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Updated: Nov 23, 2025
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Published on: January 27, 2023
Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely
Lilly-Ann Mohlkert1,2, Jenny Hallberg2,3, Olof Broberg4
1Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, 141 52 Stockholm, Sweden.
Insights
Children born extremely preterm show lasting right heart and pulmonary changes. These include smaller heart chambers and higher pulmonary vascular resistance, impacting long-term cardiac health.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Cardiopulmonary Research
Background:
- Preterm birth is linked to adult cardiac alterations.
- The impact on children's right heart and pulmonary circulation requires further investigation.
Purpose of the Study:
- To determine if extremely preterm survivors have structural/functional right heart or pulmonary changes.
- To examine associations between birth size, gestational age, BPD, and PDA with cardiac outcomes.
Main Methods:
- Population-based cohort study of 176 children born before 27 weeks gestation.
- Echocardiography at 6.5 years of age, comparing preterm children to matched term-born controls.
- Analysis of relationships between neonatal factors (BPD, PDA) and cardiac outcomes.
Main Results:
- Preterm children had smaller right atria/ventricles, higher relative wall thickness, and elevated pulmonary vascular resistance (PVR).
- Neonatal patent ductus arteriosus (PDA) was associated with higher PVR and right ventricular myocardial performance index (RVmpi') in preterm survivors.
- Bronchopulmonary dysplasia (BPD) showed no significant association with cardiac outcomes.
Conclusions:
- Children born extremely preterm exhibit altered right heart structure and function.
- Elevated PVR and impaired right ventricular function are significant findings in this cohort.
- Neonatal PDA is a key factor associated with adverse cardiac outcomes in extremely preterm infants.
Abstract:
Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi') were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.
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