Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
Pediatr Nephrol. 2023 Sep;38(9):3139-3144. doi: 10.1007/s00467-023-05936-8. Epub 2023 Mar 29.
Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants.
We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA).
We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = - 0.57 (- 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = - 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA.
Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies. A higher resolution version of the Graphical abstract is available as Supplementary information.
早产会改变肾发生并减少总肾单位数量。宫内生长受限（IUGR）似乎会加重肾单位丢失，但只有少数研究调查了其在新生儿肾损伤中的作用。我们研究了宫内生长受限（IUGR），即通过估计胎儿生长和/或胎盘血流改变以及低出生体重 z 评分来定义，是否会增加极早产儿发生急性肾损伤（AKI）的风险。
我们进行了一项回顾性研究，纳入了 2016 年 1 月至 2021 年 12 月期间在我们中心住院的出生体重（BW）≤1500g 和/或胎龄（GA）≤32 周的婴儿。新生儿 AKI 根据新生儿 KDIGO 分类标准定义为尿量减少和/或肌酐升高。我们使用多变量线性回归来验证 AKI 与 GA、BW z 评分、IUGR 定义和有血流动力学意义的动脉导管未闭（PDA）之间的关联。
我们纳入了 282 名婴儿进行分析，GA 的中位数（IQR）为 29.4（27.4，31.3）周，BW 为 1150（870，1360）g，BW z 评分为-0.57（-1.64，0.25）。36 名（13%）患者诊断为 AKI，58 名（21%）患有 PDA。AKI 与 BW z 评分（β（标准误差）= -0.08（0.03），p=0.008）和严重 IUGR（β（标准误差）= 0.21（0.08），p=0.009）显著相关，调整 GA 和 PDA 后。
我们的数据表明，低 BW z 评分和 IUGR 可能是早产儿肾脏损伤的附加危险因素。更清晰的图表可在补充信息中查看。
