From a Regional Cohort of Extremely Low Birth Weight Infants: Cardiac Function at the Age of 7 Years

Abstract

Background: The long-term impact of prematurity on cardiac structure and function has not yet been fully discovered. Objectives: To assess long-term cardiac complications in the regional cohort of extremely low birth weight (ELBW) children born in 2002-2004. Material and Methods: Eighty-one children born as ELBW infants (91% of the available cohort) with a median birth weight of 890 g (25-75th percentile: 760-950) were evaluated at the mean age of 6.7 years. The control group included 40 children born full-term, selected from one general practice in the district. Echocardiography and 24-hour ambulatory blood pressure measurements (ABPM) were performed. The primary outcome variable was the presence of cardiac complications such as left ventricular hypertrophy (LVH), diastolic dysfunction or systolic dysfunction. Results: LVH was diagnosed in 4/81 ELBW children and 2/40 control children (p = 1.0). Concentric remodeling was detected in 8 (10%) subjects from the ELBW group and in 2 (5%) from the control group (p = 0.49). There were no patients with diastolic or systolic dysfunction in either group. After having expressed the results of M-mode echocardiography as z-scores for body surface area (BSA), statistically significant differences were observed for right-ventricle dimension in diastole (-1.49 ± 1.25 vs. -0.31 ± 0.91; p < 0.001), LV inner dimension in diastole (-0.53 ± 1.26 vs. 0.13 ± 0.94; p = 0.01) and left atrium (-0.93 ± 1.07 vs. -0.15 ± 1.02; p < 0.01). Heart rate (HR) was significantly faster in ELBW children (92.9 ± 8.4 vs. 86.7 ± 7.4 bpm; p = 0.01 adjusted for BSA) and they also had significantly higher night-time blood pressure [mean (z-score): 1.15 vs. 0.2; p = 0.02] without nocturnal dipping (night-time dipping <10%: 13 (16.7%) vs. 2 (5.2%), p = 0.13). Conclusions: No differences were found between the groups in the occurrence of cardiac complications. Ex-preterm ELBW children at age 6 may have a faster HR, smaller cardiac dimensions on echocardiography and higher nocturnal blood pressure. The clinical relevance of these findings is unknown.

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

“…The results of the present study are in line with previous studies demonstrating more globular hearts with impaired longitudinal motion and relaxation in FGR fetuses, 5,19 infants, 20 and children. 3 Our data are also partially in agreement with recent reports in late childhood, 8,21 adolescence, 9 and youth, 10,11 suggesting smaller cardiovascular dimensions and mass with preserved cardiac function (assessed by 2D and Doppler) in FGR. These previous studies on adolescents and young FGR cases did not evaluate ventricular shape.…”

The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

“…Children,7 adolescents,8 and young adults born very preterm4 have previously been reported to exhibit a reduction in cardiac size similar to that in our study (ie, short left ventricles with smaller internal diameters). Adults who were born preterm were also reported to have higher LVM than those born at term 4.…”

“…The higher LVM in adults could be attributed to higher blood pressures in adults who were born preterm than in those born at term,4 whereas blood pressure differences in our cohort were small or nonexistent. Infants,19 children,7 and adolescents8 born preterm have—as in our cohort—been found to exhibit similar or even lower LVM than peers born at term, also in the presence of elevated blood pressure 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20…”

“…Given a relationship between lower gestational age and poorer cardiovascular fitness and health in adults,3, 4, 5, 6 the most vulnerable group would be survivors of extremely preterm birth. Two previous studies of children7 and adolescents8 concluded that no or only minor cardiovascular effects were associated with extremely preterm birth. In contrast, more profound cardiac changes were reported in young adults, including left ventricular (LV) hypertrophy, altered ventricular shape, and reduced systolic and diastolic functions 4.…”

“…children 7 and adolescents 8 concluded that no or only minor cardiovascular effects were associated with extremely preterm birth. In contrast, more profound cardiac changes were reported in young adults, including left ventricular (LV) hypertrophy, altered ventricular shape, and reduced systolic and diastolic functions.…”