Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury

Authors

DOI:

https://doi.org/10.22141/2224-0551.15.7.2020.219234

Keywords:

premature infants, hemodynamically significant pa­tent ductus arteriosus, acute kidney injury, renal oxygenation

Abstract

Background. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the phenomenon of “stea­ling” the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI) in premature infants. Near-infrared spectroscopy (NIRS) method of renal oxygenation measurement on the first day of life may be useful in identifying the risk group for AKI in these patients. The study aimed to assess the prognostic value of renal oxygenation in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 74 premature babies (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Intensive Care of Newborns. The patients were divided into three groups depen­ding on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: group I — 40 children with HSPDA, group II — 17 children with PDA without hemodynamic disorders, group III — 17 children with a closed arterial duct (CAD). In each of the groups, subgroups were identified: with the presence or absence of AKI. Clinical examination and treatment of premature infants were carried out according to the generally accepted routine. Diagnosis and stratification of AKI severity were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine and the level of urine output were studied. Doppler echocardiography was performed at 5–11 hours of life. Regional renal oxygenation (RrSO2) was monitored using spectroscopy in the near-infrared range. Results. AKI on the third day of life was diagnosed in 52.5 % of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p < 0.05) and 4.4 times more often than in individuals with CAD (p < 0.007). On the fifth day of life, AKI was detected in two more children with HSPDA, and the total number increased to 57.5 %. In the groups of children with PDA wi­thout hemodynamic disorders and CAD, on the third and fifth days of life, only I grade AKI was registered. Whereas, children with HSPDA had II–III grade AKI. Renal oxygenation on the first day of life was below 68 %, mainly in children with ­HSPDA + AKI. Extremely low levels of RrSO2 on the first day, associated with the development of AKI on the third day, in the group of HSPDA + AKI were registered in 49–52 %. In children with HSPDA who developed AKI by the third day of life, the RrSO2 index on the first day of life was 56.1 ± 4.5 % versus 63.9 ± 9.72 % in children without AKI (p < 0.01). An inverse correlation was established between the RrSO2 indicator on the first day of life and the blood creatinine concentration on the third day of life (ρ = –0.434, p < 0.02). Conclusions. Low renal oxyge­nation on near-infrared spectroscopy on the first day of life is associated with the development of acute kidney injury on the third day of life in premature infants with HSPDA.

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References

Jetton JG, Boohaker LJ, Sethi SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017 Nov;1(3):184-194. doi: 10.1016/S2352-4642(17)30069-X.

Majed B, Bateman DA, Uy N, Lin F. Patent ductus arteriosus is associated with acute kidney injury in the preterm infant. Pediatr Nephrol. 2019 Jun;34(6):1129-1139.doi: 10.1007/s00467-019-4194-5.

Velazquez DM, Reidy KJ, Sharma M, Kim M, Vega M, Havranek T. The effect of hemodynamically significant patent ductus arteriosus on acute kidney injury and systemic hypertension in extremely low gestational age newborns. J Matern Fetal Neonatal Med. 2019 Oct;32(19):3209-3214. doi: 10.1080/14767058.2018.1460349.

Seo ES, Sung SI, Ahn SY, Chang YS, Park WS. Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23-26 Weeks of Gestation. J Clin Med. 2020 Mar 4;9(3):699. doi: 10.3390/jcm9030699.

Stojanović V, Barišić N, Milanović B, Doronjski A. Acute kidney injury in preterm infants admitted to a neonatal intensive care unit. Pediatr Nephrol. 2014 Nov;29(11):2213-20. doi: 10.1007/s00467-014-2837-0.

Coffman Z, Steflik D, Chowdhury SM, Twombley K, Buckley J. Echocardiographic predictors of acute kidney injury in neonates with a patent ductus arteriosus. J Perinatol. 2020 Mar;40(3):510-514. doi: 10.1038/s41372-019-0560-1.

Rios DR, Bhattacharya S, Levy PT, McNamara PJ. Circulatory Insufficiency and Hypotension Related to the Ductus Arteriosus in Neonates. Front Pediatr. 2018;6:62. doi:10.3389/fped.2018.00062.

Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol. 2012;36(2):123-9. doi:10.1053/j.semperi.2011.09.022.

El Hajjar M, Vaksmann G, Rakza T, Kongolo G, Storme L. Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed. 2005;90(5):F419-22. doi: 10.1136/adc.2003.027698.

Slaughter JL, Cua CL, Notestine JL et al. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation. BMC Pediatr. 2019;19(1):333. doi: 10.1186/s12887-019-1708-z.

Selewski DT, Charlton JR, Jetton JG, et al. Neonatal Acute Kidney Injury. Pediatrics. 2015 Aug;136(2):e463-473. doi: 10.1542/peds.2014-3819.

Hodovanets Yu, Babintseva A, Nicorich S. Acute kidney injury in newborns: undersolved questions of diagnostics and stratification of the severity of pathology. Neonatologìâ, hìrurgìâ ta perinatalʹna medicina. 2014;4(3):89-94. doi: 10.24061/2413-4260.IV.3.13.2014.16.

Yablon OS, Savrun TI, Bertsun KT, Serheta DP, Shovkoplyas NA. Modern problems of neonatal nephrology. Neonatologìâ, hìrurgìâ ta perinatalʹna medicina. 2014;4(3):45-49. doi: 10.24061/2413-4260.IV.3.13.2014.8.

Dempsey EM, El-Khuffash AF. Objective cardiovascular assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2018;103(1):F72-F77. doi:10.1136/archdischild-2017-313837.

Sood BG, McLaughlin K, Cortez J. Near-infrared spectroscopy: applications in neonates. Semin Fetal Neonatal Med. 2015;20(3):164-72. doi: 10.1016/j.siny.2015.03.008.

Hazle MA, Gajarski RJ, Aiyagari R, et al. Urinary biomarkers and renal near-infrared spectroscopy predict intensive care unit outcomes after cardiac surgery in infants younger than 6 months of age. J Thorac Cardiovasc Surg. 2013;146(4):861-867.e1. doi:10.1016/j.jtcvs.2012.12.012.

Ruf B, Bonelli V, Balling G, et al. Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study. Crit Care. 2015;19(1):27. doi:10.1186/s13054-015-0760-9.

McNeill S, Gatenby JC, McElroy S, Engelhardt B. Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants. J Perinatol. 2011;31(1):51-57. doi:10.1038/jp.2010.71.

Marin T, Williams BL. Renal Oxygenation Measured by Near-Infrared Spectroscopy in Neonates. Adv Neonatal Care. 2020 Aug 5. doi: 10.1097/ANC.0000000000000779.

Ministry of Health of Ukraine. Order 584 from 2006 Aug 29: Protocol of medical care for a newborn child with low birth weight. Available at: http://zakon.rada.gov.ua/rada/show/v0584282-06.

Association of Neonatologists of Ukraine. Updated unified clinical protocol - Respiratory distress syndrome in premature infants. 2018. Available at: https://neonatology.org.ua/news/docs/2018/04/75-onovleniy-unifikovaniy-klinichniy-protokol-respiratorniy-distres-sindrom-u-peredchasno-narodzhenikh-ditey .

Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed. 2007 Jul;92(4):F244-7. doi: 10.1136/adc.2006.104596.

Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants? Congenit Heart Dis. 2019 Jan;14(1):21-26. doi: 10.1111/chd.12727.

Bonsante F, Ramful D, Binquet C, et al. Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants. Neonatology. 2019;115(3):198-204. doi: 10.1159/000494462.

Altit G, Bhombal S, Tacy TA, Chock VY. End-organ saturation differences in early neonatal transition for left- versus right-sided congenital heart disease. Neonatology. 2018;114(1):53-61. doi: 10.1159/000487472.

Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013 Feb 4;17(1):204. doi: 10.1186/cc11454.

Harer MW, Chock VY. Renal Tissue Oxygenation Monitoring-An Opportunity to Improve Kidney Outcomes in the Vulnerable Neonatal Population. Front Pediatr. 2020 May 14;8:241. doi: 10.3389/fped.2020.00241.

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Published

2021-09-10

How to Cite

Borysova, T., & Obolonskaya, O. (2021). Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury. CHILD`S HEALTH, 15(7), 518–524. https://doi.org/10.22141/2224-0551.15.7.2020.219234

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Section

Clinical Pediatrics

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