Pediatric heart physiology and pathogenetic mechanisms affecting the process of growth and development of the cardiovascular system premature infants: a modern view at the problem

Aim: To study the state of cardiac tissue homeostasis in the process of ontogenesis in prematurity in the light of modern fundamental knowledge on the biology of cardiac stem cells, the structure of cardiomyocytes, paracrine regulation mechanisms and other pathogenetic mechanisms affecting the growth, development and remodeling of the cardiovascular system in childhood and in follow-up.

Literature search strategy. A search for studies and analytical literature reviews was conducted in databases Cochrane library, MEDLINE, Google Academy, PubMed and other databases mainly from the beginning of 2018 to December 2023. Publications/ studies reflecting various aspects of the physiology of the infant heart in premature infants (clinical and experimental aspects) were independently selected for inclusion. Preference was given to randomized controlled trials.

Results. Based on modern concepts of pre- and post-implantation (postnatal) development and growth of the infant heart, the analysis of the processes of postnatal growth and development of the heart of children born healthy full-term and premature with spontaneous natural conception is given. The analysis of the main pathogenetic mechanisms influencing the processes of growth and development of the child’s heart in the intrauterine and postnatal period is carried out.

Conclusion. Experimental and clinical data reasonably require a conscious revision of the fundamental theoretical postulates about the regenerative capabilities of the myocardium in various periods of childhood, including the clinical group of premature babies, and practical guidelines for pregnancy management with the threat of abortion and infertility (preimplantation measures using assisted reproductive technologies), combined/intensive (including, respiratory) therapy in the neonatal period, longterm outpatient follow-up of children and adults born prematurely with low, very low and extremely low body weight in order to prevent, screen and treat potential effects on the health of the cardiovascular system throughout life. The information provided is very useful for a wide range of readers – biologists, embryologists, reproductive doctors, obstetricians, gynecologists, neonatologists, pediatricians, internists, cardiologists, surgeons.

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