Cardiac Autonomic Function in Adults Born Preterm

  • Risto Karvonen
    Correspondence
    Reprint requests: Risto Karvonen, MD, Department of Chronic Disease Prevention, National Institute for Health and Welfare, PO Box 310, 90101 Oulu, Finland.
    Affiliations
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland

    Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Medical Research Center Oulu, University of Oulu, Oulu, Finland
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  • Marika Sipola
    Affiliations
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland

    Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Medical Research Center Oulu, University of Oulu, Oulu, Finland

    Institute of Health Sciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
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  • Antti Kiviniemi
    Affiliations
    Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Marjaana Tikanmäki
    Affiliations
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland

    Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Medical Research Center Oulu, University of Oulu, Oulu, Finland

    Institute of Health Sciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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  • Marjo-Riitta Järvelin
    Affiliations
    Institute of Health Sciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Department of Children and Families, Oulu and Helsinki, Finland

    Biocenter Oulu, Oulu, Finland

    Unit of Primary Care Unit, Oulu, Finland

    Department of Epidemiology and Biostatistics, Imperial College London, Medical Research Council Health Protection Agency Center for Environment and Health, School of Public Health, London, United Kingdom
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  • Johan G. Eriksson
    Affiliations
    Department of General Practice and Primary Health Care, Helsinki, Finland

    Folkhälsan Research Center, Helsinki, Finland
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  • Mikko Tulppo
    Affiliations
    Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Marja Vääräsmäki
    Affiliations
    Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Medical Research Center Oulu, University of Oulu, Oulu, Finland

    Department of Children and Families, Oulu and Helsinki, Finland
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  • Eero Kajantie
    Affiliations
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu and Helsinki, Finland

    Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Medical Research Center Oulu, University of Oulu, Oulu, Finland

    Hospital of Children and Adolescents, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Published:February 04, 2019DOI:https://doi.org/10.1016/j.jpeds.2018.12.061

      Objective

      To evaluate cardiac autonomic function in adults born preterm.

      Study design

      We studied the association between prematurity and cardiac autonomic function using heart rate variability measurements in 600 adults (mean age of 23.3 years) from a geographically based cohort in Northern Finland. There were 117 young adults born early preterm (<34 weeks), 207 born late preterm (34-36 weeks), and 276 born at term (≥37 weeks, controls). Autonomic function was analyzed by calculating time and frequency domain heart rate variability measurements using linear regression.

      Results

      Compared with controls, the mean difference in root mean square of successive differences (indicating cardiac vagal activity) was −12.0% (95% CI −22.2%, −0.5%, adjusted for sex, age, source cohort, and season P = .04) for the early preterm group and −7.8% (−16.8%, 2.0%, P = .12) for the late preterm group. Mean differences with controls in low frequency power (indicating cardiac vagal activity, including some sympathetic- and baroreflex-mediated effects) were −13.6% (−26.7%, 1.8%, P = .08) for the early preterm group and −16.4% (−27.0%, −4.3%, P = .01) for the late preterm group. Mean differences in high frequency power (quantifying cardiac vagal modulation in respiratory frequency) were −19.2% (−36.6%, 2.9%, P = .09) for the early preterm group and −13.8% (−29.4%, 5.3%, P = .15) for the late preterm group. Differences were attenuated when controlled for body mass index and physical activity.

      Conclusions

      Our results suggest altered autonomic regulatory control in adults born preterm, including those born late preterm. Altered autonomic regulatory control may contribute to increased cardiovascular risk in adults born preterm.

      Keywords

      Abbreviations:

      BMI ( Body mass index), ESTER ( Preterm Birth and Early-Life Programming of Adult Health and Disease), HF ( High frequency), HFP ( HF power), HR ( Heart rate), HRV ( HR variability), LF ( Low frequency), LFP ( LF power), rMSSD ( Root mean square of successive differences), VLBW ( Very low birth weight)
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