title: In adolescence, extreme prematurity is associated with significant changes in the microvasculature, elevated blood pressure and increased carotid intima-media thickness.
abstract: OBJECTIVE
  Increased carotid intima-media thickness (cIMT) and loss of capillary density are antecedents of cardiovascular disease in adults. Former preterm infants are at risk for metabolic precursors of vascular disease, but vascular changes have not yet been studied in this population.
  
  
  METHODS
  In 54 former preterm (birth weigh (BW) 753±152 g) and 12 term children (BW 3395±558 g), functional vessel density (FVD) on the forearm and cIMT were obtained at a mean (±SD) age of 11.8±1.5 years. FVD was measured using sidestream dark field imaging before, during and after arterial occlusion, and cIMT using high resolution B-mode ultrasonography. Statistical comparisons were made using the t test, Mann-Whitney U test and the sign test for symmetry, with a two-sided p value as appropriate.
  
  
  RESULTS
  The systolic blood pressure of the former preterm children was significantly increased compared to reference values (females 119±8, z score 1.23; males 118±11, z score 1.14 mm Hg), as were the cIMT values (0.45±0.03 mm vs 0.38±0.04 mm; p<0.001). FVD was significantly higher in former preterm children compared to controls at baseline (mean±SD 33.6±14.5 cm/cm(2) vs 23.0±7.1 cm/cm(2); p=0.002) with decreased reactivity during arterial occlusion (χ(2) 7.14, p=0.008).
  
  
  CONCLUSIONS
  Preterm birth is associated with significant permanent alteration in the microcirculation and increased cIMT and systolic blood pressure. It is unknown whether these changes are due to preterm birth and rapid maturation of the skin or to nutritional factors, as previously thought. This is an important area of future research.
authors.affiliation: Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany.
authors.forename: HaNa
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dichtl
authors.affiliation: Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany.
authors.forename: Zuzanna
authors.initials: Z
authors.lastname: Mormanova
authors.affiliation: Department of Pediatric Cardiology, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Dalla Pozza
authors.affiliation: Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Genzel-Boroviczeny
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D008297:Male; D055806:Microvessels / Q000503:physiopathology*; D012307:Risk Factors; D047929:Term Birth
keywords: Circulatory; Infant Feeding; Neonatology; Nutrition; Vascular Disease