Early Pulmonary Vascular Disease Onset Risk in Adults Born Preterm

Young adults who are born preterm may have an elevated risk for early pulmonary vascular disease, according to a study in the American Journal of Respiratory and Critical Care Medicine. The early disease onset was typically characterized by increased pulmonary pressures, right ventricular (RV) dysfunction, and a stiffer pulmonary vascular bed.

A total of 11 preterm individuals from the Newborn Lung Project, which comprised preterm infants born with a weight of ≤1500 grams between 1988 and1991, were enrolled and followed prospectively. In addition, study investigators enrolled 10 control infants born at a healthy weight during the same time period. The initial screening visit was used to test pulmonary function and maximal exercise for peak oxygen consumption and maximal power output. Right heart catheterization was also performed to evaluate both RV and pulmonary vascular hemodynamics at rest and during hypoxic and exercise periods.

At rest, participants who were born preterm had a 41% higher pulmonary arterial pressure compared with control participants (mean pulmonary arterial pressure19.7±4.6 mm Hg vs 14.0±3.4 mm Hg, respectively; P =.006). A stiffer vascular bed was also found in preterm vs term infants, as demonstrated by higher total pulmonary vascular resistance (tPVR) and elastance at rest (tPVR: 1.5±0.4 mm Hg/L/min vs 2.1±0.8 mm Hg/L/min; P =.03 and elastance: 0.11±0.02 mm Hg/mL vs 0.18±0.07 mm Hg/mL; P =.007) and during exercise (tPVR: 1.0±0.4 mm Hg/L/min vs 1.6±0.3 mm Hg/L/min; P =.02 and elastase: 0.11±0.05 mm Hg/mL vs 0.20±0.04 mm Hg/mL; P =.004;).

In addition, the number of days spent on combined invasive and noninvasive ventilation was the strongest neonatal predictor of elevated mean pulmonary arterial pressure in adulthood.

The study’s fairly small sample size and the potential selection bias because of the enrollment of preterm infants with no known history of adult respiratory or cardiovascular disease were the primary limitations of the analysis.

The investigators reported that further study “should evaluate the role of earlier treatment of pulmonary vascular disease in order to maintain RV function in this high-risk population.”

Reference

Goss KN, Beshish AG, Barton GP, et al. Early pulmonary vascular disease in young adults born preterm [published online June 26, 2018]. Am J Respir Crit Care Med. doi:10.1164/rccm.201710-2016OC