OBJECTIVES: Increased carotid intima-media thickness (cIMT) and loss of capillary density are antecedents of cardiovascular disease in adults. Former preterm infants are at risk for metabolic precursors of vascular disease, but vascular changes have not yet been studied in this population. PATIENTS AND METHODS: In 54 former preterm (birth weigh (BW) 753±152 g) and 12 term children (BW 3395±558 g), functional vessel density (FVD) on the forearm and cIMT were obtained at a mean (±SD) age of 11.8±1.5 years. FVD was measured using sidestream dark field imaging before, during and after arterial occlusion, and cIMT using high resolution B-mode ultrasonography. Statistical comparisons were made using the t test, Mann-Whitney U test and the sign test for symmetry, with a two-sided p value as appropriate. RESULTS: The systolic blood pressure of the former preterm children was significantly increased compared to reference values (females 119±8, z score 1.23; males 118±11, z score 1.14 mm Hg), as were the cIMT values (0.45±0.03 mm vs 0.38±0.04 mm; p<0.001). FVD was significantly higher in former preterm children compared to controls at baseline (mean±SD 33.6±14.5 cm/cm(2) vs 23.0±7.1 cm/cm(2); p=0.002) with decreased reactivity during arterial occlusion (χ(2) 7.14, p=0.008). CONCLUSIONS: Preterm birth is associated with significant permanent alteration in the microcirculation and increased cIMT and systolic blood pressure. It is unknown whether these changes are due to preterm birth and rapid maturation of the skin or to nutritional factors, as previously thought. This is an important area of future research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: Increased carotid intima-media thickness (cIMT) and loss of capillary density are antecedents of cardiovascular disease in adults. Former preterm infants are at risk for metabolic precursors of vascular disease, but vascular changes have not yet been studied in this population. PATIENTS AND METHODS: In 54 former preterm (birth weigh (BW) 753±152 g) and 12 term children (BW 3395±558 g), functional vessel density (FVD) on the forearm and cIMT were obtained at a mean (±SD) age of 11.8±1.5 years. FVD was measured using sidestream dark field imaging before, during and after arterial occlusion, and cIMT using high resolution B-mode ultrasonography. Statistical comparisons were made using the t test, Mann-Whitney U test and the sign test for symmetry, with a two-sided p value as appropriate. RESULTS: The systolic blood pressure of the former preterm children was significantly increased compared to reference values (females 119±8, z score 1.23; males 118±11, z score 1.14 mm Hg), as were the cIMT values (0.45±0.03 mm vs 0.38±0.04 mm; p<0.001). FVD was significantly higher in former preterm children compared to controls at baseline (mean±SD 33.6±14.5 cm/cm(2) vs 23.0±7.1 cm/cm(2); p=0.002) with decreased reactivity during arterial occlusion (χ(2) 7.14, p=0.008). CONCLUSIONS:Preterm birth is associated with significant permanent alteration in the microcirculation and increased cIMT and systolic blood pressure. It is unknown whether these changes are due to preterm birth and rapid maturation of the skin or to nutritional factors, as previously thought. This is an important area of future research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Jay D Pruetz; Sheree M Schrager; Tiffany V Wang; Arlyn Llanes; Ramen H Chmait; Douglas L Vanderbilt Journal: Am J Obstet Gynecol Date: 2015-05-21 Impact factor: 8.661