDI parameters was applied to variables, significant differences were noted for predicting decreases in M-TDI S' (6.55 to 3.97, p < 0.001) and IVS-TDI A', (6.69 to 4.69, p < 0.001), and increases in IVS-TDI E'/A' ratio (0.77 to 1.02, p < 0.001) and IVS-TDI E/E' ratio (8.25 to 13.65, p < 0.001). CONCLUSION: In conclusion, we found that the myocardial performances of both ventricles decreased during the transition from fetus to neonate using TDI parameters. In particular, left ventricular systolic performance was affected more than when fetal circulation changed to neonate circulation. Our findings suggest that serial change in TDI can give new information to estimate myocardial performance of the neonate.

B-type natriuretic peptide and N-terminal pro-BNP in the acute phase of Kawasaki disease.

BACKGROUND: This study was undertaken to identify factors correlating with plasma levels of B-type natriuretic peptide (BNP) and its N-terminal portion (NTpro BNP) in the acute phase of Kawasaki disease (KD). METHODS: This study included 91 patients with KD treated at a hospital affiliated to Hamamatsu University School of Medicine between October 2003 and June 2011. We quantified BNP and NT-pro BNP in the acute phase. The BNP level was expressed as the NT-pro BNP level using the formula NT-pro BNP=9.080×BNP(0.923). We sought relationships between NT-pro BNP values and different clinical and laboratory data in the acute phase of KD. RESULTS: Of the 91 patients, 14 failed to respond to the initial intravenous immunoglobulins therapy. NTpro BNP levels were significantly higher in these nonresponders than in the responders (1689.3±1168.8 pg/ dL vs. 844.4±1276.3 pg/dL, P<0.001). Seventeen patients developed coronary artery lesions, but this was not associated with NT-proBNP levels. NT-pro BNP was positively correlated with CRP (r=0.421, P<0.001) and negatively correlated with the hematocrit (r=-0.206, P=0.050), Na value (r=-0.214, P=0.041) and albumin level (r=-0.345, P<0.001). Stepwise multiple linear regression analysis with NT-pro BNP as a dependent variable revealed significant correlations with CRP and albumin (beta=0.345, P=0.001; beta=-0.225, P=0.027). CONCLUSIONS: A high level of NT-pro BNP in acute phase KD is associated with systemic inflammatory responses and increased vascular permeability. The NT-pro BNP level is a useful marker to identify potential non-responders to IVIG among KD patients.

Ophthalmic artery Doppler waveform in the newborn.

BACKGROUND: The ophthalmic artery Doppler waveform (OADW) is thought to correlate with severity of systemic atherosclerosis. The goal of the present study was to evaluate risk of cardiovascular disease (CVD) in newborns small for gestational age (SGA) and appropriate for gestational age (AGA). METHODS AND RESULTS: A total of 15 SGA and 26 AGA newborns were enrolled in the study. OADW was compared between SGA and AGA groups. The median Doppler maximums of both eyes in the SGA group were significantly smaller than in the AGA group (maximum average velocity (max A) 6.4cm/s vs. 8.3cm/s, P=0.028; maximum end diastolic velocity (max D) 2.2cm/s vs. 3.4cm/s, P=0.003). The maximums of both eyes for the maximum resistivity index (max RI) and maximum pulsatility index (max PI) in the SGA group were significantly greater than in the AGA group (RI, 0.88 vs. 0.82, P=0.005; PI, 2.23 vs. 1.72, P=0.002). When a multiple linear regression analysis of the SGA group with a stepwise procedure was applied to positive variables from 2-sided comparisons, significant correlations were noted for max A and max PI (max A: R(2)=0.495, ß=0.541, P=0.034; max PI: ß=-3.318, P=0.012). CONCLUSIONS: OADW in SGA newborns may be related to future risk of CVD, which is undetectable in infancy, and can provide information to estimate future cardiovascular health.

Association of abdominal aortic wall thickness in the newborn with maternal factors.

PURPOSE: The goal of the present study is to carry out prospective echocardiographic measurements of intima-media thickness (IMT) in the abdominal artery of newborns. METHODS: Study subjects were 96 mothers and their newborns. We measured the adjusted IMT (aIMT, mm/mm) of newborn abdominal arteries by high-resolution ultrasound and evaluated the association of aIMT with various maternal and newborn factors. RESULTS: Negative correlations were observed between aIMT and gestational age (r = - 0.678, p < 0.01) and positive correlations between aIMT and placenta-to-fetus weight ratio (r = 0.418, p < 0.01). Comparing the small-for-gestational-age (SGA) versus appropriate-for-gestational-age (AGA) categories, aIMT in the SGA (n = 14) was greater than in the AGA (n = 82), with values of [0.115 (0.117) mm/mm versus 0.084 (0.074) mm/mm, p < 0.01], respectively. A multiple linear regression analysis was performed with aIMT as a dependent variable, and significant correlations were noted with gestational age (R2 = 0.524, ß = - 0.515, p < 0.001 for gestational age). CONCLUSION: On the basis of these findings, we suggest that aIMT thickness is associated with placenta-to-fetus weight ratio and gestational age, and that increased values of aIMT in SGA may indicate presence of a latent link to cardiovascular disease that might otherwise go undetected in infancy.