Sinelli Mariateresa, Zannin Emanuela, Kullmann Gaia Alessandra, Lombardo Ilaria, Malpezzi Elena, Rinaldi Alessandro, Riva Anna, Ventura Maria Luisa
Neonatal Intensive Care Unit and Neonatology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
Neuropsichiatria Infantile, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Pediatr Nephrol. 2025 Aug 19. doi: 10.1007/s00467-025-06926-8.
To evaluate the incidence and potential predisposing factors for the development of acute kidney injury (AKI) in asphyxiated neonates undergoing hypothermic treatment.
This retrospective study was conducted at the Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. All neonates above 34 weeks of gestation diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with hypothermia, weighing more than 1800 g, admitted from January 1, 2013 to December 31, 2022, were included. AKI was defined according to the neonatal KDIGO classification.
A total of 75 neonates were enrolled, including 13 (17%) with severe HIE. The incidence of AKI was 35%, with 62% of cases identified as a reduction in diuresis, 27% as changes in creatinine and oliguria, and only 11% as isolated creatinine elevation. The rate of AKI was significantly higher in infants with severe HIE (p < 0.001). The development of AKI added significantly (aOR = 41.2, p = 0.007) to the probability of death, even after adjusting for severe HIE. Infants who developed AKI required more inotropes, had higher rates of hyponatremia (serum sodium < 125 mEq/L), and were less likely to normalize lactate levels within 24 h of birth.
In asphyxiated newborns, reduced kidney perfusion can cause kidney impairment in nearly 40% of those undergoing treatment. Enhancing the detection of AKI is crucial for improving patient outcomes. We recommend proactive monitoring of lactate trends, urinary output, and serum sodium levels to enable early interventions that protect kidney function and improve outcomes for these vulnerable infants.
评估接受低温治疗的窒息新生儿发生急性肾损伤（AKI）的发生率及潜在诱发因素。
本回顾性研究在意大利蒙扎的圣杰拉尔多·德伊·廷托里基金会IRCCS进行。纳入2013年1月1日至2022年12月31日期间收治的所有孕周大于34周、诊断为缺氧缺血性脑病（HIE）且接受低温治疗、体重超过1800克的新生儿。AKI根据新生儿KDIGO分类进行定义。
共纳入75例新生儿，其中13例（17%）为重度HIE。AKI的发生率为35%，62%的病例表现为尿量减少，27%为肌酐变化和少尿，仅11%为单纯肌酐升高。重度HIE患儿的AKI发生率显著更高（p < 0.001）。即使在调整重度HIE因素后，AKI的发生也显著增加了死亡概率（调整后比值比 = 41.2，p = 0.007）。发生AKI的婴儿需要更多的血管活性药物，低钠血症（血清钠 < 125 mEq/L）发生率更高，且出生后24小时内乳酸水平恢复正常的可能性更小。
在窒息新生儿中，肾脏灌注减少可导致近40%接受治疗的患儿出现肾功能损害。加强对AKI的检测对改善患者预后至关重要。我们建议积极监测乳酸变化趋势、尿量和血清钠水平，以便早期干预，保护肾功能并改善这些脆弱婴儿的预后。
