Incidence of acute renal failure in birth asphyxia and its correlation with hypoxic-ischemic encephalopathy staging

Abstract

Introduction: Acute renal failure (ARF) is a recognized complication of birth asphyxia and it carries a poor prognosis. Early recognition of ARF is particularly important in asphyxiated neonates with hypoxic-ischemic encephalopathy (HIE). Objectives: To determine the incidence of ARF in term asphyxiated neonates and to correlate it with HIE staging. Methods: A total of 50 term (37-42 weeks) neonates born with Apgar score of <7 at 5 min after birth were selected as cases and 50 normal term (37-42 weeks) neonates as controls. All asphyxiated neonates with clinical features of HIE are staged by Sarnat and Sarnat staging. Gestational age, birth weight, relevant perinatal history, and examination findings are recorded in predesigned pro forma. After 72 h and before 96 h of life, blood was collected and sent for relevant investigations, and clinical condition of the neonate and urine output were monitored and neonates were managed according to the standard protocol. Results: Incidence of ARF is significantly more in cases (76.0% vs. 4.0%) than the controls. Among 38 cases with ARF, 32 (84.2%) had pre-renal ARF and 6 (15.8%) had intrinsic ARF. On the basis of urine output, 12 (24.0%) had oliguric ARF and 38 cases (76.0%) had non-oliguric ARF while out of 50 controls, 2 (4%) neonates had pre-renal and non-oliguric type of ARF. Incidence of ARF correlated well with HIE staging. Among the 50 cases, 32 (84.3%) improved clinically after fluid therapy, while 6 (15.7%) did not improve. Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. ARF in birth asphyxia is predominantly pre-renal and non-oliguric type and it responds to fluid challenge. ARF in birth asphyxia correlates well with HIE staging.