RT Journal Article
SR Electronic
T1 In adolescence, extreme prematurity is associated with significant changes in the microvasculature, elevated blood pressure and increased carotid intima–media thickness
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 907
OP 911
DO 10.1136/archdischild-2013-304074
VO 99
IS 10
A1 HaNa Lee
A1 Sabrina Dichtl
A1 Zuzanna Mormanova
A1 Robert Dalla Pozza
A1 Orsolya Genzel-Boroviczeny
YR 2014
UL http://adc.bmj.com/content/99/10/907.abstract
AB Objectives Increased carotid intima–media thickness (cIMT) and loss of capillary density are antecedents of cardiovascular disease in adults. Former preterm infants are at risk for metabolic precursors of vascular disease, but vascular changes have not yet been studied in this population. Patients and methods In 54 former preterm (birth weigh (BW) 753±152 g) and 12 term children (BW 3395±558 g), functional vessel density (FVD) on the forearm and cIMT were obtained at a mean (±SD) age of 11.8±1.5 years. FVD was measured using sidestream dark field imaging before, during and after arterial occlusion, and cIMT using high resolution B-mode ultrasonography. Statistical comparisons were made using the t test, Mann–Whitney U test and the sign test for symmetry, with a two-sided p value as appropriate. Results The systolic blood pressure of the former preterm children was significantly increased compared to reference values (females 119±8, z score 1.23; males 118±11, z score 1.14 mm Hg), as were the cIMT values (0.45±0.03 mm vs 0.38±0.04 mm; p<0.001). FVD was significantly higher in former preterm children compared to controls at baseline (mean±SD 33.6±14.5 cm/cm2 vs 23.0±7.1 cm/cm2; p=0.002) with decreased reactivity during arterial occlusion (χ2 7.14, p=0.008). Conclusions Preterm birth is associated with significant permanent alteration in the microcirculation and increased cIMT and systolic blood pressure. It is unknown whether these changes are due to preterm birth and rapid maturation of the skin or to nutritional factors, as previously thought. This is an important area of future research.