Antenatal Steroids and Acute Kidney Injury in Preterm Infants

Abstract

Objective The aim of this study was to identify the effects of antenatal steroids (ANS) on acute kidney injury (AKI) in very low birth weight (VLBW) preterm infants.

Study Design We performed a retrospective cohort study of VLBW infants admitted to a tertiary-care neonatal intensive care unit between January 2016 and June 2019. Infants were divided into no ANS, partial ANS, and complete ANS groups. Serum creatinine (SCr) levels and rates of AKI during the first 2 weeks of life were compared.

Results During the study period, 335 infants met our inclusion criteria. Among no, partial, and complete ANS groups, there were significant differences in rates of stages 2 and 3 AKI (17, 11, and 6%, respectively). Logistic regression analysis revealed that complete ANS course was associated with lower rates of AKI (odds ratio [OR] = 0.41 95% confidence interval [CI]: 0.20–0.83) and stages 2 and 3 AKI (OR = 0.205 95% CI: 0.075–0.563) compared with no ANS. Infants in complete ANS group had significantly lower SCr at 72 hours of life and at discharge, SCr peak was compared with infants in no ANS group.

Conclusion In VLBW infants, complete ANS exposure may be associated with improved renal function and decreased risk for AKI compared with no ANS.

Key Points

• The effects of antenatal steroid treatment on renal function in preterm infants are not clear.

• A complete course of antenatal steroid decreases the risk for acute kidney injury in preterm infants.

• Infants who are not exposed to antenatal steroids need closer observation of their renal function.

Keywords

antenatal steroids - acute kidney injury - preterm infants - very low birth weight infants

Publication History

Received: 31 July 2020

Accepted: 01 December 2020

Article published online:
06 January 2021

• References

• 1 Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50 (04) 515-525
• 2 Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1990; 97 (01) 11-25
• 3 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454
• 4 Melamed N, Shah J, Soraisham A. et al. Association between antenatal corticosteroid administration-to-birth interval and outcomes of preterm neonates. Obstet Gynecol 2015; 125 (06) 1377-1384
• 5 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (03) CD004454
• 6 Chawla S, Natarajan G, Rane S, Thomas R, Cortez J, Lua J. Outcomes of extremely low birth weight infants with varying doses and intervals of antenatal steroid exposure. J Perinat Med 2010; 38 (04) 419-423
• 7 Weintraub AS, Connors J, Carey A, Blanco V, Green RS. The spectrum of onset of acute kidney injury in premature infants less than 30 weeks gestation. J Perinatol 2016; 36 (06) 474-480
• 8 Mian AN, Guillet R, Ruck L, Wang H, Schwartz GJ. Acute kidney injury in premature, very low-birth-weight infants. J Pediatr Intensive Care 2016; 5 (02) 69-78
• 9 Daga A, Dapaah-Siakwan F, Rajbhandari S, Arevalo C, Salvador A. Diagnosis and risk factors of acute kidney injury in very low birth weight infants. Pediatr Neonatol 2017; 58 (03) 258-263
• 10 Srinivasan N, Schwartz A, John E, Price R, Amin S. Acute kidney injury impairs postnatal renal adaptation and increases morbidity and mortality in very lowbirth- weight infants. Am J Perinatol 2018; 35 (01) 39-47
• 11 Carmody JB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 2014; 9 (12) 2036-2043
• 12 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
• 13 Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Probl Pediatr Adolesc Health Care 1987; 17: 243-288
• 14 Bateman DA, Thomas W, Parravicini E, Polesana E, Locatelli C, Lorenz JM. Serum creatinine concentration in very-low-birth-weight infants from birth to 34-36 wk postmenstrual age. Pediatr Res 2015; 77 (05) 696-702
• 15 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (02) 191-196
• 16 Koc E, Demirel N, Bas AY. et al. Early neonatal outcomes of very-low-birth-weight infants in Turkey: a prospective multicenter study of the Turkish Neonatal Society. PLoS One 2019; 14 (12) e0226679
• 17 Liggins GC. The role of cortisol in preparing the fetus for birth. Reprod Fertil Dev 1994; 6 (02) 141-150
• 18 Brophy PD, Robillard JE. Functional development of the kidney in utero. In: Polin RA, Fox WW, Abman SW. eds. Fetal and Neonatal Physiology, 3th ed. Philadelphia, PA: W.B. Saunders; 2004: 1229-1239
• 19 Stritzke A, Thomas S, Amin H, Fusch C, Lodha A. Renal consequences of preterm birth. Mol Cell Pediatr 2017; 4 (01) 2
• 20 Padbury JF, Ervin MG, Polk DH. Extrapulmonary effects of antenatally administered steroids. J Pediatr 1996; 128 (02) 167-172
• 21 Jahnukainen T, Chen M, Berg U, Celsi G. Antenatal glucocorticoids and renal function after birth. Semin Neonatol 2001; 6 (04) 351-355
• 22 Baylis C, Handa RK, Sorkin M. Glucocorticoids and control of glomerular filtration rate. Semin Nephrol 1990; 10 (04) 320-329
• 23 al-Dahan J, Stimmler L, Chantler C, Haycock GB. The effect of antenatal dexamethasone administration on glomerular filtration rate and renal sodium excretion in premature infants. Pediatr Nephrol 1987; 1 (02) 131-135
• 24 van den Anker JN, Hop WC, de Groot R. et al. Effects of prenatal exposure to betamethasone and indomethacin on the glomerular filtration rate in the preterm infant. Pediatr Res 1994; 36 (05) 578-581
• 25 MacKintosh D, Baird-Lambert J, Drage D, Buchanan N. Effects of prenatal glucocorticoids on renal maturation in newborn infants. Dev Pharmacol Ther 1985; 8 (02) 107-114
• 26 Kuiper JW, Groeneveld ABJ, Slutsky AS, Plötz FB. Mechanical ventilation and acute renal failure. Crit Care Med 2005; 33 (06) 1408-1415
• 27 Shelton EL, Waleh N, Plosa EJ. et al. Effects of antenatal betamethasone on preterm human and mouse ductus arteriosus: comparison with baboon data. Pediatr Res 2018; 84 (03) 458-465
• 28 Wong D, Abdel-Latif M, Kent A. NICUS Network. Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed 2014; 99 (01) F12-F20
• 29 Crocker JF, Ogborn MR. Glucocorticoid teratogenesis in the developing nephron. Teratology 1991; 43 (06) 571-574
• 30 Slotkin TA, Seidler FJ, Kavlock RJ, Bartolome JV. Fetal dexamethasone exposure impairs cellular development in neonatal rat heart and kidney: effects on DNA and protein in whole tissues. Teratology 1991; 43 (04) 301-306
• 31 McCarty MF. Prenatal high-dose pyridoxine may prevent hypertension and syndrome X in-utero by protecting the fetus from excess glucocorticoid activity. Med Hypotheses 2000; 54 (05) 808-813
• 32 Barker DJ. In utero programming of chronic disease. Clin Sci (Lond) 1998; 95 (02) 115-128
• 33 Langley-Evans SC, Sherman RC, Welham SJ, Nwagwu MO, Gardner DS, Jackson AA. Intrauterine programming of hypertension: the role of the renin-angiotensin system. Biochem Soc Trans 1999; 27 (02) 88-93