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Structural and Functional Abnormalities in the Preterm Heart: From Development to Adulthood
Phillip Zegelbone1, Karen Young2, Fintan Hughes3
1Division of Pediatric Cardiology, Department of Pediatrics University of Miami Miller School of Medicine Miami FL.
Insights
Infants born prematurely with healthy hearts face increased adult cardiovascular disease risk. Early monitoring and risk reduction education are crucial for these children.
Area of Science:
- Neonatal Medicine
- Cardiovascular Medicine
- Developmental Biology
Background:
- Premature infants with structurally normal hearts exhibit elevated risks for adult cardiovascular disease compared to term infants.
- Multiple factors contribute to cardiovascular morbidity and mortality in preterm infants, including oxygen exposure, cellular damage, and procedural stress.
Purpose of the Study:
- To review the mechanisms underlying increased cardiovascular risk in preterm infants.
- To highlight the need for clinical surveillance and updated management guidelines for preterm infants.
Main Methods:
- Literature review of factors contributing to cardiovascular disease in preterm infants.
- Discussion of current diagnostic technologies for cardiovascular abnormalities.
- Analysis of existing clinical practice guidelines.
Main Results:
- Premature birth is associated with significant cardiovascular risks, necessitating clinical attention.
- Various factors like oxygen exposure, cellular changes, and procedural stress contribute to this risk.
- Current diagnostic tools can detect abnormalities, but management guidelines are inconsistent.
Conclusions:
- Heightened cardiovascular risk in preterm infants warrants consistent clinical surveillance and management.
- Further research is needed, particularly regarding the impact of obesity.
- Standard care should include educating families on cardiovascular risk reduction strategies.
Abstract:
Preterm infants with structurally normal hearts have a higher risk of developing cardiovascular disease in adulthood when compared with term infants with structurally normal hearts. A milieu of factors are implicated in these patients' cardiovascular morbidity and mortality: supraphysiologic/subphysiologic exposure to oxygen, disrupted cellular architecture, changes in extracellular matrix composition, abnormal cardiomyocyte mitochondria number and function, immature sarcoplasmic/endoplasmic reticulum, and increased exposure to surgical procedural stress (among other mechanisms to be reviewed herein). Heightened cardiovascular risk merits clinical surveillance. Current technologies, like blood pressure monitoring, lipid panel testing, echocardiography, and cardiac magnetic resonance imaging, can identify abnormalities in these patients. Best practice guidelines vary on the identification of premature birth as a significant risk factor for cardiovascular morbidity and mortality that should impact patient management. Obesity in these patients may confer heightened risk, and merits further study. Education on cardiovascular risk reduction should be standard of care when counseling the family of a child with a history of prematurity.
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