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Background Infants with neonatal asphyxia have multiorgan damage, such as to the kidneys (50%), central nervous system (28%), cardiovascular system (25%), and lungs (23%). Neonatal asphyxia reduces kidney perfusion, often leading to acute kidney injury (AKI) after asphyxia. Neutrophil gelatinase-associated lipocalin (NGAL) levels in the blood, urine and kidney tissue increased rapidly in AKI. Urinary NGAL is proposed to have better performance in diagnosing AKI than creatinine due to its earlier, rapid level increase and it is less invasive.
Objective To compare urinary NGAL to serum creatinine as a marker to assess kidney function in neonatal asphyxia.
Methods Diagnostic comparison study with cross-sectional design was performed at neonatal intensive care unit (NICU) of Prof. Dr. R. D. Kandou Hospital, Manado from November 2015 to February 2016. All subjects had neonatal asphyxia. Data were analyzed using descriptive analysis, receiver-operator characteristic (ROC) curve, and Z-test.
Results Urinary NGAL with cut-off point of 652.24 ng/mL can predict AKI in neonates with asphyxia with 100% sensitivity, 75% specificity, 52.3% positive predictive value, and 100% negative predictive value. Chi-square test resulted in a value of x2 = 20.036, P=0.0001).This shows that urinary NGAL levels >652,24 ng/mL can predicts AKI by 20 times in infants with neonatal asphyxia. So, urinary NGAL performs better than serum creatinine, therefore it can replace serum creatinine as an alternative non-invasive diagnostic test for diagnosing AKI in infants with neonatal asphyxia.
Conclusion The diagnostic value of urinary NGAL is higher than that of serum creatinine in assessing kidney function in neonatal asphyxia.
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2. de Haan M, Wyatt JS, Roth S, Vargha-Khadem F, Gadian D, Mishkin M. Brain and cognitive-behavioural development after asphyxia at term birth. Dev Sci. 2006;9:350-8.
3. Mohan PV, Pai PM. Renal insult in asphyxia neonatorum. Indian Pediatr. 2000;37:1102-6.
4. Devarajan P. Acute kidney injury (AKI). In: Chand DH, Valentini RP, editors. Clinician’s manual of pediatric nephrology. Singapore: World Scientific Publishing; 2011. p. 435-64.
5. Antonucci R, Porcella A, Pilloni MD. Perinatal asphyxia in term newborn. J PediatrNeonat Individual Med. 2014;3:1-14.
6. Waikar SS, Bonventre J. Creatinine kinetics and the definition of acute kidney injury. J Am SocNephrol. 2009;20:672-9.
7. Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? PediatrNephrol. 2009;24:265-74.
8. Carrillo-Esper R1, Castillo-Albarrán FM, Pérez-Jáuregui J. Neutrophil gelatinase-associated lipocalin: a novel biomarker in acute kidney injury. Cir Cir. 2011;79:577-81.
9. Atta H, Bakry S, Obaia E, Gengehy SE, Mohamed W. Serum and urinary N-GAL in acute and chronic kidney disease. JBPMS. 2011;4:1-6.
10. Gilstrap LC, Oh W. American Academy of Pediatrics and American College of Obstetricians and Gynaecologists. Care of the neonate. Guidelines for perinatal care. Elk Grove Village (IL): American Academy of Pediatrics. 2002:196-7.
11. Chiabi A, Nguefack S, Mah E, Nodem S, Mbuagbaw L, Mbonda E, et al. Risk factors for birth asphyxia in an urban health facility in Cameroon. Iran J Child Neurol. 2013;7:46-54.
12. Haase M, Bellomo R, Devarajan P, Schlattmann P, Fielitz AH. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009:54;1012-24.