Value of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in predicting acute kidney injury in neonates with perinatal asphyxia.

Abstract

Background: Acute Kidney Injury (AKI) affects 30%-55% of asphyxiated neonates, with a 60%-66% mortality rate. Because novel biomarkers measured at the time of Intensive Care Unit (ICU) admission have been shown to predict short and long-term outcomes, the purpose of this study was to assess the role of urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) as an early biomarker for detecting Acute Kidney Injury (AKI) in neonates with perinatal asphyxia. Methods: This study included 91 full-term neonates (45 of whom were asphyxiated and 46 of whom were not). The asphyxiated group was subdivided further into AKI and non-AKI groups. UNGAL was measured 6 hours after birth, while CRP, creatinine, potassium, and blood urea nitrogen levels were measured 48 hours later. The biomarkers' diagnostic value was determined using Receiver Operating Characteristic (ROC) curves. Results: In terms of age and gender, there was no significant difference between the two groups (asphyxiated and non-asphyxiated). In contrast, there was a significant difference between the two groups in terms of the need for resuscitation, the need for oxygen support, the need for ventilation, the need for total parenteral nutrition, and the mode of delivery, with a P value of (<0.001, < 0.001, <0.001, <0.001 and 0.018 respectively). The results of laboratory tests (uNGAL, potassium, blood urea nitrogen, and creatinine) were significantly higher in the asphyxiated group than in the non-asphyxiated group, with a P value of (<0.001, 0.03, <0.001 and <0.001 respectively). The non-asphyxiated group had significantly higher Apgar scores at one and five minutes, urine output, albumin, and base excess than the asphyxiated group, with a P value of (<0.001, <0.001, <0.001 and 0.012 respectively). In the asphyxiated group with AKI, uNGAL showed a significant positive correlation with serum creatinine (P<0.001) and a significant negative correlation with (pH, base excess, and Apgar score at (1min-5 min) with P value (<0.001, 0.021, and <0.001 respectively). Conclusion: As a result, early detection of uNGAL as a novel and non-invasive biomarker can predict the occurrence of AKI in neonates with perinatal asphyxia, allowing for early intervention and the avoidance of complications.