Babies may be born appropriately grown for gestational age (AGA, \>10th centile) or small for gestational age (SGA, \<10th centile). Babies who are SGA and have evidence in utero of vascular compromise using antenatal doppler indices are classified as having fetal growth restriction (FGR). Babies with FGR are at increased risk of cardiovascular disease in adult life. Increased arterial stiffness and intima-media thickness are thought to mediate this risk in adults. It is not known how early in life these changes can be robustly detected. In addition, very little is known generally about how babies' hearts and arteries change in structure and function over the first year of life, whether affected by SGA or not. This study aims to understand if there are differences in cardiac and arterial structure and function between babies born AGA or SGA. Within the group of SGA babies, the study team will investigate whether FGR and maternal pre-eclampsia influence these measurements. The effects gestational age on these parameters will be studied within all groups: half of the babies recruited will be \<32 weeks gestational age (GA), and half will be ≥32 weeks GA. Study participants will have further measurements at 3-6 months of life to assess if cardiac and arterial structure and function change in babies over the first year of life. The study team will use the Vicorder device to measure arterial stiffness, and assess the feasibility of using this device in neonates. The Vicorder will also be used to measure cardiac output. The feasibility and validity of this device for this purpose will be investigated (Vicorder is not validated for cardiac output measurement in infants). Vicorder cardiac output results will be compared to echocardiography and bioimpedence technology (using the NICaS monitor). The study team will use ultrasound for arterial structure measurements of the carotid artery and aorta.
Healthy term infants (including those with SGA+/-FGR) in the postnatal ward
Term and Preterm infants (including those with SGA+/-FGR) admitted to the neonatal unit
Written informed parental consent
Antenatal or postnatal diagnosis of complex/life-limiting congenital anomaly or genetic condition
Infants with no realistic chance of survival
Infants with fragile skin not permitting use of cuffs for research purposes
Babies whose parents have a limited understanding of English will be excluded in the event that communication via NHS translation services is not possible due to clinical demands on these services
All term and preterm infants born at the Imperial College Healthcare NHS trust can be included to the study after parental consent.
Cohort
Prospective
Vicorder: pulse wave velocity, pulse wave analysis, stroke volume, cardiac output
DeviceMeasurement of arterial stiffness and cardiac output
NICaS
DeviceMeasurement of cardiac output
Echocardiography and ultrasound of arteries
DeviceMeasurement of cardiac output; measurement of intima-media thickness of arteries
Feasibility of arterial and cardiac function measurements: the proportion of babies from whom study measurements are successfully obtained.
Feasibility of arterial and cardiac function measurements assessed through establishing from what proportion of babies the team is able to successfully obtain these measurements.
Non-invasive measurement of arterial stiffness: brachial-femoral pulse wave velocity
Brachial-femoral pulse wave velocity in metres per second (m/s) will be measured using the Vicorder and compared between neonates of different gestational age and birth weight groups at or near term corrected gestational age, and at 3-6 months of age.
Non-invasive measurement of arterial stiffness: augmentation index
Augmentation index (%) will be measured using the Vicorder and compared between neonates of different gestational age and birth weight groups at or near term corrected gestational age, and at 3-6 months of age.
Arterial structure measurements
The intima-media thickness of the carotid artery and abdominal aorta will be measured in micrometres (µm) using ultrasound at or near term corrected gestational age, and at 3-6 months of age. Gestational age and birth weight groups will be compared at each time point.
Cardiac output measurements: comparison of neonatal and infant birth weight and gestational age cohorts
Cardiac output in L/min and ml/min/kg will be measured using echocardiography, the NICaS monitor and the Vicorder. Values obtained in different gestational age and birth weight groups will be compared at or near term corrected gestational age and at 3-6 months of age.
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