Akutna bubrežna insuficijencija kod novorođenčadi kao posledica perinatalne asfiksije

Midhat Mujić,Emina Hadžimuratović,Admir Hadžimuratović,Amra Hadžipasić-Nazdrajić,Fahrija Skokić,Adnan Hadžimuratović

doi:10.24125/sanamed.v1i1.162

Abstract

Introduction: Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. Objectives: was to determine the incidence of acute renal failure (ARF) in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE). Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score < 3 and moderate PA as 5. minute Apgar score 4-6. Criteria adopted for ARF were serum creatinine > 1.5 mg/dl (> 133 micromol/L) on 3rd day of life or urine output < 0.5 ml/kg/hr for > 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74%) had ARF. Most of them (63.6%) had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4%) had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4%) had severe PA while in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %) (Figure 1). This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p < 0.05). Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF.

Highlights

Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected
Criteria adopted for acute renal failure (ARF) were serum creatinine > 1.5 mg/dl (> 133 micromol/L) on 3rd day of life or urine output < 0.5 ml/kg/hr for > 6 hrs beyond 24 hrs of life
ARF was highest in the neonates with hypoxic ischemic encephalopathy (HIE) III (85.71 %) (Figure 1)

Summary

Introduction

Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. It results in hypoxic damage to almost all organs of the neonate; with kidneys being most frequently (40%) involved [1]. Renal insufficiency manifests as early as 24 hours of life leading to irreversible cortical necrosis when prolonged. Detection of renal failure is vital in neonates with hypoxic ischemic encephalopathy (HIE) to sustain a stable biochemical milieu and initiate appropriate treatment [2]. Neonatal acute renal failure (ARF) is a diagnostic and therapeutic challenge as clinical and laboratory parameters are not strictly defined yet [2]. World Health Organisation (WHO) defined birth asphyxia as “failure to initiate and sustain breathing at birth” with Apgar score of < 7 at 1. American College of Obstetrics and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) have laid down essential criteria to diagnose PA which include, prolonged metabolic or mixed acidemia (pH < 7.0 on cord arterial blood sample), persistence of an Apgar score of < 3 for 5 min or longer, clinical neurologic manifestation as seizures, hypotonia, coma or HIE in the immediate neonatal period coupled with multiorgan dysfunction [1, 3]

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