Martinez Stephanie, Chen Zhengyi, Di Fiore Juliann M, Nguyen Christina, Minich Nori M, Hibbs Anna Maria
Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
Division of Neonatology, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Pediatr Res. 2025 Jan 31. doi: 10.1038/s41390-025-03881-w.
Approximately 5% of very premature infants delivered at less than 30 weeks' gestation have systemic hypertension. In adult human and animal models, intermittent hypoxemia events are associated with systemic hypertension. In neonates, intermittent hypoxemia events are associated with adverse outcomes, but it is unknown if they are a risk factor for hypertension. We hypothesize that early intermittent hypoxemia events in very preterm neonates are associated with systemic hypertension at 34-36 weeks' postmenstrual age.
Secondary analysis of a single-center cohort study of 164 infants, <31 weeks' gestational age. Intermittent hypoxemia events were continuously recorded during the first 21 days of age.
There was a significant association between the number of intermittent hypoxemia events (per 100) and systemic hypertension (OR (95% CI) = 1.08 (1.01-1.15)), and both the number of intermittent hypoxemia events (per 100 β (95% CI) = 0.22 (0.10-0.34)) and percent of time with hypoxemia (β (95% CI) = 0.10 (0.01-0.19)) and systolic blood pressure at 34-36 weeks' postmenstrual age.
This study demonstrated a higher incidence of early intermittent hypoxemia events in preterm infants with hypertension. Decreasing intermittent hypoxemia during this critical period may reduce incidence of later vascular stress in this population.
Intermittent hypoxemia events are very common in premature infants and increased frequency of intermittent hypoxemia events is associated with morbidity. Intermittent hypoxemia events in adult human as well as adult and neonatal animal models are associated with systemic hypertension. This study demonstrated an association between early intermittent hypoxemia events and systemic hypertension in very preterm neonates, adding to the body of literature of possible morbidities caused by intermittent hypoxemia events. This study addresses the common, though under-recognized, issue of neonatal hypertension, and suggests increased intermittent hypoxemia events may be contributory.
孕龄小于30周出生的极早产儿中约5%患有系统性高血压。在成年人类和动物模型中，间歇性低氧血症事件与系统性高血压有关。在新生儿中，间歇性低氧血症事件与不良结局有关，但尚不清楚它们是否是高血压的危险因素。我们假设极早早产儿早期的间歇性低氧血症事件与孕龄34 - 36周时的系统性高血压有关。
对164例孕龄小于31周的单中心队列研究进行二次分析。在出生后前21天连续记录间歇性低氧血症事件。
间歇性低氧血症事件数量（每100次）与系统性高血压之间存在显著关联（比值比（95%置信区间）= 1.08（1.01 - 1.15）），并且间歇性低氧血症事件数量（每100次β（95%置信区间）= 0.22（0.10 - 0.34））、低氧血症时间百分比（β（95%置信区间）= 0.10（0.01 - 0.19））均与孕龄34 - 36周时的收缩压有关。
本研究表明高血压早产儿早期间歇性低氧血症事件的发生率更高。在此关键时期减少间歇性低氧血症可能会降低该人群后期血管应激的发生率。
间歇性低氧血症事件在早产儿中非常常见，间歇性低氧血症事件频率增加与发病率相关。成年人类以及成年和新生动物模型中的间歇性低氧血症事件与系统性高血压有关。本研究证明了极早早产儿早期间歇性低氧血症事件与系统性高血压之间的关联，增加了关于间歇性低氧血症事件可能导致的发病率的文献资料。本研究解决了常见但未得到充分认识的新生儿高血压问题，并表明间歇性低氧血症事件增加可能是一个原因。
