Neonatal outcomes of hypertensive pregnancy subtypes in very preterm infants: a multicenter cohort study.
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de Araujo Fernanda Gabriella Bezerra, Silveira Rita C, Teixeira Diego Gomes, de Godoi Fernanda Pegoraro, Venzon Paulyne Stadler, Cherpak Maria Eduarda Gurgel, do Vale Maryne A Silva, de Souza Rugolo Ligia Maria Suppo, da Costa Fla Via Maria Batista, Fiori Humberto, Marba Se Rgio Tadeu Martins, Cwajg Silvia, Duarte Jose Luiz Muniz Bandeira, Gonçalves-Ferri Walusa Assad, Machado Ma Rcia Gomes Penido, de Lima Mota Ferreira Daniela Marques, Alves Junior Jose Mariano Sales, Dos Santos Juliana Paula Ferraz, Miyoshi Milton Harumi, de Mello E Silva Nathalia Moura, Procianoy Renato Soibelmman
Аннотация
METHODS: We conducted a multicenter retrospective cohort study using prospectively collected data from the Brazilian Neonatal Research Network, including infants with birthweights 401-1500 g and gestational age 22 + 0 to 32 + 6 weeks (2013-2020). Infants were classified according to maternal hypertensive status. Primary outcomes included major neonatal morbidities and in-hospital mortality. Associations were assessed using Poisson regression with robust variance, adjusting for gestational age, birthweight, sex, antenatal corticosteroids, and perinatal variables. Analyses were stratified by gestational age (≤ 28 and > 28 weeks).
RESULTS: Among 9,689 infants, 4,011 (41.4%) were exposed to HDP. PSHD and CH + PE were associated with higher risks of respiratory distress syndrome and surfactant use across models. CH + PE was additionally associated with higher mortality, particularly in infants ≤ 28 weeks. In contrast, CH was associated with lower observed risks of late-onset sepsis and, among infants > 28 weeks, severe intraventricular hemorrhage. Several crude associations were attenuated after adjustment, highlighting the confounding effect of gestational age.
CONCLUSIONS: HDP subtypes were associated with distinct neonatal outcome profiles. PSHD and CH + PE were associated with higher risks of respiratory morbidity and mortality, whereas CH showed a more neutral profile and lower observed risks for selected outcomes. These findings support subtype-specific risk stratification in very preterm infants.