Doppler abnormality predisposes preterm infants with fetal growth restriction to postnatal intestinal disorder

Intestinal disorders (ID) impose a significant burden on preterm infants. Although previous studies have examined individual risk factors for types of ID such as necrotizing enterocolitis (NEC), meconium-related ileus (MRI), and focal intestinal perforation (FIP), the overarching etiology of ID as a whole remains underexplored. Therefore, this study aimed to identify obstetric risk factors for ID. We retrospectively investigated singletons without congenital anomalies born between 22 weeks 0 days and 28 weeks 6 days of gestation between January 2013 and December 2022. We compared the frequencies of obstetric factors between patients with ID (ID group) and those without (non-ID group). The obstetric risk factors were maternal background, complications, fetal growth restriction (FGR), chorioamnionitis, Apgar score, and umbilical artery blood gas. A total of 119 preterm infants were investigated. Of these, 22 (18.5%) had ID, including 14 MRI, 4 FIP, and 5 NEC cases. A total of 33 infants (27.7%) had FGR, which was more common in the ID group (10/22, 45.5% vs. 23/97, 23.7%, p = 0.047). Among patients with FGR, the median time from the onset of Doppler abnormalities in the umbilical artery, middle cerebral artery, or ductus venosus to delivery was significantly longer in patients with ID than in those without (180 h vs. 24 h, p = 0.049). FGR was potentially associated with ID in preterm infants. To our knowledge, this is the first study to highlight the impact of prolonged Doppler abnormalities on ID development. These findings suggest that a chronically stressful intrauterine environment may increase postnatal intestinal vulnerability.