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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
› Institutsangaben 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


Publikationsverlauf

Eingereicht: 31. August 2019

Angenommen: 12. Dezember 2019

Artikel online veröffentlicht:
27. Januar 2020

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Sharma D, Pandita A, Kumar C. Therapeutic hypothermia in asphyxiated newborn: its applicability, feasibility and accessibility in developing country India: a long way to go. J Neonatal Biol 2014; 3 (05) 111
    PubMedGoogle Scholar
  • 2 Pauliah SS, Shankaran S, Wade A, Cady EB, Thayyil S. Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis. PLoS One 2013; 8 (03) e58834
    CrossrefPubMedGoogle Scholar
  • 3 Behrman RE, Lees MH, Peterson EN, De Lannoy CW, Seeds AE. Distribution of the circulation in the normal and asphyxiated fetal primate. Am J Obstet Gynecol 1970; 108 (06) 956-969
    CrossrefPubMedGoogle Scholar
  • 4 Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child 1989; 143 (05) 617-620
    PubMedGoogle Scholar
  • 5 Karlowicz MG, Adelman RD. Nonoliguric and oliguric acute renal failure in asphyxiated term neonates. Pediatr Nephrol 1995; 9 (06) 718-722
    CrossrefPubMedGoogle Scholar
  • 6 Hankins GD, Koen S, Gei AF, Lopez SM, Van Hook JW, Anderson GD. Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy. Obstet Gynecol 2002; 99 (5 Pt 1): 688-691
    PubMedGoogle Scholar
  • 7 Aggarwal A, Kumar P, Chowdhary G, Majumdar S, Narang A. Evaluation of renal functions in asphyxiated newborns. J Trop Pediatr 2005; 51 (05) 295-299
    CrossrefPubMedGoogle Scholar
  • 8 Kaur S, Jain S, Saha A. et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr 2011; 31 (02) 129-134
    CrossrefPubMedGoogle Scholar
  • 9 Sarkar S, Askenazi DJ, Jordan BK. et al. Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia. Pediatr Res 2014; 75 (03) 431-435
    CrossrefPubMedGoogle Scholar
  • 10 Oncel MY, Canpolat FE, Arayici S, Alyamac Dizdar E, Uras N, Oguz SS. Urinary markers of acute kidney injury in newborns with perinatal asphyxia (.). Ren Fail 2016; 38 (06) 882-888
    CrossrefPubMedGoogle Scholar
  • 11 Tanigasalam V, Bhat V, Adhisivam B, Sridhar MG. Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia?--a randomized controlled trial. J Matern Fetal Neonatal Med 2016; 29 (15) 2545-2548
    PubMedGoogle Scholar
  • 12 Delbridge MS, Shrestha BM, Raftery AT, El Nahas AM, Haylor JL. The effect of body temperature in a rat model of renal ischemia-reperfusion injury. Transplant Proc 2007; 39 (10) 2983-2985
    CrossrefPubMedGoogle Scholar
  • 13 Hasslacher J, Barbieri F, Harler U. et al. Acute kidney injury and mild therapeutic hypothermia in patients after cardiopulmonary resuscitation - a post hoc analysis of a prospective observational trial. Crit Care 2018; 22 (01) 154
    CrossrefPubMedGoogle Scholar
  • 14 Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr 2013; 162 (04) 725-729
    CrossrefPubMedGoogle Scholar
  • 15 Nada A, Bonachea EM, Askenazi DJ. Acute kidney injury in the fetus and neonate. Semin Fetal Neonatal Med 2017; 22 (02) 90-97
    CrossrefPubMedGoogle Scholar
  • 16 Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn?. Pediatr Nephrol 2009; 24 (02) 265-274
    CrossrefPubMedGoogle Scholar
  • 17 Sarafidis K, Tsepkentzi E, Agakidou E. et al. Serum and urine acute kidney injury biomarkers in asphyxiated neonates. Pediatr Nephrol 2012; 27 (09) 1575-1582
    CrossrefPubMedGoogle Scholar
  • 18 Karlo J, Bhat BV, Koner BC, Adhisivam B. Evaluation of renal function in term babies with perinatal asphyxia. Indian J Pediatr 2014; 81 (03) 243-247
    CrossrefPubMedGoogle Scholar
  • 19 Selewski DT, Charlton JR, Jetton JG. et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
    CrossrefPubMedGoogle Scholar
  • 20 Kellum JA, Lameire N. KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17 (01) 204
    CrossrefPubMedGoogle Scholar
  • 21 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10) 696-705
    CrossrefPubMedGoogle Scholar
  • 22 Thompson CM, Puterman AS, Linley LL. et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr 1997; 86 (07) 757-761
    CrossrefPubMedGoogle Scholar
  • 23 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (02) 191-196
    CrossrefPubMedGoogle Scholar
  • 24 Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol 2014; 41 (03) 487-502
    CrossrefPubMedGoogle Scholar
  • 25 Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007; 71 (10) 1028-1035
    CrossrefPubMedGoogle Scholar
  • 26 Mehta RL, Kellum JA, Shah SV. et al; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (02) R31
    CrossrefPubMedGoogle Scholar
  • 27 Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 2013; 28 (04) 661-666
    CrossrefPubMedGoogle Scholar
  • 28 Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Compr Physiol 2012; 2 (02) 1303-1353
    CrossrefPubMedGoogle Scholar
  • 29 Saikumar P, Venkatachalam MA. Role of apoptosis in hypoxic/ischemic damage in the kidney. Semin Nephrol 2003; 23 (06) 511-521
    CrossrefPubMedGoogle Scholar
  • 30 Deshpande SA, Platt MP. Association between blood lactate and acid-base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed 1997; 76 (01) F15-F20
    CrossrefPubMedGoogle Scholar
  • 31 Singarajah C, Carlson RW. A review of the role of blood lactate measurements in the ICU. J Intensive Care Med 1998; 13: 218-226
    CrossrefPubMedGoogle Scholar
  • 32 Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2014; 42 (09) 2118-2125
    CrossrefPubMedGoogle Scholar
  • 33 Duke TD, Butt W, South M. Predictors of mortality and multiple organ failure in children with sepsis. Intensive Care Med 1997; 23 (06) 684-692
    CrossrefPubMedGoogle Scholar
  • 34 Manikis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 1995; 13 (06) 619-622
    CrossrefPubMedGoogle Scholar
  • 35 Nadeem M, Clarke A, Dempsey EM. Day 1 serum lactate values in preterm infants less than 32 weeks gestation. Eur J Pediatr 2010; 169 (06) 667-670
    CrossrefPubMedGoogle Scholar
  • 36 Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000; 120 (01) 73-80
    CrossrefPubMedGoogle Scholar
  • 37 Grayck EN, Meliones JN, Kern FH, Hansell DR, Ungerleider RM, Greeley WJ. Elevated serum lactate correlates with intracranial hemorrhage in neonates treated with extracorporeal life support. Pediatrics 1995; 96 (5 Pt 1): 914-917
    CrossrefPubMedGoogle Scholar
  • 38 Cheung PY, Finer NN. Plasma lactate concentration as a predictor of death in neonates with severe hypoxemia requiring extracorporeal membrane oxygenation. J Pediatr 1994; 125 (5 Pt 1): 763-768
    CrossrefPubMedGoogle Scholar
  • 39 Cheung PY, Robertson CMT, Finer NN. Plasma lactate as a predictor of early childhood neurodevelopmental outcome of neonates with severe hypoxaemia requiring extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 1996; 74 (01) F47-F50
    CrossrefPubMedGoogle Scholar
  • 40 da Silva S, Hennebert N, Denis R, Wayenberg JL. Clinical value of a single postnatal lactate measurement after intrapartum asphyxia. Acta Paediatr 2000; 89 (03) 320-323
    CrossrefPubMedGoogle Scholar
  • 41 Shah S, Tracy M, Smyth J. Postnatal lactate as an early predictor of short-term outcome after intrapartum asphyxia. J Perinatol 2004; 24 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 42 Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy BP, Connolly S. persistent lactic acidosis in neonatal hypoxic-ischemic encephalopathy correlates with EEG grade and electrographic seizure burden. Arch Dis Child Fetal Neonatal Ed 2008; 93 (03) 183-186
    CrossrefPubMedGoogle Scholar
  • 43 Polackova R, Salounova D, Kantor L. Lactate as an early predictor of psychomotor development in neonates with asphyxia receiving therapeutic hypothermia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162 (02) 144-148
    CrossrefPubMedGoogle Scholar
  • 44 Chiang MC, Lien R, Chu SM. et al. Serum lactate, brain magnetic resonance imaging and outcome of neonatal hypoxic ischemic encephalopathy after therapeutic hypothermia. Pediatr Neonatol 2016; 57 (01) 35-40
    CrossrefPubMedGoogle Scholar
  • 45 Sweetman DU, Onwuneme C, Watson WR, O'Neill A, Murphy JFA, Molloy EJ. Renal function and novel urinary biomarkers in infants with neonatal encephalopathy. Acta Paediatr 2016; 105 (11) e513-e519
    CrossrefPubMedGoogle Scholar
  • 46 Abitbol CL, Bauer CR, Montané B, Chandar J, Duara S, Zilleruelo G. Long-term follow-up of extremely low birth weight infants with neonatal renal failure. Pediatr Nephrol 2003; 18 (09) 887-893
    CrossrefPubMedGoogle Scholar
  • 47 Mammen C, Al Abbas A, Skippen P. et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012; 59 (04) 523-530
    CrossrefPubMedGoogle Scholar
  • 48 Jenik AG, Ceriani Cernadas JM, Gorenstein A. et al. A randomized, double-blind, placebo-controlled trial of the effects of prophylactic theophylline on renal function in term neonates with perinatal asphyxia. Pediatrics 2000; 105 (04) E45
    CrossrefPubMedGoogle Scholar
  • 49 Bakr AF. Prophylactic theophylline to prevent renal dysfunction in newborns exposed to perinatal asphyxia--a study in a developing country. Pediatr Nephrol 2005; 20 (09) 1249-1252
    CrossrefPubMedGoogle Scholar
  • 50 Bhat MA, Shah ZA, Makhdoomi MS, Mufti MH. Theophylline for renal function in term neonates with perinatal asphyxia: a randomized, placebo-controlled trial. J Pediatr 2006; 149 (02) 180-184
    CrossrefPubMedGoogle Scholar
  • 51 Raina A, Pandita A, Harish R, Yachha M, Jamwal A. Treating perinatal asphyxia with theophylline at birth helps to reduce the severity of renal dysfunction in term neonates. Acta Paediatr 2016; 105 (10) e448-e451
    CrossrefPubMedGoogle Scholar
  • 52 Bellos I, Pandita A, Yachha M. Effectiveness of theophylline administration in neonates with perinatal asphyxia: a meta-analysis. J Matern Fetal Neonatal Med 2019; DOI: 10.1080/14767058.2019.1673722.
    CrossrefPubMedGoogle Scholar