Skip to main content
SpringerLink
Log in

Elevated systolic blood pressure in preterm very-low-birth-weight infants ≤3 years of life

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Preterm, very-low-birth-weight neonates (≤1500 gm, VLBW) exhibit elevated systolic blood pressures (SBP) in adolescence and adulthood; however, the age of onset and causes are unknown. We assessed SBP in a cross-sectional study of VLBW infants at 1, 2 and 3 years of age (n = 40 per cohort). SBP was manually measured using Doppler amplification (observed), and calm values were compared to reference ranges used for clinical purposes (expected). SBP was converted to age-, gender- and height-specific z-scores (SBPz). Perinatal variables and growth parameters measured between 6 and 36 months were assessed as predictors of an elevated SBP. Observed SBP and SBPz exceeded the expected value at each age (P < 0.01); for example 1 year SBP was 94 ± 10 (standard deviation) vs. 85 ± 3 mmHg, respectively. Although the expected SBP rose from 85 ± 3 to 90 ± 3 mmHg with advancing age (P < 0.05), VLBW SBP was unchanged (P > 0.1), averaging 93 mmHg across ages. Height and weight z-scores were below expected (P < 0.01), while weight-for-height z-scores exceeded zero at 6, 12 and 24 months (P < 0.05). Male subscapular skinfold thickness:abdominal circumference ratio decreased with advancing age, paralleling the decreases in SBPz. The VLBW neonates demonstrated an elevated SBP as early as 1 year of age. Although predictive perinatal variables were not identified, gender-specific relationships between infant growth and SBP were observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barker DJP (1995) Fetal origins of coronary heart disease. Br Med J 311:171–174

    Article  CAS  Google Scholar 

  2. Nilsson PM, Ostergren PO, Nyberg P, Soderstrom M, Allebeck P (1997) Low birth weight is associated with elevated systolic blood pressure in adolescence: a prospective study of a birth cohort of 149, 378 Swedish boys. J Hypertens 15:1627–1631

    Article  CAS  Google Scholar 

  3. Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG (2005) Trajectories of growth among children who have coronary events as adults. N Engl J Med 353:1802–1809

    Article  CAS  Google Scholar 

  4. Hardy R, Wadsworth ME, Langenberg C, Kuh D (2004) Birthweight, childhood growth, and blood pressure at 43 years in a British birth cohort. Int J Epidemiol 33:121–129

    Article  Google Scholar 

  5. Eriksson JG (2007) Epidemiology, genes and the environment: lessons learned from the Helsinki Birth Cohort Study. J Intern Med 261:418–425

    Article  CAS  Google Scholar 

  6. Belfort MB, Rifas-Shiman SL, Rich-Edwards J, Kleinman KP, Gillman MW (2007) Size at birth, infant growth, and blood pressure at three years of age. J Pediatr 151:670–674

    Article  Google Scholar 

  7. Siewert-Delle LS (1998) The impact of birth weight and gestational age on blood pressure in adult life. A population-based study of 49-year-old men. Am J Hypertens 11:946–953

    Article  CAS  Google Scholar 

  8. Johansson S, Thadou A, Bergvall N, Tuvemo T, Noramn M, Cnattinhius S (2005) Risk of high blood pressure among young men increases with the degree of immaturity at birth. Circulation 112:3430–3436

    Article  Google Scholar 

  9. Bonamy AE, Bendito A, Martin H, Andolf E, Sedin G, Norman M (2005) Preterm birth contributes to increased vascular resistance and higher blood pressure in adolescent girls. Pediatr Res 58:845–849

    Article  Google Scholar 

  10. Hack M, Schluchter M, Cartar L, Rahman M (2005) Blood pressure among very low birth weight (<1.5 kg) young adults. Pediatr Res 58:677–684

    Article  Google Scholar 

  11. Keijzer-Veen MG, Finken MJ, Nauta J, Dekker FW, Hille ET, Frölich M, Wit JM, van der Heijden AJ, Dutch POPS-19 Collaborative Study Group (2005) Is blood pressure increased 19 years after intrauterine growth restriction and preterm birth? A prospective follow-up study in the Netherlands. Pediatrics 116:725–731

    Article  Google Scholar 

  12. (2004) National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents:The Fourth Report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 144:555–576

  13. Duncan AF, Rosenfeld CR, Morgan JS, Ahmad HRJ (2008) Interrater reliability and effect of state on blood pressure measurements in infants 1 to 3 years of age. Pediatrics 122:e590–e594

    Article  Google Scholar 

  14. Whyte RK, Elseed AM, Fraser CB, Shinebourne EA, de Swiet M (1975) Assessment of Doppler ultrasound to measure systolic and diastolic blood pressures in infants and young children. Arch Dis Child 50:542–544

    Article  CAS  Google Scholar 

  15. Butani L, Morgenstern B (2003) Are pitfalls of oscillometric blood pressure measurements preventable in children? Pediatr Nephrol 18:313–318

    Article  Google Scholar 

  16. He J, Whelton PK (1999) Elevated systolic blood pressure and risk of cardiovascular and renal disease: Overview of evidence from observational epidemiologic studies and randomized controlled trials. Am Heart J 138:S211–S219

    Article  Google Scholar 

  17. Berenson GS, McMahan CA, Voors AW, Webber LS, Frank GC, Foster TA, Blonde CV (1980) Cardiovascular risk factors in children: the early natural history of atherosclerosis and essential hypertension. Oxford University Press, New York

    Google Scholar 

  18. Gutgesell M, Terrell G, Labarthe D (1981) Pediatric blood pressure: ethnic comparison in a primary care center. Hypertension 3:39–49

    Article  CAS  Google Scholar 

  19. Rosner B, Prineas RJ, Loggie JMH, Daniels SR (1993) Blood pressure nomograms for children and adolescents, by height, sex, and age in the United States. J Pediatr 123:871–886

    Article  CAS  Google Scholar 

  20. Schacter J, Kuller LH, Perfetti C (1984) Blood pressure during the first five years of life: relation to ethnic group (black or white) and to parental hypertension. Am J Epidemiol 119:541–553

    Article  Google Scholar 

  21. Zinner SH, Rosner B, Oh WO, Kass EH (1985) Significance of blood pressure in infancy. Hypertension 7:411–416

    Article  CAS  Google Scholar 

  22. World Health Organization (WHO) (2007) WHO Anthro for Personal Computers, version 2. Software for assessing growth and development of the world’s children. World Health Organization, Geneva

  23. WHO Multicentre Growth Reference Study Group (2007) WHO child growth standards: Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age: methods and development. World Health Organization, Geneva

  24. WHO Multicentre Growth Reference Study Group (2006) WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization, Geneva

  25. de Onis M, Garza C, Onyango AW, Martorell R (2006) WHO Child growth standards. Acta Paediatr 95[Suppl 450]:76–85

    Google Scholar 

  26. Tabachnick BG, Fidell LS (1996) Using multivariate statistics, 3rd edn. Harper Collins College Publ, New York

  27. Kanai H, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Nagai Y, Fujioka S, Tokunaga K, Tarui S (1990) Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension 16:484–490

    Article  CAS  Google Scholar 

  28. Ll N, Laaksonen DE, Nyyssönen K, Punnonen K, Valkonen V, Fuentes R, Tuomainen T, Salonen R, Salonen JT (2004) Inflammation, abdominal obesity, and smoking as predictors of hypertension. Hypertension 44:859–865

    Article  Google Scholar 

  29. Snijder MB, Zimmet PZ, Visser M, Dekker JM, Seidell JC, Shaw JE (2004) Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study. Int J Obes 28:402–409

    Article  CAS  Google Scholar 

  30. Irving RJ, Belton NR, Elton RA, Walker BR (2000) Adult cardiovascular risk factors in premature babies. Lancet 355:2135–2136

    Article  CAS  Google Scholar 

  31. Task Force on Blood Pressure Control in Children (1987) Report of the Second Task Force on Blood Pressure Control in Children. Pediatrics 79:1–25

    Google Scholar 

  32. Bracewell MA, Hennessy EM, Wolke D, Marlow (2008) The EPICure study: growth and blood pressure at 6 years of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 93:F108-F114

  33. Zubrow AB, Hulman S, Kushner H, Falkner B (1995) Determinants of blood pressure in neonates admitted to neonatal intensive care units: a prospective multicenter study. J Perinatol 15:470–479

    CAS  PubMed  Google Scholar 

  34. LaFlore JL, Engle WD, Rosenfeld CR (2000) Determinants of blood pressure in very low birth weight neonates: lack of effect of antenatal steroids. Early Hum Dev 59:37–50

    Article  Google Scholar 

  35. Georgieff MK, Mills MM, Gomez-Marin O, Sinaiko AR (1996) Rate of change in blood pressure in premature and full term infants from birth to 4 months. Pediatr Nephrol 10:152–155

    Article  CAS  Google Scholar 

  36. Rodriguez MM, Gomez AH, Abitbol CL, Chandar JJ, Duara S, Zilleruelo GE (2004) Histomorphometric analysis of postnatal glomerulogenesis in extremely preterm infants. Pediatr Dev Pathol 7:17–25

    Article  Google Scholar 

  37. Bagby SP (2009) Developmental origins of renal disease: Should nephron protection begin at birth? Clin J Am Soc Nephrol 4:10–13

    Article  Google Scholar 

  38. Hodgin JB, Rasoulpour M, Markowitz GS, D’Agati VD (2009) Very low birth weight is a risk factor for secondary focal segmental glomerulosclerosis. Clin J Am Soc Nephrol 4:71–76

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Duncan received funding from a Marshall Klaus Research Award from the American Academy of Pediatrics, Section on Perinatal Pediatrics; additional support was provided by the George L. MacGregor Professorship awarded to Dr. Rosenfeld.

Author information

Authors and Affiliations

  1. Division of Neonatal–Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical School at Dallas, 5323 Harry Hines Blvd, Dallas, TX, 75390–9002, USA

    Andrea F. Duncan, Roy J. Heyne, Janet S. Morgan & Charles R. Rosenfeld

  2. Department of Clinical Research, Children’s Medical Center of Dallas, Dallas, TX, 75235, USA

    Naveed Ahmad

Authors
  1. Andrea F. Duncan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roy J. Heyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janet S. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naveed Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles R. Rosenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles R. Rosenfeld.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duncan, A.F., Heyne, R.J., Morgan, J.S. et al. Elevated systolic blood pressure in preterm very-low-birth-weight infants ≤3 years of life. Pediatr Nephrol 26, 1115–1121 (2011). https://doi.org/10.1007/s00467-011-1833-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-011-1833-x

Keywords

Search

Navigation