Background: The premature-born adult population is set to grow significantly, and prematurity has emerged as an important cardiovascular risk factor. We aimed to comprehensively assess cardiac mechanics and function in a cohort of ex-preterm preschoolers. Methods: Ex-preterm children (<30 weeks of gestation), aged 2 to 5 years, underwent transthoracic 2D, speckle-tracking, and 4D echocardiography. The findings were compared with 19 full-term children. Results: Our cohort of 38 children with prematurity history showed a normal morpho-functional echocardiographic assessment. However, compared to controls, the indexed 3D end-diastolic volumes of ventricular chambers were reduced (left ventricle 58.7 ± 11.2 vs. 67.2 ± 8.5 mL/m²; right ventricle 50.3 ± 10.4 vs. 57.7 ± 11 mL/m²; p = 0.02). Left ventricle global and longitudinal systolic function were worse in terms of fraction shortening (32.9% ± 6.8 vs. 36.5% ± 5.4; p = 0.05), ejection fraction (59.2% ± 4.3 vs. 62.3% ± 3.7; p = 0.003), and global longitudinal strain (−23.6% ± 2.4 vs. −25.5% ± 1.7; p = 0.003). Finally, we found a reduced left atrial strain (47.4% ± 9.7 vs. 54.9% ± 6.8; p = 0.004). Conclusions: Preschool-aged ex-preterm children exhibited smaller ventricles and subclinical impairment of left ventricle systolic and diastolic function compared to term children. Long-term follow-up is warranted to track the evolution of these findings.

SignificanceVery preterm infants are prone to large fluctuations in their blood glucose concentration (BGC), i.e., they can experience episodes of hyper- and hypoglycemia, due to impaired glucose control. To date, the relationship among how specific regions of the brain respond to glycemic events has not been fully explored, and characterizing how glucose fluctuations affect region-specific functional connectivity at birth may provide insight into neurodevelopment and could help identify early biomarkers of brain vulnerability in very preterm infants.AimThe aim is to evaluate whether the differences in task-free functional connectivity (tfFC) patterns before and after experiencing several days of BGC fluctuations were correlated with changes in the glucose profile during this time interval.ApproachWe continuously monitored both glucose concentration with a continuous glucose monitoring device and brain hemodynamics with diffuse optical tomography in a group of very preterm newborns to conduct tfFC analysis (N=12).ResultsChanges in tfFC patterns between the left frontal and left parietal regions were found to be correlated with the standard deviation of the glucose profile, whereas changes between the central prefrontal cortex and the right prefrontal region were found to be correlated with the maximum value of glucose concentration.ConclusionsWe suggest that changes in the coupling of these brain areas during rest are dependent on and occur during exposures to glycemic changes in the preterm brain.