Abstract
Background: Preterm infants are at increased risk for hypertension in adolescence. Microcirculatory dysfunction has been identified as an underlying cause for cardiovascular disease. Our goal was to document the development of the cutaneous microcirculation in preterm infants during the first weeks of life and to compare it to the situation in term infants at birth.Methods: In 20 preterm infants, microcirculatory parameters were obtained prospectively by Sidestream Dark Field (SDF) Imaging at the upper inner arm once a week until discharge or 37 weeks of gestational age. A single microcirculatory measurement was obtained in 30 term infants during the first 3 days of life. Videos were blinded and analyzed with the AVA software.Results: Microcirculatory parameters in preterm infants differ significantly from term infants with a lower vessel surface (VS), a lower percentage of large and medium but higher percentage of small vessels, a higher Functional Vessel Density (FVD), and a higher Microcirculatory Flow Index (MFI). In multivariable linear regression models we could demonstrate a statistically significant association between the dependent microcirculatory variables (VS, diameter distribution, MFI) and gestational age as independent predictor variable while adjusting for postnatal days of life. Looking at the longitudinal follow-up data of preterm infants by means of a multivariable mixed-effects linear regression model adjusting for clinical variables, there is a significant decrease in FVD with increasing postnatal age, however no other significant changes in microcirculatory parameters over time. Accordingly, comparing the microcirculatory parameters of near term former preterm infants with term born neonates, we could still find significant differences with a higher FVD, lower VS and differences in vessel diameters in the former premature group.Conclusion: Infants born prematurely exhibit distinct microcirculatory alterations compared to term neonates with gestational age at birth being associated with microvascular parameters. Interestingly, this premature vascular phenotype persists even close to corrected term age. In view of the known increased cardiovascular risk of former preterm infants, our observations might have important clinical impact. The factors governing the development of the microvascular network in preterm infants and the contribution of microcirculatory changes observed here to vascular pathology in later life need to be further investigated.
Highlights
Microcirculatory dysfunction has been linked to the risk of vascular pathology in cardiovascular disease and infection [1,2,3,4]
Two infants in the preterm group were treated for a hemodynamically significant patent ductus arteriosus, which was already closed at the second measurement
We saw that Functional Vessel Density (FVD) was higher in older preterm neonates at corrected 34 weeks of gestation compared to term neonates
Summary
Microcirculatory dysfunction has been linked to the risk of vascular pathology in cardiovascular disease and infection [1,2,3,4]. The observation that very preterm infants have higher blood pressure throughout early life [7, 8, 11,12,13] suggests that preterm birth might trigger or lack intrauterine factors leading to a different microvascular development affecting microcirculatory function and vasomotion. We have obtained skin microcirculation images from former preterm infants at age 10–15 years and found significant differences to age matched term children. In the former preterm infants, small vessels were stiffer and the intima media thickness of the carotic artery was increased as marker for beginning arteriosclerosis [14]. Our goal was to document the development of the cutaneous microcirculation in preterm infants during the first weeks of life and to compare it to the situation in term infants at birth
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