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Published on: November 20, 2015
The long-term renal and cardiovascular consequences of prematurity
Carolyn L Abitbol1, Maria M Rodriguez
1Division of Pediatric Nephrology, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL 33101, USA. cabitbol@med.miami.edu
Insights
Preterm birth, often resulting in low birth weight (LBW), is linked to lifelong cardiovascular and kidney disease due to interrupted organ development. Early interventions may mitigate these risks.
Area of Science:
- Developmental biology
- Neonatology
- Cardiovascular and Renal Medicine
Background:
- Preterm birth (<37 weeks gestation) is a major cause of low birth weight (LBW), a marker for adult disease.
- LBW infants face higher risks of cardiovascular and renal diseases later in life, linked to 'developmental programming'.
- Distinguishing between intrauterine growth restriction and preterm birth is complex, as both impact nephron endowment and are associated with hypertension and chronic kidney disease.
Purpose of the Study:
- To review the impact of preterm birth on the development of cardiovascular and kidney disease.
- To explore the developmental origins of adult disease in preterm infants.
- To discuss potential early interventions to modify disease progression.
Main Methods:
- Literature review of landmark studies spanning four decades.
- Analysis of developmental associations between preterm birth and organogenesis.
- Examination of the impact on vascular and renal systems development.
Main Results:
- Preterm birth interrupts normal organogenesis, particularly affecting the vascular tree and kidneys.
- Developmental aberrations lead to deficits in organ structure and function.
- These can result in lifelong endothelial dysfunction, hypertension, proteinuria, and metabolic abnormalities.
Conclusions:
- Preterm birth has significant long-term consequences for cardiovascular and renal health.
- Understanding developmental programming is crucial for identifying at-risk individuals.
- Early interventions hold promise for altering the trajectory of adult disease in preterm infants.
Abstract:
Infants born prematurely at <37 weeks' gestation account for over 80% of infants weighing <2,500 g at birth-low birth weight (LBW) infants. This designation remains the surrogate marker for developmental origins of adult disease. Landmark studies spanning four decades have shown that individuals born with a LBW are more likely to develop cardiovascular and renal disease in later life, which is believed to be related to 'developmental programming' of such adult disease during vulnerable periods of growth in utero and in the early postnatal period. There has long been ambiguity regarding the distinction between infants with intrauterine growth restriction and preterm infants since both show a low nephron endowment that is associated with subsequent hypertension and chronic kidney disease. Knowledge is growing specific to the preterm infant and the developmental associations of being born preterm with the interruption of normal organogenesis relative to the vascular tree and kidney. Both systems develop by branching morphogenesis and interruptions lead to considerable deficits in their structure and function. These developmental aberrations can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. This Review will examine the effect of preterm birth on the development of cardiovascular and kidney disease in later life and will also discuss potential early interventions to alter the progression of disease.
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