Abstract
Many neonates undergoing whole body hypothermia (WBH) following moderate to severe perinatal asphyxia may also suffer from renal impairment. While recent data suggest WBH-related reno-protection, differences in serum creatinine (Scr) patterns to reference patterns were not yet reported. We therefore aimed to document Scr trends and patterns in asphyxiated neonates undergoing WBH and compared these to centiles from a reference Scr data set of non-asphyxiated (near)term neonates. Using a systematic review strategy, reports on Scr trends (mean ± SD, median or interquartile range) were collected (day 1–7) in WBH cohorts and compared to centiles of an earlier reported reference cohort of non-asphyxia cases. Based on 13 papers on asphyxia + WBH cases, a pattern of postnatal Scr trends in asphyxia + WBH cases was constructed. Compared to the reference 50th centile Scr values, mean or median Scr values at birth and up to 48 h were higher in asphyxia + WBH cases with a subsequent uncertain declining trend towards, at best, high or high–normal creatinine values afterwards. Such patterns are valuable for anticipating average changes in renal drug clearance but do not yet cover the relevant inter-patient variability observed in WBH cases, as this needs pooling of individual Screa profiles, preferably beyond the first week of life.
Highlights
In addition to the fact that kidney function is a prognostic factor for survival and In addition to the fact that kidney function is a prognostic factor for survival and neurocognitive outcome in neonates born with asphyxia, serum creatinine (Scr) trends are relevant for neurocognitive outcome in neonates born with asphyxia, Scr trends are relevant for adjusting pharmacotherapy and fluid management to the individual neonatal kidney adjusting pharmacotherapy and fluid management to the individual neonatal kidney function [17,18]
Based on a systematic search strategy, 13 papers were retained to construct a provisional pattern on postnatal Scr trends in asphyxia + Whole body hypothermia (WBH) cases
Compared to a reference cohort of term non-asphyxia cases, mean or median Scr values at birth and the first two days during WBH remained higher in asphyxia + WBH cases, with a subsequent decline to reach at best high or high normal creatinine values from day 4 onwards, be it that this decline was only poorly described
Summary
Perinatal asphyxia is the final result of different types of events such as placental blood flow disruption, prolonged labor, or compression of the umbilical cord All of these events result in reduced circulating blood oxygen, while asphyxia is the most common cause of encephalopathy in neonates. Hypoxic-ischemic encephalopathy is hereby characterized by both clinical- and biomarker-based (laboratory, electro-encephalography (EEG)) evidence of acute or subacute brain injury (encephalopathy) due to the fact of intrapartum or late antepartum brain hypoxia and ischemia [2,3] It still accounts for a relevant proportion of neonatal deaths, especially when we focus on causes of mortality in (near)term neonates [4]. Whole body hypothermia (WBH) is an effective intervention to reduce mortality, even more pronounced in low-income countries [5,6]
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