Neonatology Unit, Department of Pediatrics, Faculty of Medicine, Lokman Hekim University, Söğütözü Mh. 2179 Cd. No: 6, Ankara, Turkey.
Neonatology Unit, Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Pediatr Nephrol. 2024 Apr;39(4):1253-1261. doi: 10.1007/s00467-023-06193-5. Epub 2023 Oct 27.
To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life.
Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life.
Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2.
Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties.
比较缺氧缺血性脑病（HIE）婴儿的肾血流和肾功能检查，以及治疗性低温（TH）在生命最初 7 天的影响。
前瞻性评估 59 例 HIE 婴儿。需要 TH 的中重度 HIE 婴儿分为 1 组（n=36），轻度 HIE 婴儿分为 2 组（n=23），健康婴儿分为 3 组（n=60）。第 1 组和第 2 组在第 6 小时、第 3 天和第 7 天评估肾功能检查，第 3 组在第 6 小时和第 3 天评估肾功能检查。所有婴儿在第 1、第 3 和第 7 天进行肾动脉（RA）多普勒超声检查（dUS）。
1 组的收缩期和舒张末期 RA 血流倾向于随时间增加，RA 阻力指数（RI）倾向于降低（p=0.0001）。重度 HIE 和轻度 HIE 患者第 3 天的 RA 舒张末期血流率相似，但中重度 HIE 患者低于健康新生儿。第 7 天，三组的数值相似（p＞0.05）。1 组在 TH 期间，血清血尿素氮（BUN）、肌酐、尿酸和胱抑素 C 水平逐渐降低，肾小球滤过率（GFR）逐渐增加（p=0.0001）。第 2 组在研究期间，血清肌酐水平逐渐降低，肾小球滤过率逐渐增加。
治疗性低温似乎通过其神经保护特性有助于在新生儿适应期恢复肾血流和肾功能。
