Sabino Annibal Tagliaferri, Souza Eduardo de, Goulart Ana Lucia, Lima Adriana Martins de, Sass Nelson
Departament of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Rev Bras Ginecol Obstet. 2017 Apr;39(4):155-161. doi: 10.1055/s-0037-1601883. Epub 2017 Apr 13.
To evaluate whether the presence of maternal blood pressure reduces the risks of morbidity, perinatal mortality and morbidity at 24 months of age in very low birth weight infants (VLBWIs) compared with a control group. A retrospective, observational, case-control study. Total 49 VLBWIs were allocated to the study group, called the maternal arterial hypertension group (AHG), and matched with 44 in the control group (CG). The infants were assessed during hospitalization and at 12 and 24 months corrected age at a specialized clinic. For the assessment of growth, the World Health Organization (WHO) Anthro software (Geneva, 2006) was used, and for the psychomotor assessment, the Denver II test was used. In relation to the antenatal variables, the infants of the AHG had more centralized circulation assessed by Doppler, received more corticosteroids and magnesium sulfate, and were born by cesarean section more frequently. In terms of the postnatal and in-hospital outcomes, the AHG had a higher gestational age at birth (30.7 versus 29.6 weeks) and a lower frequency of 5-minute Apgar scores of less than 7 (26.5% versus 52.3%). The CG had a higher rate of pulmonary dysplasia (30.2% versus 8.3%). There were no differences in terms of hospital mortality, complications, somatic growth and functional problems at 24 months of corrected age. The presence of maternal hypertension, especially preeclampsia, was not a protective factor against morbidity, mortality and evolution in VLBWIs aged up to 24 months. Therefore, the clinical practice should be focused on prolonging the pregnancy for as long as possible in these conditions as well.
为评估与对照组相比,母亲高血压的存在是否会降低极低出生体重儿(VLBWIs)24个月时的发病风险、围产期死亡率和发病率。 一项回顾性、观察性病例对照研究。总共49例VLBWIs被分配到研究组,称为母亲动脉高血压组(AHG),并与44例对照组(CG)进行匹配。在住院期间以及在专门诊所校正年龄12个月和24个月时对婴儿进行评估。对于生长评估,使用世界卫生组织(WHO)Anthro软件(日内瓦,2006年),对于精神运动评估,使用丹佛发育筛查测验第二版。 关于产前变量,AHG组的婴儿通过多普勒评估有更多的中心循环,接受了更多的皮质类固醇和硫酸镁,并且更频繁地通过剖宫产出生。就产后和住院结局而言,AHG组出生时的胎龄较高(30.7周对29.6周),5分钟Apgar评分低于7分的频率较低(26.5%对52.3%)。CG组有更高的肺发育不良发生率(30.2%对8.3%)。在校正年龄24个月时,两组在医院死亡率、并发症、身体生长和功能问题方面没有差异。 母亲高血压的存在,尤其是先兆子痫,并不是24个月龄以下VLBWIs发病、死亡和发育的保护因素。因此,在这些情况下,临床实践也应尽可能延长妊娠时间。