The effect of intraumbilical fetal nutrition via subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses

Objective: To determine if intrauterine intraumbilical supplementation with amino acids (AA) and glucose can improve neonatal outcome of severe growth restricted human fetuses (IUGR). Methods: Prospective pilot study of intrauterine treatment of severe IUGR fetuses (26.6 ± 3.3 week of gestation) with cerebroplacental ratio < 1 with long-term intraumbilical AA and glucose supplementation (10% of feto-placental blood volume/day) using perinatal port system (n = 6) and hyperbaric oxygenation (HBO). Results: Daily intravascular fetal nutrition prolonged the brain sparing to delivery interval by 23.3 ± 6.7 days vs. 5.3 ± 4 days in controls. Long-term substitution with a commercial AA formula caused a reduction in some non-essential and also essential AAs, like lysine and threonine. In fetuses > 28 week of gestation the mean weight gain remained under the 3 rd percentile in parallel to that until delivery. The HBO can be combined with AA supplementation via a port system. Conclusion: Intravascular treatment of IUGR with fetal nutrition and HBO can prolong pregnancy with severe placental insufficiency and brain sparing for many weeks. Commercial AA solutions cannot be safely recommended for the prenatal supplementation of extreme preterm IUGR fetuses because of extreme deviations of the given AA proportions to physiologic fetal conditions.