Persistent high blood pressure and renal dysfunction in preterm infants during childhood

Background Infants born very preterm (<= 32 weeks gestational age, GA) and very-low birth weight (<= 1500 g; PT-VLBW) demonstrate high systolic blood pressure (SBP), renal dysfunction, and obesity at 6 months-3 years and in early adulthood. Their parallel measurement and progression during childhood is unclear. Methods We reenrolled 62/120 patients originally seen at 1-3 years at 10-13 years and remeasured anthropometric indices, SBP, and serum creatinine (Cr) and cystatin C (cysC) to determine estimated glomerular filtration rate (eGFR). We selected Term-matched Controls at 10-13 years from the 2015-2016 NHANES database at a ratio of 2 Controls:1 Case (124:62). Results Reenrolled patients were predominantly Hispanic, birth weight 1073 +/- 251 g, and GA at birth 28 +/- 2 weeks. At 10-13 years, 45% were classified overweight/obese, 48% had SBP >= 90th centile (77% considered hypertensive), and 34% had low eGFR (<90 mL min(-1) [1.73 m(2)](-1)). Notably, 57% of reenrolled PT-VLBW Cases had low eGFR(cysC) at both 1-3 and 10-13 years, P < 0.03. Compared to Controls, Cases had four times the adjusted odds for having an elevated SBP and low eGFR(Cr) despite similar proportions with overweight/obesity among Cases and Controls. Conclusions PT-VLBW infants seen at 1-3 years exhibit obesity, elevated SBP, and low eGFR in infancy and 10-13 years. Although the small sample size may limit conclusions, pediatricians should consider serial evaluations of PT-VLBW throughout childhood. Impact The association between preterm birth and elevated blood pressure, renal dysfunction, and obesity in young adults begins as early as 1 year and persists at 10-13 years of age. This is the first study reporting serial measurements of blood pressure, renal function, and obesity from infancy to preadolescence in children born very preterm. Fifty-seven percent of preterm 1-3 year olds have persistent low estimated glomerular filtration rate associated with hypertension at 10-13 years. Clinicians should consider serial evaluations of blood pressure, renal function, and obesity throughout infancy and childhood in all preterm births.

Automated summary

Infants born very preterm and with very-low birth weight often exhibit high blood pressure, renal dysfunction, and obesity. This study aimed to determine the progression of these conditions during childhood. The results showed that PT-VLBW infants at 1-3 years and at 10-13 years still had obesity, elevated blood pressure, and low glomerular filtration rate. It is important for pediatricians to conduct regular evaluations throughout childhood for children born very preterm.