Abstract
Changes in kidney function in extremely preterm infants (EPT) with conservatively managed hemodynamically significant (HS) patent ductus arteriosus (PDA) are not known well. We aimed to present the postnatal course in serum creatinine levels (sCr), prevalence of acute kidney injury (AKI), then relevance between AKI and adverse outcomes in EPT with conservatively managed HS PDA. By review of medical records, we analyzed the postnatal course of sCr and prevalence of stage 3 AKI defined by the modified Kidney Disease Improving Global Outcome (KDIGO) in EPT at gestational age of 23 to 26 weeks with conservatively treated HS PDA. We investigated if the presence and/or prolonged duration of stage 3 AKI elevated the risk of adverse outcomes. The results showed that, neither factor was associated with adverse outcomes. While the average PDA closure date was at postnatal day (P) 41 and 53, sCr peaked at P 10 and 14 and the cumulative prevalence of stage 3 AKI was 57% and 72% in the EPT of 25–26 and 23–24 weeks’ gestation, respectively. The high prevalence of stage 3 AKI without adverse outcomes in EPT with conservatively managed HS PDA suggests that it might reflect renal immaturity rather than pathologic conditions.
Highlights
Assessing kidney function is crucial for meticulous fluid, electrolyte, and nutritional support, and the adjustment of medication dosage in extremely preterm infants (EPT) [1,2,3,4]
The use of Serum creatinine level (sCr) for renal function assessment in preterm infants is problematic as their sCr at birth reflects maternal levels [8,9], and sCr is quite variable according to gestational age (GA), birth weight, and chronological age [4,7,10,11]
We reviewed medical charts of 97 EPT at gestation of 23–26 weeks admitted to our Neonatal Intensive Care Unit (NICU) from January 2011 to June 2014 presenting with hemodynamically significant (HS) patent ductus arteriosus (PDA), and treated exclusively by a conservative approach [31,32]
Summary
Assessing kidney function is crucial for meticulous fluid, electrolyte, and nutritional support, and the adjustment of medication dosage in extremely preterm infants (EPT) [1,2,3,4]. Limited data are available on how sCr is affected by gestational age and birth weight and how this value changes over time, especially in the peri-viable EPT [5,7,10,12,13,14] Despite these limitations, all the three current available acute kidney injury (AKI) definitions use change in sCr to classify the stage of AKI in the newborn infants [5,15,16]. AKI in premature infants are known to be related to increased mortality [11,17,18,19,20,21] and morbidities, which includes bronchopulmonary dysplasia (BPD) [2,22,23] and intraventricular hemorrhage (IVH) [24] These associations have not been well reported and elucidated in EPT,
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