Risk Factors for Deranged Renal Function in Term Asphyxiated Newborn Babies: A Cross-sectional Study

Abstract

Introduction: Perinatal asphyxia is a significant cause of morbidity and mortality in the Neonatal Intensive Care Unit (NICU). As the kidneys are very sensitive to hypoxia, renal insufficiency can occur within 24 hours of a hypoxic insult and may lead to irreversible injury. Aim: To evaluate risk factors for impaired renal function in term asphyxiated newborn babies in a tertiary care hospital located in Central India. Materials and Methods: A cross-sectional observational study was conducted in the Neonatal Intensive Care Unit (NICU), IGGMC and Mayo Hospital, Nagpur, Maharashtra, Central India, from October 2020 to September 2022. A total of 95 term neonates with perinatal asphyxia were enrolled. Risk factors were noted, urine output was recorded, and neonates were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Network (AKIN) criteria. Data were tabulated and statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 21.0 to determine the significance of each risk factor for AKI. Continuous variables were compared using the unpaired t-test or Mann-Whitney U Test (when datasets were not normally distributed). Categorical variables were compared using the Chi-square test or Fisher’s-exact test. Results: Out of 95 neonates, comprising 53 males and 42 females with a mean gestational age of 38.6 weeks in the AKI group and 34 weeks in the non AKI group, 58 (61.1%) had AKI; 15 (25.86%) were AKI stage 1, 28 (48.27%) were AKI stage 2, and 15 (25.86%) were AKI stage 3. Among the risk factors, significant perinatal risk factors included Meconium-Stained Liquor (MSL) (p-value=0.0252), oligohydramnios (p-value=0.0246), prolonged labour (p-value=0.0276), and endotracheal tube (ETT) intubation as a mode of resuscitation (p-value=0.0008). Maternal risk factors such as Gestational Diabetes Mellitus (GDM) (p-value=0.0488) and Pregnancy-induced Hypertension (PIH) (p-value=0.0392) were significant. Neonatal shock (p-value=0.001) and Hypoxic- ischaemic Encephalopathy (HIE) (p-value=0.0049) were significant risk factors for AKI in this study. Conclusion: Perinatal asphyxia is one of the common causes of neonatal mortality, with AKI being the earliest and most common complication as seen in the current study, where 61.1% of neonates with perinatal asphyxia had AKI. By early detection and prevention of risk factors causing AKI in perinatal asphyxia, neonatal mortality can be reduced significantly.