ACUTE KIDNEY INJURY IN PRETERM NEONATES: PERINATAL RISK FACTORS

Abstract

Introduction. Acute kidney injury (AKI) is the most threatening sign of the syndrome of multiple organ failure in critically sick neonates, especially under conditions of their preterm birth. The frequency of AKI diagnosis among patients at neonatal resuscitation units constitutes from 18 to 70 %. AKI in neonates is associated with a high risk of mortality, continuous hospitalization, unfavourable early and late consequences. Objective: to determine perinatal risk factors promoting formation of AKI in critically sick preterm neonates. Materials and methods. A retrospective analysis of findings from exchange prenatal records, case histories of labor and development of newborns was made in 46 critically sick preterm neonates evaluated by the modified NEOMOD scale more than 7 points. І group of the study included 23 infants with AKI signs, ІІ group of the study – 23 babies without AKI signs. AKI was diagnosed in neonates according to the recommendations of the International Group of Experts “Kidney Disease: Improving Global Outcomes” modified by J. G. Jetton and D. J. Askenazi (2015). In order to determine correlation between perinatal risk factors and AKI formation in children, a logistic regressive analysis was performed with calculation of odds ratio (OR) and its 95 % confidence interval (95 % CІ).Results. In the course of the study there was no statistical significance found concerning any separate unfavourable factor of anamnesis, somatic and gynecological maternal pathology associated with the formation of AKI in preterm neonates, though a tendency to higher frequency of their birth from mothers aged older than35, in case of infertility and cardio-vascular maternal pathology. Development of AKI in preterm neonates was found to be associated with the threat of spontaneous abortion available (OR 4.68; 95 % CІ 1.28-16.98, р=0.0189), threat of preterm labor (OR 5.64; 95 % CІ 1.31-24.32, р = 0,0203), anemia of mother (OR 5.31; 95 % CІ 1.49-18.84, р = 0.0097), as well as lacking of antenatal prevention of respiratory distress-syndrome (OR 4.68; 95 % CІ 1.29-16.98, р = 0.0189).Statistically higher associations of AKI were demonstrated in infants born earlier than physiological term of gestation, with intracranial hemorrhages (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451), early neonatal sepsis (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451), anemia (OR 6.75; 95 % CІ 1.26-36.03, р = 0.0254), hemorrhagic syndrome (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451) and decreased tolerance to food (OR 3.56; 95 % CІ 1.05-12.05, р = 0.0417). Statistically significant associations of AKI formation were found in critically sick preterm neonates with indications to fresh frozen blood (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451), erythrocytes (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451), loop diuretics (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451) and antibacterial drugs of carbapenems group (OR 5.6; 95 % CІ 1.04-30.21, р = 0.0451). Conclusions. AKI formation in critically sick preterm neonates is of a multifactor etiology, which is more associated with unfavourable development of gestational period, lack of antenatal steroid prevention of RDS, development of multiple organ failure after birth, and administration of potentially nephrotoxic therapeutic complex. Further studies will enable to create a comprehensive algorithm to predict AKI development in patients at the intensive care units considering possible perinatal risk factors.