Postnatal nutritional intakes and hyperglycemia as determinants of blood pressure at 6.5 years of age in children born extremely preterm

Abstract

BackgroundAdverse developmental programming by early-life exposures might account for higher blood pressure (BP) in children born extremely preterm. We assessed associations between nutrition, growth and hyperglycemia early in infancy, and BP at 6.5 years of age in children born extremely preterm.MethodsData regarding perinatal exposures including nutrition, growth and glycemia status were collected from the Extremely Preterm Infants in Sweden Study (EXPRESS), a population-based cohort including infants born <27 gestational weeks during 2004–2007. BP measurements were performed at 6.5 years of age in a sub-cohort of 171 children (35% of the surviving children).ResultsHigher mean daily protein intake (+1 g/kg/day) during postnatal weeks 1–8 was associated with 0.40 (±0.18) SD higher diastolic BP. Higher mean daily carbohydrate intake (+1 g/kg/day) during the same period was associated with 0.18 (±0.05) and 0.14 (±0.04) SD higher systolic and diastolic BP, respectively. No associations were found between infant growth (weight, length) and later BP. Hyperglycemia and its duration during postnatal weeks 1–4 were associated primarily with higher diastolic BP z-scores.ConclusionsThese findings emphasize the importance of modifiable early-life exposures, such as nutrition and hyperglycemia, in determining long-term outcomes in children born extremely preterm.

Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

“…In a previous study of the EXPRESS cohort, increased intakes of carbohydrates and hyperglycemia during the neonatal period were significantly and independently associated with higher systolic and diastolic blood pressures at 6.5 years of age [14]. In the present study, total and parenteral carbohydrate intakes were linked to smaller aortic annulus of the LV outflow tract, and hyperglycemia in the neonatal period was associated with increased LV wall thickness at a 6-year follow-up.…”

“…Undernutrition and nutritional imbalances may have long term consequences. Both neonatal hyperglycemia and higher carbohydrate intake during the first eight postnatal weeks were associated with increased blood pressure at 6.5 years of age in children born extremely preterm [14]. Lewandowski et al reported that breast-milk consumption in preterm-born neonates was associated with increased ventricular end-diastolic volume index and stroke volume index later in young adulthood [15].…”

Real-time continuous glucose monitoring in preterm infants (REACT): an international, open-label, randomised controlled trial

“…9 The reduction in hyperglycaemia, which has been associated with increased risk of multiple neonatal morbidities as well as poor growth, also has the potential to improve childhood outcomes in the longterm. 28 Clinical management in the intervention group was based on the ability to be guided by trends in glucose concentrations shown by the realtime CGM data and did not require blood glucose concentrations to be checked before altering treatment. However, the advice on checking blood glucose concentrations when there was a rapid change in CGM values or if CGM values fell to less than 4 mmol/L was key to ensuring a safe decision system and resulted in unanticipated hypoglycaemia being detected.…”

“… 9 The reduction in hyperglycaemia, which has been associated with increased risk of multiple neonatal morbidities as well as poor growth, also has the potential to improve childhood outcomes in the long-term. 28 …”

Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

“…Inclusion and exclusion criteria for EXPT, perinatal characteristics, data on survival, neonatal morbidity, neurodevelopmental outcomes at 30 months and 6.5 years-of-age, as well as details on lung function, vascular assessments and left ventricular functions in childhood have previously been reported [ 2 , 3 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Twelve EXPT children were excluded due to congenital heart malformations, and CTRL children were only invited if they had a history of a normal neonatal period without any diagnoses of congenital malformations or ongoing cardiovascular or pulmonary disease.…”