Abstract
Objective:
Systemic hypertension is common among preterm infants with severe bronchopulmonary dysplasia (BPD); the exact cause is unknown. The objective of this preliminary hypothesis generating study was to examine systemic arterial structure and vasomotor function in a cohort of preterm infants with severe BPD, using a cohort of preterm infants without BPD and a cohort of term infants for comparison.
Study Design:
After obtaining informed consent, we measured aortic wall thickness and vasomotor function by ultrasonography in 20 infants with severe BPD, 7 infants with no BPD, and compared them with 20 healthy term infants.
Results:
Maximum aortic thickness was significantly higher in infants with BPD (827±163 μm) compared to those with no BPD (674±22 μm) and term infants (657±67 μm) (unadjusted P<0.0001). The input impedance was similarly elevated in the infants with BPD (574±127 dynes scm−5) compared to those with no BPD (325±24 dynes s cm−5) or term infants (328±113 dynes s cm−5) (unadjusted P<0.0001). Stiffness index was significantly higher in the infants with BPD (3.4±0.6) compared to those with no BPD (2.6±0.3) or term infants (2.3±0.4) (unadjusted P<0.0001). Systemic vascular resistance was also significantly elevated in the infants with BPD. The results remained significant even after adjusting for gestational age and birth weight. Measures of vasomotor function significantly correlated with blood pressure.
Conclusion:
The aortic wall thickness and vasomotor function are significantly altered in preterm infants with severe BPD. These findings may explain the higher incidence of systemic hypertension in this population.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Chow SSW, Le Marsney R, Hossain S, Haslam R, Lui K . Report of the Australian and New Zealand Neonatal Network 2013. ANZNN: Sydney, 2015.
Slaughter JL, Pakrashi T, Jones DE, South AP, Shah TA . Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol 2011; 31: 635–640.
Mourani PM, Sontag MK, Ivy DD, Abman SH . Effects of long-term sildenafil treatment for pulmonary hypertension in infants with chronic lung disease. J Pediatr 2009; 154: 379–384.
Anderson AH, Warady BA, Daily DK, Johnson JA, Thomas MK . Systemic hypertension in infants with severe bronchopulmonary dysplasia: associated clinical factors. Am J Perinatol 1993; 10: 190–193.
Alagappan A, Malloy MH . Systemic hypertension in very low birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol 1998; 15: 3–8.
Abman SH, Warady BA, Lum GM, Koops BL . Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr 1984; 104: 928–931.
Kinsella JP, Greenough A, Abman SH . Bronchopulmonary dysplasia. Lancet 2006; 367: 1421–1431.
Kojima T, Sasai M, Kobayashi Y . Increased soluble ICAM-1 in tracheal aspirates of infants with bronchopulmonary dysplasia. Lancet 1993; 342: 1023–1024.
Vlachopoulos C, Aznaouridis K, Stefanadis C . Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 55: 1318–1327.
Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.
Skilton MR, Evans N, Griffiths KA, Harmer JA, Celermajer DS . Aortic wall thickness in newborns with intrauterine growth restriction. Lancet 2005; 365: 1484–1486.
Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 2001; 104: 2943–2947.
Bradley TJ, Potts JE, Lee SK, Potts MT, De Souza AM . Sandor GGS. Early changes in the vasomotor function of the aorta in pre-adolescent children born small for gestational age. J Pediatr 2010; 156: 388–392.
McNamara PJ, Stewart L, Shivananda SP, Stephens D, Sehgal A . Patent ductus arteriosus ligation is associated with impaired left ventricular systolic performance in premature infants weighing less than 1000 g. J Thorac Cardiovasc Surg 2010; 140: 150–157.
Gan CTJ, Lankhaar JW, Westerhof N, Marcus JT, Becker A, Twisk JWR et al. Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest 2007; 132 (6): 1906–1912.
Wang Z, Chesler N . Pulmonary vascular wall stiffness: an important contributor to the increased right ventricular afterload with pulmonary hypertension. Pulm Circ 2011; 1: 212–223.
Mukherjee D . Atherogenic vascular stiffness and hypertension cause or effect? JAMA 2012; 308: 919–920.
Cheung YF, Wong KY, Lam BCC, Tsoi NS . Relation of arterial stiffness with gestational age and birth weight. Arch Dis Child 2004; 89: 217–221.
Koklu E, Ozturk MA, Kurtoglu S, Akcakus M, Yikilmaz A, Gunes T . Aortic intima-media thickness, serum IGF-I, IGFBP-3, and leptin levels in intrauterine growth-restricted newborns of healthy mothers. Pediatr Res 2007; 62: 704–709.
Lurbe E, Torro MI, Carvajal E, Alvarez V, Redon J . Birth weight impacts on wave reflections in children and adolescents. Hypertension 2003; 41: 646–650.
te Velde SJ, Ferreira I, Twisk JWR, Stehouwer CDA, van Mechelen W, Kemper HCG . Birth weight and arterial stiffness and blood pressure in adulthood: results from the Amsterdam Growth and Health Longitudinal Study. Int J Epidemiol 2004; 33: 154–161.
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–2605.
Vlachopoulos C, Aznaouridis K, Stefanadis C . Clinical appraisal of arterial stiffness: the argonauts in front of the golden fleece. Heart 2006; 92: 1544–1550.
Blacher J, Safar ME . Large-artery stiffness, hypertension and cardiovascular risk in older patients. Nat Rev Cardiol 2005; 2: 450–455.
Waldstein SR, Rice SC, Thayer JF, Najjar SS, Scuteri A, Zonderman AB . Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Ageing. Hypertension 2008; 51: 99–104.
Takenaka T, Mimura T, Kanno Y, Suzuki H . Quantification of arterial stiffness as a risk factor to the progression of chronic kidney diseases. Am J Nephrol 2005; 25: 417–424.
Price RJ, Skalak TC . Circumferential wall stress as a mechanism for arteriolar rarefaction and proliferation in a network model. Microvasc Res 1994; 47: 188–202.
Avolio A, Jones D, Tafazzoli-Shadpour M . Quantification of alterations in structure and function of elastin in the arterial media. Hypertension 1998; 32: 170–175.
Vivodtzev I, Tamisier R, Baguet JP, Borel JC, Levy P, Pépin JL . Arterial stiffness in COPD. Chest 2014; 145: 861–875.
Laurent S, Alivon M, Beaussier H, Boutouyrie P . Aortic stiffness as a tissue biomarker for predicting future cardiovascular events in asymptomatic hypertensive subjects. Ann Med 2012; 44: S93–S97.
Abman SH . Pulmonary hypertension in chronic lung disease of infancy. Pathogenesis, pathophysiology and treatment. In: Bland RD, Coalson JJ (eds). Chronic Lung Disease of Infancy. Marcel Dekker: New York, USA, 2000, pp 619–668.
Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA 2012; 308: 875–881.
Mervaala EM, Muller DN, Park JK, Schmidt F, Fiebeler A, Theuer J et al. Monocyte infiltration and adhesion molecules in a rat model of high human renin hypertension. Hypertension 1999; 33: 389–395.
Dransfield MT, Cockcroft JR, Townsend RR, Coxson HO, Sharma SS, Rubin DB et al. Effect of fluticasone propionate/salmeterol on arterial stiffness in patients with COPD. Respir Med 2011; 105: 1322–1330.
Mourani PM, Ivy DD, Rosenberg AA, Fagan TE, Abman SH . Left ventricular diastolic dysfunction in bronchopulmonary dysplasia. J Pediatr 2008; 152: 291–293.
Skilton MR, Raitakari OT, Celermajer DS . High intake of dietary long chain omega-3 fatty acids is associated with lower blood pressure in children born with low birth weight: NHANES 2003–2008. Hypertension 2013; 61: 972–976.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Awarded the 2015 Monash Health and MHTP Award for Clinical Research (II prize).
Rights and permissions
About this article
Cite this article
Sehgal, A., Malikiwi, A., Paul, E. et al. Systemic arterial stiffness in infants with bronchopulmonary dysplasia: potential cause of systemic hypertension. J Perinatol 36, 564–569 (2016). https://doi.org/10.1038/jp.2016.10
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2016.10
This article is cited by
-
Systemic hypertension in preterm infants and neurodevelopmental outcomes
Journal of Perinatology (2023)
-
Left ventricular diastolic function and respiratory outcomes in preterm infants: a retrospective study
Pediatric Research (2023)
-
Assessment of Vascular Indices by Abdominal Aortic Ultrasonography in Preterm Neonates with Bronchopulmonary Dysplasia
Pediatric Cardiology (2023)
-
Sequelae associated with systemic hypertension in infants with severe bronchopulmonary dysplasia
Journal of Perinatology (2022)
-
Systemic Hypertension in Infants with Bronchopulmonary Dysplasia
Current Hypertension Reports (2022)