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

Abstract

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.

Effect of gestational age and postnatal age on the endothelial glycocalyx in neonates

“…More than 20 years ago, it was already suggested that early impairment of vascular structure in fetal life might not be reversible and thus contribute to long term vascular sequelae 43 . In line with this notion, we have been able to show that preterm neonates have a characteristic vascular phenotype with increased vessel density that persists into adolescence 6 , 11 . In support of our previous results, the present study also showed higher vessel densities in preterm neonates compared to term infants.…”

“…Alterations in microvascular architecture and function associated with prematurity may play a role in the development of hypertension 9,10 . In a previous study, we were able to demonstrate that premature neonates exhibit a distinct microvascular phenotype compared to mature neonates that persists throughout the first month of life and even into adolescence 6,11 . Furthermore, several studies reported a disturbed endothelial function-considered a key factor in the development of vascular disease-in low birth weight neonates [12][13][14][15] .…”

Successful treatment of facial port-wine birthmark in a premature infant

“…In an analysis of premature infants (gestational age, 24-34 weeks), a distinct premature microvascular phenotype was characterized through non-invasive in vivo photothermal imaging technology. 8 Compared with healthy age-matched full-term neonates, premature infants have an increased density of proportionately smaller-diameter vessels, resulting in an overall lower cutaneous surface area covered by vessels. Interestingly, this premature vascular phenotype persists, as the infants reach term age, and is not yet organized until 14-17 weeks of age.…”

Monitoring of the microcirculation in children undergoing major abdominal and thoracic surgery: A pilot study

“…Intravital recordings of the sublingual microcirculation were performed using Sidestream Dark Field (SDF) imaging technology as previously described [16,17]. Images were obtained with the Microscan videomicroscope (5x-magnification; Microvision Medical, Amsterdam, Netherlands) by two researchers not involved in patient care.…”