Miall L S, Henderson M J, Turner A J, Brownlee K G, Brocklebank J T, Newell S J, Allgar V L
Regional Neonatal Intensive Care Unit, St. James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Pediatrics. 1999 Dec;104(6):e76. doi: 10.1542/peds.104.6.e76.
Published data show that plasma creatinine falls steadily during the first 28 days of life and that creatinine levels in the neonatal period are higher in more premature infants. However, the best reference data commence on day 2 of life. The objective of this study was to document how plasma creatinine changes in the first 48 hours of life and to examine the reason for the apparently high levels of creatinine in preterm infants, compared with maternal levels.
A prospective observational study on a regional neonatal intensive care unit.
A total of 42 preterm infants, mean gestational age of 29.4 weeks (range: 23-35), mean birth weight of 1.42 kg (.55-2.77), divided into 4 gestation groups: 23 to 26 weeks (n = 9), 27 to 29 weeks (n = 13), 30 to 32 weeks (n = 12), and 33 to 35 weeks (n = 8).
Measurement of plasma creatinine and urea concentration in cord blood and in serial samples taken for routine arterial blood gas analysis.
Changes in creatinine concentration with time and relationship to gestational age, birth weight, and illness severity.
Mean creatinine at birth was 73 micromol/L (95% confidence interval [CI]: 68-79 micromol/L). Plasma creatinine rose significantly over the first 48 hours. Mean peak creatinine in the most preterm infants (23-26 weeks) was 221 micromol/L (CI: 195-247 micromol/L). Peak plasma creatinine was inversely related to gestation (Spearman's coefficient: -.73) and birth weight (Spearman's coefficient: -.76). Significant differences in creatinine concentration were seen among different gestational groups at 24 and 48 hours of life. Peak creatinine correlated with a high Clinical Risk Index for Babies score (Spearman's coefficient:. 64). The fall in creatinine began later in more premature infants. All 38 surviving infants had normal renal function; their mean plasma creatinine at discharge was 52 micromol/L (CI: 46-58 micromol/L).
Rather than falling steadily from birth, creatinine rises dramatically in the first 48 hours of life, especially in infants of <30 weeks' gestation. Even large rises in creatinine in the first 48 hours may be expected and should not be used in isolation to diagnose renal failure.
已发表的数据表明，出生后前28天血浆肌酐水平会稳步下降，且胎龄越小的新生儿肌酐水平越高。然而，最佳参考数据是从出生后第2天开始的。本研究的目的是记录出生后48小时内血浆肌酐的变化情况，并探讨与母亲相比，早产儿肌酐水平明显较高的原因。
在一个地区性新生儿重症监护病房进行的前瞻性观察研究。
共42例早产儿，平均胎龄29.4周（范围：23 - 35周），平均出生体重1.42千克（0.55 - 2.77千克），分为4个胎龄组：23至26周（n = 9），27至29周（n = 13），30至32周（n = 12），33至35周（n = 8）。
测量脐血以及用于常规动脉血气分析的系列样本中的血浆肌酐和尿素浓度。
肌酐浓度随时间的变化以及与胎龄、出生体重和疾病严重程度的关系。
出生时肌酐平均水平为73微摩尔/升（95%置信区间[CI]：68 - 79微摩尔/升）。出生后前48小时血浆肌酐显著升高。胎龄最小的婴儿（23 - 26周）肌酐平均峰值为221微摩尔/升（CI：195 - 247微摩尔/升）。血浆肌酐峰值与胎龄（斯皮尔曼系数： - 0.73）和出生体重（斯皮尔曼系数： - 0.76）呈负相关。在出生后24小时和48小时，不同胎龄组之间肌酐浓度存在显著差异。肌酐峰值与高婴儿临床风险指数评分相关（斯皮尔曼系数：0.64）。胎龄越小的婴儿肌酐下降开始得越晚。所有38例存活婴儿肾功能正常；出院时他们的血浆肌酐平均水平为52微摩尔/升（CI：46 - 58微摩尔/升）。
肌酐并非从出生起就稳步下降，而是在出生后48小时内显著升高，尤其是胎龄小于30周的婴儿。即使出生后48小时内肌酐大幅升高也可能是正常的，不应仅凭此诊断肾衰竭。
