Case-control study on long-term kidney outcomes in very low birth weight infants: impact of growth restriction and maternal preeclampsia

Objective: To identify factors, particularly neonatal acute kidney injury, associated with an increased risk of developing chronic kidney disease (CKD) within the first 10 years of life in children with a history of prematurity and very low birth weight (VLBW). Methods: This nested case-control study was conducted on VLBW infants (> 500 g and <1.500 g) born between 2012 and 2022. The population (n = 119) included children who developed CKD (n = 55) and controls with normal findings (n = 64). CKD was defined by abnormal blood pressure, reduced glomerular filtration rate, or elevated urinary albumin excretion. Data on neonatal and maternal factors were analyzed using logistic regression to identify predictors of CKD. Results: Of the 267 eligible children 119 were included, with a median age of 32 months, and median gestational age and birth weight of 30 weeks and 1170 g, respectively. Children with CKD had lower birth weight Z-scores (-1.06 vs. -0.89), a higher occurrence of extrauterine growth restriction (EUGR) (72 % vs. 51 %), and an increased likelihood of maternal preeclampsia exposure. Maternal preeclampsia was identified as an independent predictor of CKD, associated with a 5 % increase in the odds of developing the condition (OR 1.05, 95 % CI 1.01-1.66). Conclusion: Maternal preeclampsia was associated with CKD in children with a history of VLBW. This finding highlights the importance of long-term follow-up and early identification of at-risk individuals. (c) 2025 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).