Adaptation of the Cutaneous Microcirculation in Preterm Neonates

Elteren, Hugo A. van; Jonge, Rogier C. J. de; Rosmalen, Joost van; İnce, Can

doi:10.1111/micc.12295

Cited by 10 publications

(20 citation statements)

References 39 publications

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“…In the postnatal follow-up of preterm infants, FVD decreased significantly over time after adjusting for additional clinical parameters. This is consistent with the study by van Elteren and colleagues who report a significant reduction in FVD in preterm infants over the first postnatal month of life (29). Still, FVD remained higher in preterm children even after 1 month compared to term children at birth (29).…”

Section: Discussionsupporting

confidence: 93%

“…We found significantly higher FVD in our preterm infants than in term infants with a trend for higher FVD values in lower gestational age neonates. These results are congruent with previous studies, showing that preterm infants have a higher FVD than term infants (15, 29). In the postnatal follow-up of preterm infants, FVD decreased significantly over time after adjusting for additional clinical parameters.…”

Section: Discussionsupporting

confidence: 93%

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Effects of Prematurity on the Cutaneous Microcirculatory Network in the First Weeks of Life

Puchwein-Schwepcke

Genzel‐Boroviczény

et al. 2019

Front. Pediatr.

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Background: Preterm infants are at increased risk for hypertension in adolescence. Microcirculatory dysfunction has been identified as an underlying cause for cardiovascular disease. Our goal was to document the development of the cutaneous microcirculation in preterm infants during the first weeks of life and to compare it to the situation in term infants at birth. Methods: In 20 preterm infants, microcirculatory parameters were obtained prospectively by Sidestream Dark Field (SDF) Imaging at the upper inner arm once a week until discharge or 37 weeks of gestational age. A single microcirculatory measurement was obtained in 30 term infants during the first 3 days of life. Videos were blinded and analyzed with the AVA software. Results: Microcirculatory parameters in preterm infants differ significantly from term infants with a lower vessel surface (VS), a lower percentage of large and medium but higher percentage of small vessels, a higher Functional Vessel Density (FVD), and a higher Microcirculatory Flow Index (MFI). In multivariable linear regression models we could demonstrate a statistically significant association between the dependent microcirculatory variables (VS, diameter distribution, MFI) and gestational age as independent predictor variable while adjusting for postnatal days of life. Looking at the longitudinal follow-up data of preterm infants by means of a multivariable mixed-effects linear regression model adjusting for clinical variables, there is a significant decrease in FVD with increasing postnatal age, however no other significant changes in microcirculatory parameters over time. Accordingly, comparing the microcirculatory parameters of near term former preterm infants with term born neonates, we could still find significant differences with a higher FVD, lower VS and differences in vessel diameters in the former premature group. Conclusion: Infants born prematurely exhibit distinct microcirculatory alterations compared to term neonates with gestational age at birth being associated with microvascular parameters. Interestingly, this premature vascular phenotype persists even close to corrected term age. In view of the known increased cardiovascular risk of former preterm infants, our observations might have important clinical impact. The factors governing the development of the microvascular network in preterm infants and the contribution of microcirculatory changes observed here to vascular pathology in later life need to be further investigated.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Effects of Prematurity on the Cutaneous Microcirculatory Network in the First Weeks of Life

Puchwein-Schwepcke

Genzel‐Boroviczény

et al. 2019

Front. Pediatr.

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“…However, they did not observe any significant change in BP, but observed a negative correlation between FSVD and systolic BP [24]. Similarly van Elteren et al [25] measured total vascular density (TVD) using incident dark field technology in 60 preterm infants born less than 32 weeks and 33 term infants during the first month of life. Similar to us, they found that TVD was higher in preterm infants at birth and that there was a progressive decline in TVD from birth to 28 days in preterm infants.…”

Section: Discussionmentioning

confidence: 98%

Oxygen therapy in premature low birth weight infants is associated with capillary loss and increases in blood pressure: a pilot study

et al. 2019

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Low birth weight (LBW) and premature birth are known risk factors for future cardiovascular disease and in particular essential hypertension (EH). Capillary rarefaction (CR) is an established hallmark of EH and is known to occur in individuals with a history of LBW. We previously reported that LBW infants do not have CR at birth but rather increased capillary density (CD). We hypothesized that LBW infants undergo a process of accelerated CR in early life, triggered in part by oxygen therapy. We studied 26 LBW infants, of whom 10 infants received oxygen therapy, and compared them to 14 normal birth weight (NBW) infants. We measured CD at 1, 5 and 10 days after birth and again after 40 weeks adjusted gestational age equivalent to birth at full term. We confirmed that LBW infants had higher CD at birth compared to NBW infants and found that significant structural CR occurred at term age in LBW infants who had received oxygen therapy (mean difference −22 capillaries/field, p = 0.007) and in those who did not receive oxygen therapy (mean difference −29 capillaries/field, p < 0.001) compared to baseline at birth. Both LBW groups showed a significant rise in BP at 40 weeks adjusted term age and the rise in systolic (mean difference 24 mm Hg, p < 0.0001) and diastolic BP (mean difference 14 mm Hg, p < 0.001) was more pronounced in the oxygen treated group compared to the nonoxygen group (mean difference 14 mm Hg, p = 0.043 and mean difference = 9 mm Hg p = 0.056 respectively). In conclusion, oxygen therapy in premature LBW infants may induce significant increases in their BP in early life.

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“…Therefore, our new findings provide an explanation for the results of Goh et al 26 ; as we too found no difference between NBW and LBW infants at 3 months and suggest that LBW infants, having undergone an accelerated capillary remodeling, bring their CD to a level equivalent to that of NBW infants. van Elteren et al 27 studied the microcirculation in infants and found that both preterm (<32 weeks’ gestation) and term neonates undergo a significant reduction in their total vessel density (TVD) in the 1st month of life and that preterm infants have a consistently higher TVD than term infants. 27 The authors suggested that this is an adaptation of the cutaneous microcirculation at birth and that differences in antenatal oxygen exposure may explain differences in the way the microcirculation develops in the early postnatal period.…”

Section: Discussionmentioning

confidence: 99%

“…van Elteren et al 27 studied the microcirculation in infants and found that both preterm (<32 weeks’ gestation) and term neonates undergo a significant reduction in their total vessel density (TVD) in the 1st month of life and that preterm infants have a consistently higher TVD than term infants. 27 The authors suggested that this is an adaptation of the cutaneous microcirculation at birth and that differences in antenatal oxygen exposure may explain differences in the way the microcirculation develops in the early postnatal period. However, when we investigated the effects of oxygen therapy on CD and BP in LBW infants in a recent study, we found that oxygen therapy was associated with higher BP levels at 40 weeks postnatally, but had no effect on CR.…”

Section: Discussionmentioning

confidence: 99%

Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study

Goloba

Raghuraman

Botros

et al. 2019

American Journal of Hypertension

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BACKGROUND Capillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life. METHODS We studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months. RESULTS We found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD. CONCLUSIONS This study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.

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Adaptation of the Cutaneous Microcirculation in Preterm Neonates

Abstract: TVD decreases in the first month after birth and is higher in preterm infants compared to those born term. Differences in antenatal oxygen exposure might explain the adaptation of the microcirculation.

Cited by 10 publications

References 39 publications

Effects of Prematurity on the Cutaneous Microcirculatory Network in the First Weeks of Life

Effects of Prematurity on the Cutaneous Microcirculatory Network in the First Weeks of Life

Oxygen therapy in premature low birth weight infants is associated with capillary loss and increases in blood pressure: a pilot study

Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study

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