Blood Pressure in 6-Year-Old Children Born Extremely Preterm.
Blood Pressure in 6-Year-Old Children Born Extremely Preterm.
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DOI：
10.1161/jaha.117.005858
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发表时间：
2017-08-01
影响因子：
5.4
通讯作者：
Norman M
中科院分区：
文献类型：
--
作者：
Edstedt Bonamy AK;Mohlkert LA;Hallberg J;Liuba P;Fellman V;Domellöf M;Norman M
围产期医学的进步提高了早产婴儿的存活率。尽管这一进展是可喜的，但越来越多的人担心早产是年轻时高血压的一个新的危险因素，对心血管疾病的终生风险有影响。我们测量了以人群为基础的6岁极早产幸存者(妊娠27周；n=171)和足月出生的年龄和性别匹配的对照组(n=172)的随意血压(BP)。测量的血压没有差异，但性别、年龄和身高调整后的中位数z分数在极早产儿中收缩压比对照组高0.14±SD(P=0.02)，舒张压比对照组高0.10±SD(P=0.01)。在极早产儿中，胎龄较短、体重指数较高和随访时心率较高都与6岁时的血压升高独立相关，而先兆子痫、孕期吸烟、新生儿发病率和围产期皮质类固醇治疗没有独立关联。多因素回归分析显示，孕周每延长一周，收缩压下降0.10±SD(P=0.08)，舒张压下降0.09±SD(P=0.02)。极早产的6岁儿童血压正常，但略高于足月出生的同龄人。虽然这一发现对早产儿及其家人来说是令人放心的，但在较大年龄进行随访是有必要的。
Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. We measured casual blood pressures (BPs) in a population‐based cohort of 6‐year‐old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age‐ and sex‐matched controls born at term (n=172). Measured BP did not differ, but sex, age‐, and height‐adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow‐up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week‐longer gestation. Six‐year‐old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow‐up at older age is warranted.