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Published on: January 27, 2023
Cardiac function in 6-year-old children born extremely preterm and associations to prolonged patent ductus arteriosus
Jonna Karlén1,2, Lilly-Ann Mohlkert3,4, Anna Gudmundsdottir5,6
1Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden. jonna.karlen@ki.se.
Insights
Extremely preterm born children show altered heart development. However, prolonged patent ductus arteriosus (PDA) shunting did not lead to significant long-term cardiac issues by age 6.5.
Area of Science:
- Neonatal cardiology
- Pediatric cardiac imaging
- Fetal and neonatal development
Background:
- Extremely preterm born (EPT) individuals often exhibit reduced cardiac dimensions and altered biventricular function compared to term-born controls.
- A hemodynamically significant patent ductus arteriosus (hsPDA) increases neonatal cardiac load, but long-term impacts of prolonged shunting remain unclear.
Purpose of the Study:
- To assess cardiac dimensions and function in EPT children at 6.5 years of age.
- To investigate the long-term cardiac impact of prolonged neonatal hsPDA shunting.
Main Methods:
- Follow-up study involving EPT children (n=57) and term-born controls (n=63).
- Repeated neonatal echocardiograms to assess PDA shunt duration.
- Echocardiography at 6.5 years for cardiac measurements and function analysis.
- Subgroup analysis based on neonatal PDA shunt duration.
Main Results:
- EPT children displayed significantly smaller heart chambers and a more globe-shaped left ventricle compared to controls.
- Altered biventricular systolic function was observed in EPT children.
- No major cardiac alterations were found in EPT children with hsPDA shunt duration >21 days compared to those with shorter durations.
Conclusions:
- Early cardiac remodeling is supported in extremely preterm born individuals.
- Prolonged neonatal hsPDA shunting does not appear to cause significant long-term cardiac alterations by age 6.5.
Abstract:
Follow-up studies of extremely preterm born (EPT) individuals have shown reduced cardiac dimensions and altered biventricular function compared with term born controls. A hemodynamically significant patent ductus arteriosus (hsPDA) increases cardiac load during the neonatal period but potential long-term risks associated with prolonged hsPDA shunting are still largely unknown. We aimed to describe cardiac dimensions and functions in EPT children at 6.5 years of age and to investigate if a prolonged neonatal hsPDA shunt would have a negative cardiac impact. In this follow-up study, EPT children underwent repeated neonatal echocardiograms to evaluate PDA shunt duration. At 6.5 years of age, echocardiography was performed for measurements of dimensions and functions and compared with age matched term born controls. Subgroup analyses were made according to neonatal PDA shunt duration. EPT children (n = 57) had significantly smaller heart chambers, a more globe-shaped left ventricle, and signs of altered biventricular systolic function compared with age matched term born controls (n = 63). Children exposed to a hsPDA for > 21 days showed no major cardiac alterations compared with children with shorter shunt duration. Our findings support the theory of early cardiac remodeling following EPT birth. Reassuringly, no major cardiac alterations were seen after a prolonged hsPDA shunt.
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