AT ACC 16
CHICAGO (FRONTLINE MEDICAL NEWS) – The abnormal arterial hemodynamics identified in 11-year-olds with an extremely preterm birth persist at age 19, according to an update from the landmark longitudinal EPICure study.
“Given the implications of these significant findings, cardiovascular monitoring and risk prevention would be highly recommended for all individuals born extremely preterm,” Dr. Joanne Beckmann said in presenting the EPICure results on the long-term consequences of extreme prematurity at the annual meeting of the American College of Cardiology.
EPICure is a longitudinal study investigating health outcomes in a national cohort of babies born extremely preterm at 22-25 weeks’ gestation in the United Kingdom during 1995-1996. It is the longest such study conducted anywhere.
“Neonatal survival at the lowest gestations has improved significantly since the 1990s with the advancement in neonatal care treatments and the implementation of evidence-based practices. Therefore, long-term health outcomes following extremely preterm birth will have increasing relevance to adult physicians,” observed Dr. Beckmann of University College London.
She reported on the results of detailed cardiovascular assessments conducted in 130 extremely premature EPICure participants and 64 matched controls who made it to London for 2 days of health testing when they turned 19 years of age. The findings update the results of similar comprehensive examinations done at age 11 years.
The extremely premature birth (EP) subjects were shorter and weighed less than did the controls. The two groups had similar seated systolic and diastolic blood pressure, and cardiac index didn’t differ between the two groups. However, the EP group had significantly higher supine central systolic and diastolic blood pressure and a higher heart rate.
Moreover, the increases in aortic augmentation index – a composite of arterial stiffness and global wave reflections – and total peripheral resistance seen in the EP group at age 11 years persisted at the 19-year mark. It’s unclear whether the abnormal peripheral resistance in the EP group is structural or functional in nature. All hemodynamic differences between the two groups remained significant after adjustment for potential confounders.
Aortic pulse wave velocity was not significantly different between the two groups of 19-year-olds.
Data pertaining to other aspects of health in the 19-year-olds are now being analyzed. At the age-11 assessment, the EP group was found to have significantly impaired lung function ( J Pediatr. 2012 Oct;161[4]:595-601.e2 ), high risk for neurodevelopmental disability ( Pediatrics. 2009 Aug;124[2]:3249-57 ), a high rate of learning impairments, and an 18-fold increased risk of poor academic attainment compared to their matched peers ( Arch Dis Child Fetal Neonatal Ed. 2009 Jul;94[4]:F283-9 ).
EPICure is funded by the Medical Research Council. Dr. Beckmann reported having no financial conflicts of interest.
