Effects of Pre-Term Birth on the Cardio-Respiratory Responses to Hypoxic Exercise in Children

Narang, Benjamin J; Manferdelli, Giorgio; Kepic, Katja; Sotiridis, Alexandros; Osredkar, Damjan; Bourdillon, Nicolas; Millet, Grégoire P.; Debevec, Tadej

doi:10.3390/life12010079

Cited by 7 publications

(2 citation statements)

References 30 publications

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“…This highlights that cardiovascular rather than diffusive mechanisms at muscle level underlie the reduced exercise capacity reported in the present study as well as by a growing number of other investigations (7-10). Moreover, despite preliminary evidence on animal models (16) and preterm kids (47), the present work is the first to demonstrate a lower sensitivity to the detrimental effects of hypoxia in preterm adults on exercise cardiac hemodynamics compared with their term born peers.…”

Section: Discussioncontrasting

confidence: 58%

Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O2 Transport

Manferdelli

Narang

Bourdillon

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: Premature birth induces long-term sequelae on the cardiopulmonary system, leading to reduced exercise capacity. However, the mechanisms of this functional impairment during incremental exercise remain unclear. Also, a blunted hypoxic ventilatory response was found in preterm adults, suggesting an increased risk for adverse effects of hypoxia in this population. This study aimed to investigate the oxygen cascade during incremental exercise to exhaustion in both normoxia and hypobaric hypoxia in prematurely born adults with normal lung function and their term born counterparts. Methods: Noninvasive measures of gas exchange, cardiac hemodynamics, and both muscle and cerebral oxygenation were continuously performed using metabolic cart, transthoracic impedance, and near-infrared spectroscopy, respectively, during an incremental exercise test to exhaustion performed at sea level and after 3 d of high-altitude exposure in healthy preterm (n = 17; gestational age, 29 ± 1 wk; normal lung function) and term born (n = 17) adults. Results: At peak, power output, oxygen uptake, stroke volume indexed for body surface area, and cardiac output were lower in preterm compared with term born in normoxia (P = 0.042, P = 0.027, P = 0.030, and P = 0.018, respectively) but not in hypoxia, whereas pulmonary ventilation, peripheral oxygen saturation, and muscle and cerebral oxygenation were similar between groups. These later parameters were modified by hypoxia (P < 0.001). Hypoxia increased muscle oxygen extraction at submaximal and maximal intensity in term born (P < 0.05) but not in preterm participants. Hypoxia decreased cerebral oxygen saturation in term born but not in preterm adults at rest and during exercise (P < 0.05). Convective oxygen delivery was decreased by hypoxia in term born (P < 0.001) but not preterm adults, whereas diffusive oxygen transport decreased similarly in both groups (P < 0.001 and P < 0.001, respectively). Conclusions: These results suggest that exercise capacity in preterm is primarily reduced by impaired convective, rather than diffusive, oxygen transport. Moreover, healthy preterm adults may experience blunted hypoxia-induced impairments during maximal exercise compared with their term counterparts.

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Section: Discussioncontrasting

confidence: 58%

Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O2 Transport

Manferdelli

Narang

Bourdillon

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Even though human investigations and animal models on the mechanisms by which premature birth per se leads to increased blood pressure (BP) remain limited, recent work demonstrated impaired vascular structure and function in young adults born preterm with high systolic blood pressure (SBP) in adult life (Lazdam et al., 2010 ). Moreover, increasing evidence demonstrates specific cardiovascular (Barton et al., 2021 ; Goss et al., 2015 ; Narang et al., 2022 ), respiratory (Bates et al., 2014 ; Debevec et al., 2019 , 2022b ; Duke et al., 2014 ; Farrell et al., 2015 ; Narang et al., 2022 ) and molecular (Martin et al., 2018 and 2020 ) responses to both hypoxia and hypercapnia in prematurely born children and young adults. While some authors reported beneficial effects of preterm birth during acute hypoxia exposure (Farrell et al., 2015 ; Goss et al., 2015 ), others suggested exaggerated and/or impaired responses to a reduced oxygen (O 2 ) availability (Barton et al., 2021 ; Bates et al., 2014 ; Debevec et al., 2019 ) or increased CO 2 breathing (Manferdelli et al., 2021 ; Rigatto et al., 1975 ).…”

Section: Introductionmentioning

confidence: 99%

Baroreflex sensitivity is blunted in hypoxia independently of changes in inspired carbon dioxide pressure in prematurely born male adults

Manferdelli,

Narang,

Bourdillon

et al. 2024

Physiological Reports

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Premature birth may result in specific cardiovascular responses to hypoxia and hypercapnia, that might hamper high‐altitude acclimatization. This study investigated the consequences of premature birth on baroreflex sensitivity (BRS) under hypoxic, hypobaric and hypercapnic conditions. Seventeen preterm born males (gestational age, 29 ± 1 weeks), and 17 age‐matched term born adults (40 ± 0 weeks) underwent consecutive 6‐min stages breathing different oxygen and carbon dioxide concentrations at both sea‐level and high‐altitude (3375 m). Continuous blood pressure and ventilatory parameters were recorded in normobaric normoxia (NNx), normobaric normoxic hypercapnia (NNx + CO2), hypobaric hypoxia (HHx), hypobaric normoxia (HNx), hypobaric normoxia hypercapnia (HNx + CO2), and hypobaric hypoxia with end‐tidal CO2 clamped at NNx value (HHx + clamp). BRS was assessed using the sequence method. Across all conditions, BRS was lower in term born compared to preterm (13.0 ± 7.5 vs. 21.2 ± 8.8 ms⋅mmHg−1, main group effect: p < 0.01) participants. BRS was lower in HHx compared to NNx in term born (10.5 ± 4.9 vs. 16.0 ± 6.0 ms⋅mmHg−1, p = 0.05), but not in preterm (27.3 ± 15.7 vs. 17.6 ± 8.3 ms⋅mmHg−1, p = 0.43) participants, leading to a lower BRS in HHx in term born compared to preterm (p < 0.01). In conclusion, this study reports a blunted response of BRS during acute high‐altitude exposure without any influence of changes in inspired CO2 in healthy prematurely born adults.

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Influence of Preterm Birth and Low Birthweight on Physical Fitness: A Systematic Review, Meta-Analysis, and Meta-Regression

Martínez-Zamora,

Martín-Martínez,

Martínez-de-Quel

et al. 2024

Sports Med

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Background Preterm birth and low birthweight (LBW) might be associated with reduced physical fitness, although evidence remains inconclusive. Objective To examine the influence of preterm birth and LBW on physical fitness, as well as to assess whether variables such as gestational age, birthweight, or age at assessment moderate these effects. Methods PubMed, Scopus, and PsycINFO were systematically searched from inception to 7 December 2023 for case–control and cohort studies analyzing the association between preterm birth or LBW (or gestational age or birthweight as continuous variables) with at least one physical fitness-related outcome (i.e., cardiorespiratory fitness (CRF), muscle strength, flexibility, speed, agility). Random-effects meta-analysis and meta-regression models were used to estimate the pooled effect size, as well as to examine potential associations between the magnitude of the effect and gestational age, birthweight, or age at assessment. Results Fifty-two studies (n = 920,603 participants, average age ranging from 4.7 to 34.4 years) were included. Preterm birth was associated with reduced CRF (standardized mean difference (SMD) = −0.38, 95% confidence interval (CI) = −0.51 to −0.25) and muscle strength (SMD = −0.44, 95% CI = −0.79 to −0.08). LBW was associated with reduced CRF (SMD = −0.40, 95% CI = −0.64 to −0.17), muscle strength (SMD = −0.18, 95% CI = −0.24 to −0.13), flexibility (SMD = −0.11, 95% CI = −0.22 to −0.01), and agility (SMD = −0.99, 95% CI = −1.91 to −0.07). Meta-regression analyses showed that a lower gestational age or birthweight were associated with larger reductions in physical fitness, whereas no consistent association was found for the age at assessment. Conclusion Both preterm birth and LBW seem associated with reduced physical fitness regardless of age, with larger reductions overall observed in individuals with lower gestational age or birthweight. These findings might support the implementation of preventive strategies (e.g., fitness monitoring and physical exercise interventions) in these populations through the life course. PROSPERO registration: CRD42021231845. Graphical Abstract

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Effects of Pre-Term Birth on the Cardio-Respiratory Responses to Hypoxic Exercise in Children

Cited by 7 publications

References 30 publications

Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O2 Transport

Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O2 Transport

Baroreflex sensitivity is blunted in hypoxia independently of changes in inspired carbon dioxide pressure in prematurely born male adults

Influence of Preterm Birth and Low Birthweight on Physical Fitness: A Systematic Review, Meta-Analysis, and Meta-Regression

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