Preterm graduates from the neonatal intensive care unit and future adult cardiac problems: A narrative review

Preterm birth, defined as delivery before 37 weeks of gestation, is associated with increased risks of cardiovascular diseases (CVDs) in adulthood, including hypertension, coronary artery disease, and heart failure. Advances in neonatal intensive care unit (NICU) practices have improved survival rates for preterm infants, particularly very low birth weight infants (<1500 g), but these survivors face unique long-term health challenges. This narrative review synthesizes recent evidence on the mechanisms linking preterm birth to adult cardiac problems, including altered cardiovascular development, epigenetic changes, and NICU-related exposures. We summarize key studies demonstrating elevated risks of hypertension and cardiac remodeling in preterm-born adults, alongside controversies surrounding neonatal interventions such as oxygen therapy and nutrition. Recommendations for long-term follow-up, including early screening and lifestyle interventions, are proposed to mitigate CVD risk. Despite growing evidence, gaps remain in defining optimal monitoring and prevention strategies, particularly in low- and middle-income countries. This review aims to guide clinicians and researchers in addressing the cardiovascular health of preterm NICU graduates into adulthood.