No abstract

Preterm birth increases risk of cardiovascular disease and early death. A body of evidence suggests left ventricle (LV) echocardiographic alterations in children and adults born preterm. We aimed to determine if neonatal characteristics were associated with alterations in LV structure and function in preterm adults. We evaluated a cohort of 86 young adults born preterm below 30 weeks of gestation, and 85 full-term controls. We determined LV dimensions and function using tissue Doppler imaging, conventional and speckle tracking echocardiography (STE). Adults born preterm had smaller LV dimensions, but these differences did not remain after adjustment for body surface area (BSA), which was smaller in the preterm group. Stroke volume and cardiac output were reduced even after adjustment for BSA. We found a smaller e’ wave in the preterm group, but other markers of systolic and diastolic function did not differ. Use of antenatal steroids may be associated with a further reduced cardiac output in those born preterm. Adults born preterm show alterations in markers of LV dimensions and function. Identification of these markers may represent opportunities for early prevention of cardiovascular events in this at-risk population.

The maximal oxygen consumption (VO₂ max) of 68 patients, at a mean of 5.6 years after total correction for tetralogy of Fallot, was lower than that of normal subjects (36.3 ± 7.5 and 43.1 ± 9.0 ml/kg-min). At the time of treadmill evaluation only the female patients were less active in daily life than the normals. Patients having had an elevated right ventricle to pulmonary artery resting systolic pressure gradient, evaluated at a mean of 2.2 years after surgery, had lower VO₂ max than those with lesser residual gradients (34.7 ± 7.2 and 38.7 ± 7.3 ml/kg-min). No significant differences in VO₂ max were found between patients with none or slight versus moderate to severe pulmonary regurgitation as well as between patients with and without a residual left-to-right ventricular shunt.

Background Sodium fluctuations in very preterm neonates and their neurodevelopmental consequences are not well described. Methods We assessed the changes in plasma sodium and glucose in the first days of life in very preterm neonates and studied the association of glucose-corrected plasma sodium fluctuations on neurodevelopmental outcomes. We included 147 consecutive neonates born before 29 weeks of gestation in our center and retrospectively obtained plasma sodium, glucose, and glucose-corrected sodium levels. Neurodevelopmental assessment was obtained from the Canadian Neonatal Follow-Up Network. Results Mean ± standard deviation of plasma sodium changes within the first 10 days of life were 16.2 ± 6.0, 14.8 ± 5.3, and 11.1 ± 5.2 mmol/l in neonates born ≤25, 25–26, and 26–27 weeks of gestation, respectively ( p < 0.001). Non-steroidal anti-inflammatory drug administration was associated with larger plasma sodium fluctuation. Eighty-six percent had a known neurological status at 18 months. Higher fluctuations in glucose-corrected plasma sodium were associated with death or neurodevelopmental impairment at 18 months corrected age ( B = 3.19, 95% CI [1.24, 5.14]), and this association remained after adjustment for gestational age ( B = 2.1, 95% CI [0.16, 4.04]). Conclusions Neonates born very preterm show fluctuations in glucose-corrected plasma sodium during the first days of life, which may increase the risk of death or developmental impairment. Impact Risk factors and neurodevelopmental consequences of plasma sodium changes in early neonatal life of preterm infants are not well characterized. This study shows for the first time that glucose-corrected plasma sodium fluctuations within the first days of life are more severe in preterm infants receiving non-steroidal anti-inflammatory drugs (NSAIDs) and are associated with death or neurodevelopmental impairment at 18 months corrected age. Large plasma sodium and glucose fluctuations should be expected more often in preterm infants receiving NSAIDs and should be avoided.