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(Circulation. 2008;118:1848-1853.)
© 2008 American Heart Association, Inc.

Pediatric Cardiology

Cardiovascular Stress Hyperreactivity in Babies of Smokers and in Babies Born Preterm

Gary Cohen, PhD; Silvano Vella, MD; Heather Jeffery, PhD, MPH, FRACP; Hugo Lagercrantz, MD, PhD; Miriam Katz-Salamon, PhD

From the Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden (G.C., H.L., M.K.-S.); Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, Australia (G.C., H.J.); and Department of Neuropaediatrics and Sleep Medicine, Lindenhof Hospital, Bern, Switzerland (S.V.).

Correspondence to Gary Cohen, Department of Women and Child Health, Neonatal Unit, Karolinska Institute, Elevhemmet H1-02, S-171 76 Stockholm, Sweden. E-mail Gary.Cohen{at}kbh.ki.se

Received April 2, 2008; accepted August 18, 2008.

Background— Being born preterm, small, and to a mother who smokes are common perinatal complications with major public health implications. Evidence suggests that each affects the body’s structure and function in ways that could increase susceptibility to cardiovascular dysfunction later in life. Here, we used 2 routine stress reactivity tests to identify incipient "silent" programming of cardiovascular dysfunction associated with adverse perinatal events.

Methods and Results— We studied 29 control babies born at term to nonsmokers, 18 term-born babies of mothers who smoked throughout pregnancy (mean, 15 cigarettes a day), and 31 babies born preterm to nonsmokers. All infants were compared at the same age after conception (ie, at 40 to 42 weeks), during sleep. We analyzed blood pressure (BP) and heart rate responses to breathing 4% CO₂ for 4 minutes or to passive head-up tilt to 60°. BP was measured continuously from a wrist cuff. CO₂ exposure raised heart rate and BP in controls by 10%, and tilt increased their BP by 5%. CO₂ elicited the expected BP but no heart rate response from preterm infants but a much-greater-than-expected BP and heart rate response from babies of smokers. Tilt elicited a 3- to 4-fold greater rise in BP from preterm and tobacco-exposed babies.

Conclusions— Vascular, cardiac, and blood pressure reactivity is heightened in babies born preterm or to smokers. The findings are consistent with in utero and early postnatal "programming" of human cardiovascular dysfunction by adverse circumstances. This incipient dysfunction may be an early manifestation of processes that lead to other problems or complications later on (eg, higher BP or sudden infant death syndrome).

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 1777-1778. [Extract] [Full Text]