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Renal function and blood pressure in 11 year old children born extremely preterm or small for gestational age
Maria Vollsæter1,2, Thomas Halvorsen1,2, Trond Markestad2
1Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
Insights
Children born extremely preterm or with extremely low birth weight, especially those small for gestational age, show impaired kidney function by age 11. This highlights the need for long-term monitoring to mitigate future health risks.
Area of Science:
- Pediatric Nephrology
- Neonatal Medicine
- Public Health
Background:
- Preterm birth and low birth weight are linked to fewer nephrons, increasing risks for hypertension and kidney disease later in life.
- Understanding the long-term renal consequences of extreme preterm birth and intrauterine growth restriction is crucial for early intervention.
Purpose of the Study:
- To investigate the association between extremely preterm birth or extremely low birth weight and renal function in mid-childhood.
- To determine if intrauterine growth restriction exacerbates impaired renal function in this cohort.
Main Methods:
- Assessed renal function (estimated GFR, plasma creatinine, cystatin C, SDMA) and anthropometrics at age 11 in extremely preterm/extremely low birth weight children and matched controls.
- Categorized children by gestational age, birth weight (extremely preterm/extremely low birth weight vs. term appropriate for gestational age), and small for gestational age status.
- Utilized established equations (Schwartz, Zappitelli, Gao) to estimate glomerular filtration rate.
Main Results:
- Children born extremely preterm/extremely low birth weight, particularly those small for gestational age, exhibited decreased estimated GFR and elevated plasma SDMA levels.
- Systolic blood pressure showed a correlation with fat mass but not with renal function and did not differ significantly between groups.
- A gradient of decreasing renal function was observed from term-born appropriate for gestational age children to preterm appropriate for gestational age, and further to preterm small for gestational age.
Conclusions:
- Extremely preterm birth and extremely low birth weight, especially with intrauterine growth restriction, are associated with impaired renal function in mid-childhood.
- Reduced renal function in childhood may predispose individuals to future kidney disease and hypertension.
- Long-term follow-up is recommended for these children to identify and manage additional risk factors for renal health.
Background:
Preterm birth and low birth weight are associated with reduced nephron numbers and increased risk of hypertension and kidney disease in later life.
Aims:
We tested the hypothesis that extremely preterm birth and intrauterine growth restriction is associated with decreased renal function in mid childhood.
Methods:
At 11 years of age the following measures were obtained in a regional cohort of children born extremely premature (EP, i.e. < 28 weeks gestational age-GA) or with extremely low birth weight (ELBW, i.e. BW < 1000 grams) and in matched controls born at term with appropriate BW (AGA): Height, weight, abdominal circumference, triceps and subscapular skin fold thicknesses, blood pressure, plasma levels of creatinine, cystatin C and symmetric dimethyl arginine (SDMA). Small for gestational age (SGA) was defined as a BW < 10th percentile for GA. Glomerular filtration rate (GFR) was estimated according to the equations by Schwartz, Zappitelli and Gao.
Results:
Fifty-seven of 61 eligible EP/ELBW children, 20 (35%) born SGA, and 54 controls, were assessed. Estimated GFR decreased while plasma SDMA increased from the children born AGA at term through those born preterm AGA to preterm SGA. Systolic BP was correlated to fat mass indices (p<0.03), but not to renal function (p>0.2) and did not differ between the groups.
Conclusions:
Children born EP/ELBW, particularly those born SGA, had impaired renal function at age 11 years as judged from estimated GFRs and plasma levels of SDMA. Since reduced renal function is associated with an increased risk of later disease, these children should be followed in order to minimize additional risk factors.
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