Nouri S, Mahdhaoui N, Beizig S, Zakhama R, Salem N, Ben Dhafer S, Methlouthi J, Seboui H
Service de néonatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie.
Arch Pediatr. 2008 Mar;15(3):229-35. doi: 10.1016/j.arcped.2008.01.011. Epub 2008 Mar 7.
Renal involvement is frequent in neonates with perinatal asphyxia. It is correlated with the severity of neurological damage and seems to worsen the long-term neurological outcome.
The aim of this study was to determine the incidence of renal failure after perinatal asphyxia, to precise the relationship between severity of cerebral damage and renal failure and to evaluate the place of renal damage in the short- and middle-term neurological outcome.
We conducted a prospective study including 87 full-term neonates admitted in the neonatology department of F. Hached university hospital in Sousse (Tunisia) and suffering from hypoxic ischemic encephalopathy from 1st January 2003 to 30 June 2005. Renal function was assessed by measuring plasma urea and creatinine at age 48 h. Renal failure was defined by a level of creatinine above 90 micromol/l. Neurologic examination was performed on day 7. The survivors were followed up by the same senior after discharge.
During the study period, 87 full-term neonates were admitted for hypoxic ischemic encephalopathy. The degree of neurological impairment was determined according to Sarnat classification: 1st stage 9 neonates (10,3%), 2nd stage 67 (77%) and 3rd stage 11(12,6%). Renal failure involved 15 neonates (17,2%) of whom 10 belonging to the 2nd stage group. Renal function outcome was favorable in all survivors with normalisation of plasma creatinine level between day 5 and day 15. Eight neonates died, of whom 3 with renal failure. Neurologic examination was abnormal in 36 out of 72 (50%) neonates without renal failure and in 9 of the 12 (75%) survivors with renal failure. Among the 12 neonates with renal failure, 7 had abnormal neurologic features at discharge. Neurologic assessment between 6 and 18 months was abnormal in 4/12 (33%) of neonates with renal failure versus 8/72(11%) of neonates without renal failure.
Transient renal failure is commonly observed in perinatal asphyxia. Renal failure is correlated with neurologic severity. Renal function assessment using creatinine plasma level seems to be correlated with neurologic outcome. However, other tools appreciating renal function, namely tubular function, should be determined earlier in order to predict neurologic outcome after hypoxic ischemic encephalopathy.
围产期窒息的新生儿中肾脏受累很常见。它与神经损伤的严重程度相关，并且似乎会使长期神经预后恶化。
本研究的目的是确定围产期窒息后肾衰竭的发生率，明确脑损伤严重程度与肾衰竭之间的关系，并评估肾损伤在短期和中期神经预后中的地位。
我们进行了一项前瞻性研究，纳入了2003年1月1日至2005年6月30日在突尼斯苏塞市法赫德大学医院新生儿科收治的87例足月新生儿，这些新生儿患有缺氧缺血性脑病。在48小时龄时通过测量血浆尿素和肌酐来评估肾功能。肾衰竭定义为肌酐水平高于90微摩尔/升。在第7天进行神经检查。存活者出院后由同一位资深医生进行随访。
在研究期间，87例足月新生儿因缺氧缺血性脑病入院。根据萨纳特分类确定神经损伤程度：1期9例新生儿（10.3%），2期67例（77%），3期11例（12.6%）。15例新生儿（17.2%）出现肾衰竭，其中10例属于2期组。所有存活者的肾功能预后良好，血浆肌酐水平在第5天至第15天恢复正常。8例新生儿死亡，其中3例伴有肾衰竭。72例无肾衰竭的新生儿中有36例（50%）神经检查异常，12例有肾衰竭的存活者中有9例（75%）神经检查异常。在12例有肾衰竭的新生儿中，7例出院时神经特征异常。6至18个月时，有肾衰竭的新生儿中4/12（33%）神经评估异常，无肾衰竭的新生儿中8/72（11%）神经评估异常。
围产期窒息中常观察到短暂性肾衰竭。肾衰竭与神经严重程度相关。使用血浆肌酐水平评估肾功能似乎与神经预后相关。然而，为了预测缺氧缺血性脑病后的神经预后，应该更早地确定其他评估肾功能的工具，即肾小管功能。
