Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA.
Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA.
Pediatr Nephrol. 2019 Apr;34(4):729-736. doi: 10.1007/s00467-018-4140-y. Epub 2018 Nov 10.
Acute kidney injury (AKI) is common in preterm infants, but specific therapies remain scarce. Recent studies have demonstrated an association between caffeine exposure and less frequent AKI in the first 7-10 days after birth. We hypothesized that patients with necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) would provide a better natural model of AKI to evaluate this association.
We reviewed all premature patients diagnosed with NEC or SIP at our institution from 2008 to 2014. AKI was defined by change in serum creatinine using the neonatal Kidney Disease: Improving Global Outcomes definition. Caffeine was prescribed for apnea of prematurity and caffeine exposure was determined by chart review.
A total of 146 patients with NEC/SIP were reviewed. Of these, 119 (81.5%) received caffeine, and 91 (62.3%) developed AKI. AKI occurred less frequently in patients who received caffeine than in those who did not (55.5% vs. 92.6%; odds ratio (OR) 0.10; 95% confidence interval (CI) 0.02-0.44). This association persisted in multivariable models after adjustment for potential confounders (adjusted OR 0.08; 95% CI 0.01-0.42; number needed to be exposed to caffeine to prevent one case of AKI = 2.6). Although baseline serum creatinine did not differ by caffeine exposure, patients receiving caffeine had lower peak creatinine (median 1.0 mg/dl vs. 1.5 mg/dl; p = 0.008) and absolute creatinine change (median 0.42 mg/dl vs. 0.68 mg/dl; p = 0.003) than those who did not.
Caffeine exposure in preterm infants with NEC/SIP is associated with decreased incidence and severity of AKI.
急性肾损伤（AKI）在早产儿中很常见，但特定的治疗方法仍然很少。最近的研究表明，咖啡因暴露与出生后 7-10 天内 AKI 的发生频率较低有关。我们假设坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）患者将为评估这种相关性提供更好的 AKI 自然模型。
我们回顾了 2008 年至 2014 年期间在我们机构诊断为 NEC 或 SIP 的所有早产儿患者。使用新生儿肾脏病：改善全球结局定义来定义 AKI。因早产儿呼吸暂停而开处方使用咖啡因，并通过图表审查来确定咖啡因暴露情况。
共回顾了 146 例 NEC/SIP 患者。其中 119 例（81.5%）接受了咖啡因治疗，91 例（62.3%）发生了 AKI。接受咖啡因治疗的患者 AKI 发生率低于未接受咖啡因治疗的患者（55.5% vs. 92.6%；优势比（OR）0.10；95%置信区间（CI）0.02-0.44）。在调整潜在混杂因素后，多变量模型中仍存在这种关联（调整后的 OR 0.08；95%CI 0.01-0.42；预防一例 AKI 需要暴露于咖啡因的人数为 2.6）。尽管基线血清肌酐不因咖啡因暴露而有所不同，但接受咖啡因治疗的患者的峰值肌酐（中位数 1.0mg/dl vs. 1.5mg/dl；p=0.008）和绝对肌酐变化（中位数 0.42mg/dl vs. 0.68mg/dl；p=0.003）均低于未接受咖啡因治疗的患者。
在患有 NEC/SIP 的早产儿中，咖啡因暴露与 AKI 的发生率和严重程度降低有关。
