The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

Mohlkert, Lilly-Ann; Hallberg, Jenny; Broberg, Olof; Rydberg, Annika; Halvorsen, Cecilia Pegelow; Liuba, Petru; Fellman, Vineta; Domellöf, Magnus; Sjöberg, Gunnar; Norman, Mikael

doi:10.1161/jaha.117.007742

Cited by 55 publications

(75 citation statements)

References 34 publications

(84 reference statements)

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“…Children born prior to a gestational age of 37 weeks (premature), have an altered myocardium compared to term-born children (5)(6)(7)21). These alterations, as described in echocardiographic and magnetic resonance imaging studies, are present even long after the neonatal period (6)(7)(8)(9)(10)21). Preterm birth (prior to 32 gestational weeks), as well an extremely preterm birth (prior to 28 gestational weeks), was more common among children with an early closure before 2 years of age, as well as for closure before 1 year of age.…”

Section: Premature Birthmentioning

confidence: 99%

“…The myocardium of the preterm child has irreversible morphological and global structural alterations (5)(6)(7)(8). Even long after the neonatal period and into adulthood, the morphology of both the ventricles as well as the function is impaired or altered (6)(7)(8)(9)(10). Being born prematurely, prior to 37 gestational weeks, accounts for 6% of all newborns in Sweden (11).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Tanghöj

Liuba

Sjöberg

et al. 2020

Front. Cardiovasc. Med.

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An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. "Cases" were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5-3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8-6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6-12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7-4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.

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Section: Premature Birthmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Tanghöj

Liuba

Sjöberg

et al. 2020

Front. Cardiovasc. Med.

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“…6,7 Inclusion and exclusion criteria, perinatal characteristics and outcome, and characteristics of the systemic circulation and lung function in childhood have been reported previously. 4,[8][9][10] Children taking part in the EXPRESS study in Lund, Stockholm, and Umeå regions (n = 250; 51% of the national cohort) were invited to a comprehensive followup study of somatic health at the age of 6.5 ± 3 months. In total, 176/250 (70%) children born extremely preterm accepted to be assessed with lung function and echocardiography.…”

Section: Participantsmentioning

confidence: 99%

“…The full assessment protocol and the echocardiography equipment used have been reported previously. 10 A complete echocardiographic assessment was performed to exclude structural heart defects. All analyses were performed offline by two operators blinded to lung function of the participants.…”

Section: Echocardiographymentioning

confidence: 99%

Lung function and pulmonary vascular resistance are not associated in 6‐year‐old children born extremely preterm

et al. 2019

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Aim Children born preterm are at increased risk of reduced lung function. The aim was to test whether lung function was associated with pulmonary vascular resistance. Methods Participants were recruited from a population‐based cohort born in 2004‐2007. Lung function was assessed with spirometry after administration of a beta2‐agonist. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined. Estimations of pulmonary vascular resistance, arterial dimensions, right ventricular wall thickness, sphericity, and systolic (TAPSE) and diastolic functions were performed with echocardiography. Adjusted regression analyses were used to study associations. Results Sixty‐six children (33 boys) born at 22‐26 weeks of gestational age (birthweights 460‐1134 g) were assessed at a mean age of 6.7 years. Despite large variations in lung function with FVC z‐scores ranging from −4.6 to +2.8, there were no associations between lung function and pulmonary arterial pressure, right ventricular structure or function. Children with higher FVC z‐scores (r = .52, β = .55 mm, P = .015) and higher FEV1 z‐scores (r = .58, β = .73 mm, P = .001) exhibited larger pulmonary arteries. Conclusion In children born extremely preterm, lung function was not associated with pulmonary vascular resistance. Routine echocardiographic evaluation of extremely preterm children may not be indicated at age 6.5 years.

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“…However, in the very and extremely preterm infant, the reduction in cardiomyocyte number may be too great for this compensatory mechanism to normalise heart size: left ventricular mass is reduced in adults born extremely preterm ( Kowalski et al . 2016 ) and in children born very preterm ( Mohlkert et al . 2018 ).…”

Section: The Heart In Preterm Infantsmentioning

confidence: 99%

Glucocorticoids, antenatal corticosteroid therapy and fetal heart maturation

Agnew

Ivy

Stock

et al. 2018

Journal of Molecular Endocrinology

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Glucocorticoids are essential in mammals to mature fetal organs and tissues in order to survive after birth. Hence, antenatal glucocorticoid treatment (termed antenatal corticosteroid therapy) can be life-saving in preterm babies and is commonly used in women at risk of preterm birth. While the effects of glucocorticoids on lung maturation have been well described, the effects on the fetal heart remain less clear. Experiments in mice have shown that endogenous glucocorticoid action is required to mature the fetal heart. However, whether the potent synthetic glucocorticoids used in antenatal corticosteroid therapy have similar maturational effects on the fetal heart is less clear. Moreover, antenatal corticosteroid therapy may increase the risk of cardiovascular disease in adulthood. Here, we present a narrative review of the evidence relating to the effects of antenatal glucocorticoid action on the fetal heart and discuss the implications for antenatal corticosteroid therapy.

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The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

Cited by 55 publications

References 34 publications

Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Lung function and pulmonary vascular resistance are not associated in 6‐year‐old children born extremely preterm

Glucocorticoids, antenatal corticosteroid therapy and fetal heart maturation

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