早产儿和足月新生儿的早期急性肾损伤：发生率、结局和相关临床特征。

Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features.

机构信息

Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.

Department of Paediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.

出版信息

Neonatology. 2021;118(2):174-179. doi: 10.1159/000513666. Epub 2021 Mar 29.

DOI:10.1159/000513666

PMID:33780939

Abstract

BACKGROUND

Critically ill neonates are at high risk of kidney injury, mainly in the first days of life. Acute kidney injury (AKI) may be underdiagnosed due to lack of a uniform definition. In addition, long-term renal follow-up is limited.

OBJECTIVE

To describe incidence, etiology, and outcome of neonates developing AKI within the first week after birth in a cohort of NICU-admitted neonates between 2008 and 2018. Renal function at discharge in infants with early AKI was assessed.

METHODS AND SUBJECTS

AKI was defined as an absolute serum Cr (sCr) value above 1.5 mg/dL (132 μmol/L) after the first 24 h or as stage 2-3 of the NIDDK neonatal definition. Clinical data and outcomes were collected from medical records and retrospectively analyzed.

RESULTS

From January 2008 to December 2018, a total of 9,376 infants were admitted to the NICU of Wilhelmina Children's Hospital/UMC Utrecht, of whom 139 were diagnosed with AKI during the first week after birth. In 72 term infants, the most common etiology was perinatal asphyxia (72.2%), followed by congenital kidney and urinary tract malformations (CAKUT) (8.3%), congenital heart disease (6.9%), and sepsis (2.8%). Associated conditions in 67 preterm infants were medical treatment of a hemodynamic significant PDA (27.2%), -CAKUT (21%), and birth asphyxia (19.4%). Among preterm neonates and neonates with perinatal asphyxia, AKI was mainly diagnosed by the sCr >1.5 mg/dL criterion. Renal function at discharge improved in 76 neonates with AKI associated with acquired conditions. Neonates with stage 3 AKI showed increased sCr values at discharge. Half of these were caused by congenital kidney malformations and evolved into chronic kidney disease (CKD) later in life. Neurodevelopmental outcome (NDO) at 2 years was favorable in 93% of surviving neonates with detailed follow-up.

CONCLUSION

During the first week after birth, AKI was seen in 1.5% of infants admitted to a level III NICU. Renal function at discharge had improved in most neonates with acquired AKI but not in infants diagnosed with stage 3 AKI. Long-term renal function needs further exploration, whereas NDO appears to be good.

摘要

背景

危重新生儿有发生肾脏损伤的高风险，主要发生在生命的最初几天。由于缺乏统一的定义，急性肾损伤（AKI）可能诊断不足。此外，长期的肾脏随访受到限制。

目的

描述 2008 年至 2018 年期间在新生儿重症监护病房（NICU）收治的新生儿队列中，出生后第一周内发生 AKI 的新生儿的发病率、病因和结局。评估早期 AKI 婴儿出院时的肾功能。

方法和对象

AKI 定义为出生后 24 小时内血清肌酐（sCr）绝对值>1.5mg/dL（132μmol/L），或符合 NIDDK 新生儿定义的 2-3 期。从病历中收集临床数据和结局，并进行回顾性分析。

结果

2008 年 1 月至 2018 年 12 月，共有 9376 名婴儿入住威廉敏娜儿童医院/乌得勒支大学医学中心的 NICU，其中 139 名婴儿在出生后第一周被诊断为 AKI。在 72 名足月婴儿中，最常见的病因是围产期窒息（72.2%），其次是先天性肾脏和泌尿道畸形（CAKUT）（8.3%）、先天性心脏病（6.9%）和败血症（2.8%）。67 名早产儿的合并症为治疗与血液动力学显著的动脉导管未闭（PDA）相关的药物治疗（27.2%）、-CAKUT（21%）和出生窒息（19.4%）。在早产儿和围产期窒息的新生儿中，AKI 主要通过 sCr>1.5mg/dL 标准诊断。与获得性疾病相关的 76 名 AKI 患儿出院时肾功能改善。在这些患儿中，有一半是由先天性肾脏畸形引起的，后来发展为慢性肾脏病（CKD）。在有详细随访的存活新生儿中，93%的患儿神经发育结局（NDO）良好。