Oso Bolanle Idowu, Oseni Saheed Babajide A, Aladekomo Theophilus Adesola, Adedeji Tewogbade Adeoye, Olowu Wasiu Adekunle
Department of Paediatrics, Wesley Guild Hospital Unit (Ilesa), Obafemi Awolowo University Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.
Department of Chemical Pathology, OAUTHC, Ile-Ife, Nigeria.
Pediatr Nephrol. 2024 Jan;39(1):283-289. doi: 10.1007/s00467-023-06054-1. Epub 2023 Jul 13.
Acute kidney injury (AKI) is a common cause of mortality and morbidity in asphyxiated newborns. Recent research suggests serum neutrophil gelatinase-associated lipocalin (sNGAL) as an early biomarker of AKI in newborns with perinatal asphyxia. The prospect of sNGAL is yet to be studied in Nigeria, with a huge burden of asphyxia-related neonatal deaths.
A cross-sectional analytic study was conducted on 53 asphyxiated term newborns and 53 healthy babies at the newborn unit of the Wesley Guild Hospital Ilesa, Nigeria. sNGAL was assessed in all neonates with perinatal asphyxia at baseline (within 30 min of delivery), 2 h, and 48 h of life.
Mean sNGAL was significantly higher in asphyxiated newborns than in the control group, 81.4 (45.9) vs. 53.7 (29.2), p < 0.001. However, the mean 2-h sNGAL levels were similar in asphyxiated babies with and without AKI 100.5 (36.7) ng/ml vs. 85.3 (31.4) ng/ml, p = 0.115. The 2-h sNGAL with an AUC of 0.61 at an 83.0 ng/ml cut-off had an acceptable discriminating capability of predicting AKI. The sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 51.5%, 50%, and 81%, respectively.
This study shows that sNGAL levels were significantly elevated in newborns with perinatal asphyxia compared to healthy neonates, but the 2-h sNGAL is less predictive of AKI in newborns with perinatal asphyxia. The negative predictive value is high, and this may find some relevance in the attempts at early exclusion of asphyxiated babies prone to AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
急性肾损伤（AKI）是窒息新生儿死亡和发病的常见原因。最近的研究表明，血清中性粒细胞明胶酶相关脂质运载蛋白（sNGAL）是围产期窒息新生儿AKI的早期生物标志物。在尼日利亚，窒息相关新生儿死亡负担沉重，sNGAL的前景尚待研究。
在尼日利亚伊莱萨卫斯理公会医院新生儿科，对53名窒息足月儿和53名健康婴儿进行了一项横断面分析研究。对所有围产期窒息新生儿在基线（出生后30分钟内）、出生后2小时和48小时评估sNGAL。
窒息新生儿的平均sNGAL显著高于对照组，分别为81.4（45.9）和53.7（29.2），p<0.001。然而，有和没有AKI的窒息婴儿2小时的平均sNGAL水平相似，分别为100.5（36.7）ng/ml和85.3（31.4）ng/ml，p = 0.115。截断值为83.0 ng/ml时，2小时sNGAL的AUC为0.61，具有可接受的预测AKI的鉴别能力。敏感性、特异性、阳性预测值和阴性预测值分别为80%、51.5%、50%和81%。
本研究表明，与健康新生儿相比，围产期窒息新生儿的sNGAL水平显著升高，但2小时sNGAL对围产期窒息新生儿AKI的预测性较低。阴性预测值较高，这可能在早期排除易患AKI的窒息婴儿的尝试中具有一定相关性。更高分辨率的图形摘要版本可作为补充信息获取。
