Baixo peso e prematuridade em recém-nascidos: uma comparação entre lactentes de mães em diálise e mães com função renal normal

Abstract

Introduction: Chronic kidney disease has grown worldwide and has consequently been considered a public health problem. With the improvement of dialysis treatment, more patients with the aforementioned disease have had pregnancies. While the literature has focused on the pregnancies evolution, little attention is paid to the newborns (NB). The clinical condition of NBs can be affected by prematurity, which is frequent amongst mother in dialysis, as well as by uremia and by the renal replacement therapy itself. In this context, the objective of this research was to evaluate birth conditions and in-hospital complications of NBs from mothers on dialysis. Methods: This is a cross-sectional study with a quantitative approach, with data collected from medical records at the Hospital das Clínicas of the University of São Paulo. We compared 2 groups of patients, NBs from mothers on dialysis and NBs from mothers with high-risk pregnancies, but with normal renal function. Apgar scores in the 1st, 5th, and 10th minutes, birth and discharge weight, clinical complications, and length of stay were analyzed. Results: the comparison between NBs of mothers on dialysis (N=29) with NBs of mothers with normal renal function (N=21) showed that gestational age was lower among mothers on dialysis (32.4  3.7 vs. 38.0  1.2 weeks, p<0.001), NBs of dialysis mothers had worse Apgar scores in the 1st minute (6.9  2.6 vs. 8.3  1.0, p=0.027), lower birth weight (1766  748 vs. 3004  458g, p<0.001) and at the discharge (2271  232 vs. 2909  489g, p<0.001), and longer hospital stay [10 (4-15) vs. 4 (3-4.5) days, p=0.006]. Hypoglycemia and jaundice were more frequent among NBs of mothers on dialysis, while respiratory failure was more frequent among NBs of mothers with normal renal function. Conclusion: NBs from mothers on dialysis have a higher risk of asphyxia than those from mother with normal renal function, as measured by Apgar scores. Whether this outcome is due to the prematurity, or the uremic environment is still unknown. However, due to the great spectrum of complications these NBs, we point out with this study a potential field of research.