RESUMEN

OBJETIVOS: Avaliar os riscos para hipertensão pulmonar persistente do recém-nascido, confirmada por ecocardiografia, associada a partos cesáreos e outros fatores. MÉTODOS: Coorte de todos os nascimentos com idade gestacional acima de 36 semanas em um período de 23 meses. Um estudo caso-controle aninhado foi feito em uma parte da coorte, envolvendo um grupo de recém-nascidos com diagnóstico de hipertensão pulmonar persistente do recém-nascido comparados com um grupo de controles normais, com aplicação de questionários às mães para identificação de riscos. Regressão logística foi utilizada para calcular odds ratios. RESULTADOS: De 9452 recém-nascidos, 8388 (88,7 por cento) nasceram de cesáreas, e 1064 (11,3 por cento) de parto vaginal. Questionários foram aplicados a 173 mães. Recém-nascidos de cesáreas apresentaram um risco 5 vezes maior de hipertensão pulmonar persistente do recém-nascido: 42 casos (0,5 por cento) versus 1 caso (0,09 por cento) entre os de partos vaginais (OR 5,32, p=0,027). Não foram observadas interações entre tabagismo, paridade, hipertensão arterial materna e trabalho de parto antes da cesárea e a hipertensão pulmonar persistente do recém-nascido. Apgar no 1º minuto <7 e diabetes materno se relacionaram a um risco aumentado. CONCLUSÃO: A redução do número de partos cesáreos poderia prevenir muitos casos graves de hipertensão pulmonar persistente do recém-nascido.

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OBJECTIVES: To evaluate risks for persistent pulmonary hypertension in the newborn, confirmed by echocardiography, associated with cesarean deliveries and other factors. METHODS: Cohort of all deliveries >36 weeks within a period of 23 months. A nested case-control study was performed in a subset of the cohort, involving newborns admitted into neonatal intensive care unit with diagnosis of persistent pulmonary hypertension matched with normal controls, with application of questionnaires to mothers to identify risks. Logistic regression was used to calculate odds ratios. RESULTS: From 9452 newborns, 8388 (88.7 percent) were delivered by cesarean and 1064 (11.3 percent) by vaginal delivery. Questionnaires were applied to 173 mothers. Infants from cesareans had a fivefold increased risk of persistent pulmonary hypertension of the newborn: 42 (0.5 percent) versus 1 case (0.09 percent) in the vaginal group (OR 5.32, p=0.027). No interactions were found between smoking, parity, arterial hypertension and labor before cesarean section and persistent pulmonary hypertension of the newborn. First minute Apgar score <7 and maternal diabetes were related to increased risk. CONCLUSION: Reducing cesarean deliveries could prevent many cases of serious persistent pulmonary hypertension of the newborn.

Asunto(s)

Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Cesárea/efectos adversos , Hipertensión Pulmonar/epidemiología , Recién Nacido

RESUMEN

OBJECTIVES: To evaluate risks for persistent pulmonary hypertension in the newborn, confirmed by echocardiography, associated with cesarean deliveries and other factors. METHODS: Cohort of all deliveries >36 weeks within a period of 23 months. A nested case-control study was performed in a subset of the cohort, involving newborns admitted into neonatal intensive care unit with diagnosis of persistent pulmonary hypertension matched with normal controls, with application of questionnaires to mothers to identify risks. Logistic regression was used to calculate odds ratios. RESULTS: From 9452 newborns, 8388 (88.7%) were delivered by cesarean and 1064 (11.3%) by vaginal delivery. Questionnaires were applied to 173 mothers. Infants from cesareans had a fivefold increased risk of persistent pulmonary hypertension of the newborn: 42 (0.5%) versus 1 case (0.09%) in the vaginal group (OR 5.32, p=0.027). No interactions were found between smoking, parity, arterial hypertension and labor before cesarean section and persistent pulmonary hypertension of the newborn. First minute Apgar score <7 and maternal diabetes were related to increased risk. CONCLUSION: Reducing cesarean deliveries could prevent many cases of serious persistent pulmonary hypertension of the newborn.