Endothelial dysfunction in preterm infants: The hidden legacy of uteroplacental pathologies

Area of Science:

• Neonatology
• Vascular Biology
• Obstetrics

Background:

• Prematurity is a major global health challenge linked to high infant mortality and morbidity.
• Uteroplacental pathologies significantly affect fetal development and neonatal outcomes, particularly endothelial homeostasis.
• Endothelial dysfunction is increasingly recognized as a critical factor in preterm infants.

Purpose of the Study:

• To review current knowledge on endothelial dysfunction in preterm infants.
• To explore the molecular features, biomarkers, and clinical impact of endothelial dysfunction in two main endotypes of prematurity: infection/inflammation and dysfunctional placentation.
• To identify knowledge gaps and future research directions.

Main Methods:

• Literature review focusing on endothelial physiology and damage in neonates.
• Analysis of studies examining uteroplacental pathologies and their impact on endothelial function.
• Synthesis of information on molecular mechanisms, biomarkers, and clinical outcomes.

Main Results:

• Preterm birth is associated with endothelial dysfunction, influenced by prenatal factors.
• Two distinct endotypes of prematurity, infection/inflammation and dysfunctional placentation, exhibit unique pathophysiological patterns.
• Endothelial dysfunction in preterm infants involves altered vascular tone, permeability, oxidative stress, and growth factor imbalance.

Conclusions:

• Endothelial dysfunction is a critical consequence of prematurity, with distinct mechanisms in different endotypes.
• Further research is needed to fully elucidate endothelial pathophysiology and develop targeted therapies for preterm infants.
• Improved understanding of endothelial dysfunction can lead to better clinical management and improved outcomes for premature neonates.