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Long term cardiovascular consequences of chronic lung disease of prematurity
Chuen Yeow Poon1, Martin Oliver Edwards, Sailesh Kotecha
1Department of Child Health, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK.
Insights
Preterm infants with chronic lung disease (CLD) may develop pulmonary hypertension and long-term systemic blood pressure issues. Their pulmonary vasculature remains sensitive to hypoxia into early childhood.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Pulmonary Medicine
Background:
- Chronic lung disease of prematurity (CLD) is linked to pulmonary arterial (PA) hypertension in infants.
- Impaired alveolar development and angiogenesis contribute to PA hypertension in CLD.
- Children with CLD exhibit persistent pulmonary vascular hyper-reactivity to hypoxia.
Purpose of the Study:
- To review the long-term effects of CLD on pulmonary and systemic circulations.
- To explore clinical correlates and therapeutic strategies for CLD-related vascular changes.
- To investigate potential increases in arterial stiffness in CLD survivors.
Main Methods:
- Literature review of studies on preterm infants with CLD.
- Analysis of data on pulmonary artery pressure and resistance.
- Examination of systemic blood pressure and arterial stiffness in CLD survivors.
Main Results:
- PA hypertension in preterm infants with CLD often resolves by school age.
- Pulmonary vasculature remains hyper-reactive to hypoxia until early childhood.
- Preterm children, with or without CLD, show mildly increased systemic blood pressure and arterial stiffness.
Conclusions:
- CLD survivors may experience long-term alterations in both pulmonary and systemic circulations.
- Increased smooth muscle tone, rather than reduced elasticity, may contribute to arterial stiffness.
- Understanding these long-term effects is crucial for clinical management and therapeutic development.
Abstract:
Pulmonary arterial (PA) hypertension in preterm infant is an important consequence of chronic lung disease of prematurity (CLD) arising mainly due to impaired alveolar development and dysregulated angiogenesis of the pulmonary circulation. Although PA pressure and resistance in these children normalise by school age, their pulmonary vasculature remains hyper-reactive to hypoxia until early childhood. Furthermore, there is evidence that systemic blood pressure in preterm born children with or without CLD is mildly increased at school age and in young adulthood when compared to term-born children. Arterial stiffness may be increased in CLD survivors due to increased smooth muscle tone of the pre-resistance and resistance vessels rather than the loss of elasticity in the large arteries. This review explores the long term effects of CLD on the pulmonary and systemic circulations along with their clinical correlates and therapeutic approaches.
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