The “brain-sparing” effect and thromboelastometric features of newborns with growth retardation

Background. The phenomenon of «brain-sparing» is usually seen as a protective response to placental insufficiency. However, there are many reasons to consider the protectiveness insufficient, even questionable. For example, due to the high incidence of hemorrhagic complications in newborns. Increased cerebral perfusion may be associated with postnatal functional and structural complications. A deficient intrauterine environment increases the risk of coronary heart disease, hypertension, stroke, and metabolic syndrome.Objective of the study: to investigate an elastometric blood coagulation and fibrinolysis parameters in newborns with intrauterine growth retardation.Materials and methods. 42 children born at 28–34 weeks and 20 full-term babies with spectral dopplerometric blood flow in maternal and fetal vascular pools (uterine, umbilical and middle cerebral arteries) performed within 24–48 hours before birth were divided into three groups. The main group (group I) included 24 newborns in the period of 28-34 weeks with growth retardation. Comparison groups: 18 premature infants of the appropriate term without growth retardation (group II), 20 healthy full-term infants (group III).Blood samples from umbilical arteries were examined by the method of rotational thromboelastometry with the feb-tem® reagent. The parameters of volumetric blood flow in the specified vascular basins were determined by the Doppler ultrasound examination.Results. Synchronous acceleration of blood flow and a moderate decrease in resistance were observed in all the examined basins, except for the middle cerebral artery in fetuses with growth retardation, which fits into the definition of «brain spare». They also showed elastometric signs of increased coagulation ability – increased blood clot density and delayed blood lysis.Conclusions. The appearance of Doppler signs of the middle cerebral artery dilation and slowing of blood flow in its basin should be regarded as an advanced violation of the blood supply. The tendency to increase coagulation and slow fibrinolysis in neonates with growth retardation further complicates their neonatal prognosis. Such newborns require monitoring of the blood coagulation system and fibrinolysis in the early neonatal period.