Вплив хронічних вогнищ інфекції у матері на розвиток гострого пошкодження нирок у недоношених дітей з гемодинамічно значущою відкритою артеріальною протокою

Abstract

Nephrogenesis may be disrupted antenatally because of chronic infection foci (CIF) in the mother, the development of chorioamnionitis, feto-placental insufficiency. As a result, in the postnatal period, the kidneys are more sensitive to hypoperfusion, which occurs in premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) and can lead to the development of acute kidney injury (AKI). Purpose — to study the influence of CIF in the mother on the development of AKI in premature infants with HSPDA. Materials and methods. 74 premature infants (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Neonatal Intensive Care MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council» were examined. Patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: Group I — 40 children with HSPDA, Group II — 17 children with PDA without hemodynamic disorders, Group III — 17 children with a closed ductus arteriosus. The presence of CIF in the mother was determined according to medical records, chorioamnionitis on the basis of histopathological examination of the placenta. Patients with HSPDA were divided into two subgroups: 28 children from mothers with CIF, 12 — without CIF. Clinical examination and treatment of premature infants was carried out according to generally accepted methods. Echocardiography with Doppler was performed at 5–11 hours of life and then daily to determine PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. Results. Chronic foci of infection were found in 28 (70.0%) mothers of group I, in 5 (29.4%) — group II, in 6 (35.2%) — group III. Chorioamnionitis in group I — 10 (25%) cases, in group II–ІII — 6 (17.6%). The presence of CIF in the mother caused a significant increase in the size of the PDA on the first day of life in the group of HSPDA against groups II–III: 2.61±0.861 (2.3; 2–3.5) mm against 1.79±0.365 (1.7; 1.5–2) mm, p<0.001. Patent arterial duct with a diameter of >2 mm on the first day of life in premature infants of group I from mothers with foci of infection was observed more often — 19 (67.9%) against 2(6.7%) of groups II–III (OR=10.56; CI: 1.9–58.53, p<0.005). Analysis of the incidence of AKI on the third day of life depending on HSPDA and the presence of CIF showed that 64.3% of preterm infants with HSPDA and maternal infection developed AKI — 6.6 times more often than in groups without HSPDA (OR=8.40; CI: 2.60–27.14; p<0.001), and 2.6 times more often compared to children of the subgroup HSPDA without recorded maternal infection (OR=5.40; CI: 1.18–24.65; p<0.03). On the background of HSPDA and CIF stage II–III AKI was observed in every third child. Comparative analysis within group I depending on the CIF revealed that the frequency of AKI for 10 days in the subgroup with infection was almost three times higher than the level of the subgroup without infection: 71.4% vs. 25.0% (OR=7.50; CI: 1.60–35.07; p<0.009). Conclusions. The presence of CIF in the mother is a risk factor for AKI in premature infants with HSPDA. Therefore, such children should be classified as at risk of developing AKI. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute kidney injury, chronic foci of maternal infection, hemodynamically significant patent ductus arteriosus, premature infants.