Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

Elisabeth Stoltz Sjöström,Magnus Domellöf,Itay Zamir,Mikael Norman,Lilly-Ann Mohlkert,Jawwad Hamayun

doi:10.3390/jcm10122554

Abstract

Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.

Highlights

* Adjusted for family history of cardiovascular disease; gestational age; days with mechanical ventilation treatment and incidence of treated patent ductus arteriosus in the neonatal period; body surface area and center at follow-up. In this retrospective cohort study, longer periods with hyperglycemia during the neonatal period were significantly associated with increased end-diastolic interventricular septum and left ventricle posterior wall thickness, left atrial length, and sphericity in
Higher neonatal lipid intake was significantly associated with increased end-diastolic aortic sinus valsalva diameter, whereas a higher carbohydrate intake was significantly associated with a smaller aorta annulus diameter
The stroke volume and cardiac output were lower in children born extremely preterm than in controls born at term

Summary

Introduction

Advances in perinatal care have led to increased survival rates in high resource settings, especially among extremely preterm infants, where 4 out of 5 survive to 1-year-of-age [2] This development has been very positive, concerns have been risen regarding the long-term health of preterm birth survivors. A unique cardiovascular phenotype characterized by smaller arteries and a more spherical heart shape has been observed in children and young adults born preterm [3,4,5,6] These observations may provide insights as to why preterm birth has been associated with adult heart failure [7] and increased cardiovascular mortality in some [8]

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