Acute kidney injury in premature infants: frequency, clinical features, associated factors and conditions

Abstract

The difficulty in diagnosing acute kidney injury (AKI) in premature infants is due to the absence of specific symptoms of AKI, the presence of a nonoliguric AKI variant, and the lack of a common understanding of the normal concentration of serum creatinine depending on gestational and postnatal age.

The aim was to determine the frequency and clinical features of AKI in premature infants.

Material and methods. A retrospective and observational prospective study was carried out, which included clinical, laboratory and ultrasound examination of premature infants born at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Center). The retrospective study included 459 preterm infants born at the Center in 2018 and admitted to the ICU from the maternity back. The prospective study included 80 preterm infants who needed treatment in the ICU. The children were divided into 2 groups. Group 1 included 60 premature babies without AKI, group 2 - 20 premature babies with AKI. The groups were comparable for birth weight and gestational age.

Results. The incidence of AKI in premature infants treated in the ICU was 6.5%. The incidence of AKI increased with decreasing gestational age and was the highest (71%) in the group of children with gestational age less than 28 weeks. Among the forms of AKI, there was an early form (60%) and a late form (40%). It was noted that the development of AKI significantly increased the risk of a poor prognosis. Among children who had such a complication as AKI, death occurred in 36.7%. Grade 2-3 intraventricular hemorrhages and periventricular leukomalacia were 6 times more common in children with AKI. The presence of fetal transfusion syndrome in multiple pregnancies increased the risk of AKI by 3.27 times (95% CI 0.98-10.93). Among diseases and conditions of the early neonatal period, congenital pneumonia (p=0.004), circulatory failure (p<0.001) and hemodynamically significant functioning ductus arteriosus (p=0.046) were significant for the development of AKI. In children who required high frequency mechanical ventilation, traditional mechanical ventilation and cardiotonic therapy in the early neonatal period, AKI developed much more often (p<0.001). The use of nephrotoxic drugs (Gentamicin and Vancomycin) was significantly more common in the group of children with AKI; the majority had their consistent appointment: 17 (85%) vs 30 (50%) (p=0.045).

Conclusion. The factors that increased the risk of AKI in preterm infants include: congenital pneumonia, hemodynamically significant patent ductus arteriosus, impaired central hemodynamics, respiratory and cardiovascular insufficiency, requiring mechanical ventilation and cardiotonic therapy, as well as the use of nephrotoxic drugs. AKI in premature infants is characterized by the presence of early and late forms, oliguric and non-oliguric variants. Grade 2-3 intraventricular hemorrhage and periventricular leukomalacia are diseases that are often (in 45%) associated with AKI in a premature baby.

Keywords:acute kidney injury, risk factors, mortality, neonates, intensive care, preterm infants, serum creatinine

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Derevyagina O.S., Narogan M.V., Ivanets T.Yu., Sugak A.B., Ryumina I.I. Acute kidney injury in premature infants: frequency, clinical features, associated factors and conditions. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2021; 9 (4): 12-9. DOI: https://doi.org/10.33029/2308-2402-2021-9-4-12-19 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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