Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter!

Abstract

Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. The interconnected nature of the cardio-pulmonary system means worsening morbidity and mortality in adults born preterm. Addressing the problems of adults born preterm holistically would help promote cardiovascular health, wellness, and quality of life over their lifetime. Recognizing that adults born preterm are a unique subset of the population is a challenge in the current healthcare environment. Addressing issues relevant to adults born preterm in the clinically and research domain, using technology to characterize cardiopulmonary physiology and exercise tolerance, developing screening tools for early diagnosis and treatment, and robust follow-up of these infants with access to longitudinal data would improve both the quality and longevity of life in adults born preterm.

The QTc-Bazett Interval in Former Very Preterm Infants in Adolescence and Young Adulthood is Not Different from Term-Born Controls

“…In order to exclude a relevant increase in QT/QTc as reliable and feasible, regulatory authorities define a negative ‘thorough QT/QT c study’ as one in which the upper bound of the 95% one-sided CI for the largest time-matched mean effect of the drug on the QT c interval excludes 10 ms. This 10 ms criterion is very reasonable as a clinical target, as also recently suggested [ 3 ]. Thus, our post hoc analysis, using a cut-off of 10 ms—to show non-inferiority of the former preterm-born subjects to controls with regard to QT c-Bazett —is in line with regulatory guidance and excludes this 10 ms cut-off.…”

Acute Kidney Injury in Very Low Birth Weight Infants: A Major Morbidity and Mortality Risk Factor

“…It is reported that children born prematurely have a 3-fold increased risk of chronic kidney disease and a 1.5-fold higher risk of end-stage kidney disease over their life course than children born full term [66]. Moreover, these infants are at increased risk of developing systemic hypertension, type two diabetes, metabolic syndrome, heart failure, and ischemic heart disease in adulthood, all of which have a direct impact on renal function [67]. In addition, it is important to address the high potential for glomerular sclerosis, given the challenges of maladaptive renal repair, ongoing exposure to inflammation, abnormal regeneration, and reduced nephron number [68].…”

Perinatal factors impacting echocardiographic left ventricular measurement in small for gestational age infants: a prospective cohort study

“…Adverse conditions during fetal development can result in permanent changes in the structure and function of organs, including the cardiovascular system, leading to an increased risk of CVD [ 7 ]. Several mechanisms have been proposed to explain the association between SGA and CVD, including impaired angiogenesis and vasculogenesis, altered structure and function of the heart, and changes in the metabolic and endocrine systems [ 8 ]. Many cardiac parameters have been studied over the years using echocardiography (echo) to assess heart function and reveal pathological diseases such as cardiomyopathy [ 9 ].…”