Infants born at term have all their organs fully formed, enabling them to live adequately once the intrauterine development period is complete. Premature birth can be associated with other systemic conditions such as respiratory, neurological, cardiac, metabolic, and kidney and urinary tract disorders, which are managed at birth in neonatal intensive care units (NICUs).
These precautions are especially necessary for children born before 30 weeks of gestation, also known as "extremely premature," who at birth have only 30% of the kidney capacity of full-term infants. They have a lower number of active filters (glomeruli), and by the time they reach a corrected gestational age of 38 weeks, they have not yet developed all their filters to function fully, achieving only 60-70% of their normal capacity. Therefore, the reduced number of kidney filters at birth forces them to increase their urine filtration load, which exposes them to a greater risk of kidney damage. This necessitates close monitoring by specialists throughout infancy, childhood, and adolescence.
It is important to note that some newborns may experience a condition known as intrauterine growth restriction (IUGR) or intrauterine malnutrition during gestation, which can reduce the number of filters acquired during fetal growth. This metabolic alteration during gestation leads to a decrease in the number of filters, resulting in smaller kidneys or reduced renal mass, predisposing them to chronic non-communicable diseases such as hypertension, kidney disease, diabetes, and metabolic syndromes. The fetal origin of these diseases is not solely genetic but also related to altered fetal environmental conditions.
Other factors to which the fetus or newborn may be exposed can cause changes in the function of other organs, even in the long term, leading to metabolic diseases and conditions with a risk of cardiovascular damage, such as hypertension and coronary artery disease in adulthood. Patients who become obese in the first two or three years of life, after being born extremely prematurely, have a higher risk of decreased kidney function and developing diabetes during childhood, compared to obese children born at term.
One of the most important and definitive actions to counteract or halt the impact of these alterations occurring in utero is close multidisciplinary follow-up during the postnatal period. Close monitoring by pediatric nephrology is also crucial for all premature newborns and/or those with intrauterine growth restriction, as is the adoption of healthy lifestyle habits as a lifelong goal.
Some general recommendations for this group of patients:
• Diet with adequate protein intake for each age period.
• Salt should only be introduced into the diet after two years of age. Excess salt can cause hypertension, long-term indirect kidney damage, and increased mortality from cardiovascular events.
• Weight control. In patients with reduced renal mass (such as those born prematurely or with intrauterine growth retardation), weight gain above normal generates a greater risk of deterioration of kidney function.
• Proper hydration: Water intake provides the vital fluid for the metabolism of all the substances we consume. Therefore, adequate water intake promotes better function of all organs.
• Outpatient follow-up by the pediatrician and/or pediatric nephrologist, through which the detection of early warning signs of kidney disease is guaranteed.
One of the most important and definitive actions to counteract or halt the impact of these alterations occurring in utero is close multidisciplinary follow-up during the postnatal period. Close monitoring by pediatric nephrology is also crucial for all premature newborns and/or those with intrauterine growth restriction, as is the adoption of healthy lifestyle habits as a lifelong goal.
Some general recommendations for this group of patients:
• A diet with adequate protein intake for each age group. • Salt should only be introduced into the diet after two years of age. Excess salt can cause hypertension, long-term indirect kidney damage, and increased mortality from cardiovascular events.
• Weight control. In patients with reduced renal mass (such as those born prematurely or with intrauterine growth restriction), weight gain
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