Prevention care and follow-up of premature infants - Point of view from paediatric nephrologist

Abstract

OBJECTIVE: Review renal and cardiovascular complications derived from premature births, to warn the pediatrician about preventive care and to recommend an approach toward the follow-up. METODOLOGY: non-systematic review of literature which based its data on: National Library of Medicine, US National Library of Medicine, Latin American and Caribbean Literature on Health Sciences and Scientific Electronic Library Online, ranging from 2010 to 2021. The articles were delved into the issues of prematurity, low birth weight, restricted intrauterine growth and its relation with cardiovascular and renal diseases; and proposed follow-up strategies. RESULTS: The incidence of premature births has increased in the last few decades, with a variation between 5% to 14%, and, consequently, the rate of chronic-related diseases related to this situation has increased as well. The number of incomplete and immature nephrons in premature babies derives from the lack of completeness of nephrogenesis, which takes place at around 36 weeks of pregnancy. This nephron deficit necessitates a hemodynamic adaptation to meet the demands of urinary excretion. This process may be responsible for glomerular hypertension, the hypertrophy of remaining nephrons and resulting renal injuries. Factors such as low birth weight, restricted intrauterine growth and premature birth all contribute towards the global increase of the prevalence of renal disease, systemic arterial hypertension and metabolic syndrome. CONCLUSION: Children born premature, with low birth weight and restricted intrauterine growth must have their arterial pressure and kidney functions monitored throughout the paediatric follow-up, and sent to a paediatric nephrologist whenever any abnormalities are detected.