Acute kidney injury in asphyxiated neonates
Keywords:
acute kidney injury, asphyxiated neonates, serum creatinine, urine output
Abstract
Background Asphyxia neonatorum may result in multiorgandysfunction including renal involvement. There is no consensus
on the determination of acute kidney injury (AKI) in neonates
making establishment of the diagnosis and its management
becomes difficult. The Acute Kidney Injury Network (AKIN)
recommends AKI criteria based on increased serum creatinine
level and reduced urine output.
Objectives To identify the prevalence of AKI in asphyxiated
neonates using the AKIN criteria, to compare the difference of
AKI stages, and the glomerular filtration rates (GFR) between
moderate and severe asphyxia.
Methods This was a cross-sectional analytical study conducted
between July 2012 and January 2013. Subjects were all asphyxiated
neonates (Apgar score < 7 at fifth minute) with gestational age of
>35 weeks delivered and hospitalized in Cipto Mangunkusumo
Hospital and Koja District Hospital, Jakarta, Indonesia.
Glomerular filtration rate was calculated using the components
of urine creatinine, serum creatinine, and urine output; while
AKI stages were determined according to AKIN criteria. Urinary
output was measured via urethral catheterization.
Results Of 94 subjects, there were 70 neonates with moderate
and 24 neonates with severe asphyxia, with the prevalence of AKI
was 63%. Twenty one out of 24 neonates with severe asphyxia
experienced AKI, while neonates with moderate asphyxia who
experienced AKI was 38 out of 70 subjects (54%). Two third of
neonates with severe asphyxia who experienced AKI had stage
3 of AKI. More severe AKI stages and lower median GFR were
found in neonates with severe compared to moderate asphyxia
(P<0.001) .
Conclusion The prevalence of AKI in neonatal asphyxia is high
(63%). The more severe degree of neonatal asphyxia, the more
severe AKI stage and the lower median GFR.
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with or without acute renal failure. Pediatr Nephrol.
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a practical guide. Geneva: World Health Organization.
1999.
2. Christopher P, Barnett, Max P, Paul GE. Clinicopathological
correlation in post-asphyxia! organ damage: a donor organ
perspective. Pediatrics. 1997;99:797-9.
3. Lee ACC, Mullany LC, Tielsh JM, Katz J, Khatry SK, LeClerq
SC, et al. Risk factors for neonatal mortality due to birth
asphyxia in Southern Nepal: a prospective, community-based
cohort study. Pediatrics. 2008;121:1381-90.
4. Alisjahbana A, Hidayat S, Mintardaningsih, Primardi A,
Herliani E, Sofiatin Y, et al. Management of birth asphyxia
at home and health center. Paediatr Indones. 1999;39:88-
101.
5. Data Divisi Neonatologi Departemen IKA FKUI-RSCM.
2009.
6. Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan
dysfunction in infants with post-asphyxia! hypoxic-ischemic
encephalopathy. Arc Dis Child Fetal Neonatal. 2 004;89: 15 2-
5.
7. Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, et
al. Evaluation of glomerular and tubular renal function in
neonates with birth asphyxia. Ann Trop Paediatr.2011 ;3: 129-
34.
8. Aggarwal A, Kumar P, Chowdary G, Majumdar S, Narang
A. Evaluation of renal functions in asphyxiated newborns. J
Trop Pediatr. 2005;51:295-9.
9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C,
Warnock DG, et al. Acute kidney injury network: Report of
an initiative to improve outcome in acute kidney injury. Crit
Care. 2007;11 :l -8.
10. Gupta BD, Sh arma P, BaglaJ, Parakh M, Soni JP. Renal failure
in asphyxiated neonates. Indian Pediatr. 2005;42:928-34.
11. Manoe VM. Kelainan nefrologik pada asfiksia neonatorum
di Rumah Sakit Dr. Cipto Mangunkusumo [tesis].
J akarta:Universitas Indonesia;2003.
12. Aminullah A. Asfiksia bayi barn lahir. In: Markum AH,
Ismael S, Alatas H, Akib A, Firmansyah A, Sastroasmoro S,
editor. Buku ajar ilmu kesehatan anak. Jakarta: Balai Penerbit
FKUI; 1991. p. 261-5.
13. Karlowicz MG, Adelman RD. Nonoliguric and oliguric acute
renal failure in asphyxiated term neonates. Pediatr Nephrol.
1995;9:718-22.
14. 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 neon ate.
Pediatr Nephrol. 2013;28:661-6.
15. Seleweski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar
S. Acute kidney injury in asphyxiated newborns treated with
therapeutic hypothermia. J Pediatr. 2013;162:725-29.16. Alatas H. Anatomi clan fisiologi ginjal. In: Alatas H,
Tambunan T, Trihono PP, Pardede SO, editor. Buku ajar
nefrologi anak. Edisi ke-2. Jakarta: Balai Penerbit FKUI;
2002. p. 1-28.
1 7. Guignard JP, Drukker A. Why do newborn infants have a
high plasma creatinine? Pediatrics. 1999;103:l-4.
18. Perlman JM. Renal injury in the asphyxiated newborn
infant: relationship to neurologic outcome. J Pediatr.
1988; 113 :875-9.
19. Mohan PV, Pai PM. Renal insult in asphyxia neonatorum.
Indian Pediatr. 2000;37:1102-10.
20. J ernik AG, Cernadas JMC, Gorenstein A, Ramirez JA, Vain
N. A randomized, double-blind, placebo-controlled trial of
the effect of prophylactic theophylline on renal function
in term neonates with perinatal asphyxia. Pediatrics.
238 • Paediatr lndones, Vol. 53, No. 4, July 2013
2000; 105:45.
21. Kosnadi L. Nefrologi neonatal. In: Alatas H, Tambunan T,
Trihono PP, Pardede SO, editors. Buku ajar nefrologi anak.
Edisi ke-2. Jakarta: Balai Penerbit FKUI; 2002. p. 511-49.
22. Radityo AN, Kosim MS, Muryawan H. Asfiksia neonatorum
sebagai faktor risiko gaga! ginjal akut. Sari Pediatri.
2012;13:305-10.
23. Umboh A. Hubungan asfiksia neonatorum dengan gangguan
fungsi ginjal pada bayi barn lahir. Sari Pediatri. 2002;4:50-
3.
24. Kornhauser C, Dubey LA, Garay ME, Perez-Luque EL,
Malacara JM, Vargas-Origel A. Serum and urinary insulinelike
growth factor-1 and tumor necrosis factor in neonates
with or without acute renal failure. Pediatr Nephrol.
2002; 17 :332-6.
Published
2013-08-31
How to Cite
1.
Amardiyanto R, Trihono P, Rundjan L, Pusponegoro H. Acute kidney injury in asphyxiated neonates. PI [Internet]. 31Aug.2013 [cited 22Dec.2024];53(4):232-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/288
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-08-31
Accepted 2016-08-21
Published 2013-08-31
