Incidence of Acute Renal Failure in Preterm Babies in a Tertiary Care Centre from Southern India: A Cross-sectional Study
Introduction: Preterm babies are a vulnerable population group who are more susceptible to multiple end-organ damage due to an immature immune system and incomplete organogenesis/ organ function. There is scanty data on preterm Acute Kidney Injury (AKI) in India. Aim: To investigate the inciden...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18370/63089_CE[Ra1]_F(IS)_PF1(AG_KM)_QC(SD_SL)_PFA(AG_KM)_PN(KM).pdf |
| Summary: | Introduction: Preterm babies are a vulnerable population group
who are more susceptible to multiple end-organ damage due to
an immature immune system and incomplete organogenesis/
organ function. There is scanty data on preterm Acute Kidney
Injury (AKI) in India.
Aim: To investigate the incidence of acute renal failure and the
risk factors predisposing preterm babies to renal failure in an
inborn at a tertiary care centre in Southern India. Additionally,
we aimed to evaluate the usefulness of a biomarker, Neutrophil
Gelatinase Associated Lipocalin (NGAL), as both a marker of
renal function and a predictor of AKI in preterm babies.
Materials and Methods: A cross-sectional study was conducted
in the Neonatal Intensive Care Unit (NICU) at Christian Medical
College, Vellore, Tamil Nadu, India, between May 2014 and
August 2014. The study included babies born <33 weeks of
gestation, while those with abnormal antenatal renal scans, major
systemic congenital anomalies, and chromosomal anomalies were
excluded. Demographic details and clinical features were noted.
Weekly monitoring included urine output, assessment of clinical
deterioration, details of interventions, unexpected events, and
the use of nephrotoxic drugs. Blood samples for serum creatinine
and urine samples for NGAL were collected once a week starting
from 72 hours of age. The data was statistically analysed using
Statistical Package for the Social Sciences (SPSS) software,
version 16.0. Descriptive statistics were reported using mean±SD
for continuous variables. Repeated measures Analysis of Variance
(ANOVA) and Chi-square test/Fisher’s-exact test were used for
categorical variables. Risk factor analysis was done using log
binomial to estimate the Relative Risks (RR), considering values
greater than 1 as significant.
Results: During the study period, a total of 4823 live births
were recorded. Among them, 80 babies had a gestational
age <33 weeks (10.14%). One baby was not recruited as the
parents did not provide consent, leaving a total of 79 babies
included in the study. Five babies did not complete the study
(three died and two were discharged against medical advice).
The incidence of AKI in babies <32±6 weeks in this study was
10 out of 79 (12.6%). It was higher in babies <28 weeks, with
4 out of 10 (40%) affected, and all 10 babies (100%) weighed
less than 1500 gm at birth. Risk factors for AKI included
oliguria, Patent Ductus Arteriosus (PDA), nephrotoxic drugs,
low APGAR score, mechanical ventilation, Continuous Positive
Airway Pressure (CPAP), and abnormal antenatal scans. Urine
NGAL was estimated in 30 babies, and it was found that NGAL
levels were high in week 1 or rose by week 2 in those with AKI,
while creatinine levels increased in week 2 or 3. NGAL was
inversely proportional to gestational age and birth weight. Both
NGAL rise and creatinine levels were observed in babies with
AKI associated with Non-Steroidal Anti-Inflammatory Drugs
(NSAIDS), umbilical lines, and asphyxia.
Conclusion: The incidence of AKI was found to be 10%.
Although NGAL levels were noted to rise earlier than creatinine
levels in those with AKI, a definitive cutoff value for NGAL to
define AKI could not be calculated. Due to the small study
population, the sensitivity and specificity of NGAL could not be
determined. |
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| ISSN: | 2249-782X 0973-709X |