Duration of neonatal oxygen supplementation, erythropoiesis and blood pressure in young adults born preterm

BackgroundAlthough erythropoiesis is impaired and anaemia frequent in neonates born preterm, haematopoiesis in adults born preterm has not been previously studied.ObjectiveWe, thus, aimed to evaluate haemoglobin and erythropoietin levels in young adults born preterm, to identify neonatal events associated with erythropoiesis in adulthood and to examine the relationships of haemoglobin levels with respiratory function and blood pressure.MethodsWe assessed a cohort of 101 young adults (ages 18–29) born preterm (≤29 weeks of gestation), in comparison to 105 full-term controls. We measured haemoglobin, erythropoietin levels and blood pressure. We also assessed respiratory function using spirometry.ResultsCompared with controls, tobacco use and sex-adjusted haemoglobin levels were 5.3 (95% CI 2.9 to 7.7) g/L higher in preterm-born individuals, but erythropoietin levels were similar. Duration of oxygen supplementation in the neonatal period was independently associated with higher haemoglobin levels in the preterm group. In young adults born preterm with bronchopulmonary dysplasia, airflow limitation was associated with higher haemoglobin levels. Both systolic (SBP) and diastolic (DBP) blood pressure were increased in individuals born preterm (p=0.042 and p=0.0008, respectively). Higher haemoglobin levels were associated with higher SBP and DBP, independently of term or preterm status. Mediation analysis suggests that haemoglobin increase contributes to 37% and 32% of the effect of preterm birth on SBP and DBP, respectively.ConclusionsHaemoglobin levels are higher in young adults born preterm, while erythropoietin levels are similar, especially in case of bronchopulmonary dysplasia and airflow limitation, and haemoglobin increase is associated with elevated blood pressure in this population.

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40 Duration of Neonatal Oxygen Supplementation Associated with Higher Hemoglobin and Higher Blood Pressure in Young Adults Born Preterm

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.039 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e16-e17

Author(s):

Adrien Flahault ◽

Camille Girard-Bock ◽

Yves Pastore ◽

Thuy Mai Luu ◽

Anne-Monique Nuyt

Keyword(s):

Blood Pressure ◽

Young Adults ◽

Preterm Birth ◽

Bronchopulmonary Dysplasia ◽

Mediation Analysis ◽

Test Group ◽

Airflow Limitation ◽

Oxygen Supplementation ◽

Oscillometric Device ◽

Student’S T

Abstract Introduction/Background Although erythropoiesis is impaired and anemia frequent in neonates born preterm, hematopoiesis in adults born preterm has not been previously studied. We hypothesize that adverse neonatal events durably affect erythropoiesis regulation, leading to a difference in hemoglobin levels in young adults born preterm compared to those born term. Objectives We thus aimed to evaluate hemoglobin and erythropoietin levels in young adults born preterm, to identify neonatal events associated with erythropoiesis in adulthood and to examine the relationships of hemoglobin levels with respiratory function and blood pressure. Design/Methods This study included 101 young adults (ages 18-29 years) born preterm (≤29 weeks of gestation) and 105 full-term controls. We measured office blood pressure using automated oscillometric device, complete blood count, serum erythropoietin levels (ELISA) and pulmonary function test. Group comparisons were performed using Student’s t or Mann-Whitney U tests. Correlations were assessed using Pearson’s coefficient and test. We performed a mediation analysis to assess the relationship between blood pressure, hemoglobin levels and preterm birth. Results Tobacco use and sex adjusted hemoglobin levels were 5.3 (95% CI: 2.9, 7.7) g/L higher in preterm-born individuals compared to controls (Table). We did not observe a difference in erythropoietin levels (7.3±3.4 and 8.12±3.40 U/L in the term and the preterm groups, respectively, p=0.102). Duration of oxygen supplementation in the neonatal period was independently associated with higher hemoglobin levels in the preterm group. In adults born preterm with bronchopulmonary dysplasia, airflow limitation was associated with higher hemoglobin levels. Both systolic (SBP) and diastolic (DBP) blood pressure were increased in individuals born preterm (p=0.042 and p=0.0008, respectively). Higher hemoglobin levels were associated with higher SBP and DBP, independently of term or preterm status. Mediation analysis (Figure) suggests that hemoglobin increase contributes to 37% and 32% of the effect of preterm birth on SBP and DBP, respectively. Conclusion While erythropoietin levels are similar between groups, hemoglobin levels are higher in young adults born preterm, especially in cases of bronchopulmonary dysplasia and airflow limitation. Hemoglobin increase is associated with elevated blood pressure in this population. Understanding mechanisms of impaired erythropoiesis regulation in adults born preterm will be important in designing antihypertensive approaches specific to this population. Results shown as mean ± SD or medians (25%-75%) and comparisons were performed using Student’s t test or Mann-Whitney U test, when appropriate. Systolic blood pressure (SBP). B. Diastolic blood pressure (DBP). Hb: hemoglobin. ACME: Average Causal Mediation Effect. B: unstandardized regression coefficient. All estimations are adjusted for sex.

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Regional Disparities in the Incidence of Elevated Blood Pressure Among Young Adults

Circulation ◽

10.1161/01.cir.96.4.1082 ◽

1997 ◽

Vol 96 (4) ◽

pp. 1082-1088 ◽

Cited By ~ 25

Author(s):

Catarina I. Kiefe ◽

O. Dale Williams ◽

Diane E. Bild ◽

Cora E. Lewis ◽

Joan E. Hilner ◽

...

Keyword(s):

Blood Pressure ◽

Young Adults ◽

Regional Disparities ◽

Elevated Blood Pressure ◽

Elevated Blood

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Prevalence of Elevated Blood Pressure in HIV-infected Children, Adolescents and Young Adults

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000001178 ◽

2016 ◽

Vol 35 (7) ◽

pp. 824-825 ◽

Cited By ~ 1

Author(s):

Talía Sainz ◽

Sergio Serrano-Villar ◽

María José Mellado

Keyword(s):

Blood Pressure ◽

Young Adults ◽

Adolescents And Young Adults ◽

Elevated Blood Pressure ◽

Elevated Blood

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Prevalence and Risk Factors of Elevated Blood Pressure, Overweight, and Dyslipidemia in Adolescent and Young Adults in Rural Nepal

Metabolic Syndrome and Related Disorders ◽

10.1089/met.2013.0016 ◽

2013 ◽

Vol 11 (5) ◽

pp. 319-328 ◽

Cited By ~ 10

Author(s):

Christine P. Stewart ◽

Parul Christian ◽

Lee S.F. Wu ◽

Steven C. LeClerq ◽

Subarna K. Khatry ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Young Adults ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Adolescent And Young Adults ◽

Rural Nepal

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Arterial Structure and Stiffness Are Altered in Young Adults Born Preterm

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.120.315099 ◽

2020 ◽

Vol 40 (10) ◽

pp. 2548-2556

Author(s):

Adrien Flahault ◽

Rafael Oliveira Fernandes ◽

Julie De Meulemeester ◽

Daniela Ravizzoni Dartora ◽

Anik Cloutier ◽

...

Keyword(s):

Young Adults ◽

Bronchopulmonary Dysplasia ◽

Pulse Wave ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Ascending Aorta ◽

Flow Mediated Dilation ◽

Arterial Distensibility ◽

Arterial Structure ◽

Preterm Group

Objective: Preterm birth has been associated with changes in arterial structure and function. Association with complications occurring during the neonatal period, including bronchopulmonary dysplasia, on vascular outcomes in adulthood is unknown. Approach and Results: We evaluated a cohort of 86 adults born preterm (below 30 weeks of gestation), compared to 85 adults born term, at a mean age of 23 years. We performed ultrasonographic assessment of the dimensions of the ascending aorta, carotid and brachial arteries, and estimated flow-mediated dilation, carotid-femoral pulse wave velocity, augmentation index corrected for heart rate, and carotid intima-media thickness. All analyses were performed with and without adjustment for potential confounding variables, including height, sex, and body mass index. Ascending aorta diameter in diastole was smaller in the preterm group, but carotid and brachial arteries were similar. Carotid and brachial strain, a marker of arterial distensibility, was smaller in the preterm group, while carotid-femoral pulse wave velocity, was similar between groups, indicating similar aortic stiffness. Carotid intima-media thickness, endothelial function flow-mediated dilation, blood nitrite, and nitrate levels were similar between groups. Individuals with bronchopulmonary dysplasia had lower brachial artery strain suggesting long-term association of this neonatal complication with vascular structure. Diastolic blood pressure was higher in the preterm group and was associated with decreased brachial and carotid distensibility. Conclusions: Young adults born preterm display alterations in arterial distensibility that are associated with a history of bronchopulmonary dysplasia.

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