“Programmed” futures

Article Outline

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The Barker hypothesis relates decreased size at birth to adverse cardiovascular outcomes as an adult. The original observations focused primarily on infants born small at term. There is accumulating information suggesting that preterm infants also may be at risk of cardiovascular and metabolic abnormalities as they age. In this issue of The Journal, Mikkola et al report on a 5-year follow-up of cardiovascular function in AGA and SGA very low birth weight infants in comparison with term infants. This cohort of preterm infants had increased cardiac workload and compromised hemodynamic adaptation in the first weeks of life relative to term infants. Now at 5 years, they have abnormal measurements for heart wall and chamber sizes as well as alterations in microvascular perfusion in response to sodium nitroprusside and acetylcholine. Strengths of the study are the sequential evaluation of a cohort of infants and the use of provocations to tease out differences in microvascular perfusion. The long-term importance of the detected differences will require further study at older ages. However, this study is another demonstration that fetal and/or early life events can “program” physiological responses in later life.