Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey.
Division of Neonatology, Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.
Am J Perinatol. 2021 Jul;38(9):922-929. doi: 10.1055/s-0039-1701024. Epub 2020 Jan 27.
To assess the incidence and severity of acute kidney injury (AKI) and evaluate risk factors that predict AKI in asphyxiated infants receiving therapeutic hypothermia.
Infants ≥36 weeks' gestation diagnosed with moderate-to-severe perinatal asphyxia and received therapeutic hypothermia were reviewed retrospectively ( = 166). Modified Acute Kidney Injury Network criteria were used to diagnose AKI. The results of infants with AKI were compared with the infants who did not develop AKI.
AKI developed in 49 (29.5%) infants, of whom 22 had stage I, 13 had stage II, and 14 had stage III AKI. The overall mortality rate was 15.7% and was significantly higher in infants with AKI when compared with infants without AKI (41 vs. 5%; < 0.001). Asystole at birth ( = 0.044), placental abruption ( = 0.041), outborn status ( = 0.041), need for vasopressor support ( = 0.031), increased bleeding tendency ( = 0.031), initial lactate level ( = 0.015), and 12-hour lactate level ( = 0.029) were independent risk factors for the development of AKI. Receiver operating characteristic curve analysis demonstrated a good predictive value for initial lactate level (>15 mmol/L), with 69% sensitivity (95% CI: 55-82) and 82% specificity (95% CI: 74-89), and for 12-hour lactate level (>6 mmol/L), with 83.7% sensitivity (95% CI: 70-93) and 73.5% specificity (95% CI: 64.5-81), to predict AKI.
AKI is still a common complication of perinatal asphyxia despite treatment with therapeutic hypothermia. Identification of risk factors associated with the development of AKI in asphyxiated infants would be potentially beneficial to reduce morbidity and mortality. Besides perinatal risk factors, initial and 12-hour lactate concentrations can be used for the early prediction of AKI.
评估接受治疗性低温治疗的窒息婴儿发生急性肾损伤（AKI）的发生率和严重程度，并评估预测 AKI 的危险因素。
回顾性分析胎龄≥36 周、诊断为中重度围产期窒息并接受治疗性低温治疗的婴儿（ = 166）。采用改良急性肾损伤网络标准诊断 AKI。比较 AKI 患儿与未发生 AKI 患儿的结果。
49 例（29.5%）婴儿发生 AKI，其中 22 例为Ⅰ期，13 例为Ⅱ期，14 例为Ⅲ期 AKI。总死亡率为 15.7%，AKI 组婴儿死亡率明显高于无 AKI 组（41%比 5%； < 0.001）。出生时无心跳（ = 0.044）、胎盘早剥（ = 0.041）、外出就诊（ = 0.041）、需要血管加压素支持（ = 0.031）、出血倾向增加（ = 0.031）、初始乳酸水平（ = 0.015）和 12 小时乳酸水平（ = 0.029）是 AKI 发生的独立危险因素。受试者工作特征曲线分析显示，初始乳酸水平（>15 mmol/L）和 12 小时乳酸水平（>6 mmol/L）对 AKI 有较好的预测价值，敏感性分别为 69%（95%CI：55-82）和 83.7%（95%CI：70-93），特异性分别为 82%（95%CI：74-89）和 73.5%（95%CI：64.5-81）。
尽管接受了治疗性低温治疗，围产期窒息后 AKI 仍然是一种常见的并发症。识别与窒息婴儿 AKI 发生相关的危险因素可能有助于降低发病率和死亡率。除围产期危险因素外，初始和 12 小时乳酸浓度可用于 AKI 的早期预测。
