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Wieler ME, Murphy TG, Blecherman M, Mehta H, Bender GJ. Infant heart-rate measurement and oxygen desaturation detection with a digital video camera using imaging photoplethysmography. J Perinatol 2021; 41:1725-1731. [PMID: 33649437 DOI: 10.1038/s41372-021-00967-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/21/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the feasibility of using an ordinary digital video camera to measure heart rate and detect oxygen desaturations in healthy infants. STUDY DESIGN Heart rate and oxygen saturation were measured with a video camera by detecting small color changes in 28 infants' foreheads and compared with standard pulse oximetry measures. Multivariable regression examined the relationship between infant characteristics and heart-rate measurement precision. RESULTS The average bias of camera heart-rate measures was -4.2 beats per minute (BPM) and 95% limits of agreement were ±43.8 BPM. Desaturations detected by camera were 75% sensitive (15/20) and had a positive predictive value of 20% (15/74). Lower birth-weight was independently correlated with more precise heart-rate measures (8.05 BPM per kg, [95% CI 0.764-15.3]). CONCLUSIONS A digital video camera provides accurate but imprecise measures of infant heart rate and may provide a rough screening tool for oxygen desaturations.
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Affiliation(s)
- Matthew E Wieler
- Women & Infants' Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- University of California-San Diego, San Diego, CA, USA.
| | - Thomas G Murphy
- Women & Infants' Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Goryeb Children's Hospital, Morristown, NJ, USA
| | | | - Hiral Mehta
- Women & Infants' Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - G Jesse Bender
- Women & Infants' Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Mission Health System, Asheville, NC, USA
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2
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Sabri MR, Habibi D, Ramezaninezhad D, Ghazavi R, Gheissari A, Mohammadifard N, Mansourian M, Sarrafzadegan N. The associations of low birth weight with primary hypertension in later life: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:33. [PMID: 34345244 PMCID: PMC8305774 DOI: 10.4103/jrms.jrms_869_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/28/2020] [Accepted: 12/25/2020] [Indexed: 12/04/2022]
Abstract
Background: The purpose of this study was to evaluate of the study the role of LBW on EH in children and by studying the existing published literature. Materials and Methods: A comprehensive literature search for original studies was conducted in Clarivate Analytics Web of Science, PubMed, Scopus, and Embase until July 2019. The search used all of the main keywords and its synonyms include essential hypertension, primary hypertension, essential arterial hypertension, idiopathic hypertension, spontaneous hypertension; child, childhood, children, pediatric, pediatrics, infant, infancy, newborn, neonatal, adolescence, teenagers; and BW, newborn weight, neonatal weight, BW. Results: Twelve articles were eligible for the final evaluation. Due to the difference among studies in the report, studies were divided into two-part. The first part, articles were reported in the LBW and NBW groups (interested outcome were SBP and DBP), and the second part was composed as the EH and NR groups (interested outcome were LBW and NBW). In the first part, SMD for SBP was -1.09 with 95% CI (-1.91,-0.26), and was statistically significant (Z=2.58, P=0.010). As well, SMD for DBP was -0.68 with 95% CI (-1.32,-0.05) statistically significant (Z=2.10, P=0.036). In the second part, SMD for SBP was 0.77 with 95% CI (-0.85, 2.39), and was statistically significant (Z=0.93, P=0.352). Subgroup analysis was performed on the pre-term and full- term babies. SMD for SBP was -0.08 with 95% CI (-0.51, 0.35) in the pre-term, and the full-term was -2.07 with 95% CI (-3.47, -0.67). As well, SMD for DBP was -0.02 with 95% CI (-0.20, 0.17) in the preterm, and the term was -1.35 with 95% CI (-1.57, -1.13). Conclusion: Although findings of the correlation between BW and EHTN have conflicted. To our knowledge, this is the first report that attempts to a conclusion.
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Affiliation(s)
- Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Danial Habibi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Roghaieh Ghazavi
- Vice Chancellery of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alaleh Gheissari
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Malik PRV, Edginton AN. Integration of Ontogeny Into a Physiologically Based Pharmacokinetic Model for Monoclonal Antibodies in Premature Infants. J Clin Pharmacol 2019; 60:466-476. [DOI: 10.1002/jcph.1540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Paul R. V. Malik
- School of PharmacyUniversity of Waterloo Kitchener Ontario Canada
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4
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Anyfanti P, Gkaliagkousi E, Douma S. Oxygen therapy, capillary rarefaction and blood pressure rise in premature low birth weight infants: is there a link? J Hum Hypertens 2019; 33:821-823. [PMID: 31636351 DOI: 10.1038/s41371-019-0258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Panagiota Anyfanti
- Third Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Eugenia Gkaliagkousi
- Third Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- Third Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Goloba M, Raghuraman R, Botros N, Khan U, Klein M, Brown A, Duffy D, Anim-Nyame N, Wang D, Manyonda I, Antonios TF. Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study. Am J Hypertens 2019; 32:570-578. [PMID: 30821323 PMCID: PMC6508166 DOI: 10.1093/ajh/hpz034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Capillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life. METHODS We studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months. RESULTS We found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD. CONCLUSIONS This study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.
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Affiliation(s)
- Muti Goloba
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Rajendra Raghuraman
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Nansi Botros
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Uzma Khan
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Monique Klein
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Amelia Brown
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Donovan Duffy
- Neonatal Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nick Anim-Nyame
- Obstetrics and Gynaecology Department, Kingston Hospital NHS Foundation Trust, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Isaac Manyonda
- Obstetrics and Gynaecology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Tarek F Antonios
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
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6
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Raghuraman RP, Duffy D, Carroll VA, Manyonda I, Antonios TF. Oxygen therapy in premature low birth weight infants is associated with capillary loss and increases in blood pressure: a pilot study. J Hum Hypertens 2019; 34:278-285. [PMID: 31073155 DOI: 10.1038/s41371-019-0211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 11/09/2022]
Abstract
Low birth weight (LBW) and premature birth are known risk factors for future cardiovascular disease and in particular essential hypertension (EH). Capillary rarefaction (CR) is an established hallmark of EH and is known to occur in individuals with a history of LBW. We previously reported that LBW infants do not have CR at birth but rather increased capillary density (CD). We hypothesized that LBW infants undergo a process of accelerated CR in early life, triggered in part by oxygen therapy. We studied 26 LBW infants, of whom 10 infants received oxygen therapy, and compared them to 14 normal birth weight (NBW) infants. We measured CD at 1, 5 and 10 days after birth and again after 40 weeks adjusted gestational age equivalent to birth at full term. We confirmed that LBW infants had higher CD at birth compared to NBW infants and found that significant structural CR occurred at term age in LBW infants who had received oxygen therapy (mean difference -22 capillaries/field, p = 0.007) and in those who did not receive oxygen therapy (mean difference -29 capillaries/field, p < 0.001) compared to baseline at birth. Both LBW groups showed a significant rise in BP at 40 weeks adjusted term age and the rise in systolic (mean difference 24 mm Hg, p < 0.0001) and diastolic BP (mean difference 14 mm Hg, p < 0.001) was more pronounced in the oxygen treated group compared to the nonoxygen group (mean difference 14 mm Hg, p = 0.043 and mean difference = 9 mm Hg p = 0.056 respectively). In conclusion, oxygen therapy in premature LBW infants may induce significant increases in their BP in early life.
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Affiliation(s)
- Rajendra P Raghuraman
- Molecular & Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Donovan Duffy
- Neonatal Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Veronica A Carroll
- Molecular & Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Isaac Manyonda
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tarek F Antonios
- Molecular & Clinical Sciences Research Institute, St. George's, University of London, London, UK. .,Blood Pressure Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
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7
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Malik P, Edginton A. Pediatric physiology in relation to the pharmacokinetics of monoclonal antibodies. Expert Opin Drug Metab Toxicol 2018; 14:585-599. [PMID: 29806953 DOI: 10.1080/17425255.2018.1482278] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Dose design for pediatric trials with monoclonal antibodies (mAbs) is often extrapolated from the adult dose according to weight, age, or body surface area. While these methods account for the size differences between adults and children, they do not account for the maturation of processes that may play a key role in the pharmacokinetics and/or pharmacodynamics of mAbs. With the same weight-based dose, infants and young children typically receive lower plasma exposures when compared to adults. Areas covered: The mechanistic features of mAb distribution, elimination, and absorption are explored in detail and literature-based hypotheses are generated to describe their age-dependence. This knowledge can be incorporated into a physiologically based pharmacokinetic (PBPK) modeling approach to pediatric dose determination. Expert opinion: As data from pediatric clinical trials become increasingly available, we have the opportunity to reflect on the physiologic drivers of pharmacokinetics, safety, and efficacy in children with mathematical models. A modeling approach that accounts for the age-related features of mAb disposition can be used to derive first-in-pediatric doses, design optimal sampling schemes for children in clinical trials and even explore new pharmacokinetic end-points as predictors of safety and efficacy in children.
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Affiliation(s)
- Paul Malik
- a School of Pharmacy , University of Waterloo , Kitchener , Ontario , Canada
| | - Andrea Edginton
- a School of Pharmacy , University of Waterloo , Kitchener , Ontario , Canada
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8
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van Elteren HA, de Jonge RCJ, van Rosmalen J, Ince C, Reiss IKM. Adaptation of the Cutaneous Microcirculation in Preterm Neonates. Microcirculation 2018; 23:468-74. [PMID: 27378187 DOI: 10.1111/micc.12295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/28/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Transition from fetal to neonatal circulation is characterized by multiple hemodynamic changes. The role of the microcirculation in this process is underexposed. Visualizing the cutaneous microcirculation can help us understand peripheral perfusion in a noninvasive manner. METHODS Cutaneous microcirculation of term and preterm infants born below 32 weeks of GA was measured in the first month of life using IDF imaging. Linear mixed modeling was used to identify clinical variables which influence the cutaneous microcirculation. RESULTS Sixty preterm and 33 term infants were included. TVD of preterm infants significantly decreased in the first month of life (31.7 mm/mm(2) day 1 vs 27.9 mm/mm(2) day 28), but remained significantly higher compared to TVD of term infants on day 1 (25.8 mm/mm(2) ). Besides postnatal age, no clinical variables were associated with TVD. Infants born SGA had significantly higher TVD values directly after birth than those born appropriate for GA (35.4 mm/mm(2) vs 31.6 mm/mm(2) ; p = 0.015). CONCLUSIONS TVD decreases in the first month after birth and is higher in preterm infants compared to those born term. Differences in antenatal oxygen exposure might explain the adaptation of the microcirculation.
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Affiliation(s)
- Hugo A van Elteren
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Rogier C J de Jonge
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
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9
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Houben AJHM, Martens RJH, Stehouwer CDA. Assessing Microvascular Function in Humans from a Chronic Disease Perspective. J Am Soc Nephrol 2017; 28:3461-3472. [PMID: 28904002 DOI: 10.1681/asn.2017020157] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Microvascular dysfunction (MVD) is considered a crucial pathway in the development and progression of cardiometabolic and renal disease and is associated with increased cardiovascular mortality. MVD often coexists with or even precedes macrovascular disease, possibly due to shared mechanisms of vascular damage, such as inflammatory processes and oxidative stress. One of the first events in MVD is endothelial dysfunction. With the use of different physiologic or pharmacologic stimuli, endothelium-dependent (micro)vascular reactivity can be studied. This reactivity depends on the balance between various mediators, including nitric oxide, endothelin, and prostanoids, among others. The measurement of microvascular (endothelial) function is important to understand the pathophysiologic mechanisms that contribute to MVD and the role of MVD in the development and progression of cardiometabolic/renal disease. Here, we review a selection of direct, noninvasive techniques for measuring human microcirculation, with a focus on methods, interpretation, and limitations from the perspective of chronic cardiometabolic and renal disease.
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Affiliation(s)
- Alfons J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and .,CARIM School for Cardiovascular Diseases and
| | - Remy J H Martens
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and.,School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; and.,CARIM School for Cardiovascular Diseases and
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Kuiper JW, Tibboel D, Ince C. The vulnerable microcirculation in the critically ill pediatric patient. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:352. [PMID: 27794361 PMCID: PMC5086412 DOI: 10.1186/s13054-016-1496-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients. Therefore, the development of non-invasive methods for monitoring the MC is necessary in pediatric critical care for early identification of impending deterioration and to enable the initiation and titration of therapy to ensure cell survival. To date, the MC may be non-invasively monitored at the bedside using hand-held videomicroscopy, which provides useful information regarding the microcirculation. There is an increasing number of studies on the MC in neonates and pediatric patients; however, additional steps are necessary to transition MC monitoring from bench to bedside. The recently introduced concept of hemodynamic coherence describes the relationship between changes in the MC and macrocirculation. The loss of hemodynamic coherence may result in a depressed MC despite an improvement in the macrocirculation, which represents a condition associated with adverse outcomes. In the pediatric intensive care unit, the concept of hemodynamic coherence may function as a framework to develop microcirculatory measurements towards implementation in daily clinical practice.
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Affiliation(s)
- J W Kuiper
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands.
| | - D Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands
| | - C Ince
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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11
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Yu GZ, Aye CYL, Lewandowski AJ, Davis EF, Khoo CP, Newton L, Yang CT, Al Haj Zen A, Simpson LJ, O'Brien K, Cook DA, Granne I, Kyriakou T, Channon KM, Watt SM, Leeson P. Association of Maternal Antiangiogenic Profile at Birth With Early Postnatal Loss of Microvascular Density in Offspring of Hypertensive Pregnancies. Hypertension 2016; 68:749-59. [PMID: 27456522 PMCID: PMC4978605 DOI: 10.1161/hypertensionaha.116.07586] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/27/2016] [Indexed: 12/18/2022]
Abstract
Offspring of hypertensive pregnancies are more likely to have microvascular rarefaction and increased blood pressure in later life. We tested the hypothesis that maternal angiogenic profile during a hypertensive pregnancy is associated with fetal vasculogenic capacity and abnormal postnatal microvascular remodeling. Infants (n=255) born after either hypertensive or normotensive pregnancies were recruited for quantification of postnatal dermal microvascular structure at birth and 3 months of age. Vasculogenic cell potential was assessed in umbilical vein endothelial cells from 55 offspring based on in vitro microvessel tube formation and proliferation assays. Maternal angiogenic profile (soluble fms-like tyrosine kinase-1, soluble endoglin, vascular endothelial growth factor, and placental growth factor) was measured from postpartum plasma samples to characterize severity of pregnancy disorder. At birth, offspring born after hypertensive pregnancy had similar microvessel density to those born after a normotensive pregnancy, but during the first 3 postnatal months, they had an almost 2-fold greater reduction in total vessel density (-17.7±16.4% versus -9.9±18.7%; P=0.002). This postnatal loss varied according to the vasculogenic capacity of the endothelial cells of the infant at birth (r=0.49; P=0.02). The degree of reduction in both in vitro and postnatal in vivo vascular development was proportional to levels of antiangiogenic factors in the maternal circulation. In conclusion, our data indicate that offspring born to hypertensive pregnancies have reduced vasculogenic capacity at birth that predicts microvessel density loss over the first 3 postnatal months. Degree of postnatal microvessel reduction is proportional to levels of antiangiogenic factors in the maternal circulation at birth.
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Affiliation(s)
- Grace Z Yu
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Christina Y L Aye
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Adam J Lewandowski
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Esther F Davis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Cheen P Khoo
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Laura Newton
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Cheng T Yang
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Ayman Al Haj Zen
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Lisa J Simpson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Kathryn O'Brien
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - David A Cook
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Ingrid Granne
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Theodosios Kyriakou
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Keith M Channon
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Suzanne M Watt
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.)
| | - Paul Leeson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.Y.L.A., A.J.L., E.F.D., L.N., A.A.H.Z., L.J.S., K.O'B., T.K., K.M.C., P.L.), Stem Cell Research, Radcliffe Department of Medicine, Nuffield Division of Clinical Laboratory Sciences and National Health Service Blood and Transplant (G.Z.Y., C.P.K., L.N., C.T.Y., L.J.S., D.A.C., S.M.W.), Nuffield Department of Obstetrics and Gynaecology, Medical Sciences Division (C.Y.L.A., I.G.), and Wellcome Trust Centre for Human Genetics (A.A.H.Z., T.K.), University of Oxford, United Kingdom; and Peninsula Schools of Medicine and Dentistry, Plymouth University, United Kingdom (K.O'B.).
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Capillary Rarefaction as an Index for the Microvascular Assessment of Hypertensive Patients. Curr Hypertens Rep 2015; 17:33. [DOI: 10.1007/s11906-015-0543-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lewandowski AJ, Davis EF, Yu G, Digby JE, Boardman H, Whitworth P, Singhal A, Lucas A, McCormick K, Shore AC, Leeson P. Elevated blood pressure in preterm-born offspring associates with a distinct antiangiogenic state and microvascular abnormalities in adult life. Hypertension 2014; 65:607-14. [PMID: 25534704 DOI: 10.1161/hypertensionaha.114.04662] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preterm-born individuals have elevated blood pressure. We tested the hypothesis that this associates with an enhanced antiangiogenic circulating profile and that this association is mediated by variations in capillary density. We studied 204 adults aged 25 years (range, 20-30 years), of which 102 had been followed up prospectively since very preterm birth (mean gestational age, 30.3±2.5 weeks) and 102 were born term to uncomplicated pregnancies. A panel of circulating biomarkers, including soluble endoglin and soluble fms-like tyrosine kinase-1, were compared between groups and related to perinatal history and adult cardiovascular risk. Associations with cardiovascular phenotype were studied in 90 individuals who had undergone detailed assessment of microvascular, macrovascular, and cardiac structure and function. Preterm-born individuals had elevations in soluble endoglin (5.64±1.03 versus 4.06±0.85 ng/mL; P<0.001) and soluble fms-like tyrosine kinase-1 (88.1±19.0 versus 73.0±15.3 pg/mL; P<0.001) compared with term-born individuals, proportional to elevations in resting and ambulatory blood pressure, as well as degree of prematurity (P<0.05). Maternal hypertensive pregnancy disorder was associated with additional increases in soluble fms-like tyrosine kinase-1 (P=0.002). Other circulating biomarkers, including those of inflammation and endothelial activation, were not related to blood pressure. There was a specific graded association between soluble endoglin and degree of functional and structural capillary rarefaction (P=0.002 and P<0.001), and in multivariable analysis, there were capillary density-mediated associations between soluble endoglin and blood pressure. Preterm-born individuals exhibit an enhanced antiangiogenic state in adult life that is specifically related to elevations in blood pressure. The association seems to be mediated through capillary rarefaction and is independent of other cardiovascular structural and functional differences in the offspring.
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Affiliation(s)
- Adam J Lewandowski
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Esther F Davis
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Grace Yu
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Janet E Digby
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Henry Boardman
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Polly Whitworth
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Atul Singhal
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Alan Lucas
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Kenny McCormick
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Angela C Shore
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.)
| | - Paul Leeson
- From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.J.L., E.F.D., G.Y., J.E.D., H.B., P.W., P.L.); Department of Clinical Epidemiology, Nutrition and Biostatistics, Institute of Child Health, University College London, London, United Kingdom (A.S., A.L.); Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (K.M.); and Department of Vascular Medicine, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom (A.C.S.).
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Raghuraman RP, D'Souza R, Nathan P, Wang D, Manyonda IT, Antonios TFT. Skin capillary density in infants born to normotensive mothers: a comparison between singleton and twin infants. Microcirculation 2014; 21:67-73. [PMID: 23844560 DOI: 10.1111/micc.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/09/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Twin infants tend to have LBW and microvascular alterations but do not appear to have an increase in cardiovascular mortality later in life as singleton infants. We hypothesized that twin infants born to normotensive mothers would not have capillary rarefaction at birth. METHODS We studied 26 dizygotic twin infants and compared them with 115 consecutive singleton infants to normotensive mothers. We used orthogonal polarized spectroscopy to measure basal (i.e., functional) and maximal (i.e., structural) skin capillary density according to a well-standardized protocol. RESULTS Twin infants have significantly higher BCD (mean difference 4.3 capillaries/mm(2) , 95% CI: 0.4, 8.1, p = 0.03) and have marginally significantly higher MCD (mean difference 3.9 capillaries/mm(2) , 95% CI: -0.6, 8.3, p = 0.086) compared to singleton infants. Birth weight was significantly associated with BCD and MCD (p = 0.003 and 0.006). CONCLUSIONS Twin infants with low and NBWs tend to have higher functional and structural capillary densities compared to singleton infants. Further longitudinal studies of skin capillary density and of retinal vascular parameters commencing from birth to various stages in early childhood are essential to identify the dynamics and the exact timing, if any, of the remodeling of microcirculation in these individuals.
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Affiliation(s)
- Rajendra P Raghuraman
- Blood Pressure Unit & Division of Clinical Sciences, St. George's, University of London, London, UK
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Buijs EAB, Zwiers AJM, Ista E, Tibboel D, de Wildt SN. Biomarkers and clinical tools in critically ill children: are we heading toward tailored drug therapy? Biomark Med 2012; 6:239-57. [PMID: 22731898 DOI: 10.2217/bmm.12.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In pediatric critical care, validated biomarkers are essential for guiding drug therapy. The aim of this article is to present examples of current biomarker developments in its full breadth, including biochemical substances, physiological measurements and clinical scoring tools, with a focus on the field of circulatory, renal and neurophysiologic failure. Within each field we consecutively discuss the rationale for the selected biomarkers, studies in critically ill children, biomarker validation stage and biomarker use or potential use in drug studies and clinical drug dosing. This article demonstrates that there is paucity of properly validated biomarkers. Nevertheless, recent developments in, for instance, the field of sepsis, point us toward a future wherein, for critically ill children, drug therapy may be personalized using proteomic profiling instead of a small number of biomarkers, in order to establish a personal and dynamic disease profile.
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Affiliation(s)
- Erik A B Buijs
- Intensive Care & Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Capillary remodeling in infants born to hypertensive pregnancy: pilot study. Am J Hypertens 2012; 25:848-53. [PMID: 22573013 DOI: 10.1038/ajh.2012.51] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Capillary rarefaction is pathognomonic of essential hypertension. We have previously shown significant capillary rarefaction in normotensive adult offspring of hypertensive parents, suggesting a familial predisposition in which capillary rarefaction represents a primary vascular abnormality that antedates the onset of sustained elevation of blood pressure (BP). We have recently reported that low-birth weight (LBW) infants, born at term or preterm, to normotensive mothers do not have capillary rarefaction at birth. We hypothesized that infants born to mothers with hypertensive disorders of pregnancy (HDP) would have significant capillary rarefaction at birth when compared to infants of normotensive mothers. METHODS We studied 22 infants born to hypertensive mothers and compared them to 40 normal birth weight infants born at term to normotensive mothers. We used orthogonal polarized spectroscopy to measure basal (i.e., functional) and maximal (i.e., structural) skin capillary densities according to a well-validated protocol. RESULTS We found that term infants born to hypertensive mothers had significantly lower maximal capillary density (MCD) (mean difference of -5.0 capillaries/mm(2); P < 0.05). However, preterm infants with LBW born to hypertensive mothers tended to have higher basal and maximal skin capillary densities compared with term infants. CONCLUSIONS While the results in term infants are consistent with our belief that capillary rarefaction in essential hypertension is likely to be a primary vascular abnormality, the results in preterm infants may suggest that the intrauterine environment may exert some influences on the remodeling of the microcirculation which may delay the onset of capillary rarefaction in these infants.
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Affiliation(s)
- Harry A J Struijker-Boudier
- Departments of Pharmacology, Maastricht University, room 4.254, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
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