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Eur J Pediatr. 2016 Jun;175(6):825-31. doi: 10.1007/s00431-016-2713-y. Epub 2016 Mar 16.

More than fetal urine: enteral uptake of amniotic fluid as a major predictor for fetal growth during late gestation.

Author information

1
Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany. soyhan.bagci@ukb.uni-bonn.de.
2
Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands.
3
Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
4
Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
5
Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
6
Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
7
Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
8
Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany.
9
Department of Pediatric Surgery, Asklepios Children's Hospital St. Augustin, St. Augustin, Germany.
10
Department of Pediatric Surgery, University Medicine of Mainz, Mainz, Germany.
11
Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany.
12
Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany.
13
Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany.
14
Institute of Human Genetics, University of Bonn, Bonn, Germany.
15
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
16
Department of Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg University, Mainz, Germany.
17
Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
18
Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany.

Abstract

The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = -0.185, p < 0.001).

CONCLUSIONS:

Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation.

WHAT IS KNOWN:

• Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy. • Amniotic fluid (AF) comprises large amounts of hormones and growth regulators. What is New: • A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia. • These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation.

KEYWORDS:

Amniotic fluid; Esophageal atresia; Fetal growth; Fetal nutrition; Small for gestational age

PMID:
26979529
DOI:
10.1007/s00431-016-2713-y
[Indexed for MEDLINE]

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