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Am J Perinatol 2021; 38(09): 922-929
DOI: 10.1055/s-0039-1701024
Original Article

Acute Kidney Injury in Neonates with Perinatal Asphyxia Receiving Therapeutic Hypothermia

Ozlem Bozkurt 
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
,
Ebru Yucesoy
2   Division of Neonatology, Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
› Author Affiliations Funding None.
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Abstract

Objective To assess the incidence and severity of acute kidney injury (AKI) and evaluate risk factors that predict AKI in asphyxiated infants receiving therapeutic hypothermia.

Study Design Infants ≥36 weeks' gestation diagnosed with moderate-to-severe perinatal asphyxia and received therapeutic hypothermia were reviewed retrospectively (n = 166). Modified Acute Kidney Injury Network criteria were used to diagnose AKI. The results of infants with AKI were compared with the infants who did not develop AKI.

Results AKI developed in 49 (29.5%) infants, of whom 22 had stage I, 13 had stage II, and 14 had stage III AKI. The overall mortality rate was 15.7% and was significantly higher in infants with AKI when compared with infants without AKI (41 vs. 5%; p < 0.001). Asystole at birth (p = 0.044), placental abruption (p = 0.041), outborn status (p = 0.041), need for vasopressor support (p = 0.031), increased bleeding tendency (p = 0.031), initial lactate level (p = 0.015), and 12-hour lactate level (p = 0.029) were independent risk factors for the development of AKI. Receiver operating characteristic curve analysis demonstrated a good predictive value for initial lactate level (>15 mmol/L), with 69% sensitivity (95% CI: 55–82) and 82% specificity (95% CI: 74–89), and for 12-hour lactate level (>6 mmol/L), with 83.7% sensitivity (95% CI: 70–93) and 73.5% specificity (95% CI: 64.5–81), to predict AKI.

Conclusion AKI is still a common complication of perinatal asphyxia despite treatment with therapeutic hypothermia. Identification of risk factors associated with the development of AKI in asphyxiated infants would be potentially beneficial to reduce morbidity and mortality. Besides perinatal risk factors, initial and 12-hour lactate concentrations can be used for the early prediction of AKI.

Keywords

hypoxic–ischemic encephalopathy - acute kidney injury - renal function - asphyxia


Publication History

Received: 31 August 2019

Accepted: 12 December 2019

Article published online:
27 January 2020

© 2020. Thieme. All rights reserved.

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