Effect of perinatal asphyxia on renal function in term neonates- a prospective study
Abstract
Section 1.1. Background- Perinatal asphyxia, with an estimated incidence of 1-10 per thousand live births, is a major factor that can cause neonatal mortality and long term neurological morbidity. Kidney is the most affected organ by hypoxic damage. Many studies have reported high incidence of renal injury in babies with asphyxia. Early recognition of renal injury is vital in order to maintain fluid and electrolyte homeostasis.
Section 1.2. Objectives-
- To assess the renal function in term neonates with perinatal asphyxia and to compare that with non-asphyxiated neonates.
- To assess whether the degree of renal dysfunction among term newborns with perinatal asphyxia is related to the severity of hypoxic ischemic encephalopathy.
Section 1.3. Methods- This study was a prospective cohort study, done in the neonatal intensive care units of Govt. T.D. Medical College Hospital, Alappuzha during a period of one and half years. 25 neonates with perinatal asphyxia and 25 babies without perinatal asphyxia were selected according to the inclusion and exclusion criteria. Neurological staging of hypoxic ischemic encephalopathy was done. Blood and urine samples were collected at 24- 36 hours and 72-96 hours of life. Blood urea(BU), serum creatinine and urine b2 microglobulin values of two groups were compared.
Section 1.4. Results- There was a significant increase in blood urea, day 2 serum creatinine and urine b2 microglobulin values in asphyxiated newborns. Percentage of babies with abnormal urinary b2 microglobulin increased with the severity of hypoxic ischemic encephalopathy(HIE). 12% of asphyxiated babies developed acute renal injury on day 2, out of which 66.7% were intrinsic type.
Section 1.5. Interpretation and Conclusion - Alteration in renal function parameters is more frequent in newborns with perinatal asphyxia compared to non-asphyxiated babies. Abnormality in urinary b2 microglobulin is related to the severity of neurological damage. A small proportion of babies with asphyxia developed acute kidney injury, predominantly, intrinsic renal failure.
Section 2. Key words- Acute kidney injury; Hypoxic ischemic encephalopathy; Perinatal asphyxia; Urine b2 microglobulin.
