Naunova-Timovska Silvana, Jordanova Olivera, Babinkostova Zoja
University Children's Hospital Ss. Cyril and Methodius University of Skopje Skopje Republic of Macedonia.
Open Access Maced J Med Sci. 2019 Sep 14;7(21):3559-3563. doi: 10.3889/oamjms.2019.762. eCollection 2019 Nov 15.
Acute kidney injury is a severe clinical condition. It is common in neonates in intensive care unit. It is defined as a sudden deterioration in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. The score for neonatal acute physiology perinatal extension in critically sick neonates with kidney injury is a useful tool for assessing the severity of the disease.
This study aimed to determine the incidence of AKI and the role of SNAPPE 2 score in predicting mortality and morbidity of kidney injury in neonates.
The study was designed as a prospective clinical investigation performed in the period of three years, which included 100 neonates (50 with AKI and 50 without AKI) hospitalised in intensive care unit of University Clinic of Children Diseases in Skopje. The severity of the illness of hospitalised newborn infants was estimated with SNAPPE 2 score realised in the first 12 hours of admission to NICU. Medical data records of admitted neonates with AKI were analysed. The material was statistically processed using methods of descriptive statistics.
During the study period, 770 new born's were hospitalised in the intensive care unit due to various pathological conditions and 50 new born's were selected with AKI. The control group consisted of 50 neonates with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study in both groups (AKI and non-AKI) were born at term (64% and 54%) with a predominance of male neonates (68% and 60%). The mortality rate was significantly higher in newborns with AKI than in the control group (36% vs 24%) (p < 0.01). The mean SNAPPE 2 score value in neonates with AKI was higher than in the control group (58.72 vs 40.0), and the difference was significant (p = 0.00001). Difficult score level predominated in half (50%) of newborn infants with AKI, while median score level predominated in control group (42%). There was a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs 40.2 ± 16.6) (p < 0.0001).
Acute kidney injury is a life-threatening condition with still high mortality rate. The severity of the illness of hospitalised neonates in an intensive care unit is estimated by SNAPPE 2 score. Also, the risk of mortality is estimated too, taking into consideration the fact that higher values of the score are associated with higher mortality. Appropriate treatment of neonates with severe kidney injury improves the outcome and reduces the mortality of the disease.
急性肾损伤是一种严重的临床病症。在重症监护病房的新生儿中很常见。它被定义为肾功能突然恶化，导致体液平衡、电解质和代谢废物紊乱。对于患有肾损伤的危重新生儿，新生儿急性生理学围产期扩展评分是评估疾病严重程度的有用工具。
本研究旨在确定急性肾损伤的发生率以及SNAPPE 2评分在预测新生儿肾损伤死亡率和发病率方面的作用。
该研究设计为一项为期三年的前瞻性临床调查，纳入了斯科普里儿童疾病大学诊所重症监护病房收治的100例新生儿（50例急性肾损伤患儿和50例无急性肾损伤患儿）。在入住新生儿重症监护病房的前12小时，通过SNAPPE 2评分评估住院新生儿的疾病严重程度。对收治的急性肾损伤新生儿的医疗数据记录进行分析。采用描述性统计方法对资料进行统计学处理。
研究期间，770例新生儿因各种病理状况入住重症监护病房，其中50例被选为急性肾损伤患儿。对照组由50例伴有相似相关病理状况但无肾损伤患儿组成。计算得出新生儿急性肾损伤的患病率为6.4%。两组（急性肾损伤组和非急性肾损伤组）中参与研究的大多数新生儿为足月儿（分别为64%和54%），男婴占优势（分别为68%和60%）。急性肾损伤新生儿的死亡率显著高于对照组（36%对24%）（p < 0.01）。急性肾损伤新生儿的平均SNAPPE 2评分值高于对照组（58.72对40.0），差异具有统计学意义（p = 0.00001）。急性肾损伤新生儿中有一半（50%）以困难评分水平为主，而对照组以中等评分水平为主（42%）。与无致命结局的急性肾损伤新生儿相比，有致命结局的急性肾损伤新生儿的平均评分值存在显著差异（70.73 ± 18.6对40.2 ± 16.6）（p < 0.0001）。
急性肾损伤是一种危及生命的病症，死亡率仍然很高。通过SNAPPE 2评分评估重症监护病房住院新生儿的疾病严重程度。此外，考虑到评分值越高与死亡率越高相关，也可评估死亡风险。对重症肾损伤新生儿进行适当治疗可改善预后并降低疾病死亡率。
