Adult Cardiovascular Health Risk and Cardiovascular Phenotypes of Prematurity

Bates, Melissa L.; Levy, Paul C.; Nuyt, Anne Monique; Goss, Kara N.; Lewandowski, Adam J.; McNamara, Patrick J.

doi:10.1016/j.jpeds.2020.09.019

Cited by 22 publications

(21 citation statements)

References 131 publications

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“… 7 Long-term cardiovascular consequences following preterm birth, including heart failure, ischemic heart disease, poor exercise tolerance, hypertension, cardiometabolic disease, and persistent PVD, 1 may be associated with the cardiovascular phenotypes that develop over the first year of age in individuals born preterm. 7 A meta-analysis found that individuals born preterm have persistently smaller ventricular dimensions, lower LV diastolic function that worsens with age, RV systolic impairment across all developmental stages, and an accelerated rate of LV hypertrophy from childhood to adulthood. 24 These collective observations have prompted a renewed interest in discerning potential interventions aimed at lessening or reversing those cardiovascular changes.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk

et al. 2021

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IMPORTANCE There is a beneficial association between human breast milk exposure in the neonatal period and cardiac mechanics in adults who were born preterm. It is unknown whether this benefit is apparent in infants in the first year of age.OBJECTIVE To test the hypothesis that higher consumption of mother's own milk in preterm infants is associated with enhanced cardiac performance during the first year of age. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study of cardiac and nutritional data at an academic medical center included 80 individuals born preterm and 100 individuals in the control group born full-term. All births were between 2011 and 2013. Two-dimensional echocardiograms were performed at 32 weeks' and 36 weeks' postmenstrual age and at 1 year's corrected age in individuals born preterm and at 1 month and 1 year of age in individuals born fullterm. Statistical analysis was performed from January to May 2021. EXPOSURES Consumption of mother's own milk. MAIN OUTCOMES AND MEASURESMain study outcomes included echocardiography measures of right and left ventricle longitudinal strain (function), left ventricle mass index and right ventricular areas (morphology), and pulmonary vascular resistance (pulmonary hemodynamics) at age 1 year. RESULTSOf 180 infants included in the study, 97 (54%) were Black infants and 89 (49%) were female infants. Among the 80 infants born in the preterm cohort, 43 (54%) were female infants and 43 (54%) were Black infants. The median gestational age at birth of the preterm infants was 27.0 weeks (interquartile range, 26.0-28.0 weeks) and the median birth weight was 960 g (interquartile range, 800-1138). For each week of exposure to mother's own milk, preterm infants had greater magnitudes of right ventricular strain (eg,

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Section: Discussionmentioning

confidence: 99%

Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk

et al. 2021

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“…Survivors of prematurity in an era when generous oxygen use was the standard practice, had increased aortic stiffness [ 34 ]. The use of postnatal steroids for hemodynamic support or lung rehabilitation can improve the survival of preterm infants, but their impact on fetal, neonatal, and long-term cardiovascular development is unclear [ 35 ]. When given in utero, endogenous glucocorticoids promote morphological remodeling in fetal cardiomyocytes with cardiomyocyte proliferation dictating the morphological development of the heart.…”

Section: Discussionmentioning

confidence: 99%

Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction

Stanford

Reyes

Rios

et al. 2021

JCM

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Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.

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“…Furthermore, several international studies associate low birthweight with other diseases such as systemic hypertension, 13,14 Type 2 diabetes mellitus and hyperlipidemia, 15–17 independent of classic risk factors such as diet, smoking, and exercise. Bates and colleagues nicely review work by several authors who describe the influence of preterm birth on cardiovascular development in relation to growth restriction as myocardial dysfunction, arterial remodeling, and impaired endothelial function 18 . Clinically, infants show evidence of hypertrophied intraventricular septum, left ventricular dilatation, and low myocardial reserve that persists into adulthood 19–21 .…”

Section: Fetal Origins Of Bpd and Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular impact and sequelae of bronchopulmonary dysplasia

Yallapragada

Savani

Goss

2021

Pediatric Pulmonology

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The development, growth, and function of the cardiac, pulmonary, and vascular systems are closely intertwined during both fetal and postnatal life. In utero, placental, environmental, and genetic insults may contribute to abnormal pulmonary alveolarization and vascularization that increase susceptibility to the development of bronchopulmonary dysplasia (BPD) in preterm infants. However, the shared milieu of stressors may also contribute to abnormal cardiac or vascular development in the fetus and neonate, leading to the potential for cardiovascular dysfunction. Further, cardiac or pulmonary maladaptation can potentiate dysfunction in the other organ, amplify the risk for BPD in the neonate, and increase the trajectory for overall neonatal morbidity. Beyond infancy, there is an increased risk for systemic and pulmonary vascular disease including hypertension, as well as potential cardiac dysfunction, particularly within the right ventricle. This review will focus on the cardiovascular antecedents of BPD in the fetus, cardiovascular consequences of preterm birth in the neonate including associations with BPD, and cardiovascular impact of prematurity and BPD throughout the lifespan.

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Adult Cardiovascular Health Risk and Cardiovascular Phenotypes of Prematurity

Cited by 22 publications

References 131 publications

Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk

Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk

Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction

Cardiovascular impact and sequelae of bronchopulmonary dysplasia

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