Renal Saturation and Acute Kidney Injury in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia.

Autor: Chock VY; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA. Electronic address: vchock@stanford.edu., Frymoyer A; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA., Yeh CG; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA., Van Meurs KP; Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2018 Sep; Vol. 200, pp. 232-239.e1. Date of Electronic Publication: 2018 Jun 01.
DOI: 10.1016/j.jpeds.2018.04.076
Abstrakt: Objective: To investigate the range of renal near-infrared spectroscopy (NIRS) measures in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE) and to determine the association between renal NIRS measures and the development of acute kidney injury (AKI).
Study Design: A retrospective chart review was conducted of neonates with moderate to severe HIE who received therapeutic hypothermia at a tertiary care center from 2014 to 2016. Neonates had routine continuous NIRS monitoring of cerebral and renal saturation (Rsat) as part of their clinical care for 72 hours of cooling and until 24 hours after rewarming. The outcome of AKI was defined by an abnormal rate of decline of serum creatinine over the first 5 days of life. Mixed effects models determined the association between renal NIRS measures and AKI over time.
Results: Of 38 neonates with HIE undergoing cooling, 15 (39%) developed AKI. Rsat was lower than cerebral saturation during cooling (P < .01), but Rsat increased over time after rewarming, while renal oxygen extraction levels decreased (P < .0001). Neonates with AKI had higher Rsat levels (P < .01) compared with those without AKI after 24 hours of life. Using receiver operating characteristic curves, Rsat >75% by 24-48 hours predicted AKI with a sensitivity of 79% and specificity of 82% (area under the receiver operating characteristic curve = 0.76).
Conclusions: Throughout cooling, neonates with AKI had higher Rsat measures than those without AKI. These differences may reflect lower oxygen extraction by the injured kidney. NIRS monitoring of Rsat may identify neonates with HIE at risk of developing AKI.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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