Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC126810.15690/vramn1268PEDIATRICS: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПЕДИАТРИИResearch ArticleRemodeling of the Heart of the Premature ChildРемоделирование сердца недоношенных детейhttps://orcid.org/0000-0002-5250-7351239803782009919-9048KovtunO. P.КовтунО. П.
Russian Federation

MD, PhD, Professor

д.м.н., профессор

kovtun@usma.ruhttps://orcid.org/0000-0002-8186-63291750-0200TsyvianP. B.ЦывьянП. Б.
Russian Federation

MD, PhD, Professor

д.м.н., профессор

pavel.tsyvian@gmail.comhttps://orcid.org/0000-0002-4882-84941782-9104MarkovaT. V.МарковаТ. В.
Russian Federation

MD, PhD

к.м.н.

ta.ma.vl@mail.ruhttps://orcid.org/0000-0002-7965-2364361058394007978-8955ChumarnayaT. V.ЧумарнаяТ. В.
Russian Federation

PhD in Biology

к.б.н.

chumarnaya@gmail.comUral State Medical UniversityУральский государственный медицинский университетMother and Child Care Research InstituteУральский научно-исследовательский институт охраны материнства и младенчестваInstitute of Immunology and Physiology Ural branch of Russian Academy of SciencesИнститут иммунологии и физиологии УрО РАНUral Federal UniversityУральский федеральный университет151220207566316372301202022122020Copyright ©; 2020, "Paediatrician" Publishers LLCCopyright ©; 2020, Издательство "Педиатръ"2020"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/1268

Epidemiological studies consistently have suggested an association between low birth weight and increased rate of cardiovascular morbidity and mortality in adult life. Preterm birth, as one of the leading causes of the low birth weight, is associated with cardiovascular remodeling which consists of changes in heart chambers geometry and contraction-relaxation mode, ventricular hypertrophy, arterial wall structure and density changes. Several types of preterm birth are discussed: prematurity, associated with placental insufficiency and fetal growth restriction, preterm leaking of amniotic fluid, and twin pregnancy. DNA methylation process under the influence of epigenetic factors of the intrauterine and early postnatal development is suggested as a one of the main mechanism of cardiovascular remodeling in preterm infants. The other mechanisms of cardiovascular remodeling are discussed in terms of the modern intrauterine programming concept. The early diagnostics and prevention of cardiovascular diseases in preterm born children are discussed. The treatment during prenatal and early postnatal periods as well as prevention of the remodeling causes could diminish and even reverse the development of the negative cardiovascular events and diseases in later life according to the so called concept of “one thousand days opportunities window”.

Эпидемиологические исследования доказали связь между низкой массой тела ребенка при рождении, наиболее частой причиной которой являются преждевременные роды, и увеличением заболеваемости и смертности от сердечно-сосудистых заболеваний в последующей жизни. Преждевременное рождение сопровождается ремоделированием сердечно-сосудистой системы, проявляющимся изменениями геометрии и динамики цикла сокращения-расслабления камер сердца, гипертрофией желудочков, увеличением плотности и изменением структуры стенок крупных сосудов. Выделено несколько вариантов преждевременного рождения: на фоне плацентарной недостаточности и синдрома задержки роста плода, преждевременного излития околоплодных вод и в результате многоплодия. Обсуждаются механизмы ремоделирования сердечно-сосудистой системы недоношенных новорожденных в свете современной теории внутри-утробного программирования. Предполагается, что метилирование ДНК под влиянием эпигенетических факторов, действующих в период внутриутробного и раннего постнатального развития, может быть одним из основных механизмов такого ремоделирования. Предложены подходы к ранней диагностике и профилактике кардиоваскулярных заболеваний у детей и взрослых, родившихся недоношенными. Обсуждается возможность профилактики ремоделирования сердечно-сосудистой системы у недоношенных новорожденных детей в рамках так называемой концепции тысячедневного окна возможностей, согласно которой устранение причины программирования или раннее проведение лечебных мероприятий в течение внутриутробного периода и первых двух лет жизни ребенка способны не только затормозить, но и обратить формирование стойких нарушений сердечно-сосудистой системы у данного человека в будущем.

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