Intrauterine Growth Restriction Infants Research Articles

Refeeding syndrome in very-low-birth-weight intrauterine growth-restricted neonates

Determine the incidence of refeeding syndrome, defined by the presence of hypophosphatemia in very-low-birth-weight (VLBW) infants with intrauterine growth restriction (IUGR) compared with those without IUGR. In this retrospective cohort study, VLBW infants admitted over a 10-year period (271 IUGR and 1982 non-IUGR) were evaluated for specific electrolyte abnormalities in the first postnatal week. IUGR infants were significantly more likely to have hypophosphatemia (41% vs 8.9%, relative risk (95% confidence interval: 7.25 (5.45, 9.65)) and severe hypophosphatemia (11.4% vs 1%, 12.06 (6.82, 21.33)) in the first postnatal week. The incidence of hypophosphatemia was significantly associated with the presence of maternal preeclampsia in all VLBW infants (odds ratio (OR): 2.58 (1.96, 3.40)) when controlling for birth weight and gestational age. Refeeding syndrome occurs in VLBW infants with IUGR and born to mothers with preeclampsia. Close monitoring of electrolytes, especially phosphorus, is warranted in this population.

Nutritional Management of the Low Birth Weight/Preterm Infant in Community Settings: A Perspective from the Developing World

Globally, about 20 million infants are born with low birth weight (LBW; <2500 g). Of all LBW infants, approximately 95% are born in developing countries. The greatest incidence of LBW occurs in South-Central Asia; the second greatest is in Africa. The two main reasons for LBW are preterm birth (<37 weeks) and intrauterine growth restriction (IUGR), which are risk factors for increased morbidity and mortality in newborn infants. Maternal nutrition status is one of the most important risk factors for LBW/IUGR. Providing balanced protein energy and multiple micronutrient supplements to pregnant women will reduce incidence of IUGR. Calcium supplementation during pregnancy will reduce the incidence of pre-eclampsia and preterm birth in developing countries. Exclusive breastfeeding is protective for a mother and her infant and has been shown to reduce morbidity and mortality in infancy. Kangaroo mother care for preterm infants will reduce severe morbidity and mortality as well. Community-based intervention packages are among the most effective methods of reducing morbidity and mortality in mothers and children. Future research should focus on improving triage of preterm and IUGR infants. Exclusive breastfeeding should be promoted, and appropriate alternative food supplements should be provided when breastfeeding is not possible.

Effect of Antenatal Steroids on Haemodynamics in the Normally Grown and Growth Restricted Fetus

The administration of antenatal glucocorticoids to women in preterm labour confers clear and significant benefits on perinatal outcomes, decreasing the incidence of respiratory distress syndrome and intraventricular hemorrhage in preterm babies, thereby reducing rates of mortality and morbidity. However, there is an evolving body of research addressing the non-pulmonary consequences of antenatal glucocorticoid administration, particularly in the growth restricted fetus. In particular, synthetic glucocorticoids, such as betamethasone and dexamethasone, are strong modulators of vascular structure and function such that antenatal glucocorticoids may have profound and lasting effects on fetal/neonatal cardiovasculature. This review examines the clinical and experimental literature on the benefits and risks of antenatal glucocorticoids in the well-grown preterm infant and in infants affected by intrauterine growth restriction (IUGR), highlighting the significant lack of specific information on the effects of antenatal glucocorticoids in IUGR infants. This is important because IUGR is associated with preterm birth and so the IUGR fetus is likely to be exposed to antenatal glucocorticoids. Recent experimental studies have shown that the fetal hemodynamic actions of exogenous glucocorticoids are profoundly different in IUGR fetus compared with the well-grown fetus with possible adverse implications for the development of the immature brain. Such observations merit caution clinically and further investigation. Keywords: Fetus, placenta, growth restriction, glucocorticoids, cardiovascular, brain

Fetal aortic wall thickness: a marker of hypertension in IUGR children?

Fetuses with intrauterine growth restriction (IUGR) have significant aortic intima-media thickening (aIMT), which suggests that preclinical atherosclerosis might predispose the infants to hypertension. However, the natural course of aIMT in babies with IUGR remains an open question.The study enrolled 77 pregnant women between January 2007 and August 2009. The fetuses were classified as AGA (appropriate for gestational age) or IUGR, if the estimated fetal weight was between the 10th and 90th percentile or below the 10th percentile (with umbilical artery pulsatility index (PI) >2s.d.), respectively. Anthropometric parameters and aIMT were detected in each IUGR and AGA fetus at a mean gestational age of 32 weeks. The follow-up was performed in 25 IUGR and 25 AGA infants at a mean postnatal age of 18 months; the previous measurements were repeated, and blood pressure measurements were taken. The maximum aIMT was significantly higher in the IUGR fetuses and infants compared with the AGA infants, both in utero (2.05±0.43 vs. 1.05±0.19 mm, P<0.001) and at the follow-up (2.3±0.8 vs. 1.06±0.18 mm, P<0.0001), the resulting values significantly correlated (P=0.018) with one another. The systolic blood pressure was significantly increased in the IUGR subjects (123±16 vs. 104±8.5 mm Hg, P<0.0004), and it correlated with the prenatal and postnatal aIMT values (P<0.0156 and P<0.0054, respectively). The aortic wall thickening progression in IUGR fetuses and infants differed from AGA, which may predispose the infants to hypertension early in life and cardiovascular risk later in life.

The IUGR infant: A case study and associated problems with IUGR infants

Intrauterine Growth Restriction (IUGR) is a fetal condition defined as the abnormal rate of fetal growth. The pathology is a documented cause of fetal and neonatal morbidity and mortality. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. Therefore, designing an accurate model for the early and prompt identification of pathology in the antepartum period is crucial in view of pregnancy management.We tested the performance of 15 machine learning techniques in discriminating healthy versus IUGR fetuses. The various models were trained with a set of 12 physiology based heart rate features extracted from a single antepartum CardioTocographic (CTG) recording. The reason for the utilization of time, frequency, and nonlinear indices is based on their standalone documented ability to describe several physiological and pathological fetal conditions.We validated our approach on a database of 60 healthy and 60 IUGR fetuses. The machine learning methodology achieving the best performance was Random Forests. Specifically, we obtained a mean classification accuracy of 0.911 [0.860, 0.961 (0.95 confidence interval)] averaged over 10 test sets (10 Fold Cross Validation). Similar results were provided by Classification Trees, Logistic Regression, and Support Vector Machines. A features ranking procedure highlighted that nonlinear indices showed the highest capability to discriminate between the considered fetal conditions. Nevertheless, is the combination of features investigating CTG signal in different domains, that contributes to an increase in classification accuracy.We provided validation of an accurate artificially intelligence framework for the diagnosis of IUGR condition in the antepartum period. The employed physiology based heart rate features constitute an interpretable link between the machine learning results and the quantitative estimators of fetal wellbeing.

Perinatal role of hepcidin and iron homeostasis in full‐term intrauterine growth–restricted infants

To prospectively investigate iron homeostasis in full-term intrauterine growth-restricted (IUGR) and appropriate-for-gestational-age (AGA) infants at birth, by evaluating cord blood concentrations of hepcidin (a bioactive molecule, principal regulator of iron metabolism, downregulated by hypoxia/iron deficiency and upregulated by inflammation), erythropoietin (EPO, a marker of prolonged fetal hypoxia), soluble transferrin receptor (sTfR, a marker of increased erythropoiesis and tissue iron deficiency), iron, ferritin, and unsaturated iron-binding capacity (UIBC). Serum cord blood samples from 47 well-defined IUGR and 104 AGA singleton, full-term infants were analyzed for concentrations of all the aforementioned parameters by enzyme immunoassays and spectrophotometry. Hepcidin concentrations were similar, while EPO concentrations were higher in IUGR cases than in AGA controls (P=0.047). Cord blood sTfR concentrations were increased in IUGR, compared to AGA infants (P=0.004), and negatively correlated with their customized centiles and birth weight (r=-0.238, P=0.003 and r=-0.157, P=0.050, respectively). Ferritin concentrations were lower in IUGR cases than in AGA controls (P=0.039). In both groups, no correlations were observed between cord blood hepcidin concentrations and iron status indices. Cord blood hepcidin concentrations in term IUGRs may remain unaffected, possibly due to a balance between hepcidin downregulation by chronic fetal hypoxia (indicated by higher EPO concentrations) and impaired iron metabolism (indicated by lower ferritin and higher sTfR concentrations) on the one hand, and hepcidin upregulation by the inflammatory state characterizing IUGRs, on the other. Furthermore, our findings may possibly indicate the need for regular follow-up for detection of iron-deficient anemia, not only in preterm but also in full-term IUGR neonates.

Perinatal complications and long-term neurodevelopmental outcome of infants with intrauterine growth restriction

The objective of the study was to evaluate perinatal and long-term complications of fetuses with intrauterine growth restriction (IUGR) compared with constitutionally small for gestational age (SGA) ones. The outcome of infants with IUGR and SGA born at the Medical University Graz (Austria) between 2003 and 2009 was retrospectively analyzed. Group assignment was based on birthweight, Doppler ultrasound, and placental morphology. The primary outcome was neurodevelopmental delay at 2 years corrected age. The secondary outcomes were perinatal complications. We included 219 IUGR and 299 SGA infants for perinatal and 146 and 215 for long-term analysis. Fetuses with IUGR were delivered earlier (35 vs 38 weeks) and had higher rates of mortality (8% vs 1%; odds ratio [OR], 8.3) as well as perinatal complications (24.4% vs 1.0%; OR, 31.6). The long-term outcome was affected by increased risk for neurodevelopmental impairment (24.7% vs 5.6%; OR, 5.5) and growth delay (21.2% vs 7.4%; OR, 3.4). IUGR infants are subject to an increased risk for adverse short- and long-term outcome compared with SGA children.

1355 Incidence of Serum Hypophosphatemia in Growth Restricted and Appropriately Grown Preterm Infants

BackgroundInfants with intrauterine growth restriction (IUGR) often have metabolic and electrolyte abnormalities. Our aim was to determine the incidence of hypophosphatemia in IUGR versus appropriate for gestational age (AGA) premature...

1042 Increased Plasma and Urine Nitric Oxide Level in Intrauterine Growth Restricted Late Preterm Infants

Background and AimsNitric oxide (NO) is a vasodilator produced from different groups of nitric oxide synthases and plays an important role in regulation of vascular tone and blood flow in...

Copeptin: a marker for stress reaction in fetuses with intrauterine growth restriction

To compare venous cord plasma concentrations of 4 vasoactive peptide precursors: carboxy-terminal proarginine vasopressin, CT-prondothelin (ET)-1, midregional proadrenomedullin, and MR-proatrial natriuretic peptide, between fetuses with intrauterine growth restriction and appropriate for gestational age controls. Matched-pair analysis of 12 fetuses with significant intrauterine growth restriction and 42 healthy appropriate for gestational age control fetuses. All infants were singletons, delivered by elective section after 34 weeks and without chromosomal abnormalities. Umbilical cord plasma copeptin levels (median [range]) were 4-fold higher in intrauterine growth restriction infants than in matched appropriate for gestational age controls: 23.2 (6.7-449) vs 5.1 (2.5-53) pmol/L (P < .001). Multivariate regression analysis revealed an association between copeptin and umbilical artery resistance index z-score (P = .034). The 3 other precursor peptides showed no changes. High copeptin concentrations in the cord blood of intrauterine growth restriction newborns reflect a fetal stress response and support the fetal programming hypothesis.

OP01.07: Neurodevelopmental long‐term outcome and perinatal complications of infants with intrauterine growth restriction

Objectives: Infants with intrauterine growth restriction (IUGR) feature higher rates of mortality and postnatal morbidity. This study aimed to evaluate the perinatal and long-term neurodevelopmental outcome of IUGR fetuses compared to constitutionally small fetuses (small-for-gestational-age, SGA). Methods: Data of patients with IUGR and SGA who were examined at the Department of Obstetrics and Gynecology at the Medical University of Graz, Austria between 2003 and 2009 was analyzed retrospectively. Group assignment was based on birth weight, Doppler ultrasound, biophysical profile and placental morphology. Primary outcome parameters were neurodevelopmental as well as nutritional status at the age of two-years. Secondary outcomes were perinatal complications (periventricular leukomalacia, intraventricular hemorrhage, asphyxia and meconium obstruction). Results: 565 patients with IUGR and SGA were detected, from which 47 (8.3%) were excluded from further analysis due to major congenital malformations, twin pregnancies or incomplete data, resulting in a collective of 219 IUGR and 299 SGA fetuses. 157 patients did not follow the two-year neurodevelopmental evaluation leaving 146 IUGR and 215 SGA infants for that analysis. Fetuses with IUGR were delivered significantly earlier (35 vs. 38 weeks’ gestation, P < 0.0001) and had more perinatal complications (24.4% vs. 1.0%, OR 31.6, 95% CI 9.7–103.0). IUGR infants further had higher rates of mortality (8% vs. 1%; OR 8.3, 95% CI, 2.4–28.7), long-term neurodevelopmental impairment (24.7% vs. 5.6%; OR 5.5, 95% CI, 2.8–11.1) and dystrophy (21.2% vs. 7.4%, OR 3.4, 95% CI, 1.8–6.4). Conclusions: The study confirms a significantly increased risk for adverse outcome in IUGR infants in contrast to SGA babies, emphasizing the importance of prenatal identification of affected fetuses to allow adopted management.

OP01.09: Socio‐demographic determinants and fetal sonographic measurements in patients with primary infection with cytomegalovirus during pregnancy

Objectives: Infants with intrauterine growth restriction (IUGR) feature higher rates of mortality and postnatal morbidity. This study aimed to evaluate the perinatal and long-term neurodevelopmental outcome of IUGR fetuses compared to constitutionally small fetuses (small-for-gestational-age, SGA). Methods: Data of patients with IUGR and SGA who were examined at the Department of Obstetrics and Gynecology at the Medical University of Graz, Austria between 2003 and 2009 was analyzed retrospectively. Group assignment was based on birth weight, Doppler ultrasound, biophysical profile and placental morphology. Primary outcome parameters were neurodevelopmental as well as nutritional status at the age of two-years. Secondary outcomes were perinatal complications (periventricular leukomalacia, intraventricular hemorrhage, asphyxia and meconium obstruction). Results: 565 patients with IUGR and SGA were detected, from which 47 (8.3%) were excluded from further analysis due to major congenital malformations, twin pregnancies or incomplete data, resulting in a collective of 219 IUGR and 299 SGA fetuses. 157 patients did not follow the two-year neurodevelopmental evaluation leaving 146 IUGR and 215 SGA infants for that analysis. Fetuses with IUGR were delivered significantly earlier (35 vs. 38 weeks’ gestation, P < 0.0001) and had more perinatal complications (24.4% vs. 1.0%, OR 31.6, 95% CI 9.7–103.0). IUGR infants further had higher rates of mortality (8% vs. 1%; OR 8.3, 95% CI, 2.4–28.7), long-term neurodevelopmental impairment (24.7% vs. 5.6%; OR 5.5, 95% CI, 2.8–11.1) and dystrophy (21.2% vs. 7.4%, OR 3.4, 95% CI, 1.8–6.4). Conclusions: The study confirms a significantly increased risk for adverse outcome in IUGR infants in contrast to SGA babies, emphasizing the importance of prenatal identification of affected fetuses to allow adopted management.

OC18.05: Brain connectivity in one‐year old intrauterine growth restricted infants is abnormal and correlates with neurodevelopment at two years of age

OC18.05: Brain connectivity in one‐year old intrauterine growth restricted infants is abnormal and correlates with neurodevelopment at two years of age

Association of maternal periodontal health with adverse pregnancy outcome

The present study aims to determine the association of periodontal disease (identified early in pregnancy) and adverse pregnancy outcomes in a North Indian population. A total of 340 primigravida women, aged 20-35 years with single live pregnancy were recruited at 14-20 weeks period of gestation from the antenatal clinic. These women had undergone periodontal examination at time of recruitment. The pregnancy outcomes were recorded. Out of 340 primigravida women, 147 (43.23%) women had gingivitis and 61 (17.94%) women had periodontitis. Periodontitis was found to be significantly associated with pre-eclampsia, intrauterine growth restriction, preterm delivery, and low birthweight with odds ratios (95% confidence interval) of 7.48 (2.72-22.42), 3.35 (1.20-9.55), 2.72 (1.30-5.68) and 3.03 (1.53-5.97), respectively. The study shows a significant association between periodontitis (but not with gingivitis) and adverse pregnancy outcomes. Maternal periodontitis is associated with an increased risk of pre-eclampsia, intrauterine growth restriction, preterm delivery and low birthweight infants.

Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy

To assess the maternal and fetal outcomes of pregnancies affected by hypertensive disorders treated with nifedipine versus labetalol. A retrospective study in hypertensive patients treated during pregnancy with nifedipine or labetalol was conducted. After the charts review the patients were divided in the four groups: gestational hypertension (113 patients); mild preeclampsia (77 patients); severe preeclampsia (31 patients); HELLP syndrome (21 patients). The pregnancy and neonatal records were analyzed by paired and unpaired t test. We found that there was an higher rate of intrauterine growth restriction infants among women treated with labetalol compared with those treated with nifedipine (38.8 vs. 15.5%; p<0.05), but only in the subgroup of women affected by Gestational Hypertension and Mild Preeclampsia. In this group was also higher the rate of fetal worsening assessed by fetal heart rate tracing (33.3 vs. 14.2%; p<0.05). No neonatal malformations and no differences in the rate of adverse side effects were observed. Antihypertensive therapy in pregnancy with Labetalol may have the potential to impair fetal behavior in low degrees hypertensive diseases of pregnancy. Optimal care must balance the potentially conflicting risks and benefits to mother and fetus.

Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

Admission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU. This was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR). The study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age=34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n=196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0-180], median=8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P<0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P<0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P<0.05) and at discharge (48.5% versus 40.8% for multipares, P<0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes). Our maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (<10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.

Amino Acid–based Formula as a Rescue Strategy in Feeding Very‐Low‐Birth‐Weight Infants With Intrauterine Growth Restriction

Very-low-birth-weight (VLBW) neonates may develop severe intolerance to standard preterm formula especially if they are associated with intrauterine growth restriction (IUGR). We tested the hypothesis that these infants may tolerate an elemental, amino acid-based formula as a rescue feeding strategy. In a prospective, case-control pilot study, we enrolled VLBW IUGR infants enterally fed with standard preterm formula (SPF) at daily increments of 16 mL/kg. If gastric residuals accounted for >70% of milk feed in the previous 24 hours, then feedings were temporarily withheld and then resumed with amino acid formula (AAF) increased at the same speed. Cases on AAF were compared to controls on SPF and with cases themselves while on SPF. Primary outcome was the time to reach full enteral feedings. Secondary outcomes were time on parenteral nutrition, time on central venous catheter, and formula tolerability based on the amount of gastric residual volume. Sixty-four infants (22 cases) were enrolled. Although during the total duration of nutrition, cases had worse primary and secondary outcomes, when on AAF, cases were comparable to controls in time to full enteral feeding (14.4 vs 14 days), time on parenteral nutrition, and time on central venous catheter. Cases on AAF and controls had similar gastric residual volumes. At day 3 after AAF introduction, cases had a significantly reduced number (%) of gastric residual volume >5 mL/kg over total number of feedings (5.6 vs 1.5%; P < 0.05) and the mean gastric residual volume (2.7 vs 0.6 mL; P < 0.05) compared to themselves while on SPF. No difference was detected in weight at 21 and 28 days, in main serum parameters and outcome at discharge. Growth at 12 months of corrected age was also comparable. In our population of VLBW IUGR newborns with severe feeding intolerance, a short course on AAF was a safe and effective means of nutritional rescue.

Effect of Antenatal Zinc Supplementation on Impetigo in Infants in Bangladesh

We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks' gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).

Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial

We sought to study long-term (neuro)developmental and behavioral outcome of pregnancies complicated by intrauterine growth restriction at term in relation to induction of labor or an expectant management. Parents of 2-year-old children included in the Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) answered the Ages and Stages Questionnaire (ASQ) and Child Behavior Checklist (CBCL). We approached 582 (89.5%) of 650 parents. The response rate was 50%. Of these children, 27% had an abnormal score on the ASQ and 13% on the CBCL. Results of the ASQ and the CBCL for the 2 policies were comparable. Low birthweight, positive Morbidity Assessment Index score, and admission to intermediate care increased the risk of an abnormal outcome of the ASQ. This effect was not seen for the CBCL. In women with intrauterine growth restriction at term, neither a policy of induction of labor nor expectant management affect developmental and behavioral outcome when compared to expectant management.

The long-term renal and cardiovascular consequences of prematurity

Infants born prematurely at <37 weeks' gestation account for over 80% of infants weighing <2,500 g at birth-low birth weight (LBW) infants. This designation remains the surrogate marker for developmental origins of adult disease. Landmark studies spanning four decades have shown that individuals born with a LBW are more likely to develop cardiovascular and renal disease in later life, which is believed to be related to 'developmental programming' of such adult disease during vulnerable periods of growth in utero and in the early postnatal period. There has long been ambiguity regarding the distinction between infants with intrauterine growth restriction and preterm infants since both show a low nephron endowment that is associated with subsequent hypertension and chronic kidney disease. Knowledge is growing specific to the preterm infant and the developmental associations of being born preterm with the interruption of normal organogenesis relative to the vascular tree and kidney. Both systems develop by branching morphogenesis and interruptions lead to considerable deficits in their structure and function. These developmental aberrations can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. This Review will examine the effect of preterm birth on the development of cardiovascular and kidney disease in later life and will also discuss potential early interventions to alter the progression of disease.