Repercussões da pré-eclâmpsia no trato gastrointestinal de recém-nascidos prematuros
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Data
2017-02-20
Autores
Pelicia, Simone Manso de Carvalho [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A pré-eclâmpsia é a principal indicação médica para o nascimento prematuro. Apesar dos sintomas maternos parecerem resolvidos com o nascimento do concepto, há evidências cada vez maiores indicando que a pré-eclâmpsia está associada a alterações em longo prazo na mãe e filho. A falta de conhecimento sobre as alterações fisiopatológicas dos RN de mães com PE é um fator limitante nos cuidados neonatais e motivou a realização desse estudo Objetivo: Avaliar em RN de mães com pré-eclâmpsia as alterações de fluxo sanguíneo da artéria mesentérica superior (AMS) bem como a evolução neonatal, comparando os RN de mães com PE versus mães normotensas. Método: Estudo observacional prospectivo com 120 prematuros menores que 34 semanas divididos em 60 filhos de mães com pré-eclâmpsia pareados pela idade gestacional com 60 prematuros de mães normotensas no período de 2013 a 2106. Foram avaliados dados clínicos no primeiro mês de vida e fluxo sanguíneo da artéria mesentérica superior (AMS) por ultrassom Doppler nas primeiras 72 horas. Resultados: O ultrassom Doppler mostrou que há diminuição nos fluxos pico sistólico e diastólico dos filhos de mães com PE com controle de variáveis que influenciam a vasculatura neonatal (p<0,05). Na avaliação dados maternos e gestacionais houve aumento do número de casos das seguintes variáveis nas mães com PE: uso de corticoide ante natal, trabalho de parto prematuro, uso de antibiótico intraparto e parto cesárea. Nas variáveis de nascimento e neonatais encontramos que os filhos de mãe com PE são em maior número nas seguintes variáveis: peso para a idade gestacional, restrição de crescimento fetal e uso de ventilação com pressão positiva. A correlação dessas variáveis com a Dopplerfluxometria não mostrou alteração dos valores de pico sistólico e diastólico dos filhos de mães com pré-eclâmpsia. Conclusão: A pré-eclâmpsia altera o fluxo da AMS nos primeiros dias de vida, no entanto, não há aumento de intercorrências alimentares nesses recém-nascidos.
Introduction: Pre-eclampsia is the primary medical indication for preterm birth. Although maternal symptoms seem to be solved after the birth of the neonate, there are increasing evidences that pre- eclampsia is associated with effects in the mother and in the child in the long run. Lack of knowledge about the pathophysiological effects on the neonates from mothers having PE is a limiting factor in neonatal care and this has urged this study. Objective: Evaluating the changes in the blood flow of the superior mesenteric artery (MAS) in preterm neonates from mothers who have PE, as well as the neonatal evolution, comparing to neonates from mothers with PE versus normotensive mothers. Method: Prospective observational study with 120 premature neonates younger than 34 weeks divided into 60 babies from mothers with pre-eclampsia, paired by the gestational age with 60 preterm neonates from normotensive mothers within the period 2013 to 2016. Clinical data in their first month and the blood flow of the superior mesenteric artery (MAS) have been assessed by Doppler ultrasound in the first 72 hours. Results: Doppler ultrasound showed that there was a decrease in the systolic and diastolic peak flows of the neonates from mothers who had PE with control of variables influencing neonatal vasculature (p <0.05). In the evaluation of the maternal and of the gestational data, there was an increase in the number of cases of the following variables in mothers who had PE: antenatal corticoid use, preterm labor, intrapartum antibiotic use and cesarean delivery. In birth and neonatal variables it was found out that the neonates from mothers who had PE outnumber in the following variables: weight for gestational age, fetal growth restriction and the use of ventilation with positive pressure. The correlation of these variables with Doppler flowmetry has not shown alterations in the systolic and diastolic peak values in neonates from mothers having pre-eclampsia. Conclusion: Pre-eclampsia modifies the flow of the MAS in the first days of life; however, there is no increase in dietary complication in these newborn children.
Introduction: Pre-eclampsia is the primary medical indication for preterm birth. Although maternal symptoms seem to be solved after the birth of the neonate, there are increasing evidences that pre- eclampsia is associated with effects in the mother and in the child in the long run. Lack of knowledge about the pathophysiological effects on the neonates from mothers having PE is a limiting factor in neonatal care and this has urged this study. Objective: Evaluating the changes in the blood flow of the superior mesenteric artery (MAS) in preterm neonates from mothers who have PE, as well as the neonatal evolution, comparing to neonates from mothers with PE versus normotensive mothers. Method: Prospective observational study with 120 premature neonates younger than 34 weeks divided into 60 babies from mothers with pre-eclampsia, paired by the gestational age with 60 preterm neonates from normotensive mothers within the period 2013 to 2016. Clinical data in their first month and the blood flow of the superior mesenteric artery (MAS) have been assessed by Doppler ultrasound in the first 72 hours. Results: Doppler ultrasound showed that there was a decrease in the systolic and diastolic peak flows of the neonates from mothers who had PE with control of variables influencing neonatal vasculature (p <0.05). In the evaluation of the maternal and of the gestational data, there was an increase in the number of cases of the following variables in mothers who had PE: antenatal corticoid use, preterm labor, intrapartum antibiotic use and cesarean delivery. In birth and neonatal variables it was found out that the neonates from mothers who had PE outnumber in the following variables: weight for gestational age, fetal growth restriction and the use of ventilation with positive pressure. The correlation of these variables with Doppler flowmetry has not shown alterations in the systolic and diastolic peak values in neonates from mothers having pre-eclampsia. Conclusion: Pre-eclampsia modifies the flow of the MAS in the first days of life; however, there is no increase in dietary complication in these newborn children.
Descrição
Palavras-chave
Pré-eclâmpsia, Recém-nascido prematuro, Trato gastrointestinal, Utrassonografia Doppler