Abstract
Introduction: Perinatal asphyxia has multisystem involvement, kidneys are most frequently affected. This study was conducted to determine the relation between severity of Hypoxic Ischaemic Encephalopathy (HIE) with acute kidney injury in term neonates.
 Methods: Retrospective study was done over a period of six months (Sept 2016 to Feb 2017) at Department of Neonatology of a tertiary level maternity hospital. Total 98 cases of Perinatal asphyxia cases which were diagnosed with certain degree of HIE were evaluated for its relation with renal involvement in different stage of HIE.
 Results: Out of 98 cases of perinatal asphyxia, HIE I was 21%, HIE II was 69% and HIE III was 10%, among which 72% cases had some degree of renal problem. seventy two cases had renal problem, oliguric cases were 41 (57%) among which 33% case had persistent symptoms and associated renal function deterioration. Among 42 cases of deranged RFTs, 40% of cases has persistently deranged RFTs. In comparison to HIE II in HIE III, 22% of cases had one time derangement of RFTs and 33% cases had at least one observation of oliguria, while remaining 45% cases had persistent deterioration of RFTs and urine output, suggesting that progression in HIE stage has significant association with renal dysfunction (p < 0.05). More than half of the cases of HIE III had mortality while 20.3% of HIE II cases had mortality, indicating that the mortality is highly significant with higher HIE grade (p < 0.05).
 Conclusions: Renal involvement is very common in cases of perinatal asphyxia, and severity of renal involvement increases as the HIE grading increases.
Highlights
Perinatal asphyxia has multisystem involvement, kidneys are most frequently affected.This study was conducted to determine the relation between severity of Hypoxic Ischaemic Encephalopathy (HIE) with acute kidney injury in term neonates
It is known that kidneys are very delicate and sensitive to hypoxia, renal insufficiency occurs within 24 hours of a hypoxic ischemic event
Impaired urine output was considered if urine output was < 1 ml/kg/hr in catheterised children and less than six wet nappies in uncatheterized children
Summary
Perinatal asphyxia has multisystem involvement, kidneys are most frequently affected.This study was conducted to determine the relation between severity of Hypoxic Ischaemic Encephalopathy (HIE) with acute kidney injury in term neonates. Perinatal asphyxia (PA) has multi-organ involvement with multiple complications in the neonatal period and beyond. Incidence of perinatal asphyxia is reported as 1 to 1.5% at various centres. During the event of perinatal asphyxia most of the organs are involved and damaged due to hypoxia and ischemia. The most affected organs are the kidneys in 50% followed by brain in 28%, cardiovascular system (CVS) in 25% and lungs in 23% cases.[2] It is known that kidneys are very delicate and sensitive to hypoxia, renal insufficiency occurs within 24 hours of a hypoxic ischemic event. If the hypoxia and ischemia is prolonged, that event causes irreversible cortical necrosis.[2,3,4]
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