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Am J Perinatol 2024; 41(S 01): e2606-e2612
DOI: 10.1055/a-2130-2269
Original Article

Renal Oxygen Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

Laura A. Rose 
1   Division of Neonatology, University of California San Diego School of Medicine, La Jolla, California
,
Adam Frymoyer
2   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
,
Shazia Bhombal
3   Division of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
,
Valerie Y. Chock 
2   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
› Author Affiliations Funding None.
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Abstract

Objective Decreased near-infrared spectroscopy (NIRS) measures of renal oxygen saturation (Rsat) have identified preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA). NIRS may further identify infants at risk for acute kidney injury (AKI) in a population with concern for hsPDA.

Study Design Review of infants ≤29 weeks' gestation undergoing NIRS and echocardiography due to concern for hsPDA. The hsPDA was defined by two of the following: moderate-large size, left to right shunt, aortic flow reversal, left atrial enlargement. AKI was defined by neonatal modified Kidney Disease Improving Global Outcomes (KDIGO). Rsat and cerebral saturation (Csat), averaged over 1 hour, were evaluated for the 24-hour period around echocardiography.

Results Among 77 infants, 29 (38%) had AKI by neonatal modified KDIGO criteria. hsPDA was found on echocardiography in 59 (77%). There were no differences in hsPDA in infants with and without AKI (p = 0.1). Rsat was not associated with AKI (p = 0.3). Infants on dopamine had less Rsat variability (p < 0.01).

Conclusion Rsat prior to echocardiography did not discriminate AKI in this cohort of preterm infants at risk for hsPDA; however, data may not capture optimal timing of Rsat measurement before AKI.

Key Points

  • No Rsat value was found to be associated with the development of AKI.

  • The optimal timing of Rsat measurement should be evaluated in infants at risk for hsPDA.

  • NIRS bedside monitoring of Csat and Rsat measures may be useful in trending perfusion patterns.

  • Identification of those at high risk for AKI may allow for more careful kidney function monitoring.

Keywords

acute kidney injury - near-infrared spectroscopy - patent ductus arteriosus - preterm neonate

Note

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.




Publication History

Received: 04 April 2023

Accepted: 13 July 2023

Accepted Manuscript online:
17 July 2023

Article published online:
09 August 2023

© 2023. Thieme. All rights reserved.

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