Cardiovascular status in newborns with cerebral ischaemia born to mothers who experienced a mild asthma exacerbation associated with cytomegalovirus reactivation during pregnancy

Introduction. An exacerbation of mild asthma caused by reactivation of chronic cytomegalovirus (CMV) infection during pregnancy is frequently accompanied by cerebral and cardiac pathology in the offspring. Because perinatal brain injury adversely affects myocardial electrical stability, it is important to assess cardiac function in newborns with different severities of cerebral ischaemia whose mothers underwent a mild asthma exacerbation in the acute phase of chronic CMV infection during the second trimester.
Aim. To evaluate the cardiovascular system in newborns with cerebral ischaemia born to mothers who experienced a mild asthma exacerbation associated with chronic CMV reactivation during pregnancy.
Materials and methods. Apgar scores and electrocardiographic parameters were analysed in 41 newborns of mothers with uncomplicated pregnancies (control group) and in 61 newborns with cerebral ischaemia and an antenatal history complicated by a mild asthma exacerbation triggered by CMV reactivation in the mother during the second trimester (main group). The main group was divided into a first subgroup of 36 infants with grade I cerebral ischaemia and a second subgroup of 25 infants with grade II cerebral ischaemia.
Results. Compared with controls, infants in the first subgroup had lower Apgar scores at 1 min and 5 min (both p < 0.001) and lower birth weight (p < 0.01). They more often presented with skin pallor (χ2 = 6.95; p < 0.01), perioral cyanosis (χ2 = 6.77; p < 0.01), acrocyanosis (χ2 = 5.12; p < 0.05), muffled heart sounds (χ2 = 4.04; p < 0.05), systolic murmur (χ2 = 5.48; p < 0.05), tachycardia (χ2 = 7.60; p < 0.01), incomplete right bundle-branch block (χ2 = 9.50; p < 0.01), moderate (χ2 = 13.3; p < 0.001) and marked metabolic disturbances in the myocardium (χ2 = 5.99; p < 0.05). Compared with both the control group and the first subgroup, infants in the second subgroup had even lower Apgar scores at 1 min and 5 min (both p < 0.001) and lower birth weight (p < 0.01 and p < 0.001, respectively). Relative to the first subgroup, they more frequently exhibited skin pallor (χ2 = 4.31; p < 0.05), dyspnoea (χ2 = 4.21; p < 0.05), muffled heart sounds (χ2 = 5.07; p < 0.05), hepatomegaly (χ2 = 5.50; p < 0.05), bradycardia (χ2 = 4.21; p < 0.05), sinus arrhythmia (χ2 = 4.60; p < 0.05), marked metabolic myocardial disturbances (χ2 = 5.07; p < 0.05) and increased right-atrial load (χ2 = 10.9; p < 0.001).
Conclusion. In newborns whose mothers experienced a mild asthma exacerbation associated with chronic CMV reactivation during the second trimester, grade II cerebral ischaemia is accompanied by more frequent clinical and electrocardiographic abnormalities than grade I. These findings suggest that antenatal hypoxia adversely affects peripheral circulation, contributing to cardiovascular maladaptation in the early neonatal period.

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