Impacto das síndromes hipertensivas gestacionais nos desfechos nutricionais e clínicos em recém-nascidos pré-termo: uma coorte prospectiva

Abstract

Hypertensive syndromes in pregnancy (HGS) are characterized by changes in blood pressure levels during the gestational period. For children of women with HGS, premature birth is one of the main consequences, which can impact neonatal outcomes. The objective of this research was to compare the nutritional outcomes of preterm newborns (PTNB) born to women with HGS to children of normotensive women. This was a prospective cohort study with a quantitative approach. The study participants were PTNBs born at the Januário Cicco School Maternity Hospital, in Natal-RN, from October 2021 to November 2023 who were hospitalized in the neonatal intensive care unit (NICU). PTNBs with gestational age between ≥23 and <37 weeks and weight less than 2500g were included, and neonates diagnosed with severe congenital malformation, inborn errors of metabolism and water restriction were excluded. The preterm infants were divided into 2 groups according to exposure to GHS. Data collection was performed using electronic medical records, considering anthropometric and dietary variables for the newborn and maternal comorbidities. Significant results were those with p < 0.05. Of the 220 pregnant women monitored, half had GHS. There was a statistically significant association between GHS and maternal age > 35 years (p = 0.013) and cesarean delivery (p < 0.01). Preterm infants born to women with GHS had a greater need for parenteral nutrition (p = 0.017) and a higher risk of inadequate full enteral nutrition (p = 0.020), had a higher prevalence of being classified as small for gestational age at birth (p < 0.001) and, at discharge from the NICU, with extrauterine growth restriction (p = 0.018), when compared to children of normotensive women. The results confirm that GHS are associated with unfavorable nutritional outcomes in preterm infants. Children of women with GHS had difficulty maintaining adequate nutritional status, having lower Z-scores at birth and at discharge from the NICU. Considering this, these preterm infants require differentiated care, prioritizing early and individualized nutritional interventions in order to improve their nutritional status during their stay in the NICU.