Keles Elif, Wintermark Pia, Groenendaal Floris, Borloo Noor, Smits Anne, Laenen Annouschka, Mekahli Djalila, Annaert Pieter, Şahin Suzan, Öncel Mehmet Yekta, Chock Valerie, Armangil Didem, Koc Esin, Battin Malcolm R, Frymoyer Adam, Allegaert Karel
Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey.
Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal Children's Hospital, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.
Neonatology. 2022;119(6):686-694. doi: 10.1159/000525574. Epub 2022 Jul 7.
There is large variability in kidney function and injury in neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH). Acute kidney injury (AKI) definitions that apply categorical approaches may lose valuable information about kidney function in individual patients. Centile serum creatinine (SCr) over postnatal age (PNA) may provide more valuable information in TH neonates.
Data from seven TH neonates and one non-TH-treated, non-NE control cohorts were pooled in a retrospective study. SCr centiles over PNA, and AKI incidence (definition: SCr ↑≥0.3 mg/dL within 48 h, or ↑ ≥1.5 fold vs. the lowest prior SCr within 7 days) and mortality were calculated. Repeated measurement linear models were applied to SCr trends, modeling SCr on PNA, birth weight or gestational age (GA), using heterogeneous autoregressive residual covariance structure and maximum likelihood methods. Findings were compared to patterns in the control cohort.
Among 1,136 TH neonates, representing 4,724 SCr observations, SCr (10th-25th-50th-75th-90th-95th) PNA centiles (day 1-10) were generated. In TH neonates, the AKI incidence was 132/1,136 (11.6%), mortality 193/1,136 (17%). AKI neonates had a higher mortality (37.2-14.3%, p < 0.001). Median SCr patterns over PNA were significantly higher in nonsurvivors (p < 0.01) or AKI neonates (p < 0.001). In TH-treated neonates, PNA and GA or birth weight explained SCr variability. Patterns over PNA were significantly higher in TH neonates to controls (801 neonates, 2,779 SCr).
SCr patterns in TH-treated NE neonates are specific. Knowing PNA-related patterns enable clinicians to better assess kidney function and tailor pharmacotherapy, fluids, or kidney supportive therapies.
接受治疗性低温（TH）治疗的新生儿脑病（NE）患儿的肾功能及损伤存在很大差异。采用分类方法的急性肾损伤（AKI）定义可能会丢失个体患者肾功能的宝贵信息。出生后年龄（PNA）对应的血清肌酐（SCr）百分位数可能会为接受TH治疗的新生儿提供更有价值的信息。
在一项回顾性研究中，汇总了来自7例接受TH治疗的新生儿队列以及1例未接受TH治疗、无NE的对照队列的数据。计算了PNA对应的SCr百分位数、AKI发生率（定义：48小时内SCr升高≥0.3mg/dL，或7天内较之前最低SCr升高≥1.5倍）及死亡率。对SCr趋势应用重复测量线性模型，以PNA、出生体重或胎龄（GA）为自变量对SCr进行建模，采用异质性自回归残差协方差结构和最大似然法。将研究结果与对照队列的模式进行比较。
在1136例接受TH治疗的新生儿中，共获得4724次SCr观察值，得出了PNA（第1 - 10天）对应的SCr（第10 - 25 - 50 - 75 - 90 - 95百分位数）。在接受TH治疗的新生儿中，AKI发生率为132/1136（11.6%），死亡率为193/1136（17%）。AKI新生儿的死亡率更高（37.2%对14.3%，p < 0.001）。非存活者（p < 0.01）或AKI新生儿（p < 0.001）的PNA对应的SCr中位数模式显著更高。在接受TH治疗的新生儿中，PNA以及GA或出生体重可解释SCr的变异性。与对照队列（801例新生儿，2779次SCr观察值）相比，接受TH治疗的新生儿PNA对应的SCr模式显著更高。
接受TH治疗的NE新生儿的SCr模式具有特异性。了解与PNA相关的模式可使临床医生更好地评估肾功能，并调整药物治疗、液体治疗或肾脏支持治疗方案。
