Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction
Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case seri...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-09-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/19/4519 |
| _version_ | 1797516158834835456 |
|---|---|
| author | Amy H. Stanford Melanie Reyes Danielle R. Rios Regan E. Giesinger Jennifer G. Jetton Adrianne R. Bischoff Patrick J. McNamara |
| author_facet | Amy H. Stanford Melanie Reyes Danielle R. Rios Regan E. Giesinger Jennifer G. Jetton Adrianne R. Bischoff Patrick J. McNamara |
| author_sort | Amy H. Stanford |
| collection | DOAJ |
| description | Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond. |
| first_indexed | 2024-03-10T06:58:21Z |
| format | Article |
| id | doaj.art-d5fda0dcaec646628b52cd3ffb5486ab |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:58:21Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d5fda0dcaec646628b52cd3ffb5486ab2023-11-22T16:20:38ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011019451910.3390/jcm10194519Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic DysfunctionAmy H. Stanford0Melanie Reyes1Danielle R. Rios2Regan E. Giesinger3Jennifer G. Jetton4Adrianne R. Bischoff5Patrick J. McNamara6Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Pediatric Nephrology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USANeonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.https://www.mdpi.com/2077-0383/10/19/4519left ventricular diastolic dysfunctionsystemic hypertensionbronchopulmonary dysplasiaangiotensin-converting enzyme inhibitorenalaprilcardiac lung disease |
| spellingShingle | Amy H. Stanford Melanie Reyes Danielle R. Rios Regan E. Giesinger Jennifer G. Jetton Adrianne R. Bischoff Patrick J. McNamara Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction Journal of Clinical Medicine left ventricular diastolic dysfunction systemic hypertension bronchopulmonary dysplasia angiotensin-converting enzyme inhibitor enalapril cardiac lung disease |
| title | Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction |
| title_full | Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction |
| title_fullStr | Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction |
| title_full_unstemmed | Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction |
| title_short | Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction |
| title_sort | safety feasibility and impact of enalapril on cardiorespiratory physiology and health in preterm infants with systemic hypertension and left ventricular diastolic dysfunction |
| topic | left ventricular diastolic dysfunction systemic hypertension bronchopulmonary dysplasia angiotensin-converting enzyme inhibitor enalapril cardiac lung disease |
| url | https://www.mdpi.com/2077-0383/10/19/4519 |
| work_keys_str_mv | AT amyhstanford safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT melaniereyes safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT daniellerrios safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT reganegiesinger safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT jennifergjetton safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT adriannerbischoff safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction AT patrickjmcnamara safetyfeasibilityandimpactofenalapriloncardiorespiratoryphysiologyandhealthinpreterminfantswithsystemichypertensionandleftventriculardiastolicdysfunction |