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早产和低出生体重及其对儿童生长模式和长期心血管后遗症风险的影响。

Prematurity and Low Birth Weight and Their Impact on Childhood Growth Patterns and the Risk of Long-Term Cardiovascular Sequelae.

作者信息

Jańczewska Iwona, Wierzba Jolanta, Jańczewska Alicja, Szczurek-Gierczak Małgorzata, Domżalska-Popadiuk Iwona

机构信息

Department of Neonatology, Medical University of Gdansk, Mariana Smoluchowskiego 17 Street, 80-214 Gdansk, Poland.

Department of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Medical University of Gdansk, Debinki 7 Street, 80-211 Gdansk, Poland.

出版信息

Children (Basel). 2023 Sep 25;10(10):1599. doi: 10.3390/children10101599.

Abstract

Preterm birth (before 37 completed weeks of gestation) is a global health problem, remaining the main reason for neonatal mortality and morbidity. Improvements in perinatal and neonatal care in recent decades have been associated with a higher survival rate of extremely preterm infants, leading to a higher risk of long-term sequelae in this population throughout life. Numerous surveillance programs for formerly premature infants continue to focus on neurodevelopmental disorders, while long-term assessment of the impact of preterm birth and low birth weight on child growth and the associated risk of cardiovascular disease in young adults is equally necessary. This review will discuss the influence of prematurity and low birth weight on childhood growth and cardiovascular risk in children, adolescents and young adults. The risk of cardiovascular and metabolic disorders is increased in adult preterm survivors. In early childhood, preterm infants may show elevated blood pressure, weakened vascular growth, augmented peripheral vascular resistance and cardiomyocyte remodeling. Increased weight gain during the early postnatal period may influence later body composition, promote obesity and impair cardiovascular results. These adverse metabolic alterations contribute to an increased risk of cardiovascular incidents, adult hypertension and diabetes. Preterm-born children and those with fetal growth restriction (FGR) who demonstrate rapid changes in their weight percentile should remain under surveillance with blood pressure monitoring. A better understanding of lifelong health outcomes of preterm-born individuals is crucial for developing strategies to prevent cardiovascular sequelae and may be the basis for future research to provide effective interventions.

摘要

早产(妊娠满37周前)是一个全球性的健康问题,仍是新生儿死亡和发病的主要原因。近几十年来围产期和新生儿护理的改善与极早早产儿存活率的提高有关,导致这一人群终生出现长期后遗症的风险更高。许多针对曾是早产儿的监测项目继续聚焦于神经发育障碍,而对早产和低出生体重对儿童生长的影响以及年轻成年人患心血管疾病的相关风险进行长期评估同样必要。本综述将讨论早产和低出生体重对儿童、青少年和年轻成年人童年生长及心血管风险的影响。早产幸存者成年后患心血管和代谢紊乱的风险增加。在幼儿期,早产儿可能会出现血压升高、血管生长减弱、外周血管阻力增加和心肌细胞重塑。出生后早期体重增加过多可能会影响后期身体组成,促进肥胖并损害心血管结局。这些不良的代谢改变会导致心血管事件、成人高血压和糖尿病的风险增加。早产儿童和出生体重受限(FGR)且体重百分位数变化迅速的儿童应持续接受血压监测。更好地了解早产个体的终生健康结局对于制定预防心血管后遗症的策略至关重要,可能是未来提供有效干预措施研究的基础。

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