Exercise and Acetaminophen Studies Address Preterm Birth Health Outcomes
Two separate studies examine interventions for individuals affected by preterm birth. A structured exercise program improved cardiovascular health and blood pressure in young adults born preterm. Meanwhile, prophylactic acetaminophen given to extremely preterm infants did not improve survival without severe morbidity, despite accelerating closure of a common heart defect.
Two new studies investigate interventions aimed at improving health outcomes for individuals affected by preterm birth, with one showing clear benefits and the other demonstrating no advantage for its primary goal.
A single-arm clinical trial tested a 14-week exercise program on young adults born preterm, consisting of two 90-minute in-person sessions per week of cardio, resistance, and flexibility training, plus one 30-minute at-home cardio session weekly. Sixteen preterm and 30 term participants completed the study. Both groups improved peak circulatory power and cardiac output index during cardiopulmonary exercise testing. Notably, reductions in 24-hour and awake blood pressure, heart rate, and hypertensive loads were observed specifically in the preterm participants. The term participants, who exhibited elevated or hypertensive blood pressure values pre-intervention, did not show these blood pressure improvements. The researchers concluded that cardiovascular changes associated with preterm birth are, at least partially, amenable to improvement through lifestyle intervention.
A multinational randomized trial evaluated prophylactic acetaminophen for patent ductus arteriosus (PDA) in extremely preterm infants. The TREOCAPA study was conducted across 43 neonatal intensive care units in 14 European countries from October 2020 to April 2024, enrolling infants born between 23 and 28 weeks of gestation. There were 391 infants in the acetaminophen group and 387 in the placebo group, with a median gestational age of 26 weeks and median birth weight of 850 grams.
The primary outcome—survival without severe morbidity at 36 weeks postmenstrual age—was not significantly different between groups: 66.2% of infants assigned to acetaminophen versus 63.6% of those given placebo (relative risk 1.04, 95% CI 0.94-1.16). A secondary exploratory outcome showed acetaminophen accelerated ductus arteriosus closure, with 71.2% of infants in the intervention group achieving closure on day 7 compared with 52.2% in the placebo group. Despite this effect, the researchers observed no statistically significant differences in ventilatory, hemodynamic, or nutritional support during the first week after birth. A safety analysis revealed a higher cholestasis rate in the acetaminophen group at 6.4% versus 2.6% in the placebo group. The researchers concluded that acetaminophen should not be recommended for PDA in very preterm infants.
Preterm birth has well-documented long-term consequences, including a higher risk of cardiovascular disease. The exercise study, registered as ClinicalTrials.gov ID NCT03504215, suggests that exercise-based lifestyle interventions may represent an effective, non-pharmacological strategy to reduce long-term cardiovascular risk in adults born preterm. The acetaminophen trial results align with other randomized clinical trials evaluating prophylactic or targeted treatment with indomethacin or ibuprofen, where effects on ductus arteriosus closure were not accompanied by improvements in short-term outcome measures.