Supporting preterm cardiovascular function

Lingwood, Barbara E.; Eiby, Yvonne A.; Björkman, S. T.; Miller, Stephanie M.; Wright, Ian

doi:10.1111/1440-1681.13044

Cited by 5 publications

(4 citation statements)

References 54 publications

(75 reference statements)

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“…Although ischemic strokes are extremely rare after aortic coarctation repair in children, other authors claim that they occur more often in older patients with significant arterial hypertension or in the presence of cerebral vascular anomalies (Willis circle anomalies, hypoplastic vertebral arteries) [18,19]. Patients with LBW and prematurity have lower peripheral vascular resistance and are more prone to hypotension due to immaturity of peripheral vasoregulation [20], and, in our opinion, such patients better tolerate manipulations with the aortic arch during the surgery. There is also a significant difference between hospitalisation outcomes between the low-weight and normal-weight groups: LBW patients are less often discharged home and more often transferred to other hospitals, which is attributed to their need for longer hospital stay after surgery in order to ensure weight gain or prolonged ventilatory support.…”

Section: Discussionmentioning

confidence: 99%

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Krylova,

Svobodov,

Tumanyan

et al. 2023

Life

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Introduction: Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. Materials and methods: A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients’ data in both groups. Results: All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (p = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (p < 0.001). In the long-term, period mortality was not statistically significantly different (p = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, p = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316–14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014–1.153)). Conclusions: Hospital mortality was higher among LBW patients (p = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge.

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Section: Discussionmentioning

confidence: 99%

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Krylova,

Svobodov,

Tumanyan

et al. 2023

Life

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“…TRPM7 expression is sexually dimorphic, and this could contribute to poorer outcomes in male preterm infants. Cardiac preload is low in preterm infants due to reduced blood volume and excessive vasodilation ( 26 – 28 ). This low preload state limits the contractile force generated by the heart.…”

Section: Discussionmentioning

confidence: 99%

Expression of TRPM6 and TRPM7 in the preterm piglet heart

et al. 2022

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Preterm infants are at increased risk of death and disability, and cardiovascular instability after birth is a contributing factor. Immaturity of calcium handling in the preterm heart may limit myocardial contractility and cardiac output. Two transmembrane cation channels, TRPM6 and TRPM7, may regulate intracellular cardiac calcium in the neonatal period. The aim of this study was to determine TRPM6 and TRPM7 mRNA expression in piglet hearts in late gestation, and the effects of sex, maternal glucocorticoids, and the transition to extrauterine life. Left and right ventricular tissue was collected at a range of gestational ages from cesarean delivered piglets at birth and at 6 h old. Additional groups included piglets exposed to maternal glucocorticoid treatment and spontaneously born term piglets at 12–24 h old. TRPM6 and TRPM7 mRNA expression was measured using RT-qPCR. Males had significantly lower TRPM7 expression in the left ventricle across all gestational ages compared to females. At term, both ventricles had higher TRPM7 expression at 6 h old than at birth. In preterm piglets, TRPM7 expression only increased postnatally in the right ventricle following maternal glucocorticoid exposure. At 12–24 h old, TRPM7 expression in both ventricles was lower than levels in 6 h old term Caesar piglets (113 days). Male preterm piglets may have immature myocardial Ca2+ handling and this could contribute to their poorer outcomes. Increased TRPM7 expression is the mature response to birth that is missing in preterm neonates. TRPM7 could serve as a novel target to improve cardiac function in preterm neonates.

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“…It is also assumed that late-preterm infants are at higher risk for central apnea because the central nervous system of these infants is immature (8). In addition, it is generally assumed in the cardiovascular system that immature structure and function restricts the rate of cardiovascular reserve available during stress (9). Preterm infants are at greater risk for hypoglycemia during postnatal development due to immature liver gluconeogenesis, immature lipolysis of the adipose tissue, hormonal imbalance, and failure of liver gluconeogenesis and ketogenesis (10).…”

Section: Introductionmentioning

confidence: 99%

An Investigation of Neonatal Mortality and its Main Risk Factors in Hospitalized Late Preterm Infants

Basiri

sadeghian

Pezeshki

et al. 2021

Preprint

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Background: Late preterm infants are born at a gestational age between 34+1 and 36+6 weeks, they have higher morbidity and mortality rates than term infants (gestational age ≥37 weeks). Methods: In this retrospective, cross-sectional study the medical records of late preterm infant hospitalized in Fatemieh hospital, Hamadan- Iran, were extracted during a one-year period (March 2018– March 2019). Demographic information including sex, birth weight, causes of hospitalization and complications of the disease, length of stay, and outcome were assessed. Results: Out of 150 infants studied in this research, 52% were female and 48% were male. Mean weight was 2775±572 gr with mean admission days of 9.1±4.7 days. Respiratory distress syndrome (RDS) was the most common cause of admission (80.7%). Neonatal mortality rate was overall 7.3%. According to logistic regression, need for resuscitation and ventilation, central nervous system (CNS) involvement (seizure) (P≤0.001), congenital heart disease (P≤0.001), need to surfactant administration (P=0.034), pneumonia (P=0.018), feeding problems (P≤0.001), hypoglycemia (P=0.048) and septicemia (P≤0.001), could all possibly correlate with the occurrence of death in late-preterm infants.Conclusion: Neonatal mortality is high in late preterm infants and can be predicted by the need to intensive supports for respiratory distress syndrome, CNS involvement, congenital heart disease, and septicemia.

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Supporting preterm cardiovascular function

Cited by 5 publications

References 54 publications

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Expression of TRPM6 and TRPM7 in the preterm piglet heart

An Investigation of Neonatal Mortality and its Main Risk Factors in Hospitalized Late Preterm Infants

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